bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endoscopic endonasal treatment of a spontaneous temporosphenoidal encephalocele with a detachable silicone balloon
Authors: Alfieri Alessandra , Schettino Raffaele , Taborelli Angelo , Pontiggia Maurizio , Reganati Paolo , Ballarini Valerio , Monolo Luigi 
Published: May 2009

✓ Temporosphenoidal encephaloceles are rare entities that occur when the temporal lobe herniates into the sphenoid sinus through a skull base defect of the temporal bone. Both an iatrogenic and a traumatic pathogenesis have been proposed.
The authors describe a spontaneously occurring temporosphenoidal encephalocele in a 63-year-old woman who had a 4-year history of rhinorrhea. Spiral computerized tomography (CT) scanning revealed a bone defect located inside the ophthalmomaxillary triangle. The intrasphenoidal encephalocele had a heterogeneously hypointense signal compared with cerebrospinal fluid (CSF) on T1-weighted magnetic resonance (MR) images and a hyperintense signal compared with CSF on T2-weighted MR images. Two previous endonasal endoscopic procedures, performed by ear, nose, and throat surgeons, had been unsuccessful. The authors performed an endoscopic endonasal right nostril procedure by using 0° and 45° rigid-lens endoscopes that were 4 mm in diameter and 18 cm long. The encephalocele in the sphenoid sinus was partially removed. DuraGen and fat graft were positioned in the bone defect. Two No. 2 French detachable silicone balloons (1.5 cm3 volume) inflated with surgical glue were introduced into the skull defect and into the sphenoid sinus, respectively. The CSF leakage stopped immediately. No nasal packing or postoperative CSF lumbar drainage was necessary. The patient did well. Postoperative CT and MR imaging, obtained at 24 hours and at 3 months, demonstrated that the balloon and the fat graft filled the bone defect and the sphenoid sinus. Eight months postprocedure no CSF leakage was observed. This appears to be the first case reported in the literature of a temporosphenoidal encephalocele successfully treated by an endoscopic endonasal technique involving packing of the defect with inflated detachable balloons.
Intracranial aneurysms associated with unsuspected aortic coarctation
Authors: Mercado Rodrigo , López Susana , Cantú Carlos , Sanchez Angel , Revuelta Rogelio , Gómez-Llata Sergio , Bouffard J. Antonio , Pineda Carlos 
Published: May 2009

✓ Intracranial aneurysms (IAs) are found more often in patients with aortic coarctation (AC) than in the general population and aneurysm rupture occurs much earlier in the lives of these patients when there is coexistent AC. The diagnosis of AC is frequently made only after a serious cerebrovascular complication has developed. The aim of this paper is to call attention to AC in patients presenting with aneurysmal subarachnoid hemorrhage. The literature is reviewed, the key clinical features are highlighted, and the proposed pathogenesis of this association is discussed.
The authors present clinical information and imaging data obtained in three young patients with ruptured IAs that were associated with initially unnoticed AC. Abnormal results of cardiovascular examinations led the authors to consider an underlying AC, which was later confirmed by aortography. These aneurysms were successfully treated prior to correction of the ACs.
The diagnosis of AC should be considered in adolescent and young adult patients presenting with IAs.
Downregulation of cerebrospinal fluid production in patients with chronic hydrocephalus
Authors: Silverberg Gerald D. , Huhn Stephen , Jaffe Richard A. , Chang Steven D. , Saul Thomas , Heit Gary , Von Essen Ann , Rubenstein Edward 
Published: May 2009

Object. The goal of this study was to determine the effect of hydrocephalus on cerebrospinal fluid (CSF) production rates in patients with acute and chronic hydrocephalus.
Methods. The authors studied CSF production both in patients presenting with acute and chronic hydrocephalus, and patients with Parkinson disease (PD) of a similar mean age, whose CSF production was known to be normal. A modification of the Masserman method was used to measure CSF production through a ventricular catheter. The CSF production rates (means ± standard deviations) in the three groups were then compared.
The patients with PD had a mean CSF production rate of 0.42 ± 0.13 ml/minute; this value lies within the normal range measured using this technique. Patients with acute hydrocephalus had a similar CSF production rate of 0.4 ± 0.13 ml/minute, whereas patients with chronic hydrocephalus had a significantly decreased mean CSF production rate of 0.25 ± 0.08 ml/minute.
Conclusions. The authors postulate that chronic increased intracranial pressure causes downregulation of CSF production.
Increased levels of lipid peroxides as predictive of symptomatic vasospasm and poor outcome after aneurysmal subarachnoid hemorrhage
Authors: Kamezaki Takao , Yanaka Kiyoyuki , Nagase Sohji , Fujita Keishi , Kato Noriyuki , Nose Tadao 
Published: May 2009

Object. Cerebral vasospasm remains a devastating medical complication of aneurysmal subarachnoid hemorrhage (SAH). Reactive oxygen species and subsequent lipid peroxidation are reported to participate in the causes of cerebral vasospasm. This clinical study was performed to investigate the relationships between levels of lipid peroxides in cerebrospinal fluid (CSF) and both delayed cerebral vasospasm and clinical outcome after SAH.
Methods. Levels of phosphatidylcholine hydroperoxide (PCOOH) and cholesteryl ester hydroperoxide (CEOOH) in the CSF were measured in 20 patients with aneurysmal SAH. The patients' CSF was collected within 48 hours of hemorrhage onset and on Day 6 or 7 post-SAH. On Day 7, angiography was performed to verify the degree and extent of the vasospasm. The relationship between the patients' clinical profiles and the levels of lipid peroxides in the CSF were investigated.
Both PCOOH and CEOOH were detectable in CSF, and their levels decreased within 7 days after onset of SAH. The levels of CEOOH within 48 hours after onset of hemorrhage were significantly higher in patients in whom symptomatic vasospasm later developed than in patients in whom symptomatic vasospasm did not develop (p = 0.002). Levels of PCOOH measured within 48 hours after onset of hemorrhage were significantly higher in patients with poor outcomes than in patients with good outcomes (p = 0.043).
Conclusions. Increased levels of lipid peroxides measured in the CSF during the acute stage of SAH were predictive of both symptomatic vasospasm and poor outcome. Measurements of lipid peroxides in the CSF may be useful prognostically for patient outcomes as well as for predicting symptomatic vasospasm.
New laboratory model for neurosurgical training that simulates live surgery
Authors: Aboud Emad , Al-Mefty Ossama , Yaşargil M. Gazi 
Published: May 2009

Object. Laboratory training models are essential for developing and refining surgical skills, especially for microsurgery. The closer to live surgery the model is, the greater the benefit. In this paper the authors introduce a cadaver model with unique characteristics: dynamic filling of the cerebral vasculature with colored liquid and clear fluid filling of the arachnoid cisterns. This model is distinctive and has great practical value for training in a wide range of surgical procedures.
Methods. Cadaveric heads were prepared for surgical procedures in the following manner: the carotid arteries (CAs) and vertebral arteries (VAs) in the neck were cannulated, as were the internal jugular veins (JVs) on both sides. Two tubes were introduced into the spinal canal and each one was advanced into one of the cerebellopontine angle cisterns. A CA, VA, or both were then connected to a reservoir containing light red fluid and a pressure of 80 to 120 mm Hg and a pulse rate of 60 beats/minute were established using a pump. The JV on the side currently being dissected was connected to a reservoir containing dark red fluid and kept at a pressure between 20 and 40 mm Hg. The remaining vessels were clamped in the neck. The cisternal tubes were connected to a reservoir of clear fluid that was regulated by an adjustable flow. Nine trainees have tested this model on eight specimens by practicing a variety of surgical procedures and maneuvers, including craniotomies; hemostasis; cisternal and vascular dissection; vascular anastomosis and repair; establishment of arterial bypasses; aneurysm creation, dissection, and clipping; management of an aneurysm rupture; intraparenchymal resection such as amygdalohippocampectomy; ventricular endoscopy and third ventriculostomy; cavernous sinus and skull base approaches; and resection of artificial tumors in the basal cisterns.
Conclusions. This model mimics the normal human anatomy and dynamic vascular filling found in real surgery and presents it from the training perspective, allowing a wide range of skill development and repeated practice. It provides an alternative model to laboratory animals. It is inexpensive and readily available, and has great value for the acquisition and refinement of surgical skills that are not only specific to neurosurgery, but are applicable to other surgical disciplines.
Analysis of immunoglobulin H gene rearrangement by polymerase chain reaction in primary central nervous system lymphoma
Authors: Kros Johan M. , Bagdi Eniko K. , Zheng Pingpin , Hop Wim C. , Driesse Maarten J. , Krenacs Laszlo , Dinjens Winand N. M. 
Published: May 2009

