bluuebunny/crossref_metadata_2025_split huggingface dataset:
Coexisting Cervical and Lumbar Spinal Stenosis: Diagnosis and Management
Authors: Epstein Nancy E. , Epstein Joseph A. , Carras Robert , Murthy Vishnubhakat S. , Hyman Roger A. 
Published: May 2010

Abstract
An attempt has been made to identify and manage patients symptomatic from both cervical and lumbar spinal stenosis. The order of operative intervention was related to the degree of myelopathy and radiculopathy. Patients requiring cervical surgery first had absolute stenosis with a spinal canal equal to or less than 10 mm in anteroposterior diameter. Those requiring lumbar surgery first presented with stenosis and a canal between 11 and 13 mm in depth. In the latter group, patients presented with radiculopathy in their upper and lower extremities. A significant portion (50%) had intermittent neurogenic claudication (INC). Motor and sensory changes were severe in those with absolute as compared to relative stenosis. After cervical laminectomy, myelopathy improved or stabilized, and the subsequent lumbar decompression could be completed with less risk. Cervical cord decompression often resulted in improvement in lumbar symptoms with resolution of pain, spasticity, and sensory deficits of myelopathic origin. However, latent symptoms of INC caused by lumbar stenosis were not affected by cervial decompression and increased in severity. Electrodiagnostic studies were helpful in that somatosensory evoked potentials showed conduction delays in the cervical cord in patients with significant disease. The identification of motor neuron disease and peripheral neuropathies was essential. The surgical management included extensive, multiple level laminectomy, unroofing of the lateral recesses, and foraminotomy. Neurolysis and untethering of the spinal cord was essential. Significant improvement was shown by 90% of these patients.
High Dose Glucocorticoids in the Management of Severe Head Injury
Authors: Giannotta Steven L. , Weiss Martin H. , Apuzzo Michael L.J. , Martin Evangeline 
Published: May 2010

Abstract
Eighty-eight patients with a Glasgow coma score of 8 or less 6 hours after nonpenetrating head trauma were given either high dose methylprednisolone sodium succinate (30 mg/kg q6h ×2, then 250 mg q6h ×6, then tapering over 8 days), low dose methylprednisolone (1.5 mg/kg q6h ×2, then 25 mg q6h ×6, then tapering over 8 days), or placebo. Standard care including the removal of traumatic hematomas, assisted ventilation, and intracranial pressure monitoring and control was carried out. Follow-up assessments were performed on all surviving patients at 6 months and were graded according to the Glascow outcome scale. No statistically significant difference in outcome was seen between the low dose group and the placebo group. The high dose group experienced a mortality of 39% as compared to a 52% mortality in the low dose and placebo groups (P &lt; 0.05). Mortality differences were most marked in patients less than 40 years old, with the high dose group experiencing a mortality of 6% as compared to a 43% mortality for the low dose and placebo groups (P &lt; 0.05). For patients under 50 years old, the incidence of recovery of speech was 62% compared to 36% in the low dose and placebo groups (P &lt; 0.5). The increased survival in those treated with high dose corticoids, however, was associated with an increase in the poorer outcome categories.
Computed Tomographic Guidance Stereotaxis in the Management of Lesions of the Third Ventricular Region
Authors: Apuzzo Michael L. J. , Chandrasoma Parakrama T. , Zelman Vladimir , Giannotta Steven L. , Weiss Martin H. 
Published: May 2010

Abstract
The initial management strategies for lesions of the 3rd ventricular region are often controversial. Current techniques for computed tomographic guidance stereotaxis allow accurate access to any intracranial point. A Brown-Roberts-Wells stereotactic system was used as a technical adjunct in the initial management of 42 mass lesions of the 3rd ventricular region. Objectives included biopsy, culture, aspiration, visualization, and installment of drainage conduits. Forty-five point placements were accomplished, and 140 tissue specimens were retrieved without complication. The pathological diagnosis was substantiated in all cases and included lesions of developmental (1 case), neoplastic (31 cases), and infectious (10 cases) origins. Information based on stereotactic assessment provided a rational substrate for the initiation of management, which included craniotomy, cerebrospinal fluid diversion, radiotherapy, chemotherapy, and antibiotic or antiviral therapies. Based on this experience, it is apparent that these methods offer acceptably safe and accurate access to lesions of the entire 3rd ventricular region. Histological or microbiological diagnosis without the need for craniotomy may be readily realized and offers logical guidance for therapeutic strategies. Dependent on the pathological condition, definitive treatment may be achieved.
Clinical Use of a Portable Bedside Cerebral Blood Flow Machine in the Management of Aneurysmal Subarachnoid Hemorrhage
Authors: Rosenstein Jacob , Suzuki Mikio , Symon Lindsay , Redmond Sheila 
Published: May 2010

Abstract
Recent advances in electronics and microprocessors have enabled the development of a compact portable cerebral blood flow (CBF) machine capable of being transported to the patient's bedside. We have used such a device, the Novo Cerebrograph 2a, during the past 7 months on a regular basis in the day to day management of our patients with intracranial aneurysms. One hundred three studies were performed in 23 cases of suspected intracranial aneurysm. Twenty-two cases presented with acute subarachnoid hemorrhage. Patients were studied on admission, preoperatively, in the recovery room, on postoperative Days 1, 5, and 14, and whenever the clinical condition of the patient warranted. The preoperative admission grade was found to correlate well with the mean CBFisi (ISI: initial slope index). Grade III and IV patients had flows significantly lower than those of Grade I and II patients. Serial CBF measurements proved useful in the management of 18 of 22 cases admitted with acute subarachnoid hemorrhage. Delayed ischemic deficits secondary to vasospasm occurred in 6 cases, with a concomitant average fall in mean flow in the symptomatic hemispheres of 27.9%. After volume expansion, an average increase in flow of 29.7% was noted. Low preoperative flows influenced management decision-making in 8 cases. In a further 4 cases, serial CBF measurements were helpful in the differential diagnosis of new neurological signs.
A Prospective Study of Radiofrequency Rhizotomy in the Treatment of Posttraumatic Spasticity
Authors: Kasdon David L. , Lathi Ellen S. 
Published: May 2010

Abstract
Posttraumatic spasticity severely impedes rehabilitation potential and nursing care. Treatment of severe spasticity has included medical therapy, spinal cord ablative procedures, anterior and posterior root lesions and peripheral denervations, and tendon releases. Open rhizotomy and percutaneous radiofrequency rhizotomy have achieved good results. We prospectively studied 25 patients with severe spasticity to assess the efficacy of percutaneous radiofrequency rhizotomy. All or most of the prospectively identified goals were accomplished in 24 of the 25 patients, with improvement persisting during an average follow-up period of 12 months. The improvement due to decreased tone was much greater than the improvement due to increased range of motion.
Use of High Frequency Jet Ventilation during Mechanical Hyperventilation to Reduce Intracranial Pressure in Patients with Multiple Organ System Injury
Authors: Hurst James M. , Saul Thomas G. , DeHaven Bryan C. , Branson Rich 
Published: May 2010

Abstract
Eleven patients with multiple organ system injury, including significant closed head injury, all required positive end-expiratory pressure (PEEP) for treatment of their pulmonary pathological condition, Additionally, the need for intracranial pressure (ICP) monitoring had previously been established on clinical evaluation by the Neurosurgery Service. Seven of the 11 patients met the criteria for invasive hemodynamic monitoring. Hemodynamic monitoring data are supplied for these 7 patients. All patients, after the initial institution of conventional means of hyperventilation, were transitioned to high frequency jet ventilation (HFJV) to evaluate the effects of HFJV during mechanical hyperventilation, There was a statistically significant decrease in ICP (mean decrease of 7.2 mm Hg). There was also a statistically significant fall in PaO2 from 131 to 101 torr. This was not associated with an appreciable decrease in oxygen delivery. There was no change in cardiac output or intrapulmonary shunt fraction. It is concluded that successful control of ICP was possible in all cases without impairment of cardiac output, oxygen delivery, or cerebral perfusion pressure, even when the pulmonary abnormality required the use of PEEP.
Augmentation of Cerebral Blood Flow Induced by Hemodilution in Stroke Patients after Superficial Temporal-Middle Cerebral Arterial Bypass Operation
Authors: Wood James H. , Polyzoidis Konstantinos S. , Kee David B. , Prats Antonio R. , Gibby Gordon L. , Tindall George T. 
Published: May 2010

