bluuebunny/crossref_metadata_2025_split huggingface dataset:
Traumatic Extradural Hematoma of the Cervical Spine
Authors: Garza-Mercado Román 
Published: May 2010

Abstract
An example of a traumatic extradural hematoma of the cervical spine that occurred in a 32-year-old man who suffered from chronic ankylosing spondylitis is reported. Progressive sensory and motor deficit ensued some 3 hours after the patient fell from a standing position. The patient landed on his back, striking his head on the floor. After being helped up, he was able to walk unassisted to a nearby chair, where he sat down until his left lower extremity—and shortly afterwards, the right one—became numb and weak. On admission, the patient was found to have tetraparesis that was more pronounced in the lower extremities and associated with incomplete sensation to pinprick at level T7-T10. He also had painless distention of the urinary bladder. After a few hours, the weakness in his limbs increased and his sensory level rose to C5 bilaterally. A horizontal diastatic fracture across the vertebral body of C7 was discovered on plain x-ray films of the spine, and an extradural hematoma extending dorsally from C5 to T1 was revealed by emergency magnetic resonance imaging. After an emergency decompressive cervical laminectomy and removal of the clot, the patient rapidly regained complete neurological function, except with regard to both the urinary bladder and the rectum, which remained abnormal for almost 7 weeks after the operation.
Growth of Prolactinoma despite Lowering of Serum Prolactin by Bromocriptine
Authors: Kupersmith Mark J. , Kleinberg David , Warren Floyd A. , Budzilovitch Gleb , Cooper Paul 
Published: May 2010

Abstract
Four patients with macroprolactinomas treated with bromocriptine had tumor growth and visual loss despite marked reduction in their serum prolactin levels. Explanations for this dissociation of tumor growth and prolactin measurement might include noncompliance. Patients treated with bromocriptine require periodic examination by computed tomographic scan or magnetic resonance imaging and neuro-ophthalmological evaluation in addition to monitoring of serum prolactin.
Electrophysiological Aid in High Thoracic Sympathectomy for Palmar Hyperhidrosis
Authors: Lindquist Christer , Fedorcsak Imre , Steig Phillip E. 
Published: May 2010

Abstract
High upper thoracic sympathectomy using microsurgical techniques aided by electrical stimulation of the sympathetic chain is described. Use of the microscope facilitates identification and dissection of the sympathetic chain and minimizes the risk of pleural damage. Electrical stimulation of the sympathetic chain establishes the correct functional level for surgical excision. At the correct level, the threshold for piloerection, sudomotor response, and decrease in blood flow of the ipsilateral hand to electrical stimulation was minimal, and a six-fold increase in stimulus current causing current spread was required to dilate the ipsilateral pupil. After identification of the proper level, surgical excision can be done without risking postoperative Horner's syndrome. Excision of the appropriate ganglia and intervening sympathetic chain with placement of surgical clips on the proximal and distal nerve stumps provides tissue for histological analysis, decreases the opportunity for regeneration, and facilitates localization on postoperative x-rays.
Evaluation of Brain Death Using Transcranial Doppler
Authors: Newell David W. , Grady M. Sean , Sirotta Paul , Winn H. Richard 
Published: May 2010

ABSTRACT
Cerebral blood flow velocities in the middle cerebral arteries were measured using transcranial Doppler in 12 patients with conditions that ultimately resulted in brain death. All patients had sustained closed head injury, gunshot wounds to the head, or spontaneous intracerebral hemorrhages. When clinical criteria for brain death were met, a characteristic pattern was found with transcranial Doppler. This pattern consisted of reverberating flow, with forward flow in systole and retrograde flow in diastole. When this pattern was seen, there was arrest of cerebral flow, as measured by radionuclide scanning using technetium, in all patients studied. Transcranial Doppler is a useful technique for easily assessing the arrest of the cerebral circulation.
Microsurgical Anatomy of the Venous Drainage into the Superior Sagittal Sinus
Authors: Andrews Brian T. , Dujovny Manuel , Mirchandani Haresh G. , Ausman James I. 
Published: May 2010

