bluuebunny/crossref_metadata_2025_split huggingface dataset:
Traumatic Intracranial Aneurysms Caused by Missiles: Their Presentation and Management
Authors: Haddad Fuad Sami , Haddad Georges F. , Taha Jamal 
Published: April 2011

Abstract
Only 30 cases of traumatic intracranial aneurysm (TICA) secondary to missile injury have been reported to date. To these we add 15 more cases. Missile TICAs are often seen on a secondary branch of the middle cerebral artery and are usually accompanied by a intracerebral hematoma (80%) or by an acute subdural hematoma (26%). Fourteen of our cases were secondary to shrapnel injuries and only one was secondary to a bullet. None of the injuries was through-and-through. TICAs may enlarge in time and, seemingly inoffensive, may rupture and lead to death. All seven TICAs studied histologically proved to be false aneurysms. TICAs are best treated through trapping and excision. The outcome depends on the patient's status and level of consciousness before surgery. Indications for angiography are discussed.
Cavernous Malformations and Capillary Telangiectasia: A Spectrum within a Single Pathological Entity
Authors: Rigamonti Daniele , Johnson Peter C. , Spetzler Robert F. , Hadley Mark N. , Drayer Burton P. 
Published: April 2011

Abstract
Cerebral vascular malformations have traditionally been divided into four categories: arteriovenous, venous, cavernous, and capillary telangiectases. A controversy exists about separating the latter two lesions into separate entities. Critics claim the distinction is arbitrary but have been unable to present convincing evidence linking the two types of lesions. We have reviewed the histories of 20 patients with cavernous malformations and have analyzed the clinical, radiographic, and surgical-autopsy data associated with these lesions. In some patients, multiple lesions, including cavernous malformations, capillary telangiectases, and transitional forms between the two, were identified. Based on this analysis, we conclude that capillary telangiectasia and cavernous malformations represent two pathological extremes within the same vascular malformation category and propose grouping them as a single cerebral entity called cerebral capillary malformations.
The Caspar Microsurgical Discectomy and Comparison with a Conventional Standard Lumbar Disc Procedure
Authors: Caspar Wolfhard , Campbell Bayard , Barbier Dragos D. , Kretschmmer Ralf , Gotfried Yechiel 
Published: April 2011

Abstract
The outcome in 119 patients who were operated on with a conventional standard lumbar discectomy procedure was retrospectively compared with that in 299 patients who were operated on with a microsurgical discectomy technique developed in Homburg/Saar, Federal Republic of Germany by the senior author (W.C.). All patients in this consecutive series had “virgin” lumbar radiculopathy evaluated and operated upon by two experienced surgeons at one institution. Determination of the final outcome was made objectively by an impartial third party using identical criteria for both groups, and with a patient self-evaluation form. The study looked at various pertinent aspects of the treatment course and at final outcome. The results in the microsurgical group were significantly favorable: fewer levels were explored; there was less operative blood loss and a decreased incidence of deep venous thrombosis, urinary tract infections, pulmonary emboli, and bladder catheterization; the time to full ambulation, discharge, and return to work was faster; and there was a decrease in change of occupation and a greater percentage of satisfactory final outcomes, as measured both objectively and subjectively. A description of the microsurgical technique used in this study, which differs significantly from existing microdiscectomy techniques, is presented. The authors conclude that the microsurgical discectomy technique presented in this study is a safe and effective approach to the treatment of lumbar radiculopathy.
The Transoral Approach for the Management of Intradural Lesions at the Craniovertebral Junction: Review of 7 Cases
Authors: Crockard Alan H. , Sen Chandra N. 
Published: April 2011

