bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fixation of Fractures of the Lower Cervical Spine Using Methylmethacrylate and Wire: Technique and Results in 99 Patients
Authors: Branch Charles L. , Kelly David L. , Davis Courtland H. , McWhorter J. M. 
Published: April 2011

Abstract
Surgical stabilization of traumatic fracture-dislocations of the lower cervical spine with wire and methylmethacrylate remains a controversial procedure. Yet, the resultant immediate fixation with minimal patient morbidity seems to indicate that this method provides an ideal stabilization construct. We describe and report the outcome of a technique of posterior cervical fixation with methylmethacrylate and wire for stabilization of traumatic fractures of the lower cervical spine. Over a 12-year period, 124 fracture-dislocations of the lower cervical spine in 99 patients (mean age, 32 years; range, 15-76 years) were treated at this institution using a posterior methylmethacrylate and wire technique. Eighty-two patients had a posterior element fracture; 28 had a vertebral compression with posterior ligamentous injury; and 14 had a ligamentous injury alone. Thirty-six patients were neurologically intact upon admission, while the rest had radiculopathy or partial or complete myelopathy. Ninety-one patients were available for follow-up [mean, 18.6 months; range, 1-100 months (8.33 years)]. Eighty-eight patients (97%) had a stable fixation and 77 (85%) had resumed preoperative activity or were working but with a residual deficit. Complications included fixation failure requiring a second operation in 3 patients, nonlethal pulmonary embolism in 2 patients, lethal pulmonary embolism in 1 patient, and a superficial wound infection in 3 patients (none affected the underlying fixation construct). These results indicate that this technique is a safe, simple, and effective method for stabilizing the lower cervical spine that allows rapid patient mobility with minimal morbidity.
Hemangioma of the Peroneal Nerve: Case Report and Review of the Literature
Authors: Bilge Turgay , Kaya Aziz , Alatli Metin , Bilge Semra , Alatli Canan 
Published: April 2011

Abstract
A case of hemangioma of the peroneal nerve is presented. The tumor, which exerted compression on the main trunk of the peroneal nerve, was excised without causing damage to the nerve. Symptoms due to compression vanished within a month, and there was no recurrence in the 14 months that followed.
Klippel-Feil Syndrome in Association with a Craniocervical Dermoid Cyst Presenting as Aseptic Meningitis in an Adult: Case Report
Authors: Diekmann-Guiroy Bernadette , Huang Peter S. 
Published: April 2011

Abstract
Intracranial tumors associated with Klippel-Feil syndrome usually occur in children, with spinal tumors being more common in adults affected by the syndrome. A rare case of a dermoid cyst at the craniocervical junction presenting as aseptic meningitis in an adult with Klippel-Feil syndrome is described. A review of the literature on tumors associated with this syndrome is also presented.
[11C]l-Methionine Uptake in Gliomas
Authors: Derlon Jean-Michel , Bourdet Catherine , Bustany Pierre , Chatel Marcel , Theron Jacques , Darcel Francoise , Syrota Andre 
Published: April 2011

Abstract
Treatment of gliomas remains disappointing in spite of a great number of experimental biological data and of randomized therapeutic studies. This could be partly explained by the inefficiency of our conventional methods to assess the regional metabolism of these tumors. The use of positron emission tomography (PET) brings encouraging possibilities in this field. We report our preliminary experience of measuring regional cerebral methionine uptake with PET after intravenous injection of [11C]l-methionine. Twenty-two patients with histologically confirmed gliomas were studied. An ECAT II positron emission tomograph was used for scanning. The position of the plane was chosen to include a major section of the tumor in the reconstructed brain slice. The protocol required a two-step examination: 1) after injection of 15 to 25 mCi of [11C]l-methionine, 12 scans were performed over a period of 46 minutes; and 2) 18 hours later, regional cerebral blood volume was measured in the same slice after intravenous injection of 2 to 4 mCi of 68GaCl3. The tumoral region of interest was determined as being the area of maximum activity. For each patient we calculated the ratio, R, between the activity in this tumor region of interest and the activity in the contralateral healthy symmetric region of interest which was used as an “internal standard” for the same patient. We correlated the ratio R with the histological grading. In 22 patients, mean values of R were calculated for each tumor: Grade II (n = 5): R = 1.04 ± 0.27; Grade III (n = 5): R = 1.68 ± 0.22; and Grade IV (n = 12): R= 2.33 ± 0.86. Correlations between hypermetabolism and grading are highly significant for Grades II/III (P = 0.0045) and II/IV (P = 0.00019), but not for Grades II/IV (P = 0.3141). We assessed the effects of radiotherapy: in 3 glioblastomas studied before and after radiotherapy, a significant decrease of R was observed: from 2.84 ± 1.43 to 1.35 ± 0.05. In one Grade II glioma, there was no change. Last, we assessed the early effects of intra-arterial chemotherapy: 8 patients were studied before and after the first course of treatment with an intracarotid injection of 1,3-bis-(2-chloroethyl)-l-nitrosourea (BCNU). Early modifications of R were correlated with clinical evolution after completion of treatment (intracarotid BCNU every 6 weeks). Despite a patient in whom a dramatic decrease of R was followed by a long survival with normalization of the computed tomographic scan, no significant correlation could be displayed between modifications in R and the length of survival. This approach will have to be developed in future studies.
Vertex Epidural Hematomas
Authors: Guha Abhijit , Perrin Richard G. , Grossman Harvey , Smyth Harley S. 
Published: April 2011

Abstract
Four cases of vertex epidural hematomas are presented to illustrate the unique management problems which set them apart from their more common counterparts located over the temporal convexity. Diagnosis requires a high degree of suspicion as vertex epidural hematomas are often missed by conventional horizontal scanning. Coronal computed tomographic scanning should be undertaken in all suspected cases. Clinical symptoms exceeding the small volume of clot may be present due to venous obstruction and disruption of cerebrospinal fluid absorption. Evacuation of the clot usually leads to clinical improvement.
Bilateral Extradural Hematomas in a Thrombocytopenic Infant Receiving Anticoagulants: Case Report
Authors: Grabel Jordan C. , Sacher Michael , Rothman Allen S. 
Published: April 2011

Abstract
A unique case of bilateral extradural hematomas in an infant is reported. Relevant aspects of the patient's history, including the absence of any known trauma and the presence of an underlying coagulopathy are discussed. The radiographic and operative findings of this case are presented, and an explanation of the mechanism of the hematomas is offered.
Calvarial Tuberculosis: A Report of Two Cases
Authors: Gupta P. K. , Kolluri Sastry V. R. , Chandramouli B. A. , Venkataramana N. K. , Das B. S. 
Published: April 2011

Abstract
Two cases of calvarial tuberculosis associated with neurological involvement are presented. The radiological features and therapeutic management are discussed and the literature is reviewed.
Sacral and Presacral Tumors: Problems in Diagnosis and Management
Authors: Feldenzer John A. , McGauley James L. , McGillicuddy John E. 
Published: April 2011

Abstract
We reviewed 9 cases of sacral tumors with presacral extension. These included 2 chordomas. 1 metastatic renal cell carcinoma, 2 schwannomas (1 malignant, 1 benign), 1 neurofibroma, 1 neurofibrosarcoma, 1 aneurysmal bone cyst, and an exceedingly rare meningioma. The sex of the patients was not significant. The age of the patients at diagnosis ranged from 13 to 68 years (mean, 47 years). Initial symptoms of low back and radiating leg pain were present in all but 1 patient. The duration of symptoms prior to diagnosis ranged from 1 month to 9 years (mean, 2.6 years). A delay in diagnosis of 2 years or more occurred in 6 of the 9 patients. Progressive perineal numbness and/or sphincter dysfunction were seen in 6 patients, and a palpable rectal mass was noted in 6 of 9 patients. The efficacy of various diagnostic tests is presented, as are the surgical options—needle biopsy and anterior and posterior approaches. Despite improved radiographic imaging techniques, these unusual tumors are often diagnosed at an advanced stage, and may masquerade as discogenic radiculopathy. Late diagnosis contributes to the difficulty of surgical extirpation. Anterior and posterior surgical approaches involving general, orthopedic, and urological surgeons may be required.
The Use of Electroencephalography and Brain Protection during Operation for Basilar Aneurysms
Authors: Muizelaar Paul J. 
Published: April 2011

Abstract
Intraoperative monitoring with electroencephalography and the use of brain protection with steroids, phenytoin, mannitol, and pentobarbital or etomidate were evaluated in 15 patients undergoing operation for an aneurysm of the upper basilar artery. One patient harbored a basilar trunk aneurysm, 1 an aneurysm of the proximal posterior cerebral artery, 3 an aneurysm of the superior cerebellar artery, and 10 an aneurysm at the basilar tip. The size of the aneurysms varied between 5 and 30 mm. Subarachnoid hemorrhage was the symptom exhibited in 12, mass effect the symptom in 2, and 1 patient was asymptomatic but had an angiogram because of amaurosis. There were 9 patients with multiple aneurysms, 5 of whom had aneurysms of the bilateral anterior circulation. Four patients underwent operation early. In 2 patients, the basilar artery was the sole or main blood supply of the whole brain. All patients except the one with the basilar trunk aneurysm were operated on via a transsylvian approach. All patients received 500 to 800 mg of phenytoin and 10 to 20 mg of dexamethasone shortly before and during surgery, and mannitol (0.8 g/kg) 15 minutes before the induction of hypotension or temporary clipping. Three patients showed slowing of electrical activity over the right hemisphere as a result of retraction of the internal carotid artery; with repositioning of the retractor, this disappeared within 10 minutes. Electrocortical silence was induced in 8 patients; this was in anticipation of prolonged moderate hypotension in 2, short deep hypotension in 2, temporary clipping of major vessels—including the basilar artery—in 2, and a combination of deep hypotension combined with temporary clipping in 2. At present, etomidate is preferred over thiopental for inducing electrocortical silence because it has no cardiovascular depressant effects, even in massive doses. Three patients awoke with contralateral hemiparesis, 2 of whom had spontaneous changes in the electroencep halogram and 1 in whom electrocortical silence was present for 1 hour. In all 3 patients, the electroencephalogram had returned to normal by the end of the operation, and the hemiparesis had completely resolved within 4 hours. One patient, in whom the basilar artery itself had ruptured and had to be occluded permanently, died. One patient, whose status was Grade 4 when operation was performed on Day 25, remained severely disabled. All other patients made a good recovery. The electroencephalogram was helpful in 10 cases (67%), and it allowed the surgeon to operate without stress in an unhurried manner and, when combined with pharmaceutical brain protection—even in the presence of deep hypotension—to perform temporary clipping.
Chordoma and Chondrosarcoma of the Cranial Base: An 8-Year Experience
Authors: Sen Chandra Nath , Sekhar Laligam N. , Schramm Victor L. , Janecka Ivo P. 
Published: April 2011

Abstract
Between 1980 and 1988, 8 patients with chordomas and 9 with low-grade chondrosarcomas involving the cranial base were treated. All the patients were investigated preoperatively and postoperatively with computed tomographic or magnetic resonance imaging scans, according to a standard protocol. The tumors and the involved bony structures were surgically removed in one or more operations using different operative approaches. Ten patients underwent postoperative radiation therapy, either at our institution or prior to their referral to us. Total removal was defined as the absence of identifiable tumor on magnetic resonance imaging or computed tomographic obtained 3 months postoperatively, and was accomplished in 9 patients. The ability to achieve total removal was greatly increased in patients with tumors that had not previously been operated on. We believe that these tumors must be treated by aggressive surgical resection when initially diagnosed, and this can be accomplished with low morbidity. The follow-up period in our patients was too short to allow us to determine whether such total removals can result in a cure or in long-term control of these formidable tumors.
Percutaneous Transfacial Needle Biopsy of a Middle Cranial Fossa Mass: Case Report and Technical Note
Authors: Stechison Michael T. , Bernstein Mark 
Published: April 2011

Abstract
A case of a patient with a middle fossa mass that was considered to be either a metastatic lesion or a benign intracranial neoplasm is presented. The definitive management of the patient depended on a tissue diagnosis. A biopsy was obtained using a transfacial needle aspiration technique through the foramen ovale. The details of this procedure are described.
Surgical and Electrophysiological Observations during Clipping of 134 Aneurysms with Evoked Potential Monitoring
Authors: Schramm Johannes , Koht Antoun , Schmidt Gerhard , Pechstein U. , Taniguchi M. , Fahlbusch Rudolf 
Published: April 2011