ABSTRACT
Ten unfixed human brains were examined under an operating microscope to evaluate the feasibility of reimplanting the parasagittal veins into the superior sagittal sinus. On average, there were 6.5 veins draining the surface of each hemisphere in the anterior frontal region, 3 veins draining each posterior frontal region, 4 veins draining each parietal region, and 1 vein draining each occipital region. The veins were most frequently 0.1 to 1.0 mm in diameter, but were as large as 3.0 mm in the anterior frontal and occipital regions, 3.5 mm in the parietal region, and 5.0 mm in the posterior frontal region. The mean vein length between the superior sagittal sinus and the first lateral attachment was 3.0 to 7.4 mm; individual veins were as long as 30.0 mm. The 20 hemispheres contained a total of 5 veins in the anterior frontal region. 7 veins in the posterior frontal region, and 8 veins in the parietal region that appeared to have an adequate diameter and length for microsurgical reimplantation into the superior sagittal sinus. The superior sagittal sinus had a mean width of 4.3 mm and depth of 3.6 mm in the midanterior frontal region and enlarged to a mean width of 9.9 mm and depth of 6.8 mm in the midoccipital region. In all sites, the sinus appeared to be structurally compatible with vein reimplantation. In 3 cases, veins 2.8 to 4.6 mm in diameter were reimplanted microsurgically into the sinus; in each case, the anastomosis was technically satisfactory and patent. These results support the feasibility of reimplanting parasaggital veins into the superior sagittal sinus for such problems as trauma, tumors, and cortical venous thrombosis. Veins suitable for reimplantation are located primarily in the posterior frontal and parietal regions.
Electrophrenic Respiration in Patients With High Quadriplegia
Authors: Sharkey Paul C. , Halter John A. , Nakajima Keiji 
Published: May 2010

ABSTRACT
After determining that 15 patients with high spinal cord injuries who were permanently apneic had viable phrenic nerves, electrophrenic respiration units were implanted. Thirteen of the patients (86%) achieved full-time respiration and two more achieved half-time respiration. Despite the loss of 8 patients to unrelated problems, 7 now use electrophrenic respiration continuously, one having done so for 16 years. The patient selection criteria, neurophysiological evaluation method, surgical procedure, postoperative care, and methods for diagnosis of system failures are presented. A comparison of the cervical and thoracic procedures is made. The cervical approach is preferred. Complications consisted primarily of equipment failures. For the external components there were several cases of antenna connection and battery connection failures. The implanted receivers failed in 6 cases with an average lifetime of 48 months, ranging from 24 to 108 months. In one case fibrosis around the electrode resulted in failure to stimulate the phrenic nerve effectively. In another case, infection required removal of the system which was reimplanted later and has continued to provide successful ventilation.
Microneurosurgical Treatment of Intracranial Dermoid and Epidermoid Tumors
Authors: Yaşargil M. Gazi , Abernathey Chad D. , Sarioglu Ali ç. 
Published: May 2010

ABSTRACT
Forty-three patients with intracranial, intradural dermoid (8) and epidermoid (35) tumors underwent radical surgical resection utilizing strict microneurosurgical technique. The average age was 37.3 years for the patients with epidermoid tumors and 36.2 years for the patients with dermoid tumors. The male to female ratio was 3:2 for the epidermoid group and 3:1 for the dermoid group. Common clinical presentations included cerebellar dysfunction, cranial nerve impairment, and seizures. Typically, computed tomography scans revealed the epidermoid tumors (30 cases studied) as nonhomogeneous hypodense lesions with irregular borders and without contrast enhancement. The dermoid tumors (7 cases studied) had a similar appearance, but with a wider range of attenuation values. Magnetic resonance imaging findings for the epidermoid tumors (6 cases studied) consisted of increased T1 and increased T2 relaxation times. Supratentorial tumors were excised by the pterional (frontosphenotemporal) approach, mesencephalic tumors by either a supratentorial posterior interhemispheric transtentorial approach or an infratentorial/supracerebellar method, and posterior fossa tumors by either a medially or laterally positioned suboccipital osteoplastic craniotomy. One epidermoid tumor and one dermoid tumor were considered to be subtotally resected because of dense adherences left attached to vital structures; the remaining 41 tumors were completely excised. The most frequent complications were aseptic/chemical meningitis and transient cranial nerve palsies. There were no perioperative deaths. Mean follow-up was 5.2 years. Eighty-six percent of patients reported good to excellent results. No patient had experienced symptomatic or radiographic evidence of recurrence. These results suggest that although dermoid and epidermoid tumors tend to cross anatomical boundaries via the subarachnoid system, in the majority of patients tumors can be resected in their entirety with relatively low morbidity by utilizing microneurosurgical techniques.
Multiple Complications from an Intracranial Epidermoid Cyst: Case Report and Literature Review
Authors: Abramson Robert C. , Morawetz Richard B. , Schlitt Michael 
Published: May 2010