Abstract
The main difficulty in dealing with intradural lesions located ventrally in the region of the craniovertebral junction (CVJ) is related to their relative inaccessibility. Posterolateral approaches involve some manipulation of the brain stem and provide limited access because of the necessity of working between the cranial nerves. Even then, the view of the ventral midline and across is limited. The transoral approach, which has been widely used for the management of extradural lesions in this area, is also useful for the treatment of intradural lesions. It provides an unimpeded although somewhat restricted, view of the ventral aspect of the CVJ without the need for brain retraction. The cranial nerves and vertebral arteries are not interposed between the surgeon and the lesion. The risks of cerebrospinal fluid leakage and infection are greatly diminished by the use of fibrin adhesive and prolonged diversion of the cerebrospinal fluid. The use of this approach, together with its technical difficulties and results, in the management of seven purely intradural lesions located ventrally at the CVJ, is discussed.
Improved Access to Lesions of the Central Skull Base by Mobilization of the Zygoma: Experience with 54 Cases
Authors: Uttley D. , Archer D. J. , Marsh H. T. , Bell B. A. 
Published: April 2011

Abstract
Improved access to lesions at the medial end of the sphenoid wing or in the interpeduncular cistern after mobilization of the zygoma has been a subject of growing interest in recent years. This study describes the operative technique we have adopted and records our experience with 55 operations in 54 patients who underwent the procedure in the past 3 years. Seven patients had vascular lesions, 44 had tumors, and 3 had miscellaneous lesions. The majority of the tumors were medial meningiomas, and particular note is made of those arising from the cavernous sinus with respect to their resectability. Sixteen of these tumors were encountered, and total excision was possible in 11 cases. Access to the infratemporal fossa is facilitated, and in 2 cases we were able to excise completely trigeminal neuromas that had extended there. The extra maneuver adds little to the overall operating time, and complications relating to it arc uncommon, mild in degree, and usually self-limiting. We conclude that the operation is extremely valuable in appropriate circumstances.
Orbitozygomatic Temporopolar Approach for a High Basilar Tip Aneurysm Associated with a Short Intracranial Internal Carotid Artery: A New Surgical Approach
Authors: Ikeda Kiyonobu , Yamashita Junkoh , Hashimoto Masaaki , Futami Kazuya 
Published: April 2011

Abstract
For two cases of a high basilar tip aneurysm accompanied by a short intracranial internal carotid artery, the orbitozygomatic temporopolar approach consisting of an en bloc fronto-orbitozygomatic temporal craniotomy and temporopolar approach was carried out. On angiograms, the height of the bifurcation of an elongated basilar artery and the length of the intracranial internal carotid artery from the interclinoid line between the anterior and posterior clinoid processes were 20 mm and 6 mm in Case 1, and 18 mm and 5 mm in Case 2. respectively. The skin flap was separated subfascially to preserve the frontotemporal branch of the facial nerve. The fronto-orbitozygomatic temporal bone flap was made, and a part of the basal bony structures of the orbital roof, the sphenoid ridge, and the temporal bone were removed. The basilar tip aneurysm could be seen and clipped easily by upward and oblique viewing from below through the wide operative space consisting of the less retracted internal carotid and middle cerebral arteries, the oculomotor nerve, the tentorial hiatus, and the emptied anterior temporal fossa obtained by partial division of the temporal bridging veins. The operative procedure is presented in detail and compared with other surgical approaches that have been described previously.
Direct Endovascular Thrombolytic Therapy for Dural Sinus Thrombosis
Authors: Barnwell Stanley L. , Higashida Randall T. , Halbach Van V. , Dowd Christopher F. , Hieshima Grant B. 
Published: April 2011

Abstract
Three patients, ages 51 to 71 years, sought treatment for symptomatic dural sinus thrombosis with occlusion and were treated by direct sinus perfusion with urokinase. All three patients had a dural arteriovenous fistula; one involved the inferior petrosal sinus and two involved the transverse sinus. Clinical findings included papilledema, diminished visual acuity, decreased mentation, and cranial nerve palsies. Diagnosis was made by cerebral arteriography and confirmed by sinus venography. All three patients were treated by a transjugular direct infusion of urokinase. In one patient, a transfemoral venous approach used initially was discontinued because of an infection. The period of continuous infusion for thrombolysis ranged between 4 and 10 days. In two patients, the clinical signs and symptoms improved with angiographic evidence of clot lysis and dural sinus recanalization. Angiography indicated that one patient had a partial resolution of a clot in the torcular herophili and transverse sinus but showed no clinical improvement. These preliminary results suggest that transjugular local infusion of thrombolytic agents can be an effective treatment for symptomatic, thrombosed dural sinuses. This selective lysis avoids thrombolytic effects that could aggravate or produce systemic hemorrhagic complications.
Abscess of the Sphenoid Sinus after Transsphenoidal Surgery
Authors: Nelson Paul B. , Hirsch Barry E. , De Vries Egbert J. 
Published: April 2011

