bluuebunny/crossref_metadata_2025_split huggingface dataset:
Delayed and Progressive Multiple Suture Craniosynostosis
Authors: Reddy Kesava , Hoffman Harold , Armstrong Derek 
Published: April 2011

Abstract
A considerable amount of information is available on various types of craniosynostoses. The patient exhibiting single suture synostosis that progresses to involve multiple sutures is distinctly uncommon, as is the patient exhibiting delayed synostosis involving all of the calvarial sutures. We report a group of 11 such patients with progressive and delayed holocalvarial synostosis. Most patients exhibited features of raised intracranial pressure or developmental delay, and in all patients symptoms were relieved after surgery. The diagnostic and therapeutic implications of this type of presentation in craniosynostosis are discussed.
Surgical Removal of Pontomesencephalic Cavernous Hemangiomas
Authors: Fahlbusch R. , Strauss C. , Huk W. , Röckelein G. , Kömpf D. , Ruprecht K. W. 
Published: April 2011

Abstract
Cavernous hemangiomas of the brain stem are usually discovered accidentally during evacuation of a hematoma, and successful surgical treatment of these lesions is seldom achieved. With the increasing use of magnetic resonance imaging, the presence of a cavernous hemangioma can be detected before surgery, allowing an elective surgical approach. We successfully removed pontomesencephalic cavernous hemangiomas from 2 patients and pontomedullary hemangiomas from 2 others. Elective surgery was performed with perioperative bimodal monitoring of somatosensory and auditory evoked potentials. Performing surgery soon after the hemorrhage minimizes the risk of additional postoperative neurological deficit, since surgical excision is facilitated when the hematoma is not completely organized. Pontine hemangiomas are approached via the 4th ventricle. Mesencephalic hemangiomas are removed by a midline supracerebellar approach when they are lateralized by using a subtemporal approach. The lesion can be removed through a small incision in the brain stem at the site of the lesion. The favorable results, which include marked improvement of preoperative neurological deficits and documentation of complete removal of the lesion by magnetic resonance imaging, support a more aggressive approach to the treatment of symptomatic cavernous hemangiomas of the brain stem. Further investigation of the natural history of these lesions is mandatory.
Intracranial Vertebral Endarterectomy
Authors: Ausman James I. , Diaz Fernando G. , Sadasivan Balaji , Dujovny Manuel 
Published: April 2011

Abstract
Intracranial vertebral endarterectomy was performed on six patients with vertebrobasilar insufficiency in whom medical therapy failed. The patients underwent operations for stenotic plaque in the intracranial vertebral artery with the opposite vertebral artery being occluded, hypoplastic, or severely stenosed. In four of the patients, the stenosis was mainly proximal to the posterior inferior cerebellar artery (PICA). In this group, after endarterectomy, the vertebral artery was patent in two patients, and their symptoms resolved: in one patient the endarterectomy occluded, but the patient's symptoms improved; and in one patient the endarterectomy was unsuccessful, and he continued to have symptoms. In one patient, the plaque was at the origin of the PICA. The operation appeared technically to be successful, but the patient developed a cerebellar infarction and died. In one patient the stenosis was distal to the PICA. During endarterectomy, the plaque was found to invade the posterior wall of the vertebral artery. The vertebral artery was ligated, and the patient developed a Wallenburg syndrome. The results of superficial temporal artery to superior cerebellar artery anastomosis are better than those for intracranial vertebral endarterectomy for patients with symptomatic intracranial vertebral artery stenosis. The use of intracranial vertebral endarterectomy should be limited to patients who have disabling symptoms despite medical therapy, a focal lesion proximal to the PICA, and a patent posterior circulation collateral or bypass.
Subarachnoid-Pleural and Subarachnoid-Mediastinal Fistulae
Authors: Pollack Ian I. F. , Pang Dachling , Hall Walter A. 
Published: April 2011

Abstract
Subarachnoid-pleural fistula and subarachnoid-mediastinal fistula are rare complications of chest trauma. One case each of subarachnoid-mediastinal fistula and subarachnoid-pleural fistula is described. Both patients were young children who suffered severe longitudinal distraction injuries to their thoracic spine and exhibited complete cord transection without radiographic evidence of vertebral column injury. Progressive mediastinal widening and enlarging pleural effusion in the absence of angiographic evidence of aortic injury suggested the diagnosis of an intrathoracic cerebrospinal fluid fistula. Myelograms identified the site of spinal cord rupture and cerebrospinal fluid leakage. The diagnosis. management, and outcome of these rare fistulae are discussed.
Direct Repair of an Extracranial Vertebral Artery Pseudoaneurysm: Case Report and Review of the Literature
Authors: de los Reyes R. A. , Moser Franklin G. , Sachs David P. , Boehm Harrison F. 
Published: April 2011

Abstract
A case of a 47-year-old man with weakness secondary to ossification of the posterior longitudinal ligament is presented. During removal of the ossified ligament, the patient's dominant right vertebral artery was injured. Although the bleeding from this artery was controlled intraoperatively, the patient developed an expanding cervical hematoma on the 3rd postoperative day. An angiogram demonstrated a large pseudoaneurysm of the right vertebral artery. The patient was taken back to the operating room where the cervical hematoma was removed, and direct repair of the pseudoaneurysm of the vertebral artery was performed. The previously reported cases of pseudoaneurysms of the extracranial vertebral artery are reviewed. We advocate the use of direct vascular repair as the treatment of choice in these lesions.
Surgical Excision of Cerebral Arteriovenous Malformations: Late Results
Authors: Heros Roberto C. , Korosue Kazuyoshi , Diebold Paula M. 
Published: April 2011

Abstract
A follow-up study of 153 consecutive patients who underwent complete excision of an angiographically visualized intracerebral arteriovenous malformation was conducted. The follow-up period ranged from 0.5 to 10.6 years, with a mean of 3.8 years. The presenting clinical event was hemorrhage in about one-half of the patients and seizure in about one-third. There was a marked tendency for postoperative neurological deficits to improve with time, so that whereas the immediate postoperative rate of serious morbidity was 24.2%, only 7.8% of the patients were found to have serious morbidity at follow-up. An additional 3 patients had died. one of an unrelated carcinoma, making the mortality related to arteriovenous malformation 1.3%. The classification of Spetzler and Martin (43) was used retrospectively; the percentages of Grade I (easiest) through Grade V (most difficult) lesions were 7.8%, 22.9%, 28.8%, 26.8%, and 13.8%, respectively. The early result was well correlated to grade, with good or excellent results in 100%, 94.3%, 88.6%, 61%, and 28.6% of the patients in Grades I through V, respectively. At follow-up, 98.7% of the patients with arteriovenous malformations of Grades I, II, and III were in good or excellent condition. The late morbidity and mortality rates for the patients in Grades IV and V were 12.2% and 38.4%, respectively. Of the patients who did not have seizures before surgery, 8.2% had only one or two seizures during the immediate postoperative period, and 7.1% had late seizures that were well controlled with medication in all. Of the patients who had seizures before surgery, over half were either cured or greatly improved with respect to the seizures. In 32.7% there was no change in the frequency of the seizures, and in 12.7% the seizures were more frequent after surgery. There was no history of either proven or suspected intracranial hemorrhage in any of the patients during the entire follow-up period, which in the aggregate totalled 556.3 years.
Unilateral Hydrocephalus Caused by an Intraventricular Venous Malformation Obstructing the Foramen of Monro
Authors: Tien Robert , Harsh Griffith R. , Dillon William P. , Wilson Charles B. 
Published: April 2011

Abstract
Unilateral hydrocephalus in an adult was caused by obstruction of the left foramen of Monro by an intraventricular venous malformation. Magnetic resonance imaging of the region of the foramen of Monro demonstrated the lesion, which subsequently was confirmed to be a venous malformation by angiography and surgery.
Posttraumatic Ligamentous Disruption of the Cervical Spine, an Easily Overlooked Diagnosis: Presentation of Three Cases
Authors: Fazl M. , LaFebvre J. , Willinsky R. A. , Gertzbein S. 
Published: April 2011

Abstract
Three patients with hyperflexion sprain of the cervical spine secondary to motor vehicle accidents are discussed. One patient exhibited tetraplegia and the other two only had paresthesia of the upper and/or lower extremities at the scene of the accident. All patients were young with no evidence of degenerative disc disease or osteoarthritis. Diagnosis of hyperflexion sprain is suggested by transient or persistent neurological deficits, local tenderness, or plain film findings, which include interspinous fanning, localized kyphotic angulation, subluxation, or disc space narrowing. Review of our patients' records revealed that some of these findings were evident at their initial presentation. In patients who have no neurological deficits, controlled flexion and extension views after routine plain films may be diagnostic of an unstable cervical spine. If there is a persistent neurological deficit, a magnetic resonance imaging scan is the examination of choice. If there is no compression of the thecal sac or spinal cord, supervised flexion and extension views of cervical spine should be done. Definitive management of the unstable spine is operative fixation.
Suprasellar Ectopic Pituitary Adenoma: Case Report and Review of the Literature
Authors: Matsumura Akira , Meguro Kotoo , Doi Mikio , Tsurushima Hideo , Tomono Yuji 
Published: April 2011

Abstract
The occurrence of a totally suprasellar ectopic pituitary adenoma in a 71-year-old man is described. The tumor was attached to the pituitary stalk, extending upward toward the third ventricle. No intrasellar lesion was observed. Histological examination revealed a pituitary adenoma with large numbers of eosinophilic cells with moderate nuclear polymorphism and rare mitosis. Immunohistochemical staining revealed that the tumor cells were strongly positive for anti-adrenocorticotropic hormone antibody. A review of five previously reported intracranial ectopic pituitary adenomas revealed that two were silent corticotropic tumors and two occurred with Cushing's syndrome.
Testicular Germ Cell Tumor with Pineal Metastases
Authors: Delahunt Brett , Teoh Heng H. , Balakrishnan V. , Nacey John N. , Clark Simon P. 
Published: April 2011

Abstract
A patient with a mixed testicular germ cell tumor (choriocarcinoma, teratocarcinoma and embryonal carcinoma) that had metastasized to the lungs, cerebrum, and pineal gland is presented. The metastases had resulted in localized neurological signs and initially, on clinical grounds, a primary intracranial lesion could not be excluded. The occurrence of tumor metastases to the pineal gland is discussed and the literature is reviewed.
Radiosurgery for Acoustic Neurinomas: Early Experience
Authors: Linskey Mark E. , Lunsford Dade L. , Flickinger John C. 
Published: April 2011

Abstract
We reviewed our early experience with the first 26 patients with acoustic neurinomas (21 unilateral, 5 bilateral) treated by stereotactic radiosurgery using the first North American 201-source cobalt-60 gamma knife. Follow-up ranged from 6 to 19 months (median, 13 months). Serial postoperative imaging showed either a decrease in tumor size (11 patients) or growth arrest (15 patients). Loss of central contrast enhancement was a characteristic change (18 patients). Seven patients had good or serviceable hearing preoperatively. In all 7 the preoperative hearing status was retained immediately after radiosurgery. At follow-up, 3 had preserved hearing, I had reduced hearing, and 3 had lost all hearing in the treated ear. Hearing in 1 patient that was nonserviceable preoperatively later improved to a serviceable hearing level. Delayed facial paresis developed in 6 patients, and delayed trigeminal sensory loss developed in 7 patients, none of whom had significant deficits before radiosurgery. Both facial and trigeminal deficits tended to improve within 3 to 6 months of onset with excellent recovery anticipated. Lower cranial nerve dysfunction was not observed. All 26 patients remain at their preoperative employment or functional status. At present, stereotactic radiosurgery is an alternative treatment for acoustic neurinomas in patients who are elderly, have significant concomitant medical problems, have a tumor in their only hearing ear, have bilateral acoustic neurinomas, refuse microsurgical excision, or have recurrent tumor despite surgical resection. Although longer and more extensive follow-up is required, the control of tumor growth and the acceptable rate of complications in this early experience testifies to the future expanding role of this technique in the management of selected acoustic neurinomas.
Efficacy of Closed-System Drainage in Treating Chronic Subdural Hematoma: A Prospective Comparative Study
Authors: Wakai Susumu , Hashimoto Kazuyoshi , Watanabe Naofumi , Inoh Satoshi , Ochiai Chikayuki , Nagai Masakatsu 
Published: April 2011

Abstract
The authors conducted a prospective comparative study on the recurrence rate of chronic subdural hematoma after the use of two different treatment modalities: burr-hole irrigation of the hematoma cavity with (Group A) and without closed-system drainage (Group B). Thirty-eight patients were studied. Patients were assigned to groups sequentially upon admission. There were no significant differences between the two groups for age, sex, preoperative hematoma volume, and density on computed tomographic scan. One patient in Group A (5%) suffered a recurrence as opposed to 6 in Group B (33%). The difference in recurrence rate between the two groups was statistically significant (p &lt; 0.05). The authors conclude that closed-system drainage after burr-hole irrigation reduces the recurrence rate of chronic subdural hematoma.
Long-Term Results of Percutaneous Retrogasserian Thermorhizotomy for “Essential” Trigeminal Neuralgia: Considerations in 1000 Consecutive Patients
Authors: Broggi Giovanni , Franzini Angelo , Lasio Giovanni , Giorgi Cesare , Servello Domenico 
Published: April 2011

Abstract
Long-term results (average follow-up, 9.3 years) obtained in 1000 consecutive patients suffering from cryptogenetic (“essential”) trigeminal neuralgia treated with percutaneous thermorhizotomy are analyzed. Pain relief was obtained in 95% of the treated patients. Permanent morbidity was as follows: masseter weakness in 105 patients; oculomotor palsies in 5 patients; weakening of the corneal reflex in 197 patients, 6 of whom requested an ocular operation for keratitis; and painful dysesthesia in 52 patients, 15 of whom developed a painful anesthesia syndrome. There was a recurrence rate of 18.1%, and a correlation between postoperative sensory deficit and the cure rate was found. These results are discussed and compared to the results obtained with different techniques.
Is Magnetic Resonance Imaging Useful in Guiding the Operative Approach to Large Pituitary Tumors?
Authors: Snow Robert B. , Johnson Carl E. , Morgello Susan , Lavyne Michael H. , Patterson Russel H. 
Published: April 2011

Abstract
Forty-two patients with large pitutary tumors were studied with magnetic resonance imaging scans. Based on the operative findings, the tumors were divided into two groups, Tumors in Group 1 (n = 35) were soft or partially necrotic and were easily removed by suction and curettage, Tumors in Group 2 (n = 7) were firm and required sharp dissection or use of the laser for removal. Tumors were divided into two groups based on the long TR signal: a) isointense in comparison with white matter, or b) hyperintense in comparison with white matter. All 7 firm tumors (Group 2) had an isointense signal on long TR sequences. Thirty-two of 35 soft tumors showed a hyperintense signal on long TR sequences, and 3 an isointense signal. Based on these results, we recommend a transsphenoidal approach for the initial operation in patients with large pituitary tumors. If the tumor is largely isointense on the magnetic resonance imaging scan, we discuss with the patient preoperatively the possibility (70% in this series) that the tumor may be too firm to remove in a single transsphenoidal procedure. In these circumstances, a second, transcranial, procedure may be required to decompress the suprasellar structures adequately.
Dural Arteriovenous Fistulas Supplied by Ethmoidal Arteries
Authors: Halbach Van V. , Higashida Randall T. , Hieshima Grant B. , Wilson Charles B. , Barnwell Stanley L. , Dowd Christopher F. 
Published: April 2011

Abstract
Eight patients with dural arteriovenous fistulas (DAVFs) located on the floor of the anterior cranial fossa and supplied by enlarged ethmoidal branches of the ophthalmic artery are described. Five patients showed the classical symptom of intracerebral hemorrhage (all five had ipsilateral frontal lobe hematomas and one also had an associated a subdural hematoma). Two patients exhibited atypical symptoms of proptosis, chemosis, elevated intraocular pressure, and loss of vision secondary to an ethmoidal DAVF, which drained posteriorly to the cavernous sinus. The eighth patient exhibited proptosis and chemosis secondary to a cavernous sinus DAVF and was incidentally found to have an asymptomatic ethmoidal DAVF. One additional patient had two separate dural fistulas: one located on the cribriform plate and the second located in the posterior fossa. Seven of the eight patients were cured by surgical excision of the fistula site; in the remaining patient spontaneous obliteration followed a surgical procedure for a cavernous DAVF. DAVFs involving the floor of the anterior cranial fossa usually present with hemorrhage, but can present with ocular symptoms or be entirely asymptomatic and are effectively treated by surgical excision of the fistula site.
Microsurgical Anatomy of the Cisternal Course of the Perforating Branches of the Posterior Communicating Artery
Authors: Vincentelli F. , Caruso G. , Grisoli F. , Rabehanta P. , Andriamamonjy C. , Gouaze A. 
Published: April 2011

Abstract
Both the perforating branches-especially the extracerebral segments-and the arachnoidal anatomy at the level of the posterior communicating artery were studied in 60 human brains previously fixed in formalin. The close relationships between this artery and the oculomotor nerve are described, and it is noted that each of them is enclosed in its own arachnoidal compartment, which in the case of the posterior communicating artery is to be distinguished from the interpeduncular cistern. The latter cistern was found to contain only the terminal segments of the posterior communicating artery. The hypothalamic branches were within the inner wall of the arachnoidal cistern surrounding the posterior communicating artery. The variations in diameter of this artery are explained by its embryological development and are not related to the number and the diameter of the perforators. The posterior communicating artery was absent at times. The surgical implications of such a variable anatomical arrangement are discussed in the light of the literature.
Postoperative Arteriovenous Fistula between the Middle Meningeal Artery and the Sphenoparietal Sinus
Authors: Tsutsumi Kazuo , Shiokawa Yoshiaki , Kubota Masaru , Aoki Nobuhiko , Mizutani Hiroshi 
Published: April 2011

Abstract
The authors report a case of postoperative middle meningeal arteriovenous fistula found after craniotomy for aneurysmal surgery using the pterional approach. It was no longer demonstrable at the follow-up examination 3 months later.
Persistent Hypoglossal Artery in Combination with Multifocal Arteriovenous Malformations of the Brain: Case Report
Authors: Garza-Mercado Romaá , Cavazos Elisamaria , Urrutia Gabriel 
Published: April 2011

Abstract
The persistence of embryonic cerebral vessels in the adult is not a frequent occurrence, neither is the presence of multifocal arteriovenous malformations (AVMs) of the brain. The most commonly reported type of persistent carotid-basilar anastomosis is the primitive trigeminal artery, followed by the primitive hypoglossal artery (PHA). In this report. a 30-year-old, right-handed woman hospitalized because of subarachnoid hemorrhage and harboring an intracerebral-intraventricular hematoma resulting from the rupture of one of two independent AVMs of the left cerebral hemisphere, was found also to have a right persistent PHA. One AVM was intraventricular and had ruptured: the other was subcortical, intact in the parietal lobe. The PHA originated as a large anomalous branch of the right internal carotid artery in the neck and joined the basilar artery after entering the posterior fossa through the ipsilateral anterior condyloid foramen, which was enlarged. At craniotomy, the two AVMs were successfully excised with the aid of microsurgical technique. These two independently rare conditions, namely, multifocal cerebral AVMs and persistent PHA, warrant our desire to report this case.
Aneurysms of the Intracavernous Carotid Artery: Natural History and Indications for Treatment
Authors: Linskey Mark E. , Sekhar Laligam N. , Hirsch William L. , Yonas Howard , Horton Joseph A. 
Published: April 2011

Abstract
Of 37 patients with 44 intracavernous carotid artery aneurysms (ICCAAns) diagnosed between 1976 and 1988. patients with 20 aneurysms were followed without treatment for 5 months to 13 years (median, 2.4 years). Ten of the 20 ICCAAns were asymptomatic at diagnosis, and 10 were symptomatic. Three of the asymptomatic ICCAAns were symptomatic at follow-up. One of these required clipping because of a progressing cavernous sinus syndrome; the other 2 were minimally symptomatic and have not required treatment. Of the 10 initially symptomatic ICCAAns, 2 had not changed, 4 became more symptomatic, and 4 had symptomatically improved by follow-up. One patient with an ICCAAn that had not changed clinically was lost to follow-up 6 months after diagnosis. Of the 4 ICCAAns that became more symptomatic, 2 continue to be monitored, and 2 required intervention; one with detachable balloon occlusion of the aneurysm with preservation of the internal carotid artery lumen, and the other with gradual cervical internal carotid artery occlusion. The clinical course of this selected group of patients with ICCAAns suggests that the natural history of ICCAAns can be quite variable. Although clinical progression does occur, symptomatic ICCAAns also can improve spontaneously. Therapeutic intervention for asymptomatic ICCAAns should be reserved for patients with aneurysms arising at the anterior genu of the carotid siphon and/or extending into the subarachnoid space, where subarachnoid hemorrhage is most likely. Intervention for symptomatic ICCAAns should be reserved for patients with subarachnoid hemorrhage, epistaxis, severe facial or orbital pain, evidence of radiographic enlargement, progressive ophthalmoplegia, or progressive visual loss.