Abstract
Experimental hemodilutional therapy has been shown to raise collateral perfusion to acutely ischemic brain regions distal to occluded internal carotid (ICA) and middle cerebral (MCA) arteries and to reduce infarct size. Superficial temporal (STA)-MCA anastomosis surgically establishes additional regional collateralization, and this bypass angiographically enlarges over time. Despite bypass patency verification by Doppler recording made at the edge of the craniectomy, the microsurgical STA-MCA anastomosis in 11 stroke patients did not produce early changes in cerebral perfusion parameters in the MCA territory of either hemisphere as determined by 133xenon inhalation. Therefore, hemodilution was initiated in an effort to increase cerebral perfusion during this marginal period when the STA was beginning to dilate progressively. Incremental venesections with equal intravenous volume replacement with 5% human serum albumin caused a significant lowering of the hematocrit from 40 ± 1 to 33 ± 1%. This isovolemic hemodilutional therapy resulted in significant mean regional cerebral blood flow (rCBF) elevations of 23 ± 5% (SE) in the bypassed MCA territory and of 25 ± 6% in the opposite MCA region. The mean gray flow (F1) in the involved and homologous MCA regions significantly increased 27 ± 8% and 30 ± 11%, respectively. Similarly, the initial slope index (ISI2) significantly rose by 17 ± 5% in the bypassed MCA territory and by 18 ± 6% in the homologous region. These data objectively support the premise that reductions in hematocrit without intravascular volume expansion augment cerebral blood flow, probably by reducing blood viscosity. Moreover, inovolemic hemodilution, the effect of which lasts several weeks, may be useful adjunct therapy for the postoperative care of patients with marginal cerebral circulation who undergo cerebral revascularization.
Intramedullary Neurofibroma of the Cervical Spinal Cord: Case Report with Review of the Literature
Authors: Sharma Rajeev , Tandon Shiv C. , Mohanty Sureswar , Gupta Saroj 
Published: May 2010

Abstract
A case of cervical intramedullary neurofibroma diagnosed and surgically treated is reported. This patient, a 27-year-old man, had no evidence of von Recklinghausen's disease. The case is discussed, and a review of literature is presented.
Transverse Myelitis from Intraarterial Penicillin
Authors: Stafford Wesley W. , Mena Hernando , Piskun Walter S. , Weir Michael R. 
Published: May 2010

Abstract
A child was given intramuscular benzathine penicillin and experienced manifestations of sudden, irreversible transection of the spinal cord in the lower thoracic region. The biopsy supported an intravascular injection with occlusion of the spinal vasculature as the etiological mechanism. A review of similar cases reveals a recurring pattern-intramuscular injection with standard techniques and sites into a small muscle mass without evident blood return followed by rapid progression of paralysis. The problem seems to turn upon an inability to recognize the inadvertent intraarterial injection.
Nuclear Magnetic Resonance of the Spine: Clinical Potential and Limitation
Authors: Modic Michael T. , Hardy Russell W. , Weinstein Meredith A. , Duchesneau Paul M. , Paushter David M. , Boumphrey Francis 
Published: May 2010

Abstract
Magnetic resonance can visualize the vertebral bodies, discs, neural structures, cerebrospinal fluid (CSF), neural foramina, and extradural structures in the sagittal, axial, and coronal planes. The normal nucleus pulposus can be differentiated from the anulus and changes associated with degeneration. Infection, trauma, and neoplastic conditions can be identified. The signal intensity of the CSF relative to extradural and neural structures can be increased to provide evaluation of the size and configuration of the contents of the thecal sac without the use of an intrathecal contrast medium. Impingement by disc, tumors, fracture segments, and expansile masses can then be accurately evaluted, It is the most accurate modality for the evaluation of the foramen magnum, Chiari malformation, syringomyelia, infection, and degeneration of intervertebral discs. It can identify paravertebral soft tissue and bony changes when plain films and computed tomographic (CT) studies are negative or equivocal. Not only can lesions be localized, but significant information regarding the nature of the process can be obtained. Using variations of the spin-echo technique with appropriate T1 and T2-weighted images, magnetic resonance can produce tissue contrast distinctions not possible with CT scans or conventional angiography.
Traumatic Acute Epidural Hematoma: Unrecognized High Lethality in Comatose Patients
Authors: Seelig John M. , Marshall Lawrence F. , Toutant Steven M. , Toole Belinda M. , Klauber Melville R. , Bowers Sharon A. , Varnell James A. 
Published: May 2010

