bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nimodipine-induced survival rate of facial motor neurons following intracranial transection of the facial nerve in the adult rat
Authors: Mattsson Per , Aldskogius Håkan , Svensson Mikael 
Published: May 2009

Object. Neuronal survival is an important factor in the achievement of functional restitution after peripheral nerve injuries. Intracranial tumors or trauma may cause patients to exhibit a temporary or permanent facial nerve palsy. Nimodipine, which acts as an antagonist to L-type voltage-gated calcium channels, has been shown to be neuroprotective in various lesion models of the central and peripheral nervous systems. The aim of the present study was to evaluate the effect of nimodipine on motor neuron survival in the facial motor nucleus following intracranial transection of the adult rat facial nerve.Methods. The facial nerve was cut intracranially in the posterior cranial fossa. Nimodipine was administered orally preoperatively for 3 days and postoperatively for up to 1 month, after which the number of neuronal profiles was quantified. The glial reaction was studied in the facial nucleus for up to 1 month by using immunocytochemical analysis.There was a significantly larger proportion of surviving motor neurons 1 month postinjury in animals treated with nimodipine (61 ± 6.7%) in comparison with untreated animals (26.8 ± 11.3%). Immunocytochemical analysis showed an increase in the amount of OX42 (microglia), ED1 (macrophages), and anti-glial fibrillary acidic protein (astrocytes) ipsilateral to the nerve injury; however, there was no difference between the two experimental groups of animals 2 to 28 days after surgery.Conclusions. The authors propose a neuroprotective role for nimodipine, which may be useful as a “cranial nerve protective agent” following insults such as head injury or skull base surgery.
Trigeminal nerve peripheral branch phenol/glycerol injections for tic douloureux
Authors: Wilkinson Harold A. 
Published: May 2009

Object. Trigeminal neuralgia or tic douloureux is a disease affecting older individuals, and thus, office-based “minimally invasive” therapy is inherently attractive. The author sought to determine whether injection of peripheral trigeminal branches with neurolytic solutions offers a simple, less invasive therapy, with low risk for patients with one- or two-division trigeminal neuralgia that is unresponsive to pharmacotherapy.Methods. This retrospective study focused on a review of case charts from 18 patients treated for tic douloureux. Sixty injections of 10% phenol in glycerol were given to the 18 patients, six of whom had undergone other neurosurgical procedures. The median patient age was 74 years, ranging from 36 to 94 years. There were nine women and nine men. Forty-six injections were administered into the infraorbital nerve in its canal in the midface, 11 percutaneous injections were administered into the mandibular nerve just proximal to the mandibular canal in the ramus of the jaw, and three injections were administered into supraorbital nerves. Eighty-seven percent of injections brought marked or total relief initially. Of those injections that provided initial relief, 37% still provided relief after 1 year and 30% after 2 years, with relief lasting for a median of 9 months after each injection. Most patients whose pain recurred after months of relief requested a repeated procedure, rather than undergo a ganglion nerve block procedure or open surgery. There were no serious complications or dysesthetic pain. Facial sensory loss generally recovered within 6 months and was well tolerated.Conclusions. Office-based injection of trigeminal branches is a useful technique for neurosurgeons who treat trigeminal neuralgia. It is easily repeated and can provide immediate pain relief of intermediate duration.
Surgery of epilepsy associated with focal lesions in childhood
Authors: Bourgeois Marie , Sainte-Rose Christian , Lellouch-Tubiana Arielle , Malucci Conor , Brunelle Francis , Maixner Wirginia , Cinalli Giuseppe , Pierre-Kahn Alain , Renier Dominique , Zerah Michel , Hirsch Jean-François , Goutières Francoise , Aicardi Jean 
Published: May 2009

