bluuebunny/crossref_metadata_2025_split huggingface dataset:
Radiosurgery and radiotherapy: observations and clarifications
Authors: Kondziolka Douglas , Lunsford L. Dade , Loeffler Jay S. , Friedman William A. 
Published: May 2009

Object. Radiosurgery and radiation therapy represent important but unique treatment paradigms for patients with certain neoplasms, vascular lesions, or functional disorders. The authors discuss their differences.
Methods. Reviewing the authors' experiences shows how the roles of these approaches vary just as their techniques differ. The distinct differences include the method of target localization (intraoperative compared with pretreatment) and irradiation (focused compared with wide-field), their radiobiology (effects of a single high-dose compared with multiple fractions), the physicians and other health personnel involved in the conduct of these procedures (surgical team compared with radiation team), and the expectations that follow treatment. During the last decade, considerable confusion has grown regarding nomenclature, requisite physician training, and the roles of the physician and surgeon. Ten years ago, two task forces on radiosurgery were created by national organizations in neurosurgery and radiation oncology to address these issues of procedural conduct and quality-assurance requirements. At the present time these guidelines are widely ignored. Currently, many patients, payers, and regulatory agencies are bewildered. What are the differences among stereotactic radiosurgery, fractionated radiation therapy, and stereotactic radiation therapy? Radiosurgery is to radiation therapy as microsurgery is to “microtherapy.”
Conclusions. In this report the authors discuss terminology, training, and physician roles in this expanding field.
Postoperative evaluation of microsurgical resection for cavernous malformations of the brainstem
Authors: Kikuta Ken-ichiro , Nozaki Kazuhiko , Takahashi Jun A. , Miyamoto Susumu , Kikuchi Haruhiko , Hashimoto Nobuo 
Published: May 2009

Object. The aim of this study was to propose criteria to determine whether complete resection of cavernous malformations in the brainstem had been achieved.
Methods. The authors retrospectively analyzed data in 10 patients harboring a single cavernous malformation who had presented with hemorrhagic symptoms and had been followed up for longer than 2 years postsurgery. The study population consisted of five male and five female patients ranging in age from 13 to 57 years (mean 36.8 years). When preoperative magnetic resonance (MR) images demonstrated the lesion as a homogeneous hyperintense mass, the surgery was defined as complete or incomplete based on intraoperative findings. When preoperative MR images revealed other findings, complete resection was determined according to whether postoperative MR imaging results demonstrated lesions distinct from the peripheral hemosiderin rim. Among the 13 operations in this series, nine resulted in complete resection and were associated with no postoperative clinical relapse of hemorrhage, whereas four operations resulted in incomplete resection and were correlated with postoperative recurrent hemorrhage. The seven patients in whom the outcome of the initial operation was complete demonstrated good neurological recovery in the long-term follow-up period, whereas the three patients in whom the outcome of the initial surgery was judged to be incomplete showed inadequate neurological recovery due to recurrent hemorrhage.
Conclusions. The criteria proposed in this study to evaluate surgical treatment may be a reliable means of predicting the recurrence of hemorrhage postoperatively.
Craniotomy for supratentorial brain tumors: risk factors for brain swelling after opening the dura mater
Authors: Rasmussen Mads , Bundgaard Helle , Cold Georg Emil 
Published: May 2009

