bluuebunny/crossref_metadata_2025_split huggingface dataset:
De Novo Saccular Aneurysms
Authors: Misra Basant K. , Whittle Ian R. , Steers A. James W. , Sellar Robin J. 
Published: May 2010

ABSTRACT
The authors report two patients with aneurysmal subarachnoid hemorrhage in whom carotid arteriography revealed aneurysms that had developed at previously normal locations and from infundibula during the years since initial angiography. Neither of these patients had congenital anomalies of the cerebral circulation and, apart from smoking in excess of 30 cigarettes a day, there were no common clinical features. The role of congenital and environmental factors in the formation of aneurysms and the enlargement of infundibula are reviewed.
Therapeutic Trial of Intravenous Nimodipine in Patients with Established Cerebral Vasospasm after Rupture of Intracranial Aneurysms
Authors: Jan Michel , Buchheit Fernand , Tremoulet Michel 
Published: May 2010

ABSTRACT
The therapeutic efficacy of intravenous nimodipine to treat the syndrome of delayed ischemic deterioration or vasospasm after subarachnoid hemorrhage caused by a ruptured aneurysm was investigated in a randomized, double-blind, placebo-controlled multicenter study. A total of 188 patients (nimodipine (N) = 102, placebo (P) = 86) were enrolled in the study, both pre- and postoperatively, within 24 hours of clinical deterioration connected with vasospasm or within 24 hours of arteriography that identified vasospasm. After 61 patients were excluded for not meeting study criteria or for protocol violation, the results were supported by 127 validated case reports: 73 patients received intravenous treatment with nimodipine, and 54 were given placebo. Analysis of the main criterion of efficacy, the number of deaths and of patients with severe deficit related to vasospasm alone, showed a significant statistical difference (N = 8 (19%), P = 17 (49%), P = 0.01). The risk of death or disability was reduced by 66% in the treated group. Analysis of this criterion by type of inclusion (clinical or angiographic) also showed a significant reduction in the clinical group (P = 0,05), but there was no difference in the angiographic group. The risk of mortality connected with vasospasm was reduced by 82%, but analysis by group showed that there was no significant difference for those patients included on clinical criteria, whereas mortality was reduced to a much greater extent in the angiographic group. These results demonstrate the therapeutic efficacy of nimodipine in reducing secondary ischemic brain damage in patients already suffering from angiographic vasospasm or delayed ischemic deterioration.
Localized Hypertrophic Mononeuropathy Involving the Tibial Nerve
Authors: Iyer Vasudeva G. , Garreston Henry D. , Byrd Ryland P. , Reiss Steven J. 
Published: May 2010

ABSTRACT
Localized hypertrophic neuropathy (LHN) is a disorder of unknown cause that presents with progressive, predominantly motor weakness in the distribution of a single nerve, with the histological appearance of the “onion bulb” formation. Because of its rarity, the condition is often ignored in the differential diagnosis of mononeuropathy. We report a case of LHN involving the posterior tibial nerve and review the literature.
Angiographic Examination and Surgical Treatment of Bow Hunter's Stroke
Authors: Hanakita Junya , Miyake Hidenori , Nagayasu Shinji , Nishi Shyogo , Suzuki Takanori 
Published: May 2010

ABSTRACT
Anatomically, the vertebral artery courses through six foramina transversaria of the cervical vertebrae, passing through the groove on the surface of the arch of the atlas and then penetrating the dura mater. Because of this anatomical course, the vertebral arteries are often affected by head motion. Stenotic change of the vertebral artery can occur at the atlantoaxial level in head rotation. Such a special type of stroke was named “bow hunter's stroke” by Sorensen. We report three cases of bow hunter's stroke and discuss the angiographic examinations. As surgical treatment, we performed partial transversectomy of the atlas vertebra, with favorable results. The usefulness of this surgical procedure is discussed.
Primary Intraosseous Malignant Meningioma of the Skull: Case Report
Authors: Lee Wei-Hwa , Tu Yen-Chang , Liu Ming-Yin 
Published: May 2010

Abstract
Primary intraosseous meningioma of the skull is rare. This report describes a 61-year-old man who was treated by craniectomy 3 times for a repeatedly recurrent primary intraosseous malignant meningioma. Transmission electron microscopy revealed interdigitation of cytoplasmic processes, microfilaments, and distinct desmosomal structures. Immunocytochemical studies of cultured cells showed strong expression of vimentin and weakly positive staining for S-100 protein. Primary intraosseous malignant meningioma should be considered in the differential diagnosis of massive solitary osteolytic lesions of the skull.
Sleep Apnea and the Chiari I Malformation: Case Report
Authors: Levitt Philip , Cohn Martin A. 
Published: May 2010

Abstract
The authors report the case of an ambulatory patient who presented with sleep apnea episodes of the central and obstructive types and an associated Chiari Type I malformation. The central episodes stopped and the obstructive episodes decreased markedly after decompression. The improvement in the so-called obstructive episodes was unexpected and indicates that they may have been on a central basis.
Dysembryoplastic Neuroepithelial Tumor: A Surgically Curable Tumor of Young Patients with Intractable Partial Seizures
Authors: Daumas-Duport Catherine , Scheithauer Bernd W. , Chodkiewicz Jean-Paul , Laws Edward R. , Vedrenne Claude 
Published: May 2010

Abstract
This report concerns the clinicopathological features of 39 cases of a morphologically unique and surgically curable group of neuroepithelial tumors associated with medically intractable partial complex seizures. All were supratentorial and characterized by intracortical location, multinodular architecture, and heterogeneity in cellular composition. The constituent cells included astrocytes, oligodendrocytes, and neurons. Because neuronal atypia was often inapparent, the tumors superficially resembled mixed oligoastrocytomas. The term “dysembryoplastic neuroepithelial tumor” (DNT) is proposed for these distinctive lesions, the clinicopathological features of which suggest a dysembryoplastic origin. With the exception of the occurrence of headaches in 2 patients, partial complex seizures were the exclusive symptom. Age at onset of symptoms ranged from 1 to 19 years (mean 9 years). In addition to the chronic nature of the seizures (range, 2 to 18 years; mean, 9 years), one-third of the patients showed radiological features, such as focal cranial deformity, indicating that the tumors had an early onset and were of long standing. In most cases, computed tomography showed a “pseudocystic,” well-demarcated, low density appearance associated in some cases with focal contrast enhancement (18%) or calcific hyperdensity (23%). The tumor involved the temporal lobe in 24 patients (62%), the frontal lobe in 12 (31%), and the parietal and/or occipital lobe in 3 cases. Although tumor removal was considered incomplete or subtotal in 17 patients (44%), long term follow-up (range, 1 to 18 years; mean, 9 years) showed neither clinical nor radiological evidence of recurrence in any patient. Comparison of the survival data of the 13 subjects who had undergone postoperative radiotherapy with 26 who had not indicated that radiation therapy was of no obvious benefit. The identification of DNT has therapeutic and prognostic implications because aggressive therapy can be avoided, thus sparing these young patients the deleterious long term effects of radio- or chemotherapy.
Photodynamic Therapy of Malignant Brain Tumors: Clinical Results of, Difficulties with, Questions about, and Future Prospects for the Neurosurgical Applications
Authors: Perria Carlo , Carai Martino , Falzoi Antonello , Orunesu Giuseppe , Rocca Antonio , Massarelli Giovannino , Francaviglia Natale , Jori Giulio 
Published: May 2010

Abstract
Photodynamic therapy (PDT) has been applied in a variety of oncological fields with good results. In neurosurgery, the clinical series are limited and the number of treated patients is not statistically significant. This work examines the results of PDT performed in our clinic and discusses some difficulties and causes of failure of this method in neurosurgical patients. Eight patients with malignant brain tumors underwent PDT. All had been treated previously by operation and radiation therapy and one patient had also received chemotherapy. At 24 hours after the i.v. injection of hematoporphyrin (5 mg/kg body weight), the tumor was removed as radically as possible and the residual tumor bed was exposed to either 630-nm light from an argon-dye laser or 600- to 680-nm light isolated from the emission of a quartz-halogen lamp. The type of sensitizer, the irradiation methods, and the peculiarities of glial tumors are examined as possible causes of failure. The longer survivals of some patients with glial tumors treated by PDT may make this treatment suitable when traditional therapies fail.
Outcome of Aneurysmal Subarachnoid Hemorrhage in a Hospital Population: A Prospective Study Including Early Operation, Intravenous Nimodipine, and Transcranial Doppler Ultrasound
Authors: Seiler Rolf W. , Reulen Hans J. , Huber Peter , Grolimund Peter , Ebeling Uwe , Steiger Hans J. 
Published: May 2010