Object. Surgery in children with epilepsy is a new, evolving field. The important practical issues have been to define strategies for choosing the most suitable candidates and the type and optimal timing of epilepsy surgery. This study was undertaken to elucidate these points.Methods. To identify the factors that correlated with outcome, the authors analyzed a series of 200 children (aged 1–15 years (mean 8.7 years) who underwent surgery between 1981 and 1996 at the Hôpital Necker—Enfants Malades. In 171 cases (85.5%) the epilepsy was medically refractory and was associated with focal cortical lesions. Surgery consisted of resection of the lesion without specifically attempting to identify and remove the “epileptogenic area.”In the group of children whose seizures were medically refractory, the mean follow-up period was 5.8 years. According to Engel's classification, 71.3% of these children became seizure free (Class Ia,) whereas 82% were in Class I. A multivariate statistical analysis revealed that among all the factors studied, the success of surgery in a patient in whom there was a good clinical/electroencephalogram/imaging correlation depended on the patient's having undergone a minimally traumatic operation, a complete resection of the lesion, and a short preoperative seizure duration.After the surgical control of epilepsy, behavior disorders were more improved (31% of all patients) than cognitive function (25%). The patient age at onset, duration and frequency of seizures, intractability of the disease to therapy, and seizure characteristics were correlated with cognitive, behavioral, and academic performance pre- and postoperatively. Multivariate statistical analysis revealed that cognitive dysfunction correlated highly with the duration of epilepsy prior to surgery, whereas behavioral disorders correlated more with seizure frequency.Conclusions. These data must be taken into account when selecting patients for surgical treatment and when deciding the timing of surgery. Early surgical intervention allows for optimum brain development.
Endovascular treatment of ruptured dissecting aneurysms aimed at occlusion of the dissected site by using Guglielmi detachable coils
Authors: Yamaura Ikuya , Tani Eiichi , Yokota Masayuki , Nakano Atsuhisa , Fukami Masahiro , Kaba Keizo , Matsumoto Tsuyoshi 
Published: May 2009

Object. Surgical or endovascular occlusion of the parent artery proximal to an aneurysm has been recommended for treatment of dissecting aneurysms of the intracranial posterior circulation. However, dissecting aneurysms may rupture even after proximal occlusion because distal progression of thrombus is necessary to occlude the dissecting aneurysm completely, and this may be delayed by the presence of retrograde flow. In this article the authors present their experience in treating six patients with ruptured dissecting aneurysms.Methods. The authors report on six patients with a ruptured dissecting aneurysm in the posterior fossa who were successfully treated by endovascular occlusion of the aneurysm by using Guglielmi detachable coils. The procedure was particularly aimed at occluding the dissected site.Conclusions. At the present time, endovascular occlusion of the dissected site is a safe, minimally invasive, and reliable treatment for dissecting aneurysms when a test occlusion is tolerated and adequate collateral circulation is present.
A comparison between endovascular and surgical management of basilar artery apex aneurysms
Authors: Gruber David P. , Zimmerman Gary A. , Tomsick Thomas A. , van Loveren Harry R. , Link Michael J. , Tew John M. 
Published: May 2009

Object. The goal of this retrospective study was to evaluate endovascular treatment by means of Guglielmi detachable coils (GDCs) compared with surgical management for basilar artery (BA) apex aneurysms.Methods. Forty-one patients presented with saccular BA apex aneurysms with angiographically definable necks that were judged suitable for either treatment. Of 20 patients who underwent surgery and 21 who underwent GDC embolization, 15 (75%) and 11 (52%), respectively, were treated in the acute phase after subarachnoid hemorrhage (SAH). Twenty-four (92%) of the 26 patients presenting with an SAH had a Hunt and Hess Grade III or better. Fifteen patients with unruptured or ruptured aneurysms more than 14 days post-SAH were treated electively. Patients in the endovascular and surgical treatment groups had aneurysms with comparable dimensions and configurations. Overall, 15 (75%) of the surgical patients and 20 (95%) of the patients in whom GDC embolization was performed had a good outcome (Glasgow Outcome Scale score of 4 or 5). Among those patients treated in the acute stage post-SAH, 11 (73%) of the surgical group and 10 (91%) of the endovascular group did well. Fourteen patients treated electively (93%) had good outcomes. There were two deaths (10%) in the surgical group and none in the endovascular group. Patients treated surgically were hospitalized twice as long and incurred twice the expenses of patients who underwent endovascular treatment (p < 0.001).Conclusions. Endovascular GDC embolization of select BA apex aneurysms may be a competitive alternative to direct surgical clipping. Long-term follow up is needed to better define the natural history of the endovascularly treated aneurysm and to further evaluate the accuracy of these preliminary results.
Clinical outcome of cotransplantation of peripheral nerve and adrenal medulla in patients with Parkinson's disease
Authors: López-Lozano Juan J. , Bravo Gonzalo , Abascal Javier , Brera Begoña , Millan Isabel , _ _ 
Published: May 2009

