bluuebunny/crossref_metadata_2025_split huggingface dataset:
Application of shock waves as a treatment modality in the vicinity of the brain and skull
Authors: Nakagawa Atsuhiro , Kusaka Yasuko , Hirano Takayuki , Saito Tsutomu , Shirane Reizo , Takayama Kazuyoshi , Yoshimoto Takashi 
Published: May 2009

Object. Shock waves have not previously been used as a treatment modality for lesions in the brain and skull because of the lack of a suitable shock wave source and concerns about safety. Therefore, the authors have performed experiments aimed at developing both a new, compact shock wave generator with a holmium:yttrium-aluminum-garnet (Ho:YAG) laser and a safe method for exposing the surface of the brain to these shock waves.
Methods. Twenty male Sprague—Dawley rats were used in this study. In 10 rats, a single shock wave was delivered directly to the brain, whereas the protective effect of inserting a 0.7-mm-thick expanded polytetrafluoroethylene (ePTFE) dural substitute between the dura mater and skull before applying the shock wave was investigated in the other 10 rats. Visualizations on shadowgraphy along with pressure measurements were obtained to confirm that the shock wave generator was capable of conveying waves in a limited volume without harmful effects to the target. The attenuation rates of shock waves administered through a 0.7-mm-thick ePTFE dural substitute and a surgical cottonoid were measured to determine which of these materials was suitable for avoiding propagation of the shock wave beyond the target.
Conclusions. Using the shock wave generator with the Ho:YAG laser, a localized shock wave (with a maximum overpressure of 50 bar) can be generated from a small device (external diameter 15 mm, weight 20 g). The placement of a 0.7-mm-thick ePTFE dural substitute over the dura mater reduces the overpressure of the shock wave by 96% and eliminates damage to surrounding tissue in the rat brain. These findings indicate possibilities for applying shock waves in various neurosurgical treatments such as cranioplasty, local drug delivery, embolysis, and pain management.
Osler and the “medico-chirurgical neurologists”: Horsley, Cushing, and Penfield
Authors: Feindel William 
Published: May 2009

✓ Sir Victor Horsley's lecture “On the Technique of Operations on the Central Nervous System,” delivered in Toronto in 1906, set the stage for an appraisal of Sir William Osler as a protagonist for the emerging specialty of neurosurgery.
During his time at McGill University from 1871 to 1884, Osler performed more than 1000 autopsies. His pathological reports covered the topics of cerebral aneurysm, apoplectic hemorrhage, vascular infarction, subdural hematoma, meningitis, multiple sclerosis, cerebral abscess, and brain tumor. He wrote about cerebral localization and anatomy and the relationships between the morphological characteristics of the brain and intelligence and criminality. During his continuing career at Philadelphia and Baltimore, Osler published widely on problems in clinical neurology, including monographs on cerebral palsies and chorea as well as chapters on disorders of the nervous system in the first five editions of his popular textbook, The Principles and Practice of Medicine. He became familiar with many of the outstanding figures in medical neurology of his time.
Regarding neurosurgery, Osler commended the pioneer operation for a brain tumor in 1884 by Rickman Godlee and the surgery for epilepsy in 1886 by Horsley. In 1907, in discussing the state of brain surgery as reviewed by Horsley, William Macewen, and others, Osler made a plea for “medico-chirurgical neurologists, properly trained in the anatomical, physiological, clinical and surgical aspects of the subject.” He played a significant role as a referring physician, mentor, and friend to his young colleague Harvey Cushing (later to become Osler's Boswell), who was breaking new ground in neurosurgery at Johns Hopkins Hospital. Beyond that Osler became an inspiring hero figure for his Oxford student Wilder Penfield, who a few decades later would establish a neurological institute at McGill University where medico-chirurgical neurology would flourish.
Unruptured paraclinoid aneurysms: a management strategy
Authors: Iihara Koji , Murao Kenichi , Sakai Nobuyuki , Shindo Atsushi , Sakai Hideki , Higashi Toshio , Kogure Shuji , Takahashi Jun C. , Hayashi Katsuhiko , Ishibashi Toshihiro , Nagata Izumi 
Published: May 2009