Object. Diagnosing primary central nervous system lymphoma (PCNSL) may be difficult either because of a paucity of tumor cells in the brain biopsy specimens or a failure to demonstrate monoclonality on immunomorphological studies. Monoclonality can also be demonstrated by amplification of the rearranged immunoglobulin H genes by polymerase chain reaction (PCR) to the framework region (FR)3 and FR2 complementarity determining region (CDR)-III and CDR-II of these genes. The PCR method is feasible with formalin-fixed, paraffin-embedded biopsy material and has proven to be helpful in the diagnosis of non-Hodgkin lymphoma on biopsy samples obtained from various locations in the body. Nevertheless, few studies have addressed the value of this method in the context of PCNSL. In the present study, the contribution of both FR3 single and FR2 seminested PCR procedures for confirming the diagnosis of PCNSL was estimated retrospectively in 30 cases of PCNSL and in three cases of epidural lymphoma.
Methods. Twenty-eight cases of immunophenotypically confirmed PCNSL and two of suspected lymphoma were studied. Tissue specimens obtained in 22 cases of other cerebral diseases, among which were various inflammatory conditions, were used as negative controls. In 18 (60%) of 30 cases the results of FR3 PCR demonstrated monoclonality, whereas FR2 PCR showed monoclonality in 12 cases (40%). In 11 cases FR3 PCR yielded monoclonal patterns and FR2 PCR did not, whereas reversibly in five cases FR2 PCR proved monoclonality and FR3 PCR failed to do so. Adding the results of FR3 to those of FR2 PCR, monoclonal patterns were obtained in 23 (77%) of 30 cases. In both cases in which lymphoma was suspected but not proven immunomorphologically, FR3 PCR revealed monoclonality, as did FR2 PCR in one case. In all 22 control lesions either polyclonal patterns were seen or no consistent patterns were obtained. In the PCNSL group, older age of patients and multifocal presentation of lesions on neuroimaging were significantly associated with worse survival. No correlation between histological subtype and clinical outcome was elucidated.
Conclusions. The application of FR3 and FR2 PCR is a useful additional tool in making the diagnosis of PCNSL. Moreover, in some cases the PCR method may be essential in distinguishing neoplasia from reactive conditions.
A new reproducible model of an epidural mass lesion in rodents. Part I: Characterization by neurophysiological monitoring, magnetic resonance imaging, and histopathological analysis
Authors: Burger Ralf , Bendszus Martin , Vince Giles Hamilton , Roosen Klaus , Marmarou Anthony 
Published: May 2009

