bluuebunny/crossref_metadata_2025_split huggingface dataset:
Temporary Balloon Occlusion of a Proximal Vessel as an Aid to Clipping Aneurysms of the Basilar and Paraclinoid Internal Carotid Arteries: Technical note
Authors: Shucart William A. , Kwan Eddie S. , Heilman Carl B. 
Published: April 2011

Abstract
One aneurysm of the basilar artery and three large, paraclinoid aneurysms of the internal carotid artery (ICA) were treated with the aid of intraoperative temporary balloon occlusion of the vessel. Optimal clip placement was confirmed using intraoperative angiography. This technique provided excellent proximal vascular control and for the large aneurysms of the paraclinoid ICA obviated the need for surgical exposure of the ICA in the neck. We think this is a useful adjunct in the surgical management of aneurysms of both the basilar artery and proximal ICA.
Treatment of Malignant Gliomas with Surgery, Intra-arterial Infusions of 1-(2-Hydroxyethyl)chloroethylnitrosourea, and Radiation Therapy: A Phase II Study
Authors: Fauchon François , Davila Luis , Chatellier Gilles , Fohanno Denis , Philippon Jacques , Rey Alain , Chiras Jacques , Poisson Michel , Delattre Jean Yves , Delattre Jean Yves 
Published: April 2011

Abstract
Forty patients with malignant supratentorial gliomas were treated with surgery, intra-arterial infusions of 1-(2-hydroxyethyl) chloroethylnitrosourea, and radiation therapy. The median duration of survival was 12 months: it differed according to the histological subtype (over 30 months for patients with anaplastic astrocytomas or anaplastic oligoden-droglioma and 10.5 months for glioblastoma; P= 0.0025). Serious complications of monocular blindness and leukoencephalopathy were observed in four patients (10%).
Phosphorus-31 Magnetic Resonance Spectroscopy of Cerebral Ischemia in Cats
Authors: Kobayashi Hidenori , Hayashi Minoru , Kawano Hirokazu , Handa Yuji , Kabuto Masanori , Ide Hisashi 
Published: April 2011

Abstract
The energy metabolism of the brain was measured in three types of ischemic models in the cat using phosphorus-31 magnetic resonance spectroscopy. The cerebral ischemia was produced as follows. In Group 1, two balloons were inflated in the left subclavian artery and the brachiocephalic trunk. In Group 2, the left middle cerebral artery was occluded through a transorbital approach. A combination of the two was employed in Group 3. Phosphorus-31 magnetic resonance spectra were obtained serially during 2 hours of ischemia. Immediately after occlusion, peaks of phospho-creatine and adenosine triphosphate decreased, whereas the peak of inorganic phosphate increased and split in two. Intracellular pH determined by chemical shift of the inorganic phosphate peak decreased. These changes were more pronounced in Group 3 when compared with the other groups. Histological study showed no infarction in Group 1 and infarcted areas in Groups 2 and 3. The size of the infarcted area in Group 3 was larger than that in Group 2. These results suggest that the model of middle cerebral artery occlusion potentiated with the occlusion of the brachiocephalic trunk and the left subclavian artery by balloon catheters is a reliable stroke model and that phosphorus-31 magnetic resonance spectroscopy is useful to understand the pathophysiological state of cerebral ischemia in vivo.
The Effect of Arteriovenous Malformation Resection on Cerebrovascular Reactivity to Carbon Dioxide
Authors: Young William L. , Prohovnik Isak , Prohovnik Isak , Prohovnik Isak , Ornstein Eugene , Ostapkovich Noeleen , Sisti Michael B. , Solomon Robert A. , Stein Bennett M. 
Published: April 2011

