bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increased locoregional blood flow in brain tumors after cervical spinal cord stimulation
Authors: Clavo Bernardino , Robaina Francisco , Catalá Luis , Valcárcel Benilde , Morera Jesús , Caramés Miguel Á. , Ruiz-Egea Eugenio , Panero Francisco , Lloret Marta , Hernández Maria A. 
Published: May 2009

Object. Patients with high-grade gliomas have poor prognoses following standard treatment. Generally, malignant brain tumors have a decreased blood flow that results in increased resistance to radiation and reduced delivery of chemotherapeutic agents and oxygen. The aim of the present study was to assess the effect of spinal cord stimulation (SCS) on locoregional blood flow in high-grade tumors in the brain.
Methods. Fifteen patients (11 with Grade III and four with Grade IV brain tumors) had SCS devices inserted prior to scheduled radiotherapy. Both before and after SCS, the patients underwent the following procedures: 1) single-photon emission computerized tomography (SPECT) scanning; 2) middle cerebral artery (MCA) blood flow velocity measurements (centimeters/second) with the aid of transcranial Doppler (TCD) ultrasonography; and 3) common carotid artery (CCA) blood flow volume quantification (milliliters/minute) based on time-domain processing by using color Doppler ultrasonography.
The indices demonstrated on SPECT scanning before SCS were significantly lower (p < 0.001) in tumor sites compared with those in peritumoral sites (32%) and healthy contralateral areas (41%). Poststimulation results revealed the following: 1) a mean increase of 15% in tumor blood flow in 75% of patients (p = 0.033), as demonstrated on SPECT scanning; 2) a mean increase of greater than 18% in systolic and diastolic blood flow velocities in both tumorous and healthy MCAs in all but one patient (p < 0.002), as exhibited on TCD ultrasonography; and 3) a mean increase of greater than 60% in blood flow volume in tumorous and healthy CCAs in all patients (p < 0.013), as revealed on color Doppler ultrasonography studies.
Conclusions. Preliminary data show that SCS can modify locoregional blood flow in high-grade malignant tumors in the brain, thus indicating that SCS could be used to improve blood flow, oxygenation, and drug delivery to such tumors and could be a useful adjuvant in chemoradiotherapy.
Microsurgical anatomy of the early branches of the middle cerebral artery: morphometric analysis and classification with angiographic correlation
Authors: Tanriover Necmettin , Kawashima Masatou , Rhoton Albert L. , Ulm Arthur J. , Mericle Robert A. 
Published: May 2009

Object. The cortical arteries arising from the main trunk of the middle cerebral artery, proximal to its bifurcation or trifurcation, are called “early branches.” The purpose of this study was to characterize these early branches.
Methods. The early branches were characterized according to their sites and patterns of origin, diameters, and relative proximity to the internal carotid artery bifurcation, as well as the course and area of supply of their cortical branches based on an examination of 50 hemispheres. Special attention was directed to the perforating arteries that arose from the early branches and entered the anterior perforated substance. The anatomical findings were compared with data obtained from 109 angiograms.
Conclusions. Early branches directed to the temporal and frontal lobes were found in 90 and 32% of the hemispheres, respectively. The early branches that arose more proximally from the M1 segment were larger than those arising distally. Lenticulostriate arteries arose from 81% of the early frontal branches (EFBs) and from 48% of the early temporal branches (ETBs). An average of two cortical arteries arose from the EFBs and 1.3 from the ETBs, the most common of which supplied the temporopolar and orbitofrontal areas. Although the microsurgical anatomy of the early branches demonstrates abundant diversity, they can be classified into clearly defined patterns based on anatomical features. These patterns can prove helpful in evaluating angiographic data and in planning an operative procedure.
Effect of Neuregen nutrient medium on survival of cortical neurons after aspiration lesion in rats
Authors: Brewer Gregory J. , Espinosa Jose A. , Struble Robert G. 
Published: May 2009

Object. During brain surgery, it would be beneficial to irrigate the surgical cavity with a solution that promotes neuronal growth and survival. The authors find that incubation of cultured neurons with normal saline, also known as buffered salts, which are often used in brain surgery in humans, does not support neuron survival. Neuregen is an optimized serum-free culture medium that promotes regeneration of adult rat and human central nervous system neurons in vitro. It includes balanced salts, glucose, amino acids, vitamins, essential fatty acids, hormones, antioxidants, and other ingredients. The authors hypothesize that brain lesions irrigated and soaked in Neuregen nutrients will have better neuron survival rates in deafferented regions than lesions irrigated with saline.
Methods. Lesioning of the rat fimbria—fornix area was achieved by aspiration through the cortex; animals were killed 4 weeks later. Brain sections were stained with cresyl violet for neuron counts in the medial septum and cortex. Treatment of the lesion cavity with Neuregen resulted in a 55% increase in neuron density in the septum compared with saline treatment (p = 0.02). Cortical lesions treated with Neuregen showed a 27% increase in neuron density compared with saline-treated lesions (p = 0.015); the neuron density in Neuregen-treated rat brains was equivalent to that seen with sham treatment. Efficacy of Neuregen with basic fibroblast growth factor (bFGF) was significantly better than with Dulbecco modified Eagle medium bFGF, but not better than Neuregen alone. Neuregen produced a coincidental fourfold reduction in glial fibrillary acidic protein immunoreactivity at 4 weeks compared with saline (p = 0.002), to levels equivalent to those found in sham lesions.
Conclusions. These results indicate that a highly optimized nutrient medium promotes neuron survival after brain surgery.
Ectopic intracavernous sinus adrenocorticotropic hormone—secreting microadenoma: could this be a common cause of failed transsphenoidal surgery in Cushing disease?
Authors: Kim Louis J. , Klopfenstein Jeffrey D. , Cheng Ming , Nagul Murugasu , Coons Stephen , Fredenberg Christina , Brachman David G. , White William L. 
Published: May 2009

✓ Despite diagnostic advances, it remains difficult to identify intrasellar and ectopic parasellar adrenocorticotropic hormone (ACTH)—secreting microadenomas. The authors present the case of a 61-year-old woman with Cushing disease in whom a significant central-to-peripheral and lateralized right-sided ACTH gradient was demonstrated on inferior petrosal sinus sampling; no discernible abnormality was seen on magnetic resonance imaging. She underwent transnasal transsphenoidal surgery. No tumor was found on sellar exploration and a total hypophysectomy was performed, yet her hypercortisolemia persisted. The patient died of cardiac events 17 days postsurgery. Autopsy revealed an isolated, right-sided, intracavernous ACTH-secreting adenoma with no intrasellar communication.
This case represents the first failed transsphenoidal surgery for Cushing disease in which there is postmortem confirmation of a suspected intracavernous sinus lesion. It supports the hypothesis that Cushing disease associated with nondiagnostic imaging studies, a strong ACTH gradient on venography, and negative findings on sellar exploration may be caused by an ectopic intracavernous ACTH-secreting adenoma. There are no premortem means of confirming the presence of such lesions, but these tumors could underlie similar cases of failed surgery. Radiation therapy targeting the sella turcica and both cavernous sinuses, possibly supplemented with medical treatment, is suggested for similar patients in whom transsphenoidal hypophysectomy has failed. Adrenalectomy may also be appropriate if a rapid reduction in ACTH is necessary.
Deep and brainstem cavernomas: a consecutive 8-year series
Authors: Mathiesen Tiit , Edner Göran , Kihlström Lars 
Published: May 2009

Object. The goal of this study was to provide epidemiological and clinical data on the management of cavernomas of the basal ganglia and brainstem from a long-term series at one institution.
Methods. All 68 patients who were referred to the authors' department between 1992 and 2000 for deep cavernomas were evaluated by clinic examinations, review of neuroimaging examinations, and review of charts and operative notes.
Twenty-nine patients underwent microsurgical procedures, which carried a 69% risk of transitory neurological deterioration. Radical excision was achieved in 25 of these patients, as determined by a review of neuroimages; the remaining four patients all experienced new hemorrhages that led to increased morbidity or even to mortality. Surgical results were better if surgery was performed early, within 1 month posthemorrhage, than if operations were postponed. In selected patients, deep lesions not reaching a pial surface could be safely removed from the thalamus, basal ganglia, or medulla oblongata. Of five patients who underwent gamma knife surgery, two experienced hemorrhages, one at 2 and the other at 5 years following treatment. Patients who did not undergo surgery had a yearly incidence of hemorrhage that was 2% in cases of incidental cavernomas and 7% in symptomatic ones.
Conclusions. Over the long term, outcomes were worse following conservative treatment or shunt insertion surgery than after microsurgery of symptomatic cavernomas. Incidental cavernomas carried a low risk of neurological deterioration.
Surgery should follow generally accepted indications, but only with the confidence that total removal can be safely achieved. Surgery that is performed within 10 to 30 days following ictus may be preferable to delayed surgery.
Matrix metalloproteinase—9 concentration after spontaneous intracerebral hemorrhage
Authors: Abilleira Sònia , Montaner Joan , Molina Carlos A. , Monasterio Jasone , Castillo José , Alvarez-Sabín José 
Published: May 2009

Object. Matrix metalloproteinases (MMPs) are overexpressed in the presence of some neurological diseases in which blood—brain barrier disruption exists. The authors investigated the MMP-9 concentration in patients after acute intracerebral hemorrhage (ICH) and its relation to perihematomal edema (PHE).
Methods. Concentrations of MMP-9 and related proteins were determined in plasma by performing an enzyme-linked immunosorbent assay of samples drawn after hospital admission (< 24 hours after stroke) from 57 patients with ICH. The diagnosis of ICH was made on the basis of findings on computerized tomography (CT) scans. The volumes of ICH and PHE were measured on baseline and follow-up CT scans at the same time that the patient's neurological status was assessed using the Canadian Stroke Scale and the Glasgow Coma Scale. Increased expression of MMP-9 was found among patients with ICH. In cases of deep ICH, MMP-9 was significantly associated with PHE volume (r = 0.53; p = 0.01) and neurological worsening (237.4 compared with 111.3 ng/ml MMP-9; p = 0.04). A logistic regression model focusing on the study of absolute PHE volume showed ICH volume as an independent predictor (odds ratio [OR] 3.37; 95% confidence interval [CI] 1.1–10.3; p = 0.03). A second analysis of relative PHE volume (absolute PHE volume/ICH volume) in patients with deep ICH demonstrated that the only factor related to it was MMP-9 concentration (OR 11.6; 95% CI 1.5–89.1; p = 0.018).
Conclusions. Expression of MMP-9 is raised after acute spontaneous ICH. Among patients with deep ICH this increase is associated with PHE and the development of neurological worsening within the acute stage.
Localization of stimulating electrodes in patients with Parkinson disease by using a three-dimensional atlas—magnetic resonance imaging coregistration method
Authors: Yelnik Jérôme , Damier Philippe , Demeret Sophie , Gervais David , Bardinet Eric , Bejjani Boulos-Paul , François Chantal , Houeto Jean-Luc , Arnulf Isabelle , Dormont Didier , Galanaud Damien , Pidoux Bernard , Cornu Philippe , Agid Yves 
Published: May 2009

Object. The aim of this study was to correlate the clinical improvement in patients with Parkinson disease (PD) treated using deep brain stimulation (DBS) of the subthalamic nucleus (STN) with the precise anatomical localization of stimulating electrodes.
Methods. Localization was determined by superimposing figures from an anatomical atlas with postoperative magnetic resonance (MR) images obtained in each patient. This approach was validated by an analysis of experimental and clinical MR images of the electrode, and the development of a three-dimensional (3D) atlas—MR imaging coregistration method. The PD motor score was assessed through two contacts for each of two electrodes implanted in 10 patients: the “therapeutic contact” and the “distant contact” (that is, the next but one to the therapeutic contact). Seventeen therapeutic contacts were located within or on the border of the STN, most of which were associated with significant improvement of the four PD symptoms tested. Therapeutic contacts located in other structures (zona incerta, lenticular fasciculus, or midbrain reticular formation) were also linked to a significant positive effect. Stimulation applied through distant contacts located in the STN improved symptoms of PD, whereas that delivered through distant contacts in the remaining structures had variable effects ranging from worsening of symptoms to their improvement.
Conclusions. The authors have demonstrated that 3D atlas—MR imaging coregistration is a reliable method for the precise localization of DBS electrodes on postoperative MR images. In addition, they have confirmed that although the STN is the main target during DBS treatment for PD, stimulation of surrounding regions, particularly the zona incerta or the lenticular fasciculus, can also improve symptoms of PD.
Poly(adenosine diphosphate—ribose) polymerase expression in human traumatic brain injury
Authors: Ang Beng Ti , Yap Elgin , Lim Joyce , Tan Wan Loo , Ng Puay Yong , Ng Ivan , Yeo Tseng Tsai 
Published: May 2009

Object. This study was designed to elucidate the pattern of expression of poly(adenosine diphosphate—ribose) polymerase (PARP) in human pericontusional brain tissue and to correlate these findings with commonly used clinical parameters.
Methods. The expression of PARP was ascertained using immunohistochemical studies in eight specimens of human pericontusional brain tissue obtained when the patients underwent craniotomy for mass effect. The following demographic and clinical parameters were also analyzed for each patient: age, sex, postresuscitation Glasgow Coma Scale score (GCS), computerized tomography findings, intracranial pressure (ICP) recordings during the first 24 hours postsurgery, and the time interval from injury to surgery.
The authors observed that PARP was present in neurons of pericontusional tissue and that it conformed to two patterns of subcellular localization; it was found either in the nucleus exclusively or in both nuclear and cytoplasmic compartments. They showed that a preponderance of cytoplasmic staining in neurons was significantly correlated with a short time interval from trauma to surgery (≤ 4 hours). There was no correlation, however, between the subcellular distribution of PARP and clinical parameters such as admission GCS score and ICP readings obtained intra- and postoperatively.
Conclusions. As in earlier studies in which it has been suggested that caspase-cleaved PARP translocates to the cytoplasm during apoptosis, the authors' results indicate that apoptosis may predominate in the initial time frame after head injury. This information may well influence the timing of administration of antiapoptotic neuronal salvage agents for adjunctive therapy of head injury in the future.
An inflatable balloon catheter and liquid 125I radiation source (GliaSite Radiation Therapy System) for treatment of recurrent malignant glioma: multicenter safety and feasibility trial
Authors: Tatter Stephen B. , Shaw Edward G. , Rosenblum Mark L. , Karvelis Kastytis C. , Kleinberg Lawrence , Weingart Jon , Olson Jeffrey J. , Crocker Ian R. , Brem Steven , Pearlman James L. , Fisher Joy D. , Carson Kathryn A. , Grossman Stuart A. , _ _ 
Published: May 2009

Object. In this study the authors evaluated the safety and performance of the GliaSite Radiation Therapy System (RTS) in patients with recurrent malignant brain tumors who were undergoing tumor resection.
Methods. The GliaSite is an inflatable balloon catheter that is placed in the resection cavity at the time of tumor debulking. Low-dose-rate radiation is delivered with an aqueous solution of organically bound iodine-125 (Iotrex [sodium 3-(125I)-iodo-4-hydroxybenzenesulfonate]), which are temporarily introduced into the balloon portion of the device via a subcutaneous port. Adults with recurrent malignant glioma underwent resection and GliaSite implantation. One to 2 weeks later, the device was filled with Iotrex for 3 to 6 days, following which the device was explanted. Twenty-one patients with recurrent high-grade astrocytomas were enrolled in the study and received radiation therapy. There were two end points: 1) successful implantation and delivery of brachytherapy; and 2) safety of the device.
Implantation of the device, delivery of radiation, and the explantation procedure were well tolerated. At least 40 to 60 Gy was delivered to all tissues within the target volume. There were no serious adverse device-related events during brachytherapy. One patient had a pseudomeningocele, one patient had a wound infection, and three patients had meningitis (one bacterial, one chemical, and one aseptic). No symptomatic radiation necrosis was identified during 21.8 patient-years of follow up. The median survival of previously treated patients was 12.7 months (95% confidence interval 6.9–15.3 months).
Conclusions. The GliaSite RTS performs safely and efficiently. It delivers a readily quantifiable dose of radiation to tissue at the highest risk for tumor recurrence.
Preoperative correlation of intraoperative cortical mapping with magnetic resonance imaging landmarks to predict localization of the Broca area
Authors: Quiñones-Hinojosa Alfredo , Ojemann Steven G. , Sanai Nader , Dillon William P. , Berger Mitchel S. 
Published: May 2009

Object. Broca identified the posterior third of the inferior frontal gyrus as a locus essential for the production of fluent speech. The authors have conducted this retrospective analysis in an attempt to find readily identifiable landmarks on magnetic resonance (MR) imaging that correspond to intraoperative cortical stimulation-induced speech arrest. These landmarks demonstrate novel structural—functional relationships that can be used preoperatively to predict the location of the Broca area.
Methods. Using a neuronavigation system, sites where stimulation produced speech arrest (Broca area) were recorded in a consecutive series of patients undergoing awake tumor resections in the perisylvian territory of the dominant hemisphere. The authors reviewed 33 consecutive patients by projecting the MR imaging data sets and marking the site where the Broca area was identified. Sulcus topography was analyzed with respect to this site by scrolling into neighboring planes and classifying the frontal operculum into one of the four schemes of sulcus variability described by Ebeling, et al. The following categories of frontal opercula were found: 18 (69%) of 26 were Type I, eight (31%) of 26 were Type III, and seven cases eluded classification because of sulcal effacement. For patients with Type I anatomy, the Broca area was adjacent to, and distributed evenly around, the inferior precentral sulcus (IPS). Quantitatively, the site of speech arrest was located a mean of 2.4 ± 0.25 cm from the anteroinferior aspect of the pars opercularis, where it abuts the subarachnoid space surrounding the apex of the pars triangularis. For all patients with Type III anatomy, the Broca area was adjacent to the accessory sulcus that lies immediately posterior to the IPS. In these patients the mean distance from the anterior inferior pars opercularis was 2.3 ± 0.29 cm. The mean distance from the Broca area to the edge of the tumor for the 26 patients with clear sulcal anatomy was 1.29 ± 0.12 cm.
Conclusions. The results indicate a correlation between the structure of the frontal operculum as seen on MR imaging and the functional localization of speech arrest in the dominant hemisphere. Additionally, sulcal landmarks that can be used preoperatively to predict the location of the Broca area within the inferior frontal gyrus are described based on the patient population. This information will allow the surgeon to determine if an awake craniotomy is necessary to identify the Broca area when planning a surgical procedure near the dominant frontal operculum.
Upregulation of neurogenesis and reduction in functional deficits following administration of DETA/NONOate, a nitric oxide donor, after traumatic brain injury in rats
Authors: Lu Dunyue , Mahmood Asim , Zhang Ruilan , Li Yi , Chopp Michael 
Published: May 2009

Object. Neurogenesis, which is upregulated by neural injury in the adult mammalian brain, may be involved in the repair of the injured brain and functional recovery. Therefore, the authors sought to identify agents that can enhance neurogenesis after brain injury, and they report that (Z)-1-[N-(2-aminoethyl)-N-(2-ammonioethyl)amino]diazen-1-ium-1,2-diolate (DETA/NONOate), a nitric oxide donor, upregulates neurogenesis and reduces functional deficits after traumatic brain injury (TBI) in rats.
Methods. The agent DETA/NONOate (0.4 mg/kg) was injected intraperitoneally into 16 rats daily for 7 days, starting 1 day after TBI induced by controlled cortical impact. Bromodeoxyuridine (100 mg/kg) was also injected intraperitoneally daily for 14 days after TBI to label the newly generated cells in the brain. A neurological functional evaluation was performed in all rats and the animals were killed at 14 or 42 days postinjury. Immunohistochemical staining was used to identify proliferating cells.
Conclusions. Compared with control rats, the proliferation, survival, migration and differentiation of neural progenitor cells were all significantly enhanced in the hippocampus, subventricular zone, striatum, corpus callosum, and the boundary zone of the injured cortex, as well as in the contralateral hemisphere in rats with TBI that received DETA/NONOate treatment. Neurological functional outcomes in the DETA/NONOate-treated group were also significantly improved compared with the untreated group. These data indicate that DETA/NONOate may be useful in the treatment of TBI.