Object. Transplants of adrenal medulla (AM) and fetal ventral mesencephalon (FVM) are currently being tested as therapeutic alternatives in patients with Parkinson's disease (PD). At the Clínica Puerta de Hierro in Madrid, a controlled clinical trial is underway to establish which donor tissue, if any, is the best for open surgical implantation in patients with PD.Methods. Since 1987, varying degrees of clinical improvement have been achieved in Grade IV and V parkinsonian patients by implanting perfused AM and FVM into the right caudate nucleus. To investigate further whether implantation of different types of donor tissues results in qualitatively and quantitatively different degrees of recovery, four patients with Grade IV or V PD received implants of pre-coincubated autologous AM and intercostal nerve in the caudate nucleus. Four nonsurgically treated patients served as a control group. Three years posttransplantation, longer on phases (46.2% ± 10.4% of the day presurgery to 87.5% ± 10.4% of the day 36 months postsurgery) and improved symptoms in on and off phases persist in all four cases, with reduced dyskinesias (67.1% ± 9.2% of the day in on phases presurgery to 17% ± 13.8% of the day in on phases 36 months postsurgery). Progress appears to be stepwise, starting within weeks of tranplantation and becoming clinically significant in the 2nd and 3rd months (similar to our AM- and sooner than in our FVM-implanted patients), followed by a period of stability and, after a second wave of improvement 12 to 18 months posttransplantation (similar to FVM implants), has continued (87.5 ± 7 points presurgery to 46 ± 5.6 points 36 months postsurgery). In the experimental group, doses of levodopa have been reduced by more than 60% and dopamine agonist use has not resumed. In contrast, there have been no significant clinical changes in the control group.Conclusions. Implantation of tissue other than fetal tissue can promote a long-term improvement in the clinical symptomatology of seriously disabled parkinsonian patients. This finding is supported by the autopsy report of a patient with PD who had undergone grafting of AM plus peripheral nerve in which it was demonstrated that a large number of tyrosine hydroxylase—positive cells survive 1 year after implantation. In addition, there was a dense network of host dopaminergic fibers around the graft.
Movement disorders following nonfunctional neurosurgery
Authors: Krauss Joachim K. , Borremans Jan J. , Pohle Thomas , Godoy Nelson 
Published: May 2009

Object. Knowledge is scarce about movement disorders that follow neurosurgical operations other than functional stereotactic surgery. The cases of 14 patients who suffered from movement disorders secondary to craniocerebral or spinal surgery are analyzed. None of these patients was initially treated by any of the authors.Methods. Twelve patients underwent surgery for cerebral diseases. Nine of these patients harbored tumors and three patients had neurovascular disorders. Two patients underwent spinal surgery for cervicothoracic ependymoma or for multiple cervical disc herniations. Twelve of the 14 patients had immediate postoperative side effects such as hemiparesis, ataxia, and somnolence. In all but two patients, movement disorders became manifest only after a delay.Dystonic movement disorders developed in eight patients, unilateral tremors in three patients, unilateral facial myokymia in one patient, and hemichorea—hemiballism in two patients. The mean delay of onset for tremor was 5 weeks and that for dystonic movement disorders was 5.5 months. Movement disorders were transient in three patients; however, they were persistent in 11 patients at a mean follow-up period of 5 years. These movement disorders caused marked persistent disability in four patients. Lesions of the contralateral striatum were identified in patients with dystonic syndromes and lesions of the dentatothalamic outflow in patients with tremors. In three patients who had postoperative basal ganglia lesions after partial removal of astrocytomas, tumor regrowth was later documented. Medical treatment in patients with persistent movement disorders rendered only limited benefit. Two patients improved with botulin injections. In one patient postoperative hemidystonia was alleviated by contralateral thalamotomy.Conclusions. Dystonic syndromes and tremors are the most common movement disorders that occur after craniocerebral and spinal surgery. Postoperative movement disorders can lead to various degrees of functional disability. The pathoanatomical correlations are similar to those described in other patients with secondary movement disorders.
A brainstem stereotactic atlas in a three-dimensional magnetic resonance imaging navigation system: first experiences with atlas-to-patient registration
Authors: Niemann Klaus , van den Boom Roland , Haeselbarth Katja , Afshar Farhad 
Published: May 2009