Abstract
A case of a bacterial abscess developing in the sphenoid sinus 2 weeks after transsphenoidal surgery is presented. Although abscesses within the sella turcica have been reported as rare complications of transsphenoidal surgery, this is the first reported case of the postoperative formation of an abscess of the sphenoid sinus. The patient sought treatment for severe headaches, nausea and vomiting, and marked temperature elevation. A computed tomographic scan demonstrated soft tissue and air within the sphenoid sinus. A regimen of stress doses of hydrocortisone and antibiotics was prescribed, and the patient underwent transsphenoidal drainage of the sphenoid sinus. The sella turcica was not involved. Anaerobic cultures were positive for Fusobacterium necrophorum.
Interstitial Irradiation and Hyperthermia for the Treatment of Recurrent Malignant Brain Tumors
Authors: Sneed Penny K. , Stauffer Paul R. , Gutin Philip H. , Phillips Theodore L. , Suen Stuart , Weaver Keith A. , Lamb Sharon A. , Ham Brigid , Prados Michael D. , Larson David A. , Wara William M. 
Published: April 2011

Abstract
Between June 1987 and June 1989, 29 recurrent malignant gliomas or recurrent solitary brain metastases in 28 patients were treated in a Phase I study of interstitial irradiation and hyperthermia. Patient age ranged from 18 to 65 years, and the Karnofsky Performance Status scores ranged from 40 to 90%. There were 13 glioblastomas, 10 anaplastic astrocytomas. 3 melanomas, and 3 adenocarcinomas. Catheters were implanted stereotactically after computed tomography-based preplanning. Hyperthermia was administered before and after brachytherapy, using one to six 2450- or 915-MHz helical coil microwave antennas and one to three multisensor fiberoptic thermometry probes. The goal was to heat as much of the tumor as possible to 42.5±C for 30 minutes. Within 30 minutes after the first hyperthermia treatment, implant catheters were afterloaded with high-activity iodine-125 seeds delivering tumor doses of 32.6 to 61.0 Gy. Most patients had no sensation of heating. Complications included seizures in 5 patients, reversible neurological changes in 9 patients, a scalp burn in 1, and infections in 3. Of 28 evaluable 2-month follow-up scans, 11 showed definite improvement in the radiological appearance of the tumor, 4 were slightly improved, 7 were stable, and 6 showed tumor progression. Ten patients underwent reoperation for persistent tumor and/or necrosis. Eleven of 28 patients are alive 40 to 97 weeks after treatment. Thirteen patients died of a brain tumor, 2 died of extracranial melanoma metastases, 1 died of new brain melanoma metastases, and 1 died of a pulmonary embolus. The median survival was 55 weeks overall. Median survival has not yet been reached for the anaplastic astrocytoma subgroup. We conclude that interstitial brain hyperthermia using helical coil microwave antennas is technically feasible. The level of toxicity is acceptable, and the computed tomographic response rate is encouraging.
Definition of the Role of Contemporary Surgical Management in Cisternal and Parenchymatous Cysticercosis Cerebri
Authors: Couldwell William T. , Zee Chi-Shing , Apuzzo Michael L. J. 
Published: April 2011