Object. The goal of this study was to characterize a new model of an epidural mass lesion in rodents by means of neurophysiological monitoring, magnetic resonance imaging, and histopathological analysis.
Methods. Changes in intracranial pressure (ICP), cerebral perfusion pressure (CPP), and laser Doppler flowmetry (LDF) values, intraparenchymal tissue partial oxygen pressure (PtiO2), and electroencephalography (EEG) activity were evaluated in the rat during controlled, epidural expansion of a latex balloon up to a maximum ICP of 60 mm Hg. The initial balloon inflation was followed by periods of sustained inflation (30 ± 1 minute) and reperfusion (180 ± 5 minutes). Histopathological analysis and magnetic resonance (MR) imaging were performed to characterize the lesion.
The time to maximum balloon expansion and the average balloon volume were highly reproducible. Alterations in EEG activity during inflation first appeared when the CPP decreased to 57 mm Hg, the LDF value to 66% of baseline values, and the PtiO2 to 12 mm Hg. During maximum compression, the CPP was reduced to 34 mm Hg, the LDF value to 40% of baseline, and the PtiO2 to 4 to 5 mm Hg. The EEG tracing was isoelectric during prolonged inflation and the values of LDF and PtiO2 decreased due to accompanying hypotonia. After reperfusion, the CPP was significantly decreased (p < 0.05) due to the elevation of ICP. Both the LDF value and EEG activity displayed incomplete restoration, whereas the value of PtiO2 returned to normal. Histological analysis and MR imaging revealed brain swelling with a midline shift and a combined cortical—subcortical ischemic lesion beyond the site of balloon compression.
Conclusions. This novel model of an epidural mass lesion in rodents closely resembles the process observed in humans. Evaluation of pathophysiological and morphological changes was feasible by using neurophysiological monitoring and MR imaging.
Rotational vertebral artery occlusion from occipital bone anomaly: a rare cause of embolic stroke
Authors: Tominaga Teiji , Takahashi Toshiyuki , Shimizu Hiroaki , Yoshimoto Takashi 
Published: May 2009

✓ Vertebral artery (VA) occlusion by rotation of the head is uncommon, but can result from mechanical compression of the artery, trauma, or atlantoaxial instability. Occipital bone anomalies rarely cause rotational VA occlusion, and patients with nontraumatic intermittent occlusion of the VA usually present with compromised vertebrobasilar flow.
A 34-year-old man suffered three embolic strokes in the vertebrobasilar system within 2 months. Magnetic resonance imaging demonstrated multiple infarcts in the vertebrobasilar territory. Angiography performed immediately after the third attack displayed an embolus in the right posterior cerebral artery. Radiographic and three-dimensional computerized tomography bone images exhibited an anomalous osseous process of the occipital bone projecting to the posterior arch of the atlas. Dynamic angiography indicated complete occlusion of the left VA between the osseous process and the posterior arch while the patient's head was turned to the right. Surgical decompression of the VA resulted in complete resolution of rotational occlusion of the artery.
An occipital bone anomaly can cause rotational VA occlusion at the craniovertebral junction in patients who present with repeated embolic strokes resulting from injury to the arterial wall.
Intention-to-treat analysis of Spetzler—Martin Grades IV and V arteriovenous malformations: natural history and treatment paradigm
Authors: Han Patrick P. , Ponce Francisco A. , Spetzler Robert F. 
Published: May 2009

Object. In this study the authors quantified a subgroup of patients with Spetzler—Martin Grades IV and V arteriovenous malformations (AVMs) recommended for complete, partial, or no treatment, and calculated the retrospective hemorrhage rate for these lesions.
Methods. Between July 1997 and May 2000, 73 consecutive patients with Grades IV and V AVMs were evaluated prospectively by the cerebrovascular team at Barrow Neurological Institute. Treatment recommendations given to the patients or referring physicians were classified as complete treatment, partial treatment, and no treatment. Retrospectively, the hemorrhage rates associated with these treatment groups were also calculated.
In the prospective portion of the study (the intention-to-treat analysis), no treatment of the AVM, was recommended for 55 patients (75%) and partial treatment was recommended for seven patients (10%). Aneurysms associated with an AVM were obliterated by surgical or endovascular treatment in seven patients (10%), and complete surgical removal was recommended for four patients (5%). The overall hemorrhage rate for Grades IV and V AVMs was 1.5% per year. The annual risk of hemorrhage was 10.4% among patients who previously had received incomplete treatment, compared with patients without previous treatment.
Conclusions. The hemorrhage risk of 1.5% per year, which was associated with Grades IV and V AVMs appears to be lower than that reported for Grades I through III AVMs. The authors recommend that no treatment be given for most Grades IV and V AVMs. No evidence indicates that partial treatment of an AVM reduces a patient's risk of hemorrhage. In fact, partial treatment may worsen the natural history of an AVM. The authors do not support palliative treatment of AVMs, except in the specific circumstances of arterial or intranidal aneurysms or progressive neurological deficits related to vascular steal. Complete treatment is warranted for patients with progressive neurological deficits caused by hemorrhage of the AVM. This selection process plays a significant role in the relatively low combined morbidity and mortality rates for Grade IV and Grade V AVMs (17 and 22%, respectively) reported by the cerebrovascular group in both retrospective and prospective studies.
Preoperative and postoperative cognitive functioning in patients with frontal meningiomas
Authors: Tucha Oliver , Smely Christian , Preier Michael , Becker Georg , Paul Geraldine M. , Lange Klaus W. 
Published: May 2009