Object. Cerebral swelling often occurs during craniotomy for cerebral tumors. The primary aim in this study was to determine risk factors (intracranial pressure [ICP], patient characteristics, histopathological features, neuroimaging characteristics, anesthetic regimen, and perioperative physiological data) predictive of brain swelling through the dural opening. As a secondary aim the authors attempted to define subdural ICP thresholds associated with brain swelling.
Methods. The study population consisted of 692 patients (mean age 50 ± 15 years) scheduled for elective craniotomy for supratentorial brain tumors. Brain swelling through the dural opening was estimated according to a four-point scale. The patients were dichotomized as those without cerebral swelling (that is, brain below the dura mater [59 patients] or brain at the level of the dura mater [386 patients]) and those with cerebral swelling (that is, moderate brain swelling [205 patients] or pronounced brain swelling [42 patients]). Logistic regression analysis was used to identify subdural ICP (odds ratio [OR] 1.9, 95% confidence interval [CI] 1.72–2.1, p < 0.0001), midline shift (OR 1.06, 95% CI 1.02–1.11, p = 0.008), a diagnosis of glioblastoma multiforme (OR 2.1, 95% CI 1.01–4.3, p = 0.047), and metastasis (OR 2.9, 95% CI 1.3–6.9, p = 0.01) as independent risk factors of intraoperative brain swelling. Thresholds for ICP associated with brain swelling were defined as follows: at an ICP less than 5 mm Hg, brain swelling rarely occurred (5% probability); at an ICP greater than 13 mm Hg, brain swelling occurred with 95% probability; and at an ICP greater than 26 mm Hg, severe brain swelling occurred with 95% probability.
Conclusions. Subdural ICP is the strongest predictor of intraoperative brain swelling. It is possible to define thresholds of cerebral swelling and the authors recommend subdural ICP measurement as a tool to initiate preventive measures to reduce ICP before opening the dura mater.
Acute alterations in microvascular basal lamina after subarachnoid hemorrhage
Authors: Sehba Fatima A. , Mostafa Gulam , Knopman Jared , Friedrich Victor , Bederson Joshua B. 
Published: May 2009

Object. Aneurysmal subarachnoid hemorrhage (SAH) causes acute and delayed ischemic brain injuries. The mechanisms of acute ischemic injury following SAH are poorly understood, although an acute increase in microvascular permeability has been noted. The integrity of cerebral microvessels is maintained in part by components of basal lamina: collagen IV, elastin, lamina, and so forth. Destruction of basal lamina components by collagenases and matrix metalloproteinases (MMPs), especially MMP-9, has been known to occur in other ischemic models. The authors assessed the integrity of cerebral microvasculature after acute SAH by examining collagen IV and MMP-9 levels and collagenase activity in the microvessels.
Methods. Subarachnoid hemorrhage was induced in rats through endovascular perforation of the intracranial bifurcation of the internal carotid artery. Animals were killed 10 minutes to 48 hours after SAH or sham operation (time-matched controls). Levels of collagen IV and MMP-9 were studied in the microvasculature by performing immunoperoxidase and immunofluorescence staining, and collagenase activity was assessed by in situ zymography.
Little change occurred in collagen IV and MMP-9 immunostaining or collagenase activity at 10 minutes or 1 hour after SAH. Starting 3 hours after SAH, collagen IV immunostaining was reduced or eliminated along segments of microvessels whereas MMP-9 staining was segmentally increased. These effects reached a maximum at 6 hours and returned toward those values in sham-operated controls at 48 hours.
Conclusions. Results of this study demonstrated an acute loss of collagen IV from the cerebral microvasculature after SAH and indicated that MMP-9 contributes to this event. The loss of collagen IV might contribute to the known failure of the blood—brain barrier after SAH.
Effects of arterial geometry on aneurysm growth: three-dimensional computational fluid dynamics study
Authors: Hoi Yiemeng , Meng Hui , Woodward Scott H. , Bendok Bernard R. , Hanel Ricardo A. , Guterman Lee R. , Hopkins L. Nelson 
Published: May 2009

Object. Few researchers have quantified the role of arterial geometry in the pathogenesis of saccular cerebral aneurysms. The authors investigated the effects of parent artery geometry on aneurysm hemodynamics and assessed the implications relative to aneurysm growth and treatment effectiveness.
Methods. The hemodynamics of three-dimensional saccular aneurysms arising from the lateral wall of arteries with varying arterial curves (starting with a straight vessel model) and neck sizes were studied using a computational fluid dynamics analysis. The effects of these geometric parameters on hemodynamic parameters, including flow velocity, aneurysm wall shear stress (WSS), and area of elevated WSS during the cardiac cycle (time-dependent impact zone), were quantified. Unlike simulations involving aneurysms located on straight arteries, blood flow inertia (centrifugal effects) rather than viscous diffusion was the predominant force driving blood into aneurysm sacs on curved arteries. As the degree of arterial curvature increased, flow impingement on the distal side of the neck intensified, leading to elevations in the WSS and enlargement of the impact zone at the distal side of the aneurysm neck.
Conclusions. Based on these simulations the authors postulate that lateral saccular aneurysms located on more curved arteries are subjected to higher hemodynamic stresses. Saccular aneurysms with wider necks have larger impact zones. The large impact zone at the distal side of the aneurysm neck correlates well with other findings, implicating this zone as the most likely site of aneurysm growth or regrowth of treated lesions. To protect against high hemodynamic stresses, protection of the distal side of the aneurysm neck from flow impingement is critical.
Progression of a posterior communicating artery infundibulum into an aneurysm in a patient with Alagille syndrome
Authors: Cowan John A. , Barkhoudarian Garni , Yang Lynda J. S. , Thompson B. Gregory 
Published: May 2009

✓ The authors present a case in which a posterior communicating artery (PCoA) infundibulum progressed into an aneurysm in a patient with Alagille syndrome (arteriohepatic dysplasia). The 3-mm PCoA infundibulum had been noted on angiography studies obtained 5 years earlier, prior to clip occlusion of a basilar tip aneurysm. Recently, the patient presented to the emergency department with the sudden onset of headache and decreased mental status. A computerized tomography scan of the head with three-dimensional angiography revealed no gross subarachnoid hemorrhage, but did demonstrate a 5-mm PCoA aneurysm. Lumbar puncture demonstrated xanthochromia and a large quantity of red blood cells. The patient underwent open surgery for aneurysm clip occlusion and obtained a good recovery.
This case illustrates the small but growing number of examples of infundibulum progression. It also indicates the need for a close follow up in patients with congenital abnormalities that may pose an increased risk for what has traditionally been considered a benign lesion.
White matter fiber dissection of the optic radiations of the temporal lobe and implications for surgical approaches to the temporal horn
Authors: Sincoff Eric H. , Tan Yunxi , Abdulrauf Saleem I. 
Published: May 2009

Object.The aim of this anatomical study was to define more fully the three-dimensional (3D) relationships between the optic radiations and the temporal horn and superficial anatomy of the temporal lobe by using the Klingler white matter fiber dissection technique. These findings were correlated with established surgical trajectories to the temporal horn. Such surgical trajectories have implications for amygdalohippocampectomy and other procedures that involve entering the temporal horn for the resection of tumors or vascular lesions.Methods.Ten human cadaveric hemispheres were prepared with several cycles of freezing and thawing by using a modification of the method described by Klingler. Wooden spatulas were used to strip away the deeper layers of white matter progressively in a lateromedial direction, and various association, projection, and commissural fibers were demonstrated. As the dissection progressed, photographs of each progressive layer were obtained. Special attention was given to the optic radiation and to the sagittal stratum of which the optic radiation is a part. The trajectories of fibers in the optic radiation were specifically studied in relation to the lateral, medial, superior, and inferior walls of the temporal horn as well as to the superficial anatomy of the temporal lobe. In three of the hemispheres coronal sections were made so that the relationship between the optic radiation and the temporal horn could be studied more fully.In all 10 hemispheres that were dissected the following observations were made. 1) The optic radiation covered the entire lateral aspect of the temporal horn as it extends to the occipital horn. 2) The anterior tip of the temporal horn was covered by the anterior optic radiation along its lateral half. 3) The entire medial wall of the temporal horn was free from optic radiation fibers, except at the level at which these fibers arise from the lateral geniculate body to ascend over the roof of the temporal horn. 4) The superior wall of the temporal horn was covered by optic radiation fibers. 5) The entire inferior wall of the temporal horn was free from optic radiation fibers anterior to the level of the lateral geniculate body.Conclusions.Fiber dissections of the temporal lobe and horn demonstrated the complex 3D relationships between the optic radiations and the temporal horn and superficial anatomy of the temporal lobe. Based on the results of this study, the authors define two anatomical surgical trajectories to the temporal horn that would avoid the optic radiations. The first of these involves a transsylvian anterior medial approach and the second a pure inferior trajectory through a fusiform gyrus. Lateral approaches to the temporal horn through the superior and middle gyri, based on the authors' findings, would traverse the optic radiations.
Continuous-flow shunt for treatment of hydrocephalus due to lesions of the posterior fossa
Authors: Arriada Nicasio , Sotelo Julio 
Published: May 2009

Object. Management of hydrocephalus caused by expansive lesions of the posterior fossa is complicated by two main drawbacks of shunt devices: sudden decompression and overdrainage. The ventriculoperitoneal (VP) continuous-flow (CF) shunt is characterized by a peritoneal catheter with an internal diameter of 0.51 mm that promotes continuous drainage of cerebrospinal fluid (CSF) at its production rate. The authors have previously demonstrated in adult patients with hydrocephalus that sudden decompression and overdrainage are absent when this shunt is used; here they report the findings of a prospective study in which the goal was to test the performance of this shunt in patients with severe hydrocephalus due to lesions of the posterior fossa.
Methods. During a 5-year period, 103 patients with severe hydrocephalus caused by lesions of the posterior fossa were treated by placement of a VP shunt. In 53 of these patients (control group) a shunt and valve system was surgically implanted and in 50 patients a CF shunt was implanted. All patients were followed up for a minimum of 2 years after surgery.
Shunt revision or change was necessary in 21 patients (40%) with conventional shunts and in four patients (8%) with the CF shunt (p < 0.003). Signs of overdrainage were observed in 18 patients (34%) in the control group, four of whom had ascending transtentorial herniation; this complication was not seen in patients with the CF shunt.
Conclusions. The CF shunt had a low rate of dysfunction and an absence of complications caused by overdrainage, which were frequently associated with the control shunts. The hydrodynamic properties of the CF shunt make it effective, even in severe cases of hydrocephalus caused by lesions of the posterior fossa.
Contralateral motor rootlets and ipsilateral nerve transfers in brachial plexus reconstruction
Authors: Bertelli Jayme Augusto , Ghizoni Marcos Flávio 
Published: May 2009

Object. The goal of this study was to evaluate outcomes in patients with brachial plexus avulsion injuries who underwent contralateral motor rootlet and ipsilateral nerve transfers to reconstruct shoulder abduction/external rotation and elbow flexion.
Methods. Within 6 months after the injury, 24 patients with a mean age of 21 years underwent surgery in which the contralateral C-7 motor rootlet was transferred to the suprascapular nerve by using sural nerve grafts. The biceps motor branch or the musculocutaneous nerve was repaired either by an ulnar nerve fascicular transfer or by transfer of the 11th cranial nerve or the phrenic nerve. The mean recovery in abduction was 90° and 92° in external rotation. In cases of total palsy, only two patients recovered external rotation and in those cases mean external rotation was 70°. Elbow flexion was achieved in all cases. In cases of ulnar nerve transfer, the muscle scores were M5 in one patient, M4 in six patients, and M3+ in five patients. Elbow flexion repair involving the use of the 11th cranial nerve resulted in a score of M3+ in five patients and M4 in two patients. After surgery involving the phrenic nerve, two patients received a score of M3+ and two a score of M4. Results were clearly better in patients with partial lesions and in those who were shorter than 170 cm (p < 0.01). The length of the graft used in motor rootlet transfers affected only the recovery of external rotation. There was no permanent injury at the donor sites.
Conclusions. Motor rootlet transfer represents a reliable and potent neurotizer that allows the reconstruction of abduction and external rotation in partial injuries.
Volumetric thermal devascularization of large meningiomas
Authors: Kato Amami , Fujimoto Yasunori , Taniguchi Masaaki , Hashimoto Naoya , Hirayama Azuma , Kinoshita Manabu , Baba Takahito , Maruno Motohiko , Yoshimine Toshiki 
Published: May 2009

Object. Controlling hemorrhage is crucial in the safe and efficient removal of large meningiomas. Intravascular embolization is not always a satisfactory means of accomplishing this goal because of the procedure's hemostatic effect and risk of complications. The authors in this study used a volumetric thermal ablation technique incorporating radiofrequency energy, image guidance, and local temperature control to devascularize tumor tissue.
Methods. Five patients with large meningiomas were treated. The target and orientation of the radiofrequency thermal ablation (RFTA) were simulated preoperatively to maximize devascularization of the lesion without thermal injury to adjacent critical structures. Image fusion, three-dimensional reconstruction, and image-guided methods provided for optimized trajectories and targets for insertion of the RFTA needle. During ablation, local temperatures of the tissue being cauterized were monitored continuously to limit the ablated lesion to within the target volume.
The effects of devascularization and the softening of the tumor parenchyma facilitated lesion removal. The intracranial ablated meningioma changed into necrotic tissue and shrank within a few months. Histopathological examination of the ablated lesion revealed sharply demarcated coagulation necrosis.
Conclusions. Volumetric thermal devascularization can be applied safely in the treatment of large meningiomas to facilitate surgical manipulation of the lesion as well as to reduce its size palliatively. The procedure's usefulness should be studied further in a larger number of cases with different tumor characteristics.
Transient focal cerebral ischemia—induced neurogenesis in the dentate gyrus of the adult mouse
Authors: Türeyen Kudret , Vemuganti Raghu , Sailor Kurt A. , Bowen Kellie K. , Dempsey Robert J. 
Published: May 2009