Abstract
With increasing immigration from endemic regions, the incidence of neurocysticercosis in North America is rising. This retrospective study was undertaken to examine the role of surgery in those cases presenting with large cystic parenchymal and cisternal lesions in the current era of anthelminthic agents administered orally. A total of 237 patients presented with newly diagnosed neurocysticercosis to our institution over a recent 5-year period (mean age, 31.2 years). Among those who presented with cystic mass lesions predominantly affecting the brain parenchyma and cisternal spaces. 20 (8.4%; mean age, 40.2 years) with large cystic lesions subsequently underwent surgical intervention, either because of an emergent presentation or because they were refractory to medical management. Clinical presentation included increased intracranial pressure, focal neurological deficit, and seizure. Radiographic imaging (computed tomography and/or magnetic resonance imaging) demonstrated 12 cases with cisternal lesions, 7 with parenchymal lesions, and 1 involving both compartments. Based on imaging guidelines, 30 operative procedures (excluding shunt revisions) were performed (14 craniotomies, 8 cerebrospinal fluid diversions, 7 stereotactic procedures, and 1 burr hole drainage). Fifteen (75%) showed neurological or symptomatic improvement over a median follow-up period of 36.4 months. There were three surgery-related complications and no deaths.
Iatrogenic Saphenous Neuralgia: Successful Therapy with Neuroma Resection
Authors: Senegor Moris 
Published: April 2011

Abstract
We report the case of a patient with saphenous neuralgia secondary to iatrogenic trauma resulting from bypass surgery in the femoral-popliteal region. Early symptoms of this condition were medial calf and ankle pain, with no findings of motor and reflex abnormalities. Exploration of the thigh 2 years later revealed a neuroma of the nerve in the distal dissection site, medial to the knee. Resection of the neuroma alleviated this condition. It is noted that saphenous neuropathy is seen as a spontaneous entrapment syndrome as well as a complication of orthopedic and vascular procedures performed on the medial area of the knee. Saphenous neuralgia is often not recognized by neurosurgeons. If the condition is intractable, it does respond to surgical therapy.
Exposure of the Intracavernous Carotid Artery in Aneurysm Surgery
Authors: Ohmoto Takashi , Nagao Seigo , Mino Shogo , Ito Terukazu , Honma Yutaka , Fujiwara Takashi 
Published: April 2011

Abstract
The pterional intradural approach was used in five cases of large and giant carotid-ophthalmic aneurysms and in two cases of intracavernous aneurysms that arose from the anterior siphon knee in the cavernous sinus (CS) and extended into the carotid cistern. In four cases of large carotid-ophthalmic aneurysms removal of the anterior clinoid process and the roof of the optic canal gave easy access to the pericarotid ring. The anteromedial part of the pericarotid ring was dissected to expose the extradural portion of the internal carotid artery (ICA) proximal to the neck and to make enough room between the wall of the CS and the extradural portion of the ICA, thus allowing easy clipping of the neck. In one case of a giant carotid-ophthalmic aneurysm extending into the CS with an extradural origin of the ophthalmic artery and in two cases of an intracavernous aneurysm arising from the siphon knee, neck clipping was performed by opening the lateral wall and roof of the CS after removal of the optic strut. The opening of the lateral wall anterior to the 3rd nerve facilitated wide exposure of the anterior siphon knee. The horizontal portion of the intracavernous ICA as well as the whole aspect of the aneurysm could be exposed as a result of the extended opening of the cavernous roof anterior to the posterior clinoid process. Successful operative results were obtained in all seven patients. A visual field detect as an operative complication was noted in one patient. No disturbance of ocular movements was noted.
Peritumoral Blood Flow in Intracranial Meningiomas
Authors: Tatagiba Marcos , Mirzai Shahram , Samii Madjid 
Published: April 2011

Abstract
Blood flow was measured in intratumoral tissue, the cerebral hemispheres and particularly in the peritumoral area of 12 patients with intracranial meningiomas using the stable xenon-enhanced computed tomographic scan. Tumor blood flow frequently showed a heterogeneous pattern of enhancement with high flow at the tumor periphery and a central area of hypoperfusion. Blood flow values were on average 28% lower in the peritumoral area than in the ipsilateral cerebral hemisphere. In individual cases, blood flow values in the peritumoral edematous area were very low. These findings suggest that the hypodense area surrounding meningiomas does not solely represent vasogenic edema, but may actually represent tumor pressure ischemia.
Intraoperative Electrophysiological Monitoring of the Facial Nerve in the Presence of Damage to the Pre-Parotid Segment
Authors: Linskey Mark E. , Nuss Daniel W. , Krieger Don , Sekhar Laligam N. 
Published: April 2011