Object. There is presently no specific information available concerning the nature and course of cognitive deficits caused by intracranial meningiomas. In this prospective study the authors examined the cognitive functioning of patients with frontal meningiomas.
Methods. Fifty-four patients with frontal meningiomas were examined neuropsychologically before and after neurosurgery. The test battery consisted of standardized instruments including those assessing memory, attention, visuoconstructive abilities, and executive functions. The time period between pre-and postoperative assessment ranged from 4 to 9 months. The patients' performance was compared with the results in 54 healthy adults who were also assessed twice by using the same test battery in a period ranging from 4 to 9 months. In addition, the effect on cognition of meningioma lateralization, localization, lesion size, edema, brain compression, time course, and the occurrence of preoperative seizures was analyzed.
Conclusions. Except in the case of working memory, comparisons of pre- and postoperative assessments of cognition revealed no differences in memory, visuoconstructive abilities, or executive functions, although a postoperative improvement in attentional functions was observed. The results of this study indicate that the surgical removal of frontal meningiomas does not impair patients' cognitive functioning. Furthermore, improvements in attentional functions may occur in these patients.
The impact of stereotactic pallidal surgery on the dopamine D2 receptor in Parkinson disease: a positron emission tomography study
Authors: Nakajima Takeshi , Nimura Taro , Yamaguchi Keiichiro , Ando Tadashi , Itoh Masatoshi , Yoshimoto Takashi , Shirane Reizo 
Published: May 2009

Object. The aim of this study was to estimate the impact of stereotactic pallidal surgery on the binding potential of dopamine D2 receptors in patients with advanced Parkinson disease (PD).
Methods. Six patients with advanced PD (three men and three women; mean age 56.7 ± 9.8 years, Hoehn and Yahr stage 3.3 ± 1.1/3.9 ± 1.2 [on/off scores], mean ± standard deviation) underwent stereotactic pallidal surgery. One underwent right posteroventral pallidotomy (PVP), one received left PVP, three were treated with deep brain stimulation (DBS) of the left globus pallidus internus (GPi), and one with bilateral DBS of the GPi. The binding potential of the dopamine D2 receptors of these patients was determined before and after surgery by using positron emission tomography scanning with 11C-nemonapride and it was compared with the value in eight healthy volunteers. The authors also examined whether changes in the D2 receptor binding potential were correlated with the clinical outcome. The clinical symptoms, especially those in the off state, were significantly improved after surgery. Preoperatively, the D2 receptor binding potential in the putamen was elevated by 27% (p < 0.01) and that in the thalamus was 29% lower than that in controls (p < 0.01). The D2 receptor binding potential in the putamen and thalamus returned to control levels after surgery. The preoperative level of the D2 receptor binding potential in the anterior cingulate cortex was comparable to that of controls, but it declined significantly after surgery, whereas the D2 receptor binding potential in other regions of both hemispheres showed no significant changes after surgery. Although the D2 receptor binding potential did not correlate with the Hoehn and Yahr stage, the Schwab and England score, or the Unified PD Rating Scale (UPDRS) score, a positive correlation was seen between the percent improvement rate of the total UPDRS score in the off state and the percentage change of the D2 receptor binding potential in the putamen (r = 0.773, p = 0.0417 according to the Pearson linear correlation).
Conclusions. The altered dopamine D2 receptor binding potential in the putamen might play a crucial role in clinical improvement after PVP or DBS of the GPi in advanced PD.