Abstract
To investigate the cerebral hemodynamic changes associated with obliteration of arteriovenous malformations (AVMs), we studied 26 patients undergoing total microsurgical AVM resection during isoflurane and N2/O2anesthesia. Detectors were placed 5 to 6 cm from the margin of the lesion and in a homologous contralateral position. Cerebral blood flow (CBF) was measured using the intravenous xenon-133 technique before and after AVM resection, during both hypocapnia and normocapnia at each stage. Intraoperative changes in CBF were related to a risk score system based on the patient's history and preoperative angiograms. Seven otherwise healthy patients undergoing spinal surgery were studied to control for anesthetic effects. Patient demographic and clinical data for the AVM group conformed to the expected strata of a large AVM population. The CBF increased after excision (22 ± 1 ml/100 g/min before excision to 30 ± 2 ml/100 g/min after excision; mean ± SE. n = 25, P &lt; 0.002) without a hemispheric difference. CO2reactivity increased slightly after excision (4.2 ± 0.3% change/mm Hg before excision to 4.7 ± 0.3% change/mm Hg after excision; n = 14, P &lt; 0.02). The baseline CBF and CO2reactivity were not different from the control group. There was a weak correlation between the risk score and the percentage of change in the ipsilateral CBF, with a trend for the patients with the lowest risk to have the lowest CBF changes after resection. There was no relationship between CO2reactivity and risk grade. None of the patients awoke from anesthesia with unexpected neurological deficits. The highest CBF increases were associated with postoperative brain swelling in one patient and fatal intracerebral hemorrhage in another. Both patients had normal CO2reactivity before excision. One patient suffered postoperative intracerebral hemorrhage, attributable to technical problems, and had no increase in CBF. We conclude that, with an acute increase in the arteriovenous pressure gradient (and cerebral perfusion pressure) that results from shunt obliteration, there is an immediate global effect of AVM resection to increase CBF. Cerebrovascular reactivity to CO2remains intact both before and after excision.
Pituitary Adenoma and Parasellar Cysts
Authors: Spaziante Renato , Irace Claudio , de Divitiis Enrico 
Published: April 2011

Abstract
Two cases of pituitary adenoma associated with a parasellar cyst are reported; only one similar case has been described previously. Even though such an association may be coincidental, a pathogenetic relationship between the two lesions in one of our cases may be assumed: shrinkage of the prolactin-secreting pituitary adenoma by means of bromocriptine therapy did, in fact, cause collapse of the cyst. Such an occurrence must not be disregarded in considering the therapeutic approach.
Infiltrating Spinal Angiolipoma Causing Myelopathy: Case Report
Authors: Kuroda Satoshi , Abe Hiroshi , Akino Minoru , Iwasaki Yoshinobu , Nagashima Kazuo 
Published: April 2011

Abstract
We present a case of an infiltrating spinal angiolipoma demonstrating extension into the vertebral body and the spinal epidural space. The infiltration into the epidural space caused myelopathy. About 40 cases of spinal angiolipoma and angiomyolipoma have been reported; however, only a few cases have been the infiltrating type. The radiological findings were similar to those of vertebral hemangioma, but poor enhancement of the angiolipoma on contrast-enhanced computed tomographic scans differentiated between them. The infiltrating epidural tumor was removed, and the clinical symptoms improved remarkably. Total removal of the tumor and stabilization of the involved vertebral body using the anterolateral approach may be desirable when a diagnosis of angiolipoma or angiomyolipoma is confirmed preoperatively.
Intrathoracic Meningocele Associated with Neurofibromatosis: Case Report
Authors: Dolynchuk Kenneth N. , Teskey John , West Michael 
Published: April 2011

Abstract
The authors present a case of intrathoracic meningocele associated with neurofibromatosis. Computed tomography with metrizamide myelography proved valuable in locating the lesion, thus facilitating surgical intervention. With the preoperative diagnosis established and the severity of the meningocele known, the surgeons safely employed a subpleural approach at thoracotomy.
Limited Selective Posterior Rhizotomy for the Treatment of Spasticity Secondary to Infantile Cerebral Palsy: A Preliminary Report
Authors: Lazareff Jorge A. , Mata-Acosta Ana Maria , Garcia-Mendez Martha Alejandra 
Published: April 2011

Abstract
A limited selective posterior rhizotomy was performed on 30 children suffering from spasticity secondary to infantile cerebral palsy. As opposed to standard techniques that stimulate and divide the dorsal rootlets from L2 to S1, we dissected L4, L5, and S1 dorsal roots through an L5 to S1 laminectomy. Eight to 12 rootlets from each root were electrically stimulated with two unipolar electrodes (pulse width, 50 µsec: 10–50 V). The muscle responses were observed visually and registered by electromyography. Those rootlets associated with an abnormal motor response as evidenced by sustained muscular contraction or by prolonged electromyographic response were divided. Spasticity was scored from 0 to ++++. The muscular groups assessed were those involved in the flexion of the shoulder, elbow and wrist in the upper limbs, and those involved in flexion and adduction of the hip, flexion of the leg, and plantar flexion in the lower limbs. The patients were assessed 1 week before and 6 months after the operation. Reduction of spasticity was observed in all the muscular groups, and all the patients presented functional improvement of motor abilities. These preliminary results indicate that a limited procedure that reduces the extension of the laminectomy and the length of the operation could be effective for treating spasticity secondary to infantile cerebral palsy.
Paraplegia after a Routine Lumbar Laminectomy: Report of a Rare Complication and Successful Management
Authors: Valls Patrick L. , Naul Gill L. , Kanter Steven L. 
Published: April 2011