Object. The authors describe a computer-resident digital representation of a stereotactic atlas of the human brainstem, its semiautomated registration to sagittal fast low—angle shot three-dimensional (3-D) magnetic resonance (MR) imaging data sets in 27 healthy volunteers and 24 neurosurgical patients, and an analysis of the subsequent transforms needed to refine the initial registration.Methods. Contour drawings from the atlas, which offer the 70th percentile of variation of anatomical structures, were interpolated into an isotropic 3-D representation. Initial atlas-to-patient registration was based on the fastigium/ventricular floor plane reference system. The quality of the fit was evaluated using superimposition of the atlas and MR images. If necessary, the atlas was tailored to the individual anatomy by using additional transforms. On average, the atlas had to be stretched by 2 to 6% in the three directions of space. Scale factors varied over a broad range from −8 to +19% and the benefit of visual interactive control of the atlas-to-patient registration was evident. Analysis of distances within the pons measured in the midsagittal MR imaging slices and the required scale factors revealed significant correlations that may be used to reduce the amount of user interaction in the coregistration substantially. In 70.6% of the cases, the atlas had to be shifted in a cranial direction along the brainstem axis (in 25.5% of cases 3–4 mm, in 45.1% of cases 1–2 mm). This was due to a more caudal position of the fastigium cerebelli on the MR images compared with the atlas.Conclusions. This observation, in conjunction with the variability of the height of the fourth ventricle in our MR imaging data (range 6.1–15.2 mm, mean 10.1 mm, standard deviation 1.8 mm) calls into question the role of the fastigium cerebelli as an anatomical landmark for localization within the brainstem.
Comparison of tissue impedance measurements with nerve fiber architecture in human telencephalon: value in identification of intact subcortical structures
Authors: Axer Hubertus , Stegelmeyer Jörn , von Keyserlingk Diedrich Graf 
Published: May 2009

Object. After establishing the general possibility of real-time impedance monitoring during stereotactic procedures in five postmortem human brains, the authors proceeded to analyze the value of impedance measurements in intact cerebral structures.Methods. The authors performed impedance measurements at 24 selected points in the brain of a human cadaver and labeled the points by using 1,1′-dilinoleyl-3,3,3′,3′-tetramethylindocarbocyanine perchlorate (DiI). The texture of the nerve fibers was visualized using confocal laser scanning microscopy, which allowed classification of distinct anatomical regions in the white and gray matter according to their fiber structure (density, direction, structure, and diameter). These regions displayed characteristic differences in impedances according to their fiber structure at frequencies between 8000 and 10,000 Hz. Differences in tissue impedance are not removed, although they are shifted to higher values by fixation with formalin. The reference frequency used in clinical environments (50,000 Hz) is not useful for distinct localization purposes. Finally, the orientation of the electrode in relation to the tissue is a crucial factor.Conclusions. It should be possible to draw conclusions about the correct position of the stereotactic needle on the basis of the proposed location, the texture of the fibers (orientation and density), and the orientation of the electrode.
Biodegradable semirigid plate and miniscrew fixation compared with rigid titanium fixation in experimental calvarial osteotomy
Authors: Peltoniemi Hilkka H. , Tulamo Riitta-Mari , Toivonen Terttu , Hallikainen Dorrit , Törmälä Pertti , Waris Timo 
Published: May 2009