Object. To elucidate an optimal management strategy for unruptured paraclinoid aneurysms, the authors retrospectively reviewed their experience in the treatment of 100 patients who underwent 112 procedures for 111 paraclinoid aneurysms performed using direct surgery and/or endovascular treatment.
Methods. Between 1997 and 2002, 111 unruptured paraclinoid aneurysms categorized according to a modified al-Rodhan classification (Group Ia, 30 anterior wall lesions; Group Ib, 25 ventral paraclinoid lesions; Group II, 18 true ophthalmic artery lesions; Group III, 37 carotid cave lesions; and Group IV, one transitional lesion) were treated by direct surgery (35 lesions) and/or endovascular treatment (77 lesions) (one aneurysm was treated by both procedures). In lesions in Groups Ia, Ib, II, and III that were treated by endovascular treatment, complete aneurysm obliteration was achieved in 50, 65, 50, and 78%, respectively, and the combined transient and permanent morbidity rates due to cerebral embolic events were 20, 25, 20, and 13.9%, respectively. Overall, the transient morbidity rate after endovascular treatment was 14.3% and the permanent morbidity rate was 6.5%. Notably, permanent visual deficits caused by retinal embolism occurred after endovascular treatment in two patients with Group II aneurysms. Direct surgery was mainly performed in Groups Ia (20 lesions), Ib (five lesions), and II (eight lesions), with complete neck clip occlusion achieved in 80, 80, and 71.4%, respectively; the transient and permanent morbidity rates associated with aneurysms treated by surgery were 8.6 and 2.9%, respectively.
Conclusions. Endovascular therapy for superiorly projecting paraclinoid aneurysms (Groups Ia and II) is associated with lower rates of complete obliteration than direct surgery, and with rates of cerebral embolic events comparable to those of endovascular treatment in the other groups. Furthermore, endovascular treatment for Group II aneurysms entails additional risks of retinal embolism. Therefore, direct surgery is recommended for the treatment of paraclinoid aneurysms projecting superiorly. For other groups, especially for Group III, endovascular treatment is the acceptable first line of therapy.
Smaller cerebral aneurysms producing more extensive subarachnoid hemorrhage following rupture: a radiological investigation and discussion of theoretical determinants
Authors: Russell Stephen M. , Lin Ke , Hahn Sigrid A. , Jafar Jafar J. 
Published: May 2009

Object. The goal of this study was to determine the relationship between aneurysm size and the volume of subarachnoid hemorrhage (SAH).
Methods. One hundred consecutive patients who presented with acute SAH, which was diagnosed on the basis of a computerized tomography (CT) scan within 24 hours postictus and, subsequently, confirmed to be aneurysmal in origin by catheter angiography, were included in this study. The data were collected prospectively in 32 patients and retrospectively in 68. The volume of SAH on the admission CT scan was scored in a semiquantitative manner from 0 to 30, according to a previously published method.
The mean aneurysm size was 8.3 mm (range 1–25 mm). The mean SAH volume score was 15 (range 0–30). Regression analysis revealed that a smaller aneurysm size correlated with a more extensive SAH (r2 = 0.23, p < 0.0001). Other variables including patient sex and age, intraparenchymal or intraventricular hemorrhage, multiple aneurysms, history of hypertension, and aneurysm location were not statistically associated with a larger volume of SAH.
Conclusions. Smaller cerebral aneurysm size is associated with a larger volume of SAH. The pathophysiological basis for this correlation remains speculative.
Dose—volume prediction of radiation-related complications after proton beam radiosurgery for cerebral arteriovenous malformations
Authors: Barker Fred G. , Butler William E. , Lyons Sue , Cascio Ethan , Ogilvy Christopher S. , Loeffler Jay S. , Chapman Paul H. 
Published: May 2009

Object. The use of radiosurgery for the treatment of cerebral arteriovenous malformations (AVMs) and other lesions demands an accurate understanding of the risk of radiation-related complications. Some commonly used formulas for predicting risk are based on extrapolation from small numbers of animal experiments, pilot human treatment series, and theoretical radiobiological considerations. The authors studied the incidence of complications after AVM radiosurgery in relation to dose, volume, and other factors in a large patient series.
Methods. A retrospective review was conducted in 1329 patients with AVM treated by Dr. Raymond Kjellberg at the Harvard Cyclotron Laboratory (HCL) between 1965 and 1993. Dose and volume were obtained from HCL records, and information about patient follow up was derived from concurrent clinical records, questionnaires, and contact with referring physicians. Multivariate logistic regression with bootstrapped confidence intervals was used.
Follow up was available in 1250 patients (94%); the median follow-up duration was 6.5 years. The median radiation dose was 10.5 Gy and the median treatment volume was 33.7 cm3. Twenty-three percent of treated lesions were smaller than 10 cm3. Fifty-one permanent radiation-related deficits occurred (4.1%). Of 1043 patients treated with a dose predicted by the Kjellberg isoeffective centile curve to have a less than 1% complication risk, 1.8% suffered radiation-related complications. Actual complication rates were 4.7% for 128 patients treated at Kjellberg risk centile doses of 1 to 1.8%, and 34% for 61 patients treated at risk centile doses of 2 to 2.5%. The fitted logistic model showed that complication risk was related to treatment dose and volume, thalamic or brainstem location, and patient age.
Conclusions. The Kjellberg isoeffective risk centile curve significantly underpredicted actual risks of permanent complications after proton beam radiosurgery for AVMs. Actual risks were best predicted using a model that accounted for treatment dose and volume, lesion location, and patient age.
Cocaine use as a predictor of outcome in aneurysmal subarachnoid hemorrhage
Authors: Howington Jay U. , Kutz Scott C. , Wilding Gregory E. , Awasthi Deepak 
Published: May 2009

Object. The goal of this study was to analyze the relationship between cocaine use and outcomes of aneurysmal subarachnoid hemorrhage (SAH).
Methods. A retrospective review was performed of the medical records of patients with intracranial aneurysms treated at a single institution between January 1996 and December 2001. Only patients who presented with SAH were included in the study. The covariates chosen for the statistical analysis included the following: patient age, sex, and race; systolic and mean arterial blood pressure measurements on hospital admission; Hunt and Hess and Fisher grades; preexistent major systemic disease; and history of alcohol, tobacco, or cocaine use. The Glasgow Outcome Scale (GOS) was used to standardize outcome and was dichotomized such that a score between 1 and 3 was considered a poor outcome and a score of 4 or 5 was considered a favorable outcome.
The records of 151 patients were reviewed and 108 of these presented with aneurysmal SAH. Of these 108 patients, 36 (33.3%) had used cocaine within 24 hours before presentation. A Hunt and Hess grade of IV or V was assigned to 20 (55.6%) of 36 patients who used cocaine, compared with eight (11.1%) of 72 patients who did not; this difference was found to be statistically significant (p < 0.0001). Twenty-eight patients (77.8%) in the cocaine user group and 20 patients (27.8%) in the non—cocaine user group experienced clinically significant, angiographically confirmed vasospasm during their hospital course (p < 0.0001). Cocaine use was associated with a 2.8-fold greater risk of developing vasospasm (95% confidence interval [CI] 1.86–4.22). A GOS score of 1, 2, or 3 was assigned to 33 patients (91.7%) in the cocaine user group and to 20 patients (27.8%) in the non—cocaine user group (p < 0.0001). Cocaine use was associated with a 3.3-fold greater risk of poor outcome (95% CI 2.24–4.85). This association was found to be independent of Hunt and Hess grade as well as of vasospasm.
Conclusions. Cocaine adversely affects both the presentation of and outcome in patients with aneurysmal SAH who are undergoing treatment for this disease. The vasoactive properties of the drug appear to aggravate the already tenuous situation of SAH and increase both the occurrence and influence of cerebral vasospasm. Statistical analysis demonstrates that cocaine directly affects both presentation and outcome in a significant manner. It is the authors' interpretation of the results of this retrospective review that cocaine use negatively affects outcome to such an extent that it should be considered equal to the presence of a major systemic illness when determining Hunt and Hess grade.
Efficacy of aprotinin in children undergoing craniofacial surgery
Authors: D'Errico Celia C. , Munro Hamish M. , Buchman Steven R. , Wagner Deborah , Muraszko Karin M. 
Published: May 2009

Object. This prospective, randomized, placebo-controlled, double-blind trial was undertaken to assess the efficacy of aprotinin in reducing the need for blood transfusions in 39 children undergoing reconstructive craniofacial surgery.
Methods. Two demographically similar groups—a total of 39 patients with a mean age of 1.2 ± 1.2 years—were studied. The efficacy of aprotinin (240 mg/m2 administered intravenously over 20 minutes, followed by infusions of 56 mg/m2/hr) was compared with that of an equal infusion of 0.9% saline (placebo).
Patients in the aprotinin group received less blood per kilogram of body weight than patients in the placebo group (32 ± 25 ml/kg compared with 52 ± 34 ml/kg, respectively; p = 0.04). Those patients in whom aprotinin was administered experienced less change in their hematocrit levels during surgery (aprotinin −33 ± 13% compared with placebo −44 ± 9%, p = 0.01). Each patient underwent a transfusion as per study protocol, and there was no significant change in hematocrit levels from the beginning to the end of surgery. The surgical faculty judged blood loss in patients in the aprotinin group to be significantly less than usual (p = 0.03). The use of aprotinin was also associated with reduced blood transfusion requirements during the first 3 postoperative days (p = 0.03). There was no adverse event reported in either the aprotinin or placebo group.
Conclusions. Aprotinin decreased blood transfusion requirements in pediatric patients undergoing craniofacial reconstruction, thereby reducing the risks associated with exposure to banked blood components.
Surgical experience in 130 pediatric patients with Chiari I malformations
Authors: Tubbs R. Shane , McGirt Matthew J. , Oakes W. Jerry 
Published: May 2009

Object. The aim of this study was to present the long-term findings of a surgical series of pediatric patients with Chiari I malformations.
Methods. One hundred thirty symptomatic pediatric patients with Chiari I malformations underwent posterior fossa decompression. The age in this group of patients ranged from 2 months to 20 years (mean 11 years). The length of the hospital stay extended from 2 to 7 days (mean 2.7 days), and follow up was from 3 months to 15 years (mean 4.2 years). Patients most often presented with headache/neck pain (38%) and scoliosis (18%). Examples of associated diagnoses included neurofibromatosis Type 1 (5.5%), hydrocephalus (11%), idiopathic growth hormone deficiency (5.5%), and Klippel—Feil anomaly (5%). Syringes were present in 58% of patients. Seventeen percent of patients had caudal displacement of the brainstem and fourth ventricle. Postoperative relief of preoperative pathologies was experienced in 83% of patients. Of the most common presenting symptoms—headache/neck pain and scoliosis—12 and 17%, respectively, were not alleviated postoperatively. Complications occurred in 2.3% of this group and included the development of acute hydrocephalus postoperatively and severe life-threatening signs of brainstem compression that necessitated a transoral odontoidectomy. Nine patients have had to undergo repeated operations for continued symptoms or persistent large syringes. During surgery 10 patients (7.7%) were found to have arachnoid veils occluding the fourth ventricular outlet, and nine of these had syringomyelia. In our experience almost all syringes will stabilize or improve with posterior fossa decompression and duraplasty.
Conclusions. The authors believe this to be the largest reported series of pediatric patients who have undergone posterior fossa decompression for Chiari I malformations.
Shared oligodendrocyte lineage gene expression in gliomas and oligodendrocyte progenitor cells
Authors: Bouvier Corinne , Bartoli Catherine , Aguirre-Cruz Lucinda , Virard Isabelle , Colin Carole , Fernandez Carla , Gouvernet Joany , Figarella-Branger Dominique 
Published: May 2009

Object. Gliomas (astrocytic and oligodendroglial) are the most frequently occurring primary neoplasms in the central nervous system (CNS). Histological classification, which can be performed to distinguish astrocytomas from oligodendrogliomas, is essentially based on pathological features and has great prognostic and therapeutic value but lacks reproducibility. Specific markers of cell lineage, especially those for oligodendrogliomas, are still lacking. The oligodendrocyte lineage (OLIG) genes, transcriptional factors of the basic helix-loop-helix family, have been recently identified in oligodendrocyte progenitor cells (OPCs) in the CNS of developing and adult rodents. Data from a few studies have shown in a small series of brain tumors that OLIG genes characterize oligodendrogliomas. To search for a differential expression of the OLIG genes in subgroups of brain tumors, the authors investigated OLIG1 and OLIG2 gene expression.
Methods. Using semiquantitative reverse transcription—polymerase chain reaction (RT-PCR), the authors analyzed a series of 89 tumors (71 astrocytic and oligodendroglial tumors, eight ependymomas, three medulloblastomas, four meningiomas, and three schwannomas) and normal human brain tissue samples. It was demonstrated that OLIG gene expression was largely limited to glial tumors, that is, astrocytomas and oligodendrogliomas. A very low level was detected in ependymomas, whereas other tumors lacked OLIG gene expression altogether. Surprisingly, OLIG1 and OLIG2 expression was not limited to oligodendroglial tumors, but was observed in astrocytic lesions as well, independent of tumor grade. Interestingly, these genes were expressed at the highest level in pilocytic astrocytomas according to semiquantitative RT-PCR results, which were confirmed on dot blot analysis. In situ hybridization showed that the OLIG2 gene was expressed by tumor cells in pilocytic astrocytomas as well as those in oligodendrogliomas.
Conclusions. The OLIG genes are additional markers shared by all gliomas and OPCs. These markers may help to classify gliomas, to improve understanding of their histogenesis, and to identify new therapeutic targets.
Neural—dural transition at the medial anterior cranial base: an anatomical and histological study with clinical applications
Authors: Dare Amos O. , Balos Lucy L. , Grand Walter 
Published: May 2009

Object. Few anatomical studies have been focused on the morphological features and microscopic anatomy of the transition from the intracranial space to the medial anterior cranial base. The authors of the current study performed histological analyses to define the structure of the transition from neural foramina to the cranial base (neural—dural transition) at the cribriform plate, particularly as related to cerebrospinal fluid (CSF) fistula formation and surgical intervention in the region.
Methods. The medial anterior cranial base was resected in six cadaveric specimens. Histological methods were used to study the anatomy of the region on the microscopic level. Results of these examinations revealed a multilayered neural—dural transition at the cribriform plate, which consisted of an arachnoid membrane and a potential subarachnoid space as well as dura mater, periosteum, ethmoid bone, and associated layers of submucosa and mucosa of the paranasal air spaces. A subarachnoid space was identified around the olfactory nerves as they exited the neural foramina of the cribriform plates. The dura mater eventually thinned out and became continuous with the periosteum in the ethmoid bone. The dura, arachnoid membrane, and associated potential subarachnoid space were obliterated at a place 1 to 2 mm into the olfactory foramen. The authors present a case of recurrent CSF rhinorrhea successfully treated using a technique of multilayered reconstruction with pericranium, fat, and bone.
Conclusions. The findings provide an anatomical basis for CSF fistula formation in the region of the cribriform plate and help to explain the unusual presentations in patients who have CSF rhinorrhea and meningitis. These results may facilitate the treatment of CSF fistulas, repair of defects in the medial anterior cranial base, and approaches to tumors and other pathological entities in the region.
The sphenopetroclival venous gulf: a microanatomical study
Authors: Iaconetta Giorgio , Fusco Mario , Samii Madjid 
Published: May 2009

Object. The sphenopetroclival area is the border zone between the middle and posterior cranial fossa. Several authors have studied the microsurgical anatomy of this region and have furnished sometimes contradictory descriptions of this area, which still represents a great challenge for the neurosurgeon. On the basis of previous anatomical data reported in the literature, the authors undertook a new microanatomical analysis of the sphenopetroclival region and report their findings.
Methods. Twenty human cadaveric heads were used to reproduce, in the laboratory, different skull base approaches to expose the petroclival area. Measurements were taken in 40 specimens.
From this study has emerged the finding that the sphenopetroclival area is a venous space, which the authors have named the “sphenopetroclival venous gulf” (SPCVG). The SPCVG is filled anteriorly by blood from the cavernous sinus (lateral sellar compartment [LSC], medially by blood from the basilar plexus, and laterally by blood from the superior petrosal sinus; this venous gulf is drained by the inferior petrosal sinus. The SPCVG is comparable in shape to an irregular hedron figure. It contains the Dorello canal, the venous segment of the abducent nerve, and the superior sphenopetrosal (Gruber) ligament, the fibers of which are in anatomical continuity with those of the inferior sphenopetrosal (petrolingual) ligament, forming a “falciform ligament.”
Conclusions. The structures defining the posterior surface of the SPCVG may represent a helpful surgical corridor through which it is possible to approach the LSC via the posterior fossa. This conceptualization of the SPCVG is an attempt to define univocally the microanatomy of the sphenopetroclival region in its entirety.