Object. Throughout the life of a mammal, new neurons are produced each day from resident progenitor cells located in the hippocampal dentate gyrus (DG). The availability of transgenic and knockout mice enables the evaluation of specific molecular mediators of this phenomenon. To facilitate such studies the authors characterized the proliferation, survival, and maturation of progenitor cells in the DG of adult mice following transient focal cerebral ischemia.
Methods. Anesthesia was induced in adult C57BL/6 mice by administering halothane. The middle cerebral artery (MCA) was then occluded for 120 minutes by applying an endovascular suture. The marker used to detect the presence of proliferating cells, 5-bromodeoxyuridine (BrdU; 50 mg/kg) was administered intraperitoneally twice daily on Days 2 through 6 after the MCA occlusion. Cohorts of mice were killed on Days 7 and 21, after which their brains were sectioned and BrdU-positive cells were detected using immunohistochemical analysis. The phenotype of the BrdU-positive cells was identified by fluorescent triple labeling by using antibodies specific for neuronal and astroglial markers together with anti-BrdU antibodies. The infarction was confirmed by applying cresyl violet staining.
Compared with sham-operated control animals, there was a 4.6-fold (p < 0.05) increase in BrdU-positive cells in the ipsilateral DG at Day 7 postischemia. Twenty-one percent of the newly proliferated cells survived to Day 21 postischemia. At this time, the newly proliferated cells expressed the immature and mature neuron markers doublecortin and NeuN, respectively, but none expressed the astroglial marker glial fibrillary acidic protein.
Conclusions. Focal ischemia induces neurogenesis in the DG of the mouse brain; this may be critical for postischemic brain repair.
Peripheral nerve regeneration by transplantation of bone marrow stromal cell—derived Schwann cells in adult rats
Authors: Mimura Toshiro , Dezawa Mari , Kanno Hiroshi , Sawada Hajime , Yamamoto Isao 
Published: May 2009

Object. Bone marrow stromal cells (BMSCs) can be induced to form Schwann cells by sequentially treating the cells with β-mercaptoethanol and retinoic acid, followed by forskolin and neurotrophic factors including heregulin. In this study the authors made artificial grafts filled with BMSC-derived Schwann cells (BMSC-DSCs) and transplanted them into the transected sciatic nerve in adult rats to evaluate the potential of BMSCs as a novel alternative method of peripheral nerve regeneration.
Methods. The BMSC-DSCs were suspended in Matrigel and transferred into hollow fibers (12 mm in length), which were transplanted into the transected sciatic nerve in adult Wistar rats. Six months after cell transplantation, electrophysiological evaluation and walking track analysis were performed. Results of these studies showed significant improvement in motor nerve conduction velocity and sciatic nerve functional index in the BMSC-DSC—transplanted group compared with the control group (Matrigel graft only). Immunohistochemical study data demonstrated that transplanted BMSCs labeled with retrovirus green fluorescent protein were positive for P0 and myelin-associated glycoprotein and had reconstructed nodes of Ranvier and remyelinated regenerated nerve axons. The number of regenerated axons in the axial section of the central portion of the graft was significantly greater in the transplanted group. Although BMSCs can differentiate into several types of cells, tumor formation did not occur 6 months after engraftment.
Conclusions. Results in this study indicate that BMSC-DSCs have great potential to promote regeneration of peripheral nerves. The artificial graft made with BMSC-DSCs represents an alternative method for the difficult reconstruction of a long distance gap in a peripheral nerve.