bluuebunny/crossref_metadata_2025_split huggingface dataset:
Normal anatomical variations of the V3 segment of the vertebral artery: surgical implications
Authors: Ulm Arthur J. , Quiroga Monica , Russo Antonino , Russo Vittorio M. , Graziano Francesca , Velasquez Angel , Albanese Erminia 
Published: October 2010

ObjectThe authors undertook this cadaveric and angiographic study to examine the microsurgical anatomy of the V3segment of the vertebral artery (VA) and its relationship to osseous landmarks. A detailed knowledge of these variations is important when performing common neurosurgical procedures such as the suboccipital craniotomy and the far-lateral approach and when placing atlantoaxial instrumentation.MethodsA total of 30 adult cadaveric specimens (59 sides) were studied using magnification × 3 to × 40 after perfusion of the arteries and veins with colored silicone. Seventy-three vertebral angiograms were also analyzed. The morphological detail of the V3segment was described and measured in both the cadavers and angiograms. Transarticular screws were placed into 2 cadavers and the relationship of the trajectory to the V3segment was analyzed.ResultsThe authors identified 4 sites along the V3segment that are anatomically the most likely to be injured during surgical approaches to the craniovertebral junction. In 35% of the cadaveric specimens the vertical portion of V3formed a posteriorly oriented loop that could be injured during surgical exposures of the dorsal surface of C-2. The mean distance from the midline to the most posteromedial edge of the loop was 25.6 ± 3.5 mm (range 20–35 mm) on the left side and 30.4 ± 3.8 mm (range 23–36 mm) on the right side. On lateral angiograms, this loop projected posteriorly, with a mean distance of 9.8 ± 3.5 mm (range 0–15.7 mm) on the right side and 11.7 ± 1.2 mm (range 10–13.6 mm) on the left side. The horizontal segment of V3can be injured when exposing the lower lateral occipital bone and when the C-1 arch is exposed. The mean distance from the inferior border of the occipital bone to the superior surface of the horizontal segment of V3was 6 ± 2.8 mm on the right side and 5.6 ± 2.3 mm on the left. In 12% of cases the authors found no space between the horizontal portion of V3and the occipital bone. The medial edge of the horizontal segment of V3was located 23 ± 5.5 mm (range 10–30 mm) from the midline on the right side and 24 ± 5.7 mm (range 15–32 mm) on the left side. The transition between the V2–V3segments after exiting the C-2 vertebral foramen is the most likely site of injury when placing C1–2 transarticular screws or C-2 pars screws.ConclusionsThe normal variation of the V3segment of the VA has been described with quantitative measurements. An awareness of the anatomical variations and the relationships to the surrounding bony anatomy will aid in reducing VA injury during suboccipital approaches, exposure of the dorsal surfaces of C-1 and C-2, and when placing atlantoaxial spinal instrumentation.
Total subaxial reconstruction
Authors: Traynelis Vincent C. 
Published: October 2010

ObjectCertain cervical spinal conditions require decompression and reconstruction of the entire subaxial cervical spine. There are limited data concerning the clinical details and outcomes of patients treated in this manner. The object of this study was to describe the specific technique employed to perform a total subaxial reconstruction and review the postoperative outcomes following surgery.MethodsThe author performed a review of data prospectively collected in 27 consecutive patients undergoing complete anterior decompression and reconstruction of the anterior cervical spine and followed by posterior instrumented arthrodesis with or without decompression.ResultsThere were 16 men and 11 women whose mean age was 59 years (range 35–86 years). The minimum follow-up was 12 months and the mean follow-up period for all patients was 26 months. One patient underwent C2–7 surgery, and in all others the procedure crossed the cervicothoracic junction.Following surgery patients remained intubated for an average of 3.3 days (range 1–22 days). The mean hospital length of stay was 11 days (range 3–45 days). One patient died 6 weeks following an uneventful surgery. Pneumonia developed in 5 patients, 1 patient experienced a minor pulmonary embolism, and 2 patients had posterior wound infections. No patient was neurologically worse following surgery. A single patient presented with a C-8 radiculopathy 6 weeks after surgery. At final follow-up no patient complained of dysphagia when specifically questioned about this potential problem. In all patients solid fusions developed at each treated levels. Preoperatively the mean sagittal Cobb angle was 15.4° (kyphosis) and the postoperative mean angle was −10.9° (lordosis) representing a total average correction of over 25° (p < 0.0001). The mean preoperative Neck Disability Index was 27.6; this score decreased to 15.5 (p = 0.0008) postoperatively. The mean pre- and postoperative visual analog scale neck pain scores were 6.0 and 2.1, respectively (p = 0.0004), and mean visual analog scale arm pain scores decreased by 3.7 following surgery (p = 0.001). Based on Odom criteria, the author found that 8 patients had an excellent outcome and 14 patients a good outcome. There were 4 patients in whom the outcome was judged to be fair and the single death was recorded as a poor outcome. The mean preoperative Nurick score was 2.68. Postoperatively the group improved to an average score of 1.5; the difference between the 2 was statistically significant (p = 0.002).ConclusionsSegmental anterior decompression and reconstruction of the entire subaxial cervical spine, combined with an instrumented posterolateral fusion, can be performed with acceptable morbidity and is of significant benefit in selected patients.
Craniometric changes in patients with acromegaly from a surgical perspective
Authors: Ebner Florian H. , Kürschner Verena , Dietz Klaus , Bültmann Eva , Nägele Thomas , Honegger Juergen 
Published: October 2010

Object
The objective of this study was to evaluate and analyze morphometric and volumetric changes of the skull due to acromegaly in areas relevant for neurosurgical practice, focusing on the surgical implications.

Methods
On preoperatively acquired CT scans, cephalometric and volumetric measurements were performed on 45 patients with acromegaly (Group A) and 45 control patients (Group B). The authors determined thickness of the cranial vault, inner and outer diameters of the skull, and the diameter of sphenoidal and maxillary sinus, as well as frontal and maxillary sinus volumetry. The morphometric and volumetric CT data of the patients with acromegaly were compared with the data of a control group and correlated with clinical parameters.

Results
Cranial vault thickness differed significantly (p < 0.0001) between the 2 groups. A correlation of the vault thickness with preoperative human growth hormone, insulin-like growth factor–I levels, and duration of clinical history in acromegaly could not be established. The outer anterior-posterior skull diameter of Group A (18.47 ± 0.94 cm) differed significantly (p = 0.0146) from Group B (17.98 ± 0.93 cm) and correlated significantly with preoperative human growth hormone (r = 0.3277; p = 0.0299) and insulin-like growth factor-–I serum levels (r = 0.3756; p = 0.0120). Measurements of the anterior-posterior diameter of the sphenoidal sinus differed significantly (p = 0.0074) between patients with acromegaly and controls. Volumetric analysis of the frontal sinus resulted in a statistically significant difference (p = 0.0382) between patients with acromegaly (14.89 ± 10.85 cm3) and controls (10.06 ± 6.93 cm3).

Conclusions
Significant craniometric changes and volumetric remodelling of the paranasal sinus occur in acromegaly. The bone alterations are of surgical importance for using the transsphenoidal approach. Detailed preoperative diagnostic examination and planning as well as selection of appropriate instruments are mandatory for safe and successful pituitary adenoma removal in patients with acromegaly.
Pharmacological management of acromegaly: a current perspective
Authors: Manjila Sunil , Wu Osmond C. , Khan Fahd R. , Khan Mehreen M. , Arafah Baha M. , _ _ , Selman Warren R. 
Published: October 2010

Acromegaly is a chronic disorder of enhanced growth hormone (GH) secretion and elevated insulin-like growth factor–I (IGF-I) levels, the most frequent cause of which is a pituitary adenoma. Persistently elevated GH and IGF-I levels lead to substantial morbidity and mortality. Treatment goals include complete removal of the tumor causing the disease, symptomatic relief, reduction of multisystem complications, and control of local mass effect. While transsphenoidal tumor resection is considered first-line treatment of patients in whom a surgical cure can be expected, pharmacological therapy is playing an increased role in the armamentarium against acromegaly in patients unsuitable for or refusing surgery, after failure of surgical treatment (inadequate resection, cavernous sinus invasion, or transcapsular intraarachnoid invasion), or in select cases as primary treatment. Three broad drug classes are available for the treatment of acromegaly: somatostatin analogs, dopamine agonists, and GH receptor antagonists.
Somatostatin analogs are considered as the first-line pharmacological treatment of acromegaly, although efficacy varies among the different formulations. Octreotide long-acting release (LAR) appears to be more efficacious than lanreotide sustained release (SR). Lanreotide Autogel (ATG) has been shown to result in similar biological control as octreotide LAR, and there may be a benefit in switching from one to the other in some cases of treatment failure. The novel multireceptor somatostatin analog pasireotide, currently in Phase II clinical trials, also shows promise in the treatment of acromegaly. Dopamine agonists have been the earliest and most widely used agents in the treatment of acromegaly but have been found to be less effective than somatostatin analogs. In this class of drugs, cabergoline has shown greater efficacy and tolerability than bromocriptine. Dopamine agonists have the advantage of oral administration, resulting in increased use in select patient groups. Selective GH receptor antagonists, such as pegvisomant, act by blocking the effects of GH, resulting in decreased IGF-I production despite persistent elevation of GH serum levels. Thus far, tumor growth has not been a concern during pegvisomant therapy. However, combination treatment with somatostatin analogs may counteract these effects. The authors discuss the latest guidelines for biochemical cure and highlight the efficacy of combination therapy. In addition, the effects of pharmacological presurgical treatment on surgