bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rupture of a Giant Carotid Aneurysm after Extracranial-to-Intracranial Bypass Surgery
Authors: Anson John A. , Stone James L. , Crowell Robert M. 
Published: April 2011

Abstract
We report a case of a fatal rupture of a previously unruptured giant aneurysm of the bifurcation of the internal carotid artery (ICA). which occurred after an extracranial-intracranial (EC-IC) bypass and the partial occlusion of the ICA. Interim angiography showed retrograde filling of the proximal middle cerebral artery to the aneurysm. There have been four previously reported cases of giant aneurysms rupturing after treatment with an EC-IC bypass and carotid ligation. and it appears likely that a change in pressure/flow dynamics produced by the bypass may have been the cause. The technique of carotid ligation with an EC-IC bypass is used frequently to treat unclippablc intracranial aneurysms, and the resulting hemodynamic changes need to be considered carefully to prevent this type of complication. To minimize hemodynamic stress on the aneurysm, we suggest that 1) the bypass caliber should be as small as possible consistent with sufficient cerebral blood flower after ICA occlusion, and 2) complete ICA occlusion should be performed as soon as possible after the bypass.
Intracranial Hypertension in Relation to Memory Functioning during the First Year after Severe Head Injury
Authors: Levin Harvey S. , Eisenberg Howard M. , Gary Howard E. , Marmarou Anthony , Foulkes Mary A. , Jane John A. , Marshall Lawrence F. , Portman Sandra M. 
Published: April 2011

Abstract
The relationship between intracranial hypertension and residual memory deficit after closed head injury was evaluated using the 6-month and 1-year neurobehavioral outcome data obtained by the Traumatic Coma Data Bank. Intracranial pressure was analyzed using the percentage of time that it exceeded 20 mm Hg and the maximum value recorded during the first 72 hours after injury. Memory measures included recall of word lists, prose recall, and visual memory for designs that were obtained 6 months (n = 149) and 1 year (n = 132) after injury. Intracranial hypertension occurred in more than half of the Traumatic Coma Data Bank cohort who met the criteria for the neurobehavioral follow-up study. Linear regression analysis disclosed an effect of elevated intracranial pressure on some, but not all, measures of memory at 6 months, whereas the results were negative for the 1-year follow-up examination. We conclude that the elevation of intracranial pressure exerts little if any effect on later memory functioning, and that any effect it does have diminishes over 1 year in survivors of severe head injury.
The Influence of the Calcium Antagonist Nimodipine and Induced Hypertension on the Behavior of the Cerebral Pial Arteries, the Blood-Brain Barrier, Cerebral Edema, and Cerebral Infarction in Cats with One-Hour Occlusion of the Middle Cerebral Artery
Authors: Sakaki Toshisuke , Tsunoda Shigeru , Morimoto Tetsuya 
Published: April 2011

Abstract
Thirty anesthetized cats were randomly assigned to one of three groups of 10 cats each: nimodipine treatment, nimodipine treatment combined with induced hypertension, or a control group. The behavior of the cerebral pial arteries was measured by means of microscopic observation through a cranial window. The middle cerebral artery of each cat was clipped for 1 hour via the transorbital approach. Five hours after circulation was reestablished in the middle cerebral artery. Evans blue dye was injected intravenously: 30 minutes later, the animal was killed. Administration of nimodipine or saline in the treated or control group was started 5 minutes before the middle cerebral artery was clipped and maintained until the end of the experiment. Induced hypertension was produced by administration of dopamine during the occlusion. Damage to the blood-brain barrier (BBB) was judged by extravasation of Evans blue dye. Cerebral edema and infarction were evaluated from histological findings. They were most prominent in the control group; the extent of the hemisphere affected was as follows (mean ± standard error): extravasation. 40.5 ± 8.8%: edema, 43.2 ± 5.7%: infarction, 35.5 ± 9.6%. On the other hand, the extravasation of Evans blue dye and cerebral edema were significantly more extensive in the group treated with nimodipine and induced hypertension (extravasation, 28.2 ± 9.6% of the hemisphere; edema, 30.3 ± 7.1%) than in the group treated with nimodipine alone (extravasation. 18.5 ± 8.7% of the hemisphere; edema, 19.4 ± 6.3%). but the infarction size was similar in both groups (16.6 ± 4.9% of the hemisphere in the former; 17.0 ± 6.2 in the latter). Based on these results, we arc cautious in combining calcium entry blocking agents such as nimodipine with induced hypertension in patients with acute cerebral ischemia.
Spinal Charcot Arthropathy
Authors: Harrison Michael J. , Sacher Michael , Rosenblum Bruce R. , Rothman Allen S. 
Published: April 2011