Abstract

Somatosensory evoked potentials (SEPs) were monitored during 113 operations for the clipping of 134 cerebral aneurysms. Changes in peak latency and amplitude of early cortical SEP as well as central conduction time were evaluated. In 58 cases surgical occlusion of arterial vessels or other events occurred, and in 17 of these cases such events were associated with SEP changes or loss. Arterial occlusions resulted from temporary clipping of a feeding blood vessel (22), accidental clipping of a vessel (12). and intentional permanent vessel occlusion (8). A total SEP loss was seen in 2 cases of accidental vessel occlusion and in 6 cases of temporary vessel clipping. Significant SEP changes were found in 6 patients with temporary clipping, and once each with retraction of the cerebellum, retraction of the middle cerebral artery, and after intentional permanent vessel occlusion. Response to these changes included reapplication of aneurysm clips, repositioning of retractors, or removal of temporary clips. Stable SEP signals during 13 cases allowed the surgeon to proceed with the surgical course. Despite the limitations of SEP monitoring in certain anatomical locations, it has been found to be helpful in the operative management of some cases such as multilobed aneurysms of the middle cerebral artery, giant aneurysms, trapping procedures, and procedures requiring temporary vessel occlusion. (Neurosurgery 26:61-70, 1990)
A Comparative Study in Opening and Closing Pressures of Cerebral Aneurysm Clips
Authors: Atkinson John L. D. , Anderson Robert E. , Piepgras David G. 
Published: April 2011

Abstract

Modern aneurysm clips with newer metallurgic properties and state-of-the-art designs have evolved through the years. Regretfully, manufacturers are still not required to provide product information regarding clip strength, and when such information is supplied, there is no interbrand consistency to how it is obtained. This experiment compares the closing pressures of 5 commonly used brands of aneurysm clips: Yasargil, Sugita, Sundt-Kees, Vari-Angle McFadden, and Heifetz. Interclip comparison is also made of opening pressures, that is, the arterial pressure required to open an aneurysm clip. Findings show a distinct difference in closing forces among these brands of aneurysm clips. The study of opening forces indicates that the important factors determining clip release or displacement were the failure of the clip to cross the vessel completely and intrinsic characteristics of the vascular wall. (Neurosurgery 26:80-85, 1990)
Intraoperative Determination of the Extent of Corpus Callosotomy for Epilepsy: Two Simple Techniques
Authors: Awad Issam A. , Wyllie Elaine , Luders Hans , Ahl Jennifer 
Published: April 2011

Abstract

There is increasing interest in staged corpus callosotomy for intractable generalized epilepsy. At the first procedure, a portion (usually the anterior two-thirds) of the corpus callosum is sectioned. If seizures persist, completion of callosotomy or alternative treatment approaches can be considered. It is obviously important to ascertain that the desired extent of callosotomy was in fact accomplished at the time of initial operation. Our experience and the published literature indicate that the surgeon's impression at operation can be erroneous. We describe a technique of determining extent of corpus callosotomy during the procedure. The magnetic resonance imaging (MRI) scan in the midsagittal plane is used to select the desired extent of callosotomy. That point on the corpus callosum is characterized using simple planar geometry in relation to three anatomic landmarks in that same plane: the glabella, the inion, and the bregma (midline intersection of the coronal suture). The same point along the corpus callosum can then be located on a lateral skull xray using these same three anatomic landmarks. At surgery, an intraoperative lateral skull x-ray is obtained with a marking clip, thereby verifying the actual extent of callosotomy. We have verified the reliability of this scheme in 5 callosotomy procedures and have used this technique for intraoperative localization of midline and parasagittal targets in another 7 cases (3 tumors, 2 aneurysms, and 2 placements of interhemispheric subdural grids). In addition, we reviewed corpus callosum topography on 25 randomly selected MRI scans. A perpendicular line bisecting the glabellainion line intersects the corpus callosum at a point near its two-thirds extent in every case. This allows a quick determination of the approximate two-thirds point along the corpus callosum by skull x-ray alone, without the need of an MRI scan. The use of the new technique and its simple modification for the two-thirds callosotomy allows a precise determination of the extent of corpus callosum section at surgery and should avoid unintended deviations from the desired procedure. (Neurosurgery 26:102-106, 1990)
Intracranial Mycotic Aneurysm in an Infant: Report of a Case
Authors: Lee Stuart K. , Liu Shih Sing , Spetzler Robert F. , Rekate Harold L. 
Published: April 2011

Abstract

Although mycotic aneurysms tend to occur with greater frequency in children than adults, few cases of intracranial infectious aneurysms have been reported in children less than 1 year of age. The case of a previously healthy 7-month-old patient who suffered intracerebral and subarachnoid hemorrhage from multiple aneurysms of the middle cerebral artery is reported. The aneurysms proved to be infectious, based on culture material obtained at surgery from the aneurysm contents and adjacent brain tissue. (Neurosurgery 26:129-133, 1990)
Recordings from Human Dorsal Column Nuclei Using Stimulation of the Lower Limb
Authors: Møller Aage R. , Jannetta Peter J. , Jho Hae Dong 
Published: April 2011

Abstract
Responses from the surface of the dorsal column nuclei and the dorsal surface of the spinal cord were recorded using monopolar electrodes after stimulation of the lower limbs (common peroneal nerve at the knee and posterior tibial nerve at the ankle) in patients undergoing neurosurgical operations for spasmodic torticollis. Those responses were smaller in amplitude than responses to stimulation of the upper limbs (median nerve at the wrist), and the waveforms differed. The negative deflection that is prominent in the response to stimulation of the upper limbs is more variable, broader, and relatively smaller in amplitude than the response to upper limb stimulation. Another difference between responses to upper and lower limb stimulation was that multiple peaks were superimposed on the initial response to stimulation of the lower limbs, but were not as consistently seen in the responses to upper limb stimulation. The negative peak in the response from the dorsal column nuclei to lower limb stimulation was of about the same latency as the P27peak in the far-field response (somatosensory evoked potential) to stimulation of the peroneal nerve.
The Management of Paralytic Spasticity
Authors: Herz David A. , Looman Janice E. , Tiberio Angela , Ketterling Kevan , Kreitsch Robert K. , Colwill John C. , Grin Oliver D. 
Published: April 2011

Abstract
The treatment of spasticity in severely paralyzed patients undergoing rehabilitation constitutes a significant neurosurgical challenge that requires comprehensive management. In this study, 118 patients were treated with invasive modalities when medical therapy failed. The results of percutaneous radiofrequency foraminal rhizotomy were initially successful in 95% of the 77 patients who underwent this procedure; the rate of minor complications was 5%. This procedure was satisfactorily supplemented with percutaneous radiofrequency sciatic neurectomy in 32 of these 77 patients. Four myelotomies were performed with complete success and no major complications in patients in whom percutaneous techniques had proven inadequate. In 35 instances of focal spasticity and incomplete paralysis, intramuscular neurolysis by phenol injection was used. The success rate was 89%. In 9 patients with persistent recurrent spasticity of the lower limb, open tenotomies and peripheral neurectomies were done. Success was complete and without complications. Multiple modalities must be available for the comprehensive management of patients with paralytic spasticity. (Neurosurgery 26:300-306, 1990)
Radiation-induced Meningioma after Treatment for Pituitary Adenoma: Case Report and Literature Review
Authors: Partington Michael D. , Davis Dudley H. 
Published: April 2011

Abstract
Radiation-induced meningiomas are becoming increasingly well-recognized. We report a case of a 35-year-old man who developed a suprasellar meningioma 9 years after receiving a radiation dose of 4480 cGy for a pituitary adenoma. The literature is also reviewed.
Long-term Intraventricular Infusion of Morphine for Intractable Pain in Cancer of the Head and Neck
Authors: Dennis Gary C. , DeWitty Robert L. 
Published: April 2011

Abstract
The authors' experience with seven patients with intractable pain that was treated by continuous intraventricular infusion of morphine through an implanted Infusaid pump is reported. The pain was caused by head and neck cancer in six patients and was associated with postpolio syndrome in one. The average follow-up was 7 months. Pain was effectively managed through intraventricular administration of a combination of morphine and mild oral narcotic analgesics. Complications included one case of transient respiratory depression, one pump pocket infection, and one pump failure. The morphine dose required to maintain analgesia increased over time in all patients treated. This is a safe and effective method of pain management in patients with head and neck cancer. It is useful as well in patients who have intractable pain that cannot be managed through an intrathecal route because of a contraindication to lumbar puncture or an inaccessible subarachnoid space.