bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ventricular pressure monitoring during bilateral decompression with dural expansion
Authors: Yoo Do-Sung , Kim Dal-Soo , Cho Kyung-Suck , Huh Pil-Woo , Park Chun-Kun , Kang Joon-Ki 
Published: May 2009

Object. The management of massive brain swelling remains an unsolved problem in neurosurgery. Despite newly developed medical and pharmacological therapy, the rates of mortality and morbidity caused by massive brain swelling remain high. According to many recent reports, surgical decompression with dural expansion is superior to medical management in patients with massive brain swelling. To show the quantitative effect of decompressive surgery on intracranial pressure (ICP), the authors performed a ventricular puncture and measured the ventricular ICP continuously during decompressive surgery and the postoperative period.Methods. Twenty patients with massive brain swelling who underwent bilateral decompressive craniectomy with dural expansion were included in this study. In all patients, ventricular puncture was performed at Kocher's point on the side opposite the massive brain swelling. The ventricular puncture tube was connected to the continuous monitor via a transducer device. The ventricular pressure was monitored continuously, during the bilateral decompressive procedures and postoperative period.The initial ventricular ICP was variable, ranging from 16 to 65.8 mm Hg. Immediately after the bilateral craniectomy, the mean ventricular ICP decreased to 50.2 ± 16.6% of the initial ICP (range 5–51.5 mm Hg). Additional opening of the dura decreased the mean ICP by an additional 34.5% and reduced the ventricular pressure to 15.7 ± 10.7% of the initial pressure (range 0–15 mm Hg). Ventricular pressure measured postoperatively in the neurosurgical intensive care unit was lowered to 15.1 ± 16.5% of the initial ICP. The ventricular ICP trend in the first 24 hours after decompressive surgery was an important prognostic factor; if it was greater than 35 mm Hg, the mortality rate was 100%.Conclusions. Bilateral decompression with dural expansion is an effective therapeutic modality in the control of ICP. To obtain favorable clinical outcomes in patients with massive brain swelling, early decision making and proper patient selection are very important.
Empty sella syndrome: does it exist in children?
Authors: Ammar Ahmed , Al-Sultan Ali , Mulhim Fatma Al , Hassan Abdulla Yousef Al 
Published: May 2009

Object. The empty sella syndrome (ESS) is well documented in adults, and although the same phenomenon of herniation of the arachnoid space into the enlarged sella turcica has been noted in children, it is not widely known that children suffer from this syndrome. Therefore, the aims of this paper are to increase neurosurgeons' awareness of the existence of this phenomenon in children and to add to the scant body of literature on the subject.Methods. The authors treated 12 children, ranging in age between 2 and 8 years, in whom neuroradiological studies demonstrated an enlarged sella turcica filled with cerebrospinal fluid and herniation of suprasellar and arachnoid spaces. The causes of ESS in these children were high intracranial pressure, neglected or improperly treated hydrocephalus, and suprasellar arachnoid cyst. Primary ESS was found as well. Most of the children presented with headache, abnormal body weight (the majority being underweight), and short stature. The results of hormone assays were normal in all children.Conclusions. If undiagnosed and untreated, ESS in children may lead to serious consequences, including impairment of pituitary and hypothalamic function and damage to the optic chiasm. It is important to raise awareness in the neurosurgical community about the existence of ESS in children so that it can be diagnosed and treated at an early stage. A classification system for the diaphragma sellae is recapitulated.
Neuroendoscopic approach to tectal tumors: a consecutive series
Authors: Oka Kazunari , Kin Yoshiaki , Go Yoshinori , Ueno Yushi , Hirakawa Katsuyuki , Tomonaga Masamichi , Inoue Tohru , Yoshioka Susumu 
Published: May 2009

Object. The authors report a consecutive series of 10 patients who presented with signs and symptoms caused by tectal tumors. Clinical findings, radiographic features, neuroendoscopic management strategies, and histological findings are reported and discussed.Methods. Since January 1990, 11 neuroendoscopic procedures were performed in 10 patients who harbored tectal tumors. The patients were followed for an average of 5 years (range 2 months-11 years), and a retrospective study was conducted in which case notes, radiological findings, operative notes, and histopathological findings were assessed. Magnetic resonance (MR) imaging was performed, and the images were used to classify patients into three groups: those with hypertrophy of the tectum in whom isointensity appeared on T1-weighted images (Group 1); those with a tectal tumor occupying the cerebral aqueduct in whom decreased signal intensity appeared on T1-weighted images, as well as no enhancement after gadolinium administration (Group 2); and those with a tectal tumor in whom mixed signal intensity and conspicuous evidence of contrast enhancement appeared on T1-weighted images (Group 3). The results of histological examination were consistent with MR imaging features: in Group 1, glial tissue or gliosis; in Group 2, benign astrocytoma; and in Group 3, malignant astrocytoma. Cerebrospinal fluid diversion was the only surgical treatment that provided relief from obstructive hydrocephalus. One patient in Group 3 underwent radiotherapy and subsequent partial tumor removal under neuroendoscopic guidance. Thereafter, the tumor remained in decline. All patients had normal intellectual status after undergoing surgery in which a neuroendoscope was used.Conclusions. Neuroendoscopic procedures can provide histological diagnosis, define the tumor—midbrain interrelationship, and be highly effective in treating obstructive hydrocephalus and in removing tectal tumors. This procedure may receive clinical application as a new management strategy for tectal glioma.
Medulloblastoma with extensive nodularity: a variant with favorable prognosis
Authors: Giangaspero Felice , Perilongo Giorgio , Fondelli Maria Paola , Brisigotti Massimo , Carollo Carla , Burnelli Roberta , Burger Peter C. , Garrè Maria Luisa 
Published: May 2009

Object. Some medulloblastomas (MBs) are characterized by extreme nodularity and intranodular nuclear uniformity in a fine fibrillary background. These lesions have also been designated as “cerebellar neuroblastoma.” Although numerous reports have been published in which their morphological features have been investigated, only a few studies have been focused on their neuroradiological appearance, biological behavior, and response to therapy. The goal of this study was to gather more information about these lesions.Methods. The authors present 11 cases of MB with extensive nodularity. Five patients were boys and six were girls; all but one were 24 months of age or younger at diagnosis. Magnetic resonance imaging disclosed a peculiar grapelike architecture in eight cases. Surgical tumor removal was complete in nine cases and partial in one. In the other case a biopsy sample of the tumor was obtained after a preoperative course of chemotherapy. After surgery, two children were treated with radiotherapy alone and one with craniospinal irradiation followed by systemic chemotherapy. Eight patients were treated with chemotherapy only. All the patients in the study are presently alive with a median follow up of 66 months. Eight patients (73%) are in complete remission at 35 to 156 months. Three patients treated with chemotherapy alone postsurgery relapsed; however, all underwent successful retreatment (two with craniospinal irradiation and one with further surgery plus high-dose chemotherapy) and are in complete remission. A review of the literature revealed that patients in 11 of 12 reported cases were younger than 3 years of age and that seven of eight in whom follow-up information was available were alive and well, with survival times ranging from 6 to 84 months.Conclusions. Medulloblastomas with extensive nodularity represent a variant that is characterized by: 1) occurrence in very young children; 2) a peculiar grapelike appearance on neuroimaging; and 3) an apparently favorable outcome.
Effects of N-6 essential fatty acids on glioma invasion and growth: experimental studies with glioma spheroids in collagen gels
Authors: Bell Helen S. , Wharton Stephen B. , Leaver H. Anne , Whittle Ian R. 
Published: May 2009

Object. Intracranial infusions of gamma-linolenic acid (GLA), an essential fatty acid, have been used as an adjuvant therapy following malignant glioma resection; however, little is known about the dose response of glioma cells to this therapy. In this in vitro study the authors address this important pharmacological question.Methods. Glioma spheroids derived from U87, U373, MOG-G-CCM, and C6 cell lines were grown in collagen gel and exposed to a range of GLA concentrations (0–1 mM) for 5 days. The diameter of glioma spheroids was measured, the apoptotic index was assessed using both the terminal deoxynucleotidyl transferase—mediated deoxyuridine triphosphate nick-end labeling technique and cell morphological testing, and the levels of proliferating cell nuclear antigen were also measured.Conclusions. The dose—response patterns were similar for all four glioma spheroids. Low concentrations of GLA (< 100 µM) increased both apoptosis and proliferation with a net increase in tumor growth and invasion, whereas high-dose GLA (> 100 µM) significantly impaired spheroid cell growth. The proliferative effects of low-dose GLA could be a hazard in the clinical treatment of malignant glioma; however, because of the low toxicity of GLA against normal cells, local delivery of millimolar doses of GLA could significantly reduce tumor size.
Enhanced radiosensitivity of malignant glioma cells after adenoviral p53 transduction
Authors: Broaddus William C. , Liu Yue , Steele Laura L. , Gillies George T. , Lin Peck-Sun , Loudon William G. , Valerie Kristoffer , Schmidt-Ullrich Rupert K. , Fillmore Helen L. 
Published: May 2009

Object. The goal of this study was to determine whether adenoviral vector—mediated expression of human wildtype p53 can enhance the radiosensitivity of malignant glioma cells that express native wild-type p53.The p53 gene is thought to function abnormally in the majority of malignant gliomas, although it has been demonstrated to be mutated in only approximately 30%. This has led to studies in which adenoviral transduction with wild-type human p53 has been investigated in an attempt to slow tumor cell growth. Recent studies suggest that reconstitution of wild-type p53 can render cells more susceptible to radiation-mediated death, primarily by p53-mediated apoptosis.Methods. Rat RT2 glioma cells were analyzed for native p53 status by reverse transcriptase—polymerase chain reaction and sequence analysis and for p53 expression by Western blot analysis. Clonogenic survival and the terminal deoxynucleotidyl transferase—mediated deoxyuridine triphosphate nick-end labeling assay were used to characterize RT2 cell radiosensitivity and apoptosis, respectively, with and without prior transduction with p53-containing and control adenoviral vectors. Animal survival length was monitored after intracerebral implantation with transduced and nontransduced RT2 cells, with and without cranial radiation.The RT2 cells were demonstrated to express native rat wild-type p53 and to markedly overexpress human p53 following adenoviral p53 transduction. The combination of p53 transduction followed by radiation resulted in marked decreases in RT2 cell survival and increases in apoptosis at radiation doses from 2 to 6 Gy. Animals receiving cranial radiation after intracerebral implantation with RT2 cells previously transduced with p53 survived significantly longer than control animals (p < 0.01).Conclusions. The ability to enhance the radiosensitivity of malignant glioma cells that express wild-type p53 by using adenoviral transduction to induce overexpression of p53 offers hope for this approach as a therapeutic strategy, not only in human gliomas that express mutant p53, but also in those that express wild-type p53.
Quantification of increased exposure resulting from orbital rim and orbitozygomatic osteotomy via the frontotemporal transsylvian approach
Authors: Schwartz Marc S. , Anderson Gregory J. , Horgan Michael A. , Kellogg Jordi X. , McMenomey Sean O. , Delashaw Johnny B. 
Published: May 2009

Object. Use of orbital rim and orbitozygomatic osteotomy has been extensively reported to increase exposure in neurosurgical procedures. However, there have been few attempts to quantify the extent of additional exposure gained by these maneuvers. Using a novel laboratory technique, the authors have attempted to measure the increase in the “area of exposure” that is gained by removal of the orbital rim and zygomatic arch via the frontotemporal transsylvian approach.Methods. The authors dissected five cadavers bilaterally. The area of exposure provided by the frontotemporal transsylvian approach was determined by using a frameless stereotactic device. With the tip of a microdissector placed on targets deep within the exposure, the position of the end of the microdissector handle was measured in three-dimensional space as the microdissector was rotated around the periphery of the operative field. This maneuver was performed via the frontotemporal approach alone as well as with orbital rim and orbitozygomatic osteotomy approaches. After data manipulation, the areas of exposure corresponding to the polygons used to define these handle positions were calculated and directly compared. On average, the area of exposure provided by the frontotemporal transsylvian approach was increased 26 to 39% (p < 0.05) by adding orbital rim osteotomy and an additional 13 to 22% (not significant) with removal of the zygomatic arch.Conclusions. Significant and consistent increases in surgical exposure were obtained by using orbital osteotomy, whereas zygomatic arch removal produced less consistent gains. Both maneuvers may be expected to improve surgical access. However, because larger and more consistent gains were afforded by orbital rim removal, the threshold for removal of this portion of the orbitozygomatic complex should be lower.
The anatomy of the Berrettini branch: implications for carpal tunnel release
Authors: Stančić Marin F. , Mićović Vladimir , Potoćnjak Mark 
Published: May 2009

Object. Dissections were performed in 100 fresh cadaver palms to determine the frequency with which superficial palmar communication between the median and ulnar nerves occurs and to what extent it might incur iatrogenic injury during endoscopic carpal tunnel release.Methods. Superficial palmar communication between the median and ulnar nerves was present in 81% of the dissected hands. Superficial palmar communication, also known as the Berrettini branch, has been classified into four distinct types by Ferrari and Gilbert. Twelve hands were classified as Group 1 (communication in an oblique course from the ulnar to the median nerve originating > 4 mm above the distal margin of the transverse carpal ligament [TCL]), 16 hands were classified as Group 2 (communication parallel to the distal margin of the TCL), and 53 hands were classified as Group 3 (communication in an oblique course from the ulnar nerve to the third common digital nerve, originating below the distal margin of the TCL). No hand fit the Group 4 classification (atypical communication).Conclusions. The Berrettini branch can be considered a normal anatomical finding. In 28% of the hands in this study, the branch was proximal to the edge of the distal ligament and, therefore, prone to iatrogenic injury in both one-portal and two-portal endoscopic surgery.
Ruptured cerebral pseudoaneurysm caused by the removal of a ventricular catheter
Authors: Shirane Reizo , Kondo Takeo , Yoshida Yasuko K. , Furuta Susumu , Yoshimoto Takashi 
Published: May 2009

✓ A rare case of cerebral pseudoaneurysm located at the internal carotid artery (ICA) was caused by the removal of a ventricular catheter in an infant. This 4-month-old girl underwent ventriculoperitoneal shunt revision, during which the old ventricular catheter was removed from the posterior horn of the left lateral ventricle, but the choroid plexus was pulled out by the tip of the catheter. Intraventricular hemorrhage (IVH) and subarachnoid hemorrhage were observed postoperatively. Magnetic resonance (MR) angiography performed on the 12th postoperative day revealed ICA stenosis and aneurysm formation at the C1 portion of the left ICA. Contrast-enhanced computerized tomography (CT) scans obtained on the 21st postoperative day revealed recurrent IVH and enlargement of the lesion. The patient underwent surgery for treatment of the aneurysm. Operative findings revealed a pseudoaneurysm arising from the left ICA at the proximal end of the anterior choroidal artery (AChA). The aneurysm was removed and the wall of the ICA was reconstructed. Postoperative three-dimensional CT scanning and MR angiography demonstrated disappearance of the aneurysm and preservation of the ICA. The patient was discharged without additional neurological deficits.Many complications, including IVH, are associated with removal of a ventricular catheter. This case shows that pseudoaneurysm formation can occur in a remote region due to avulsion of the AChA from the ICA. In most circumstances a ventricular catheter can be removed without difficulty. However, precision and caution should be exercised when removing a ventricular catheter.
Pure sylvian fissure arteriovenous malformations
Authors: Zimmerman Gary , Lewis Adam I. , Tew John M. 
Published: May 2009