Abstract
A total of 153 consecutive patients with proven aneurysmal subarachnoid hemorrhages (SAHs) admitted immediately after diagnosis regardless of clinical condition were managed according to the same protocol. The initial evaluation included computed tomography (CT), transcranial Doppler ultrasound (TCD), angiography-CT, and/or angiography. Intravenous nimodipine (2 mg/hour) was started after confirmation of the diagnosis. The timing of operation was determined individually according to age, clinical course, and CT and TCD findings. Twenty-one Grade V patients treated with intensive care and ventriculostomy died or did not improve within 24 hours after SAH. Three patients with life-threatening intracerebral hematomas underwent emergency operation. Operation was early in 55 good risk patients and late in 57 patients because of poor initial grade, late admission, or logistic reasons. Seventeen patients had no operation because of old age, persistent poor clinical condition, medical complication, or lethal rebleeding before operation. In the total series, 90 patients (59%) made a full recovery, the overall morbidity rate was 14% (21 of 153 cases), and the mortality rate was 27% (42 of 153). Postoperative mortality including emergency evacuation of hematomas was 7.8% and mortality after elective operation was 6.2%. The causes of disability and death were the initial effect of the hemorrhage in 25 patients (16.3%), rebleeding in 15 (9.8%), delayed cerebral infarction in 8 (5.2%), surgical complications in 7 (4.5%), hydrocephalus in 4 (2.6%), and medical complications in 4 (2.6%).
Perioperative Lumbar Injection of Ringer's Lactate Solution in Chronic Subdural Hematomas: A Series of 100 Cases
Authors: Grisoli F. , Graziani N. , Peragut J. C. , Vincentelli F. , Fabrizi A. P. , Caruso G. , Bellard S. 
Published: May 2010

Abstract
A series of 100 patients underwent surgical treatment for chronic subdural hematomas between 1979 and 1987. The procedure consisted of craniectomy with a 30-mm trephine, irrigation and drainage of the hematoma, laceration of the outer and inner membranes, and lumbar intrathecal injection of Ringer's lactate solution for immediate cerebral reexpansion (average injection, 130 ml). This technique gave the following results: 2% mortality, 2% moderate morbidity, and 96% recovery. The recovery of the patients was rapid, and good outcome was achieved in Grade 3 and Grade 4 cases (Markwalder's classification).
Dysautoregulation in Patients with Ruptured Aneurysms: Cerebral Blood Flow Measurements Obtained during Surgery by a Temperature-controlled Thermoelectrical Method
Authors: Tenjin Hiroshi , Hirakawa Kimiyoshi , Mizukawa Norihiko , Yano Ichiro , Ohta Tsutomu , Uchibori Mikio , Hino Akihiko 
Published: May 2010

Abstract
We used a temperature-controlled thermoelectrical method, induced hypotension, and CO2 inhalation to obtain cerebral blood flow (CBF) measurements during surgery for investigation of the state of brain vasoreactivity in subarachnoid hemorrhage patients. The study included 11 patients who underwent 12 operations for ruptured intracranial aneurysms. The CBF data were analyzed to investigate the neurological state, presence or nonpresence of vasospasm, timing of the operation, and outcome of each patient. Autoregulation disturbance, in terms of reaction to hypotension, was consistently seen in patients in poor neurological states, and this disturbance was correlated with poor outcome. This simple monitoring system, used during emergency operations for ruptured aneurysm, was useful in predicting outcome.
Computed Tomography of Epidural Fibrosis after Discectomy: A Comparison between Symptomatic and Asymptomatic Patients
Authors: Cervellini Patrizio , Curri Decio , Volpin Lorenzo , Bernardi Lorenzo , Pinna Vittore , Benedetti Antonio 
Published: May 2010

Abstract
The evaluation of patients with symptoms recurrent after disc surgery is a difficult diagnostic problem. The most common causes are recurrent herniation and postoperative scarring; routine x-ray and myelographic differentiation between herniation and scarring is difficult or impossible. High resolution computed tomography (CT) has shown some results in the evaluation of postoperative patients, but the role of epidural fibrosis in failed back surgery syndrome (FBSS) is not clear. Some knowledge of the “normal” CT physiological healing and scarring after disc surgery is necessary. We scanned 20 asymptomatic operated patients and 20 patients with recurrent sciatic nerve pain after disc surgery who did not have bony stenosis, recurrent disc herniation, or other causes of FBSS. Our observations showed no important differences in the fibrosis demonstrated by CT between symptomatic and asymptomatic patients. The degree and type of fibrosis are not related to recurrent symptoms.
Brachytherapy in the Treatment of Recurrent Solitary Brain Metastases
Authors: Heros Deborah O. , Kasdon David L. , Chun Mison 
Published: May 2010