Abstract
Charcot joints of the spine are well-documented clinical entities most commonly associated with tabes dorsalis. Spinal neuropathic joints, however, may be produced by other disease processes including syringomyelia. In this review, the authors discuss the cause and treatment of spinal Charcot arthropathy with emphasis on surgical therapy and results.
Brain Biopsy in Tuberculoma: The Risks and Benefits
Authors: Bouchama A. , Al-Kawi M. Zuheir , Kanaan I. , Coates R. , Jallu A. , Rahm B. , Siqueira E. B. 
Published: April 2011

Abstract
In developing countries, 5 to 8% of the space-occupying lesions of the central nervous system are tuberculomas. Diagnosis can be difficult in the absence of extracranial tuberculosis; computed tomography is suggestive only. To assess the value of brain biopsies in tuberculomas, the records of 15 patients aged 6 to 80 years were reviewed. Histological confirmation was obtained in 15 patients, and acid-fast bacilli were cultured from 12 patients. Intracranial hypertension was the principal sign in 11 patients; other neurological signs were related to the location of the tuberculoma. One patient had evidence of extracranial tuberculosis. Biopsy-related complications consisted of an epidural hematoma in 1 patient and hydrocephalus in another; both required additional surgery. One case of tuberculous meningitis was probably related to surgery and poor drug compliance. There was no postoperative mortality. Thirteen patients (2 were lost to follow-up) were cured after an average of 16 months of antituberculous therapy. It was concluded that the brain biopsy is useful in diagnosing tuberculoma but that there is some associated risk.
Results of Transsphenoidal Extirpation of Craniopharyngiomas and Rathke's Cysts
Authors: Landolt Alex M. , Zachmann Milo 
Published: April 2011

Abstract
Fourteen patients undergoing transsphenoidal extirpation of craniopharyngiomas or Rathke's cysts underwent endocrinological evaluation before and after surgery. One patient died during the procedure because of uncontrollable arterial bleeding. The other patients were followed for up to 16 years (average, 8.5 years). One patient had recurrence of tumor 12 years after surgery. Another patient, the only one operated on because of a recurrent craniopharyngioma after previous radiation therapy, died 2 years after the transsphenoidal operation. No patient recovered pituitary functions that had been lost before surgery. One patient, who had an isolated growth hormone deficiency, and another, who had panhypopituitarism with sustained antidiuretic hormone secretion, had no change postoperatively from their preoperative endocrine status. The other 11 patients lost pituitary function and required pharmacological replacement of one to four pituitary hormones.
Cervical Spine Diastematomyelia in Adulthood
Authors: Rawanduzy Ahmed , Murali Raj 
Published: April 2011

Abstract
Adult cervical diastematomyelia is a rare malformation and is usually associated with posterior element anomalics. A case of isolated cervical diastematomyelia, which was initially thought to be a herniated cervical disc. is described. Diagnosis and surgical management are discussed.
New Aneurysm Clip Appliers for “Key-Hole” Neurosurgery
Authors: Solomon Robert A. , Fukushima Takanori 
Published: April 2011

Abstract
A new set of aneurysm clip appliers has been developed to overcome many of the obstacles to safe clipping of complex intracranial aneurysms. The applier set consists of six units, each one delivering clips at a different specified angle to the applier shaft. These appliers have been independently tested on over 250 aneurysm operations and found to be of great utility.
Second Operation after the Failure of Previous Resection for Epilepsy
Authors: Awad Issam A. , Nayel Mohamad H. , Lüders Hans 
Published: April 2011

Abstract
We present our surgical experience with second operations in 15 patients with recurrent intractable partial seizures after resection for epilepsy. The interval from the first operation until the first recurrence of seizures ranged from 1 day to 7 months (mean, 62 days);. The interval between the first and second operations ranged from 3 months to 12 years (mean, 38 months);. Detailed video-electroencephalographic interictal and ictal recording was performed in all patients (invasive electrodes were used in 11 patients);. Ictal onset was shown to be remote from the zone of previous resection in 3 of 15 cases (all 3 extratemporal and in the ipsilateral hemisphere);. Recurrent seizures arose from the area of previous extratemporal resection in 2 of 15 patients, and from the area of previous temporal resection in 10 of 15 patients. Both cases of extratemporal recurrences and 3 of the 10 cases of temporal lobe recurrences in the area of previous resection were associated with residual unresected structural lesion. Of the 10 patients with local temporal recurrence, 6 had proven epileptogenicity in the residual mesial structures, and 4 had residual epileptogenicity in the unresected lateral temporal lobe. The patients have been monitored for 8 to 82 months (mean, 18 months); after the second operation: 7 patients (47%); have remained seizure-free and another 5 (33%); have achieved a reduction in seizure frequency of more than 90%. There was no mortality or significant morbidity in this series. We conclude that the extent and distribution of residual epileptogenicity after failed epilepsy surgery are highly variable. Recurrent intractable seizures usually (but not always); arise from the area of previous resection, and reflect residual structural lesions or epileptogenic foci. Individualized second operations can be safe and effective, and may provide selected patients with “failed cases” another chance at seizure control. Patient selection and the technical aspects of remapping and second operations are discussed.
The Thalamogeniculate Perforators of the Posterior Cerebral Artery: The Microsurgical Anatomy
Authors: Milisavljević Milan M. , Marinković Slobodan V. , Gibo Hirohiko , Puškaš Laslo F. 
Published: April 2011

Abstract
The thalamogeniculate (TG); arteries of 30 forebrain hemispheres were examined. These vessels varied from 2 to 12 in number (mean, 5.7);, and from 70 to 580 μm in caliber (mean, 345.8 μm);. The average caliber of all the TG vessels per posterior cerebral artery ranged from 700 to 3400 μm (mean, 1972 μm);. The TG arteries most often originated as individual vessels; however, in 26.67% of the hemispheres examined they shared a common site of origin, and 33.33% of the hemispheres they arose from common stems. The common stems ranged from 320 to 800 μm in diameter (mean, 583 μm);. The TG branches arose from the crural or ambient (P2); segment of the posterior cerebral artery in 80% of the hemispheres, from the P2 and the quadrigeminal (P3); segment in 20%, from both the distal segment of the posterior cerebral artery and the common temporal artery (13.33%);, or from the distal segment and either the calcarine (3.33%); or parieto-occipital artery (3.33%);. The TG arteries usually penetrated the medial geniculate body (100%);, pulvinar thalami (80%);, brachium of the superior colliculus (53.33%);, or lateral geniculate body (13.33%);. The collateral branches of the TG arteries were noted to reach the medial geniculate body (76.67%);, pulvinar (70%);, brachium of the superior colliculus (40%);, crus cerebri (40%);, and lateral geniculate body (6.67%);. The anastomoses were present in 66.67%, usually between the TG vessels and the medial posterior choroidal artery (33.33%);, or the mesencephalothalamic artery (26.67%);. They ranged in number from 1 to 3 (mean, 1.2);, and in caliber from 90 to 400 μm (mean, 197 μm);. In spite of the anastomoses, the TG arteries must be spared during surgery within the ambient cistern.
Progressive Deterioration of Auditory Evoked Potentials after Excision of an Acoustic Neurinoma: Case Report
Authors: Sekiya Tetsuji , Iwabuchi Takashi , Takiguchi Masahiro , Ichijo Hiroaki , Sasaki Hitoshi 
Published: April 2011

Abstract
The authors report the case of a 17-year-old girl who underwent excision of bilateral neurinomas of the cerebellopontine angle. Although her auditory evoked potentials were well maintained during the operation, they deteriorated gradually and progressively for the following 2 months. This seemed to reflect degeneration of the cochlear nerve fibers initiated by operative manipulation in the cerebellopontine angle in a patient who had no hearing when she awoke from surgery.
Intracranial Arteriovenous Fistula Manifesting as Progressive Neurological Deterioration in an Infant: Case Report
Authors: Aoki Nobuhiko , Sakai Tatsuo , Oikawa Akihiro 
Published: April 2011

Abstract
This 1-year-old male infant had been diagnosed with cerebral degenerative disease because he developed psychomotor regression, and brain atrophy was demonstrated on computed tomography. He underwent magnetic resonance imaging, which suggested a cerebrovascular malformation. Cerebral angiography disclosed an arteriovenous fistula, fed by an anterior cerebral artery and directly draining into a cortical vein. The occlusion of the feeding artery was followed by a satisfactory recovery. The mechanism of the neurological symptoms in this patient is thought to be caused by a steal phenomenon and compression of the brain stem by venous engorgement in the posterior fossa.
Posterior Fossa Ependymomas: Report of 30 Cases and Review of the Literature
Authors: Lyons Mark K. , Kelly Patrick J. 
Published: April 2011

Abstract
Thirty patients with histologically confirmed posterior fossa ependymomas operated on between January 1976 and December 1988 were reviewed. The median age was 44 years (range, 1-69 yr). There were 7 children (aged 5 yr or younger) and 23 adults (aged 16 yr or older). There were 18 female patients and 12 male patients. Headache, nausea and vomiting, and disequilibrium were the most frequent symptoms. The most common findings were ataxia and nystagmus. Gross total resection was performed in 8 patients (27%), subtotal resection in 21 patients (70%), and biopsy in only 1 patient (3%), Tumors were low grade in 73% and high grade in 27%. Twenty-seven patients underwent posterior fossa radiotherapy (median dose, 5400 cGy). Fourteen patients also underwent spinal irradiation (median dose, 3520 cGy). Age was the only significant prognostic factor identified (P &lt;0.01). The 5-year survival rates were 76% for adults and 14% for children. All 14 patients who died had recurrent or residual tumor at the primary site. This review suggests that in patients with primary posterior fossa ependymomas the following is true: 1) the young patient (5 yr old or younger) has a poor prognosis: 2) there was a trend toward a better 5-year survival rate with a gross total resection; 3) if recurrence occurs, it will be at the primary intracranial site; and 4) symptomatic spinal seeding does not occur frequently.
Cervical Spondylotic Myelopathy: Treatment with Posterior Decompression and Luque Rectangle Bone Fusion
Authors: Maurer Paul Kurt , Ellenbogen Richard G. , Ecklund James , Simonds Gary R. , van Dam Bruce , Ondra Stephen L. 
Published: April 2011

Abstract
Cervical spondylotic myelopathy appears to result from a combination of factors. The two major components are 1) compressive forces resulting from narrowing of the spinal canal, and 2) dynamic forces owing to mobility of the cervical spine. There is substantial evidence to suggest that the repetitive trauma to the spinal cord that is sustained with movement in a spondylotic canal may be a major cause of progressive myelopathy. Utilization of extensive anterior procedures that remove the diseased ventral features as well as eliminate the dynamic forces owing to the accompanying fusion have grown in popularity. Cervical laminectomy enlarges the spinal canal, but does not reduce the dynamic forces affecting the spinal cord, and may actually increase cervical mobility, leading to a perpetuation of the myelopathy. The authors propose the combination of posterior decompression and Luque rectangle bone fusion to deal with both the compressive and the dynamic factors that lead to cervical spondylotic myelopathy. Ten patients who had advanced myelopathy underwent the combined procedures. Nine of the 10 experienced significant neurological improvement, and the 10th has had no progression. The combination of posterior decompression and Luque rectangle bone fusion may offer a simple, safe, and effective alternative treatment for cervical spondylotic myelopathy.
Use of Intrathecally Administered Morphine in the Treatment of Postoperative Pain after Lumbar Spinal Surgery: A Prospective, Double-Blind, Placebo-Controlled Study
Authors: Ross Donald A. , Drasner Kenneth , Weinstein Philip R. , Flaherty John F. , Barbaro Nicholas M. 
Published: April 2011

Abstract
Improved control of postoperative pain is now known to reduce the incidence of morbidity. Although spinally administered narcotics have found a clear role in chest and abdominal surgery, their role in lumbar spinal surgery is debated. We conducted a prospective, double-blind, randomized, placebo-controlled trial of intrathecally administered morphine sulfate after lumbar spinal surgery in 56 patients. Patients received 0, 0.125, 0.25, or 0.5 mg of intrathecally administered morphine during extradural lumbar spinal operations, and the effects on postoperative analog pain scores, narcotic consumption, complications, and length of hospitalization were assessed. As compared with systemic narcotic administration, intrathecally administered morphine provided superior analgesia in a dose-dependent fashion without an increase in narcotic side effects. Consumption of parenteral narcotics on the first postoperative day and over the total hospitalization period decreased in correlation with increasing doses of intrathecally administered morphine. Mean length of hospitalization was significantly decreased, as compared with the control group, in patients receiving 0.25 or 0.5 mg of intrathecally administered morphine. When proper precautions are observed, intrathecally administered morphine can improve the postoperative care of patients undergoing lumbar spinal surgery.
Giant Pseudoaneurysm of the Extracranial Vertebral Artery Successfully Treated Using Intraoperative Balloon Catheters
Authors: Hanakita Junya , Suwa Hideyuki , Nishihara Kiyoshi , Iihara Koji , Sakaida Hiroshi 
Published: April 2011

Abstract
Traumatic pseudoaneurysms of the extracranial vertebral artery rarely occur, because of its deeply protected anatomical location. Because the direct surgical approach has resulted in high morbidity and mortality rates, ligation of the vertebral artery has been adopted, but this can cause an ischemia in the vertebrobasilar system. We report the case of a 73-year-old woman with a huge pseudoaneurysm of the right vertebral artery that occurred after attempted placement of a cardiac pacemaker. The aneurysm was 7 x 7 x 5 cm in size and its neck was situated just distal to the right subclavian artery. Direct surgical repair of the injured vessel and removal of the aneurysm were successfully performed using balloon catheters placed intraoperatively in both the innominate artery and the right vertebral artery.
Positron Emission Tomography of Pituitary Macroadenomas: Hormone Production and Effects of Therapies
Authors: Francavilla Thomas L. , Miletich Robert S. , De Michele Dominic , Patronas Nicholas J. , Oldfield Edward H. , Weintraub Bruce D. , Di Chiro Giovanni 
Published: April 2011

Abstract
Positron emission tomography with [18F]fluorodeoxyglucose (FDG) was carried out in 24 patients with pituitary macro-adenomas (32 studies) to assess the glucose utilization of these tumors in vivo. The adenoma metabolic index, which is the ratio of FDG uptake of tumor to a whole brain slice, was calculated. Comparisons were made between tumor uptake of FDG and hormone secretion and response to therapies. In each positron emission tomography study, the macroadenoma could be easily identified visually as an area of increased FDG uptake near the region of the sella. FDG uptakes were highest for nonfunctional adenomas, and the prolactin, growth hormone, and thyroid-stimulating hormone-producing groups displayed similar levels of glucose metabolism. The adenoma metabolic index for all tumors averaged 1.3, ranging from 0.3 for a thyroid-stimulating hormone adenoma to 3.5 for a nonfunctional tumor. Tumors did not exhibit metabolic rates that could characterize the type of hormone produced. Recurrent macroadenomas displayed metabolism similar to tumors not operated on, whereas irradiated adenomas showed lower glucose uptake than nonir-radiated tumors. Drug therapy with bromocriptine or the long-acting somatostatin analogue octreotide also decreased the glucose utilization of the tumor. There was no correlation between the amount of hormone produced and the adenoma metabolic index when a group of tumors was analyzed. Patients scanned more than once, however, demonstrated changes in hormone levels that changed or did not change in parallel with tumor metabolism. Thus, positron emission tomography offers the potential capability for predicting and defining the growth of pituitary adenomas. This may be of particular value when plasma hormone assays and conventional imaging techniques prove inadequate for monitoring patient response to therapy.
The Mermaid Malformation: Cloacal Exstrophy and Occult Spinal Dysraphism
Authors: Cohen Alan R. 
Published: April 2011

Abstract
Five infants with cloacal exstrophy underwent neurological evaluation and radiographic examination of the caudal spine shortly after birth. Each was found to have occult spinal dysraphism. Four had terminal myelocystoceles, and one had a lipomyelomeningocele. Pathological anatomy was confirmed during surgery for the release of the tethered spinal cords. The striking association between cloacal exstrophy and occult spinal dysraphism suggests a common developmental defect in the caudal pole of the embryo. A hypothesis is offered to explain this association. Terminal myelocystocele and lipomyelomeningocele appear to be part of a continuum of lesions associated with skin-covered spina bifida.
Transoral Decompression Evaluated by Cine-Mode Magnetic Resonance Imaging: A Case of Basilar Impression Accompanied by Chiari Malformation
Authors: Tominaga Teiji , Koshu Keiji , Ogawa Akira , Yoshimoto Takashi 
Published: April 2011

Abstract
Cine-mode magnetic resonance imaging provides simultaneous images of cerebrospinal fluid flow dynamics. A patient with a basilar impression accompanied by a Chiari malformation and von Recklinghausen's disease who underwent transoral decompression is reported. Preoperative cine-mode magnetic resonance imaging visualized an associated obstruction of cerebrospinal fluid pulsatile flow at the level of the foramen magnum. Tonsilar herniation (Chiari I malformation) and hydrocephalus were also present. Postoperatively, the obstruction of cerebrospinal fluid flow was resolved concomitant with the correction of the cervicomedullary angulation. On the basis of observations made by magnetic resonance imaging, the surgical treatment of basilar impression accompanied by Chiari malformation is briefly discussed.