ABSTRACT
Intracranial epidermoid and dermoid tumors are unusual benign lesions that are potentially curable. Subtotal removal carries a high incidence of recurrence, plus the rare possibility of carcinomatous degeneration of the remnants. Aseptic meningitis from spillage of cyst contents into the subarachnoid space is frequent after operation and has been reported to occur spontaneously. A case of a patient with a posterior fossa epidermoid cyst presenting with multiple bouts of aseptic meningitis in which squamous cell carcinoma arose in recurrent tumor 5 years after subtotal removal of the benign lesion is described.
Osteoblastic Meningioma of the Fourth Ventricle
Authors: Johnson Mahlon D. , Tulipan Noel , Whetsell William O. 
Published: May 2010

ABSTRACT
Meningiomas of the fourth ventricle are rare neoplasms. Only meningothelial and fibroblastic subtypes, purportedly arising from the tela choroidea, have been described. In this report we describe clinical, neuroradiological and pathological findings in a 52-year-old man with mild hydrocephalus produced by a large, calcified, osteoblastic meningioma of the fourth ventricle.
The Surgical Anatomy of the Cerebral Sulci
Authors: Harkey H. L. , Al-Mefty O. , Haines D. E. , Smith R. R. 
Published: May 2010

ABSTRACT
Intraventricular and intra-axial lesions can be reached through a transsulcal approach, avoiding the more extensive cerebral tissue damage that may result from a conventional cortical incision. The sulci of five cadaver brains fixed in formalin solution were dissected using the operating microscope. The brains were photographed for surface mapping and x-rays to demonstrate underlying ventricular relationships were taken. The brains were then coronally sectioned to characterize anatomical relationships between sulci and deep brain structures. Three important sulci were identified and thoroughly characterized with respect to surface relationships, average depth, and underlying structures that can be readily approached. Surgical application of these findings is discussed.
Anterior Decompression and Stabilization of the Spine in Malignant Disease
Authors: Moore Anne J. , Uttley David 
Published: May 2010

ABSTRACT
Evidence has accumulated that indicates that laminectomy with or without radiotherapy is not necessarily the best mode of treatment for all cases of spinal cord compression of malignant pathogenesis. Success is limited, and there is a high risk of adverse neurological developments, particularly where there is anterior vertebral collapse. A prospective series of 26 consecutive patients with neurological complications of neoplastic extradural cord compression is described. Anterior decompression followed by stabilization in a single stage procedure was selected as the most appropriate method of treatment for all 26 patients. Various techniques were used in the replacement of the excised vertebral body, including the use of two types of prosthesis created specifically for the purpose. Of the patients who were not ambulatory at the time of surgery, 62% became so postoperatively; 71% of those with intractable pain were pain free after surgery. The postoperative mortality rate was 30%, which reflected the poor condition of the patients; in light of this, the criteria for operative selection are reviewed. Neurological deterioration did not occur in any patient. The method is recommended, for selected patients, for the management of cord compression caused by collapse of the vertebral body. The patient's prospects of restored ability to walk after a single-stage operation are good, and the risk of adverse neurological effects is negligible.
The Role of Postoperative Radiotherapy after Resection of Single Brain Metastases
Authors: DeAngelis Lisa M. , Mandell Lynda R. , Thaler H. Tzvi , Kimmel David W. , Galicich Joseph H. , Fuks Zvi , Posner Jerome B. 
Published: May 2010