Abstract
Arachnoid cysts of the spinal canal are relatively common lesions that may be either intra- or extradural. These cysts are usually asymptomatic but may produce symptoms by compressing the spinal cord or nerve roots. We report a case in which an intradural thoracic arachnoid cyst became symptomatic after a routine decompressive lumbar laminectomy for spinal stenosis. Myelography revealed no abnormality, although magnetic resonance imaging and computed tomography after myelography demonstrated a mass within the posterior aspect of the thoracic spinal canal associated with anterior displacement and compression of the spinal cord. A change in the flow dynamics of the cerebrospinal fluid probably allowed the development of spinal cord compression due to one of the following: expansion of the cyst, decreased cerebrospinal fluid buffer between the cord and the cyst, or epidural venous engorgement. A concomitant and more cephalad lesion such as an arachnoid cyst should be considered when myelopathic complications arise after lumbar surgery. Magnetic resonance imaging and computed tomography after myelography are useful to demonstrate the additional pathological processes.
Suprasellar Pituitary Adenoma Arising from the Pars Tuberalis: Case Report
Authors: Hamada Junichirou , Seto Hiroshi , Miura Masaki , Kuratsu Junichi 
Published: April 2011

Abstract
A rare case of suprasellar pituitary adenoma arising from the pars tuberalis in a 53-year-old woman is presented. The tumor was located exclusively above the diaphragma sellae, and no invasion into the sella turcica was noted.
Angiographic Study of Induced Cerebral Aneurysms in Primates
Authors: Kim Choegon , Kikuchi Haruhiko , Hashimoto Nobuo , Hazama Fumitada 
Published: April 2011

Abstract
Five cynomolgus monkeys treated with unilateral carotid ligation, renal hypertension, and β-aminopropionitrile feeding were studied repeatedly by cerebral angiography to clarify the growth process of saccular cerebral aneurysms. Repeated angiography demonstrated saccular cerebral aneurysms in three of five monkeys; two aneurysms were found 15 months and a third 12 months after the operation. At autopsy, one saccular aneurysm was found to be bilocular in shape, and the others were unilocular. Fusiform aneurysms were also observed in four monkeys. Microscopic studies revealed the walls of the saccular aneurysms were very thin and consisted of fibrous tissue. In one aneurysm, the aneurysmal sac was almost obstructed by a well-organized thrombus. No evidence of intramural hemorrhage was found in any of the saccular cerebral aneurysms. The conversion of early aneurysmal changes into saccular aneurysms was found in any of the abruptly, and no consistent growth rate was noted. The multiloculation of saccular aneurysms was closely related to the size of an aneurysm. The present study indicates that a saccular cerebral aneurysm may grow abruptly from one of several different kinds of early aneurysmal changes.
The Association of Hydrocephalus with Intramedullary Spinal Cord Tumors: A Series of 25 Patients
Authors: Rifkinson-Mann Stephanie , Wisoff Jeffrey H. , Epstein Fred 
Published: April 2011

Abstract
171 patients with intramedullary spinal cord tumors were operated on, of which 25 patients (15%), mostly children, developed symptomatic hydrocephalus. Twenty patients (12%) had malignant tumors, with 13 of the 20 cases (63%) complicated by increased intracranial pressure and ventriculomegaly. Of the remaining 151 patients with benign tumors (89%), only 12 (8%) developed symptomatic hydrocephalus. In an effort to understand the relationship between hydrocephalus and intramedullary spinal cord tumor, the authors analyze the level and histology of the neoplasm, as well as its association with spinal cysts. A review of the neurosurgical literature reveals that 34 similar cases of hydrocephalus associated with intramedullary spinal cord tumors have been reported to date. The authors note that the presence of hydrocephalus in patients with malignant intramedullary astrocytomas is associated with a shorter rate of survival than in those patients with high-grade lesions but without hydrocephalus, apparently due to rapid tumor progression. The ventriculomegaly seen with benign spinal cord gliomas has no statistically significant effect upon longterm prognosis.
Preoperative Superselective Arteriolar Embolization: A New Approach to Enhance Resectability of Spinal Tumors
Authors: Broaddus W. C. , Grady M. S. , Delashaw J. B. , Wisoff R. D. G. , Jane J. A. 
Published: April 2011