Abstract
A series of 51 comatose patients suffering traumatic epidural hematoma after closed head injury is reviewed. This prospective series was accumulated from the National Pilot Traumatic Coma Data Bank during a 2-year period and represents 9% of all patients entered into the Data Bank. The overall mortality was 41%, with 4% remaining in the vegetative state. Fifty per cent of these patients, all of whom were in coma, also had an associated intracerebral contusion. There was no difference in outcome with regard to sex, mode of injury, or the presence or absence of contusion or shift on the computed tomographic (CT) scan. The motor score immediately before operation was the most powerful preoperative predictor of outcome. Sixty-seven per cent or two-thirds of the patients with a motor score of 4, 5, or 6 on the Glasgow coma scale had a satisfactory outcome at last follow-up examination. In contrast, in patients with a motor score of 3 or less, two-thirds either died or remained in a vegetative state. The acute traumatic epidural hematoma is often lethal in the comatose patient. We recommend early evacuation of epidural hematomas, i.e., when they are first noted on the CT scan, rather than waiting for clinical motor deterioration.
Microsurgical Anatomy of the Deep Venous System of the Brain
Authors: Ono Michio , Rhoton Albert L. , Peace David , Rodriguez Roland J. 
Published: May 2010

Abstract
The microsurgical anatomy of the deep venous system of the brain was examined in 20 cerebral hemispheres. The deep venous system is composed of the internal cerebral, basal, and great veins and their tributaries. This system drains the deep white and gray matter surrounding the lateral and 3rd ventricles and the basal cisterns. The deep veins are divided into a ventricular group composed of the veins converging on the walls of the lateral ventricles and a cisternal group that includes the veins draining the walls of the basal cisterns. The internal cerebral vein is included in the ventricular group because it is predominantly related to the ventricles, and the basal and great veins are reviewed with the cisternal group because they course through the basal cisterns. The choroidal veins are included with the ventricle veins because they arise on the choroid plexus in the ventricles. The thalamic veins appear in both the ventricular and the cisternal groups because some course on the ventricular surfaces and others course in the basal cisterns. The operative approaches to the major trunks in this system are reviewed.
Natural History of Arteriovenous Malformations of the Brain: A Clinical Study
Authors: Fults Dan , Kelly David L. 
Published: May 2010

Abstract
The natural history of intracranial arteriovenous malformations (AVMs) was studied in 131 patients. The 83 patients managed nonsurgically and the 48 patients treated surgically were followed for an average of 8 years. Hemorrhage occurred in 61.8% of all patients. A second hemorrhage occurred in 67.4% of the survivors of the first hemorrhage. The mortality associated with recurrent hemorrhage did not increase significantly with successive episodes of hemorrhage. The rate of rebleeding was 17.9%/year initially, but declined to 3%/year after 5 years and then to 2%/year after 10 years. Among patients treated nonsurgically, the prognosis was more favorable for patients presenting with seizures than for patients presenting with hemorrhage. Patients in the seizure group had a 26.9% incidence of hemorrhage causing an 11.6% mortality; 40.5% of the patients in the hemorrhage group died. The prognosis was poor for patients with posterior fossa A V Ms; the mortality was 66.7% with the first hemorrhage. Recurrent posterior fossa hemorrhage was the rule in survivors, and most of those hemorrhages were fatal. The prognosis for children with AVMs was no different from that for adults.
Access to the Posterior Medial Temporal Lobe Structures in the Surgical Treatment of Temporal Lobe Epilepsy
Authors: Spencer Dennis D. , Spencer Susan S. , Mattson Richard H. , Williamson Peter D. , Novelly Robert A. 
Published: May 2010