Object. To determine the biocompatibility and suitability of resorbable plates and miniscrews, consolidation of symmetrical, bilateral frontal bone craniotomies that had been closed using various methods was studied in 20 growing lambs.Methods. Bone fixation with a flexible, punched polylactide plate and four slowly degradable, self-reinforced polylevolactide (SR-PLLA) or rapidly degradable, self-reinforced polyglycolide (SR-PGA) miniscrews (10 animals in each group) was compared intraindividually with rigid fixation by using a titanium miniplate and four miniscrews. Plain x-ray films, magnetic resonance images, histological studies, and histomorphometric studies were obtained at 4 to 104 weeks.Conclusions. No dislocation, instability, clinical foreign body reactions, infections, or loss of fixation were observed. Bone consolidation of the 2.35-mm-wide craniotomy lines was incomplete; connective tissue—filled defects through the bone were observed in 13 of 28 lines at 26 to 52 weeks. Statistical analyses based on histomorphometric studies showed no difference in consolidation with SR-PLLA miniscrew and titanium plate/screw fixation or between the two resorbable fixation methods. Fixation with rapidly degradable SR-PGA miniscrews resulted in less effective consolidation than on the contralateral titanium-treated side (p < 0.05), but the bone segment was thicker (p < 0.005). The SR-PGA miniscrews had disappeared by 6 weeks, the polyactide plate by 104 weeks, and the SR-PLLA miniscrews had been mostly resorbed at 104 weeks. Passive translocation of the titanium plates and screws into the bone tissue was seen at 52 and 104 weeks. In rapidly growing lamb frontal bone, comparable consolidation results, without complications, can be achieved with semirigid resorbable fixation compared with rigid metallic fixation.
Polymorphism of the endoglin gene in patients with intracranial saccular aneurysms
Authors: Takenaka Katsunobu , Sakai Hideki , Yamakawa Hiroyasu , Yoshimura Shin-ichi , Kumagai Morio , Yamakawa Haruki , Nakashima Shigeru , Nozawa Yoshinori , Sakai Noboru 
Published: May 2009

Object. Endoglin, a transforming growth factor β—binding protein, is a glycoprotein expressed on the surface of human vascular endothelial cells. Mutations of this gene are responsible for hereditary hemorrhagic telangiectasis and are associated with sporadic intracerebral hemorrhage as a risk factor. The purpose of this study was to examine the polymorphism of this gene in patients with intracranial aneurysms.Methods. The authors identified the mutations and insertion polymorphism around exon 7 of the endoglin gene in 82 patients with intracranial saccular aneurysms (aneurysm group) and 114 control volunteers (control group).A 6-base insertion (GGGGGA) was found in intron 7 at 26 bases beyond the 3′ end of exon 7. The homozygous insertion of intron 7 of the gene was present in 20.7% of the aneurysm group compared with 6.1% of the control group (χ2 = 9.837, p = 0.0073). The insertion allele frequency was significantly higher in the aneurysm group (67 [40.8%] of 164) than that in the control group (63 [27.6%] of 228) (χ2 = 7.48, p = 0.0062). The most notable clinical characteristic of the 17 patients with homozygous insertion in the aneurysm group was the relatively high percentage of patients with hypertension and of those with multiple aneurysms.Conclusions. The data provide evidence of an association between aneurysm development and a polymorphism at a genetic variant of endoglin in patients with these lesions.
Workforce demand for neurosurgeons in the United States of America: a 13-year retrospective study
Authors: Friedlich Daniel L. , Feustel Paul J. , Popp A. John 
Published: May 2009

Object. The workforce demand for neurosurgeons was quantified by a review and an analysis of journal recruitment advertisements published over the past 13 years.Methods. A retrospective analysis of recruitment advertisements from July 1985 through June 1998 was performed by examining issues of the Journal of Neurosurgery and Neurosurgery. Advertisement information that appeared in each journal during the last 3 years was collected from alternating months (July to May); information that appeared prior to that time was collected from alternating recruitment years back to 1985. The authors examined the following workforce parameters: practice venue, subspecialization, and practice size.They found no significant decrease in neurosurgical recruitment advertisements. There was an average of 102.7 ± 22.4 (standard deviation) advertised positions per year during the most recent 3 years compared with 92.6 ± 17.9 advertised positions per year during the preceding decade. Similarly, there has been no decline in advertised positions either in academic (33 ± 6.1/year for the most recent 3 years compared with 32.8 ± 5.9/year for 1985–1995) or private practice (69.7 ± 21.6/year for the most recent 3 years compared with 59.8 ± 13.4/year for 1985–1995). A shift in demand toward subspecialty neurosurgery was observed. During the past 3 years, 31.2 ± 5.9% of advertised positions called for subspecialty expertise, compared with 18.5 ± 2.8% for the preceding decade (p < 0.05). The largest number of subspecialty advertisements designated positions for spine and pediatric neurosurgeons. Private practice advertisements increasingly sought to add neurosurgeons to group practices.Conclusions. Contrary to previous reports and a prevailing myth, our data show no decrease in workforce demand for neurosurgeons in the United States over the past 3 years compared with the prior decade. A shift toward subspecialist recruitment, particularly for spine neurosurgeons, has been demonstrated in both academic and private practice venues.