Abstract
A method is described for obtaining intraoperative monitoring of facial nerve function in patients who have previously lost facial nerve function distal to the pes anserinus or who have absent function because of trauma to the facial nerve in the pre-parotid segment during operative exposure.
Survival of Patients with Well-Differentiated Astrocytomas Diagnosed in The Era of Computed Tomography
Authors: Vertosick Frank T. , Selker Robert G. , Arena Vincent C. 
Published: April 2011

Abstract
We report 25 verified cases of well-differentiated cerebral astrocytomas in adults treated between 1978 and 1988. All patients were diagnosed by computed tomographic (CT); scans, with 5 undergoing a craniotomy for debulking and 20 undergoing a biopsy alone. The median survival for the entire group was 8.2 years, the longest survival yet reported for a series of patients with these tumors. A review of the literature suggests that the longer survival observed in more recent series is the result of the earlier diagnosis of tumors afforded by modern brain imaging. Twenty of our patients presented with seizures in the absence of any other focal findings and would probably not have had a biopsy in the era before CT scans until their tumors had progressed. Only 8% of our patients had papilledema at the time of presentation, in contrast to almost half of the patients with low-grade astrocytomas reported before 1975, supporting the hypothesis that patients in the CT era are diagnosed earlier. None of our patients died from progressive low-grade disease. One patient died from a squamous cell cancer, and 7 died as a consequence of their tumors dedifferentiating into a more malignant astrocytoma or glioblastoma multiforme, with a median time of approximately 5 years after the diagnosis. Our findings, together with the available data in the literature, suggest that death from a focal low-grade astrocytoma, in the absence of malignant degeneration, may be a rare event. Consequently, future therapeutic efforts should be targeted at preventing dediffer-entiation. The use of radiotherapy in this series of patients did not make a significant impact upon either the time to dedifferentiation or the time to death, but the numbers are small. Given the potential long-term detrimental effect of radiotherapy, the use of this treatment modality must be re-evaluated in the light of the earlier diagnosis and longer natural survival of the patient with an astrocytoma diagnosed in the CT era. Moreover, given the longer survival we observed in a patient population diagnosed predominantly by a biopsy alone, the necessity for radical surgery may also need to be reviewed. In view of the evolving nature of this patient population, much of the older literature on astrocytomas may have little relevance in advising and treating the “modern” patient with an astrocytoma.
Traumatic Atlantooccipital Dislocation with Survival
Authors: Papadopoulos Stephen M. , Dickman Curtis A. , Sonntag Volker K.H. , Rekate Harold L. , Spetzler Robert F. 
Published: April 2011

Abstract
Survival after traumatic atlantooccipital dislocation is rare. Only long-term survivors have been reported in the literature; however, improved prehospital care is likely responsible for the increase in the number of these patients seen at neurotrauma centers over the last decade. Associated severe and persistent neurological deficits are common in the few survivors. We report the case of a 10-year-old boy with traumatic atlantooccipital dislocation and a severe neurological injury. Low-field magnetic resonance imaging provided the additional diagnosis of an associated cervicomedullary epidural hematoma. The patient underwent emergency operative evacuation of the hematoma and an occipital-cervical fusion with internal fixation. He had a remarkable recovery in neurological function and achieved stable bony fusion 3 months postoperatively. With early recognition of this entity, improved neuroradiological imaging techniques, and aggressive treatment, patients may survive with significant neurological recovery.
Acute Atraumatic Subdural Hematoma Associated with Moyamoya Disease in an African-American
Authors: Oppenheim Jeffrey S. , Gennuso Rosemaria , Sacher Michael , Hollis Peter 
Published: April 2011

Abstract
A 57-year-old black woman with an atraumatic subdural hematoma was treated for congestive heart failure and was found to have moyamoya disease. The association of these two lesions is rare and has never been described in an African-American. High cerebral venous pressures and changes in cerebral perfusion caused by congestive heart failure and the loss of cerebrovascular autoregulation in moyamoya disease may explain the spontaneous occurrence of a subdural hematoma. Recommendations for management are discussed.