Abstract
The authors describe a surgical technique that allows access to the posterior temporal horn of the lateral ventricle with preservation of the most functional lateral temporal cortex. Development of the technique was stimulated by the need to resect posteromedial temporal lobe structures in patients with intractable complex partial epilepsy and well-identified unilateral posterior hippocampal foci. This technique has also been of value in the resection of some lateral ventricular and posteromedial temporal lobe masses. The operation consists of three steps. No more than 4.5 cm of the anterolateral temporal lobe is removed en bloc such that the most anterior aspect of the temporal horn is entered. An incision is carried from the floor of the temporal horn through the inferior longitudinal fasciculus to the middle fossa dura mater and posteriorally into the lateral ventricular atrium. The lateral temporal cortex and white matter are then elevated with a self-retaining retractor. This exposes the posteromedial temporal horn or intraaxial mass for excision or allows en bloc resection of the entire hippocampus and medial temporal lobe structures while preserving the functional association areas of the lateral temporal cortex, including speech and visual spatial function.
Sacral Fractures
Authors: Schmidek Henry H. , Smith Donald A. , Kristiansen Thomas K. 
Published: May 2010

Abstract
The sacral spine has received relatively little attention in the orthopedic and neurosurgical literature, in part because of the infrequency of developmental, degenerative, or neoplastic conditions of the sacrum requiring surgical intervention. This neglect is unwarranted in trauma, however, because sacral fracture and its associated neural deficit are both common and often complex problems. The sacrum and pelvis behave as a single functional unit; an understanding of the principles of sacropelvic stability has obvious relevance in planning the occasional resection of a sacral tumor and in dealing with the common problem of massive pelvic trauma. A classification of sacral fractures is reviewed along with the usual patterns of neurological involvement. Through analysis of an institutional series of cases, a specific attempt is made to correlate varying types of vertical sacral fractures with differing types of pelvic injury. The radiographic and physiological investigation of sacral fractures is reviewed, as are the various options for achieving the reduction, decompression, and stabilization of sacral fractures.
Fifty Years of Experience with Chordomas in Southeast Scotland
Authors: O'Neill P. , Bell B.A. , Miller J.D. , Jacobson I. , Guthrie W. 
Published: May 2010

Abstract
We report the clinical presentation and management of 34 patients with a histologically proven chordoma, treated in the neurosurgical departments in Edinburgh and Dundee, over the past 50 years. Although these tumors are commonly regarded as being locally invasive with a variable, but generally slow growth rate, they can metastasize, and this may precede surgical intervention, as in one of our patients. Our cases are compared to those in previously published series, and a comprehensive review of the treatment modalities for tumors at various sites is presented. The optimal treatment to be recommended from our own experience, and that of others, is aggressive operation and radiotherapy. A combination of hyperthermia and chemotherapy has shown some promise, but remains untested, and highlights the need for a multicenter trial with long follow-up to allow the evaluation of new therapeutic approaches.
Rupture of Previously Unruptured Giant Carotid Aneurysm after Superficial Temporal-Middle Cerebral Artery Bypass and Internal Carotid Occlusion
Authors: Matsuda Masayuki , Shiino Akihiko , Handa Jyoji 
Published: May 2010

Abstract
A 51-year-old woman with an unruptured giant aneurysm of the internal carotid artery was treated by gradual occlusion of the internal carotid artery in the neck combined with a superficial temporal artery to middle cerebral artery bypass graft. Visual field defects improved after the operation, and thrombosis of the aneurysm was confirmed by angiography and computed tomography. Nevertheless, a fatal hemorrhage occurred 34 days after the final turn of the Selverstone clamp. The possible mechanism of rupture of the apparently thrombosed aneurysm is discussed. There is a risk of rupture of the aneurysm as long as the aneurysmal lumen remains after proximal ligation, no matter how small it may be.
Intraventricular Cavernous Hemangioma: Report of Three Cases and Review of the Literature
Authors: Chadduck William M. , Binet Eugene F. , Farrell Fank W. , Araoz Carlos A. , Reding David L. 
Published: May 2010

Abstract
The clinical and radiographic presentations of 3 patients with intraventricular cavernous hemangioma are described. The accumulated total of 19 cases from the literature are compared to determine whether there is a common clinical and radiographic presentation for this benign intraventricular lesion. The differential diagnosis of intraventricular cavernous hemangioma includes intraventricular meningioma, choroid plexus papilloma, arteriovenous malformation, low grade astrocytoma, and ependymoma.