ABSTRACT
To assess the value of whole brain radiotherapy (WBRT) after complete resection of a single brain metastasis we reviewed the records of 98 patients who had elective craniotomy between 1978 and 1985. Seventy-nine patients received postoperative WBRT (Group A) and 19 patients no radiotherapy (RT) (Group B). Neurological relapse was designated as local (i.e., at the site of the original metastasis) or distant (i.e., elsewhere in the brain). Postoperative WBRT significantly prolonged the time to any neurological relapse (P = 0.034) with a 1-year recurrence rate of 22% in Group A and 46% in Group B patients; however, it did not specifically control either local or distant cerebral recurrence. Recurrence of metastatic brain disease was not affected by location of the original lesion; however, meningeal relapse occurred in 38% of cerebellar lesions, but only in 4.7% of supratentorial metastases (P = 0.003). The total radiation dose or fractionation scheme of RT did not affect survival nor time to neurological relapse. The median survival was 20.6 and 14.4 months for Groups A and B, respectively (not statistically different). Forty-eight percent of Group A and 47% of Group B patients survived for 1 year or longer; however, 11% of patients who had received RT and survived 1 year developed severe radiation-induced dementia. All patients with radiation-related cerebral damage received hypo-fractionated RT with high daily fractions as commonly designed for rapid palliation of macroscopic brain metastases. Thus, postoperative WBRT may be an important adjunct to complete resection of a single brain metastasis, particularly in patients with limited or no systemic disease who have the potential for long-term survival or even cure, but it carries a substantial risk of late neurological toxicity when hypofractionated RT schedules are used. For these good-risk patients, postoperative WBRT should be administered by standard fractionation schemes of 180 to 200 cGy/day to a total of 4000 to 4500 cGy, or hyperfractionation, which provides even lower doses/fraction to minimize potential neurotoxicity while delivering a maximally efficacious total dose, should be considered.
Treatment of Recurrent Gliomas with 1,3-Bis(2-Chloroethyl)-1-Nitrosourea and A-Difluoromethylornithine
Authors: Prados Michael , Rodriguez Luis , Chamberlain Marc , Silver Pamela , Levin Victor 
Published: May 2010

Abstract
Thirty-eight patients with primary recurrent anaplastic gliomas and glioblastomas, were treated with 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) and the polyamine inhibitor A-difluoromethylornithine (DFMO). There were 5 brain stem, 1 cerebellar, and 32 supratentorial glioma tumors. All had been treated with surgery (except in the case of 4 brain stem tumors for which biopsies were not obtained) and radiotherapy. Eight patients had received prior chemotherapy. Of the 21 patients with evaluable supratentorial anaplastic gliomas, 2 (9.5%) had a partial response and 10 (47.6%) had stable disease. The median time to tumor progression for the anaplastic gliomas has not been attained yet. However, median survival for these 12 patients was 119 weeks measured from the initiation of chemotherapy. Median survival for the entire anaplastic glioma group of 21 was 56 weeks. Minimal activity was seen against glioblastoma multiforme. The median time to tumor progression was 8 weeks with median survival of 21 weeks. Of the 5 patients with brain stem tumors, 3 are alive with stable disease at 77, 93, and 220 weeks. The combination was well tolerated with doselimiting toxicity being myelosuppression and hearing loss. Further trials are warranted to compare the combination of BCNU and DFMO against BCNU alone in a prospective randomized trial.
Results of Stereotactic Aspiration in 175 Cases of Putaminal Hemorrhage
Authors: Niizuma Hiroshi , Shimizu Yukihiko , Yonemitsu Tsutomu , Nakasato Nobukazu , Suzuki Jiro 
Published: May 2010

Abstract
Believing that improved therapeutic results in cases of intracerebral hematoma might be obtained by minimal invasion of the brain, we used computed tomographic-guided stereotactic aspiration in 175 of 241 patients with putaminal hemorrhage. These patients, who were treated 6 or more hours after onset, had hematomas larger than 8 ml and were unable to raise an arm and/or leg on the affected side. Craniotomy was performed in 15 other patients, most of whom were brought to the hospital with large hematomas within 6 hours of onset. The remaining patients either had mild deficits of consciousness (33 patients) or severe deficits and/or were elderly (18 patients) and were treated conservatively. Thirteen patients (7.4%) showed rebleeding after stereotactic aspiration (6 instances of major and 7 instances of minor rebleeding). Craniotomy and removal of the hematoma were required in three of these patients. Aspiration should be avoided in patients who have a tendency for bleeding, even if mild, because rebleeding occurred in 6 of 23 such patients (26%) in these study. The consciousness level improved in 66 patients (38%), was unchanged in 103 patients (59%), and was worse in 6 patients (3%) 1 week postoperatively. Motor function of the arm improved in 55 patients (31%) and was worse in 23 patients (14%). Six months after surgery, the results for the 175 patients who underwent stereotactic aspiration were: 19% excellent, 32% good, 35% fair, 7% poor, 6% dead, and 1% unknown. For the entire series of 241 patients, the results were: 24% excellent, 26% good, 31% fair, 7% poor, 11% dead, and 1% unknown. These results seem to indicate that stereotactic aspiration can play a definite role in the treatment of spontaneous intracerebral hematoma.
Anterior Cervical Vertebrectomy and Interbody Fusion for Multi-Level Spondylosis and Ossification of the Posterior Longitudinal Ligament
Authors: Kojima Tadashi , Waga Shiro , Kubo Yoshichika , Kanamaru Kenji , Shimosaka Shinichi , Shimizu Takeo 
Published: May 2010

ABSTRACT
Multi-level cervical spondylosis and ossification of the posterior longitudinal ligament (OPLL) are well-documented causes of myelopathy. The choice of surgical procedures remain controversial. Between January 1983 and December 1987, we have performed anterior cervical vertebrectomy in 45 patients with cervical myelopathy caused by multi-level spondylosis and OPLL. They consisted of 19 patients with cervical spondylosis, 12 with OPLL, and 14 with combined lesions of both cervical spondylosis and OPLL. There were 32 men and 13 women. The mean age was 55 years, ranging from 35 to 70 years. In all of our 45 patients, anterior vertebrectomy, discectomy, removal of posterior osteophytes and OPLL, and interbody fusion were done for progressive myelopathy refractory to conservative treatment. In 2 of 45 patients, 5 vertebral bodies were resected; in 3 patients, 4 vertebral bodies were resected; in 12 patients, 3 vertebral bodies were resected, in 19 patients, 2 vertebral bodies were resected; and in 9 patients, 1 vertebral body was resected. Thirty-nine of 45 patients (87%) had good results. Neurological signs did not improve in 5 patients (11%). One patient died because of agranulocytosis secondary to treatment with antibiotics. In conclusion, cervical cord compression caused by lesions located principally in the anterior aspect of the spinal canal may be completely relieved via anterior vertebrectomy, discectomy, removal of the calcified ligament, and fusion.
Positive End-Expiratory Pressure in Supine and Sitting Positions: Its Effects on Intrathoracic and Intracranial Pressures
Authors: Lodrini Sandro , Montolivo Marcello , Pluchino Franco , Borroni Vittorio 
Published: May 2010

ABSTRACT
The effects of positive end-expiratory pressure (PEEP) on central venous and intracranial (ICP) pressures were evaluated in 10 patients with posterior fossa tumors, in both supine and sitting positions. With patients in the supine position, intrathoracic PEEP-dependent venous hypertension was clearly transmitted to the intracranial compartment but without intracranial hypertension. On the contrary, with patients in the sitting position PEEP had no influence in almost half of our patients. In patients with radiological or clinical signs of increased ICP, however, the combination of head flexion and rotation with institution of PEEP caused a dangerous increase in ICP, even when the patients were in the sitting position. The need for early withdrawal of cerebrospinal fluid in these patients is stressed.