Object. Pure sylvian fissure arteriovenous malformations (AVMs) are vascular malformations confined to the sylvian fissure without parenchymal involvement. Because the branches of the middle cerebral artery are arteries of passage and the margins between the AVM and the insula cortex may be ill defined, many surgeons regard pure sylvian fissure AVMs as inoperable. The authors reviewed their surgical experience with eight patients harboring pure sylvian fissure AVMs to determine the incidence of operative morbidity.Methods. All eight patients experienced seizures, five (63%) had headaches, and three (38%) experienced hemorrhages. Preoperatively, six patients (75%) were normal neurologically and two (25%) had neurological deficits. Five (63%) of eight sylvian fissure AVMs were located in the dominant hemisphere. The size of the nidus ranged from 6 to 27 cm3 (mean 14 cm3).Complete removal of the AVM was documented by postoperative angiography in every case. Seizures were reduced or eliminated and headaches were relieved in all affected patients. Transient neurological deficits, which included aphasia, short-term memory loss, and hemiparesis, occurred in four patients (50%). Within 3 months, all patients were functioning independently with no new neurological deficits. The status of two patients who had had preoperative neurological deficits improved postoperatively. Neuropsychological testing showed no new cognitive deficits.Conclusions. With appreciation for transient instances of postoperative morbidity, the outcome was excellent in all patients. The authors thus advocate microsurgery as the primary treatment for pure sylvian fissure AVMs.
Somatosensory representation in patients who have undergone hemispherectomy: a functional magnetic resonance study imaging
Authors: Bittar Richard G. , Ptito Alain , Reutens David C. 
Published: May 2009

Object. Removal or disconnection of an entire cerebral hemisphere is occasionally used to treat refractory seizures. Patients who have undergone a hemispherectomy provide useful models to study the reorganization of cortical somatosensory representation. This plasticity may be a consequence of the pathological lesion, the hemispherectomy itself, or both.Methods. Three patients who had undergone hemispherectomy were studied with functional magnetic resonance (fMR) imaging. Responses to sensory stimulation in normal hands and hands opposite the lesioned hemisphere were studied. Multislice T2*-weighted gradient-echo echoplanar images were obtained using a 1.5-tesla MR imager. The activation condition consisted of somatosensory stimulation of the index finger. A T1-weighted anatomical MR image was acquired. The fMR and anatomical MR images were coregistered, and statistically significant activation foci (p < 0.01) were identified. Stimulation of the normal hand produced activation in the primary somatosensory cortex (SI) in all patients. Stimulation of the impaired hand resulted in activation of the ipsilateral parietal operculum (second somatosensory area [SII]) and posterior parietal lobe (Brodmann's Area 7) in all cases, but no activation was elicited in the SI in any patient. In addition, other areas within the ipsilateral frontal and parietal lobes were activated in some individuals.Conclusions. Residual somatosensory function in the hand opposite the lesioned hemisphere is mediated by the SII and other cortical regions in the intact hemisphere, without involvement of the SI.
Activation of the anterior cingulate cortex by thalamic stimulation in patients with chronic pain: a positron emission tomography study
Authors: Davis Karen D. , Taub Ethan , Duffner Frank , Lozano Andres M. , Tasker Ronald R. , Houle Sylvain , Dostrovsky Jonathan O. 
Published: May 2009

Object. Deep brain stimulation (DBS) of the sensory thalamus has been used to treat chronic, intractable pain. The goal of this study was to investigate the thalamocortical pathways activated during thalamic DBS.Methods. The authors compared positron emission tomography (PET) images obtained before, during, and after DBS in five patients with chronic pain. Two of the five patients reported significant DBS-induced pain relief during PET scanning, and the remaining three patients did not report any analgesic effect of DBS during scanning. The most robust effect associated with DBS was activation of the anterior cingulate cortex (ACC). An anterior ACC activation was sustained throughout the 40 minutes of DBS, whereas a more posteriorly located ACC activation occurred at a delay after onset of DBS, although these activations were not dependent on the degree of pain relief reported during DBS. However, implications specific to the analgesic effect of DBS require further study of a larger, more homogeneous patient population. Additional effects of thalamic DBS were detected in motor-related regions (the globus pallidus, cortical area 4, and the cerebellum) and visual and association cortical areas.Conclusions. The authors demonstrate that the ACC is activated during thalamic DBS in patients with chronic pain.