Abstract
Conventional therapy for solitary brain metastases includes radiotherapy and surgical resection in selected cases. Often, however, the metastasis recurs and limits the quality of life and survival of the patient. Once the metastasis recurs, therapeutic options are limited. Brachytherapy delivers a high total dose of radiation to a localized area, allowing reirradiation at the time of recurrence. Three patients with recurrent brain metastases treated with iridium-192 implants are presented; two of these patients had breast carcinoma and one had malignant melanoma. The implants allowed long term survival in the two patients with recurrent metastatic breast carcinoma. Unfortunately, the patient with melanoma did not respond to the brachytherapy and died within 7 months of implantation. The approaches to treatment to metastatic brain tumors and the rationale for using brachytherapy are discussed.
Selective Neurotomy of the Tibial Nerve for Treatment of the Spastic Foot
Authors: Sindou Marc , Mertens Patrick 
Published: May 2010

Abstract
One of the most frequent neurological sequelae seen by the specialist in rehabilitation is the spastic foot. Spasticity in the foot may be responsible for abnormal posture and painful or trophic disturbances impairing standing and walking. This disability can be corrected by a simple neurosurgical procedure, the selective tibial neurotomy. In this procedure, one sections the tibial nerve branches to the muscles sustaining spasticity, i.e, the soleus and/or the gastrocnemius nerves for equinus and ankle clonus or the posterior tibialis branch for varus and the flexor fascicles for tonic flexion of the toes. After microsurgical dissection of each tibial nerve branch at the lower part of the popliteal region and their identification with bipolar electrostimulation, the selected branches are partially sectioned under the operating microscope. The present series consists of 62 operations performed in 53 patients, 9 bilaterally and 44 unilaterally. Operation obtained complete suppression of the disabling spasticity that had been present for 2 to 17 years (4 on average), total pain relief, and consequently improvement of the residual voluntary movements (by achieving a better balance between agonist and antagonist muscles) in 51 of the 62 spastic feet (i.e., 82% of the cases). For all of these patients, the beneficial effects were long-lasting over the 1- to 10-year follow-up (3 years on average). Selective neurotomy of the tibial nerve should be considered only after failure of intensive prolonged kinestherapy and of all available medical treatment. It must take place, however, before the onset of irreversible articular disturbances and musculotendinous retractions, which require complementary orthopedic corrections.
Slit Ventricle Syndrome with Aqueduct Stenosis: Third Ventriculostomy as Definitive Treatment
Authors: Reddy K. , Fewer H. D. , West M. , Hill N. C. 
Published: May 2010

Abstract
Slit ventricle syndrome is a poorly understood entity characterized by features of raised intracranial pressure and small ventricles in shunt-dependent hydrocephalics. Five patients with this syndrome were treated with antisiphon devices, high pressure shunts, or subtemporal decompression, but continued to be symptomatic. Third ventriculostomy, performed as a last resort in these patients, gave encouraging results. The patient data, operative approach, and perliminary results are presented here.
Extracranial Posterior Inferior Cerebellar Artery Aneurysm Causing Isolated Intraventricular Hemorrhage: A Case Report
Authors: Ruelle Antonio , Cavazzani Paolo , Andrioli Giancarlo 
Published: May 2010

Abstract
The authors report the unusual case of an aneurysm arising on an extracranial loop of the left posterior inferior cerebellar artery (PICA). The computed tomographic scan showed an isolated hemorrhage in the lateral ventricles, and the lesion was recognized 1.5 cm below the foramen magnum at the level of the atlas. The literature concerning peripheral PICA aneurysms is reviewed and the clinical and radiological features of these lesions are discussed. A tendency for subarachnoid bleeding from distal PICA aneurysm ruptures to spread into the ventricular system is suggested. The diagnosis of distal PICA aneurysm should also be considered in cases of isolated intraventricular hemorrhage without obvious parenchymal or subarachnoid hemorrhage. The need for four-vessel angiography when studying patients suffering from a subarachnoid hemorrhage is stressed.
Oligodendroglial Proliferative Abnormality Associated with Arteriovenous Malformation: Report of Three Cases with Review of the Literature
Authors: Nazek M. , Mandybur T. I. , Kashiwagi S. 
Published: May 2010

Abstract
A peculiar nonneoplastic oligodendroglial proliferative abnormality associated with cerebral arteriovenous malformations (AVMs) was present in three patients. Histological examination of biopsy material revealed dense oligodendroglial tissue reminiscent of oligodendroglioma in the white matter adjoining the AVMs. Careful consideration of clinical and pathological features suggested that the evidence was insufficient to qualify the lesion as truly neoplastic (oligodendroglioma); rather, a tissue collapse or a hamartomatous proliferation could be considered to be its cause. The literature contains 14 instances of various vascular malformations associated with primary brain tumors, 5 of which were diagnosed as oligodendrogliomas. It is possible, however, that some of the cases reported in the literature constitute oligodendroglial abnormality similar to that observed in our cases rather than genuine oligodendrogliomas. Attention is drawn to this interesting and prognostically important phenomenon.
Distribution of 10B after Infusion of Na210B12H11SH into a Patient with Malignant Astrocytoma: Implications for Boron Neutron Capture Therapy
Authors: Finkel Gerald C. , Poletti Charles E. , Fairchild Ralph G. , Slatkin Daniel N. , Sweet William H. 
Published: May 2010

Abstract
If a sufficient concentration of the stable isotope 10B is introduced into a neoplasm, radiation therapy can be effected by short-range heavy charged particles from the disintegration of 10B by slow neutrons. Brain tumors were irradiated postoperatively by Hatanaka and co-workers in Japan using a 1 to 2 hour intraarterial infusion of 10B-enriched Na2B12H11SH (Na210B12H11SH) before exposure of the tumor-bearing area of the brain to slow neutrons from a 100 kilowatt nuclear reactor. The clinical outcome of such boron neutron capture therapy has been favorably impressive in some patients, but its efficacy in brain tumors needs improvement. In our study, a terminally ill patient with malignant astrocytoma was infused intravenously with Na210B12H11SH for 25 hours. The postmortem distribution of 10B in unfixed, frozen, tumor-bearing brain and spinal cord tissues was studied by comparing representative cryostat sections of these specimens with neutron-induced heavy charged particle radiographs of the same sections. Preferential accumulation of 10B was observed in the tumor, with relatively little accumulation of 10B in the parenchyma of the central nervous system.
Transoral Approach to Extradural Lesions of the Lower Clivus and Upper Cervical Spine: An Experience of 19 Cases
Authors: Di Lorenzo Nicola 
Published: May 2010

Abstract
An experience with 19 cases of transoral exposure of the lower clivus and ventral aspect of the upper cervical spine is presented. The spectrum of pathological entities in this series includes malformative, neoplastic, and spondylotic conditions. The report is designed to focus upon some points of overall surgical management of patients treated by the transoral approach, with emphasis on management of postoperative instability, and to underline the discrepancy in the prognosis of congenital and acquired disorders, in terms of mortality, morbidity, and long-term results.
Craniopharyngiomas: Fluctuation in Cyst Size Following Surgery and Radiation Therapy
Authors: Constine Louis S. , Randall Stephen H. , Rubin Philip , McDonald Joseph 
Published: May 2010

Abstract
Patients with craniopharyngiomas who demonstrate cyst enlargement after surgery and radiation are often presumed to be treatment failures. Therapeutic approaches in various centers include repetitive cyst aspirations, surgical reexcision, and instillation of cytotoxic agents such as methotrexate, 32P, or 198Au. Each intervention has associated severe or even lethal side effects. Not all patients with craniopharyngioma who have cystic enlargement after primary therapy require an intervention, as demonstrated by 4 patients recently managed in the University of Rochester Medical Center. Since 1978, when computed tomography was routinely in use, we have managed 11 patients with craniopharyngiomas who were treated with surgery followed by radiation therapy. Three of these patients demonstrated post-irradiation enlargement of the residual cystic component followed by a decrease in size without surgical intervention. An additional patient showed cystic growth followed by stabilization of size. It is noteworthy that the cyst enlarged within the first 5 months after radiation therapy in the 3 patients who subsequently demonstrated a diminution in the size of their cysts. This suggests that the mechanism for cyst formation remained intact and subsequently abated because of a radiation-induced lesion. We conclude that after treatment with surgery and radiation therapy, the cystic component of craniopharyngiomas may increase and, without intervention, subsequently decrease in size. Thus, in the asymptomatic patient who demonstrates cystic growth soon after primary therapy, close observation alone may be warranted.