Abstract
The extent of surgical resection of spinal tumors is frequently limited by blood loss and technical difficulty associated with the vascularity of the tumors. We report here the use of superselective percutaneous arterial embolization to reduce the rate of blood loss at the time of surgical resection and enhance resectability. The types of tumors treated were metastatic renal carcinoma, metastatic thyroid carcinoma, metastatic melanoma, and giant cell tumor of the sacrum. Two of the patients required repeated embolization and surgery for recurrent symptoms. The estimated blood loss in seven of nine procedures performed on the six patients ranged from 300 to 800 ml, after which no transfusion was required. In two procedures, extensive resection of very large tumors resulted in larger losses of blood, and postoperative transfusion was necessary. No significant complications of embolization or surgery occurred. A key factor in our embolization technique is the use of microfibrillar collagen, which allows occlusion of tumor vessels as small as 20 µm and may prevent reconstitution of the embolized vessels by collateral flow. We conclude that preoperative arterial embolization enhances the resectability of a variety of spinal tumors by reducing intraoperative blood loss. This may provide an additional benefit by reducing the risk related to postoperative transfusion. By permitting a more aggressive surgical approach, the use of preoperative embolization also has the potential to improve outcome in patients with spinal tumors.
Fine Surface Structure of an Intraspinal Neurenteric Cyst: A Scanning and Transmission Electron Microscopy Study
Authors: Morita Yoshihiro , Kinoshita Kazuo , Wakisaka Shinichiro , Makihara Shinji 
Published: April 2011

Abstract
The case of an 11-year-old boy with an intraspinal neurenteric cyst, which recurred 8 years and 3 months after surgery, is presented. Scanning and transmission electron microscopy of the cyst epithelium revealed marked resemblance to that of the respiratory tract, despite the presence of numerous goblet cells mimicking intestine on light microscopy study. Detailed ultrastructural findings are described.
Computer-Aided Intelligence: Application of an Expert System to Brachial Plexus Injuries
Authors: Fisher Wink S. 
Published: April 2011

Abstract
When confronted with a patient with a brachial plexus injury, how often as neurosurgeons do we consult and atlas to confirm the anatomy of the brachial plexus and then attempt to establish the location of the lesion? Similar difficulties are encountered with lumbar and sacral plexus lesions. In a project organized to assist the neurosurgeon in this time-consuming task, a computer program that can rapidly determine the site of a lesion in a brachial, lumbar, or sacral plexus injury was created. Using known anatomical pathways (37 clinically relevant upper and 20 lower extremity muscle innervations), and relying solely upon the neurological motor examination, rapid computer-assisted diagnosis is possible. When more than one final common pathway lesion occurs (for example, multiple root avulsions of the brachial plexus), possible lesion sites can be obtained. An interactive dialogue between the user and the program helps to determine the location of the lesion. The program can be run on any IBM-compatible personal computer and is presented as an instrument that provides assistance in cases of complex peripheral nerve injuries, when expert consultants are unavailable. In addition, it can be used as an aid to learning and as a review of basic neuroanatomy.
Brain Retractor Edema during Induced Hypotension: The Effect of the Rate of Return of Blood Pressure
Authors: Lownie S. , Wu X. , Karlik S. , Gelb A.W. 
Published: April 2011

Abstract
This study evaluated the hypothesis that the postoperative formation of cerebral edema may be influenced by the rate of blood pressure return after induced hypotension in a graded brain retractor injury. Nineteen cats underwent unilateral craniotomy, isoflurane-induced hypotension to a mean of 50 mm Hg, and application of a brain retractor at 20 mm Hg of pressure for 1 hour. Blood pressure was returned to normal either within 3 minutes or over 20 minutes. The degree of cerebral edema formation was determined by Evans blue dye and coronal magnetic resonance imaging. All animals showed extravasation of Evans blue dye in the retracted hemisphere that was most marked at the periphery of the retractor. T1 relaxation times were significantly prolonged in the retracted hemispheres of both the fast return and slow return groups (18.8% and 17.8%, respectively) and more so at the Evans blue sites (42.8% and 40.8%), although not so strikingly beneath the retractor itself (6.3% and 7.8%). T2 relaxation times were similarly prolonged but to approximately half the degree of the T1 times. In the nonretracted hemisphere, drug-induced hypotension alone did not result in significant acute cerebral edema or blood-brain barrier alteration. There was no significant difference between the fast and slow groups in Evans blue extravasation or magnetic resonance changes. Thus, in a retractor-induced brain injury, restoration of arterial pressure to normal either gradually or rapidly did not influence the degree or extent of edema formation.
Long-Term Follow-up of Patients with Recurrent Malignant Gliomas Treated with Adjuvant Adoptive Immunotherapy
Authors: Lillehei Kevin O. , Mitchell Dawn H. , Johnson Stephen D. , McCleary Larry E. , Kruse Carol A. 
Published: April 2011

Abstract
Between August 1986 and October 1987, the Denver Brain Tumor Research Group conducted a clinical trial using autologous human recombinant interleukin-2 (rIL-2)-activated lymphocytes to treat 20 patients with recurrent high-grade gliomas. The trial involved surgical resection and/or decompression followed by intracavitary implantation of lymphokine-activated killer (LAK) cells and autologous stimulated lymphocytes (ASL) along with rIL-2 in a plasma clot. One month later, stimulated lymphocytes and rIL-2 were infused through a Rickham reservoir attached to a catheter directed into the tumor bed. The LAK cells were rIL-2-activated peripheral blood lymphocytes cultured for 4 days; the ASL were lectin- and rIL-2-activated peripheral blood lymphocytes cultured for 10 days. Of the 20 patients treated, 11 were evaluated as a group (mean age, 44 years, range, 15-61 years; mean Karnofsky rating, 69, range, 50-100; mean Decadron dose at entry, 14 mg/d. range, 0-32). The average number of lymphocytes implanted was 7.6 × 109 (range, 1.9-27.5 × 109), together with 1 to 4 × 106 U of rIL-2. To date, 10 of the 11 patients died, all from recurrent tumor growth. The median overall survival time was 63 weeks (range, 36-201; mean, 86). The median survival time after immunotherapy was 18 weeks (range, 11-151; mean, 39). No significant difference in survival after immunotherapy was found between those patients who had received previous chemotherapy and those who had not. The use of steroids or prior chemotherapy did not influence the in vitro generation of ASL or LAK cells. Prior chemotherapy did correlate, however, with diminished in vitro cytotoxicity against the natural killer-sensitive (K562) target cell by LAK cells (P &lt; 0.05) but not that by ASL. There were no major adverse side effects. Although adoptive immunotherapy was safe and well tolerated, its therapeutic potential remains in question.
The Effect of Continuous Drainage of Cerebrospinal Fluid in Patients with Subarachnoid Hemorrhage: A Retrospective Analysis of 108 Patients
Authors: Kasuya Hidetoshi , Shimizu Takashi , Kagawa Mizuo 
Published: April 2011

Abstract
The effects of continuous drainage of cerebrospinal fluid (CSF) on vasospasm and hydrocephalus were analyzed retrospectively in 108 patients with subarachnoid hemorrhage (SAH) who were operated on for ruptured aneurysms within 48 hours of their onset. Ninety-two of these patients underwent a procedure for CSF drainage (cisternal drainage, ventricular drainage, lumbar drainage, or a combination of these). The duration, the total volume, and the average daily volume of CSF drainage were 10.4 ± 7.0 days (mean ± SD), 2034 ± 1566 ml, and 190 ± 65.3 ml, respectively. Patients with a greater drainage volume at a lower height of drainage in the early period after SAH developed more cerebral infarctions later (P &lt; 0.025). The relationship between the total volume of CSF removed and shunt-dependent hydrocephalus was determined to be statistically significant (P &lt; 0.005). Cerebral infarction and hydrocephalus after SAH were also found to be statistically associated (P &lt; 0.001). Thus, continuous cerebrospinal fluid drainage should not be performed too readily in patients with SAH, because the removal of a large amount of CSF can induce cerebral vasospasm as well as hydrocephalus.
Symptomatic Diverticulum of the 4th Ventricle
Authors: Vaquero Jesus , Martinez Roberto , Coca Santiago , Saucedo Gertrudis 
Published: April 2011

Abstract
A case of symptomatic diverticulum of the 4th ventricle in a 57-year-old man is presented. This clinicopathological observation supports a relationship between ventricular diverticula and ependyma-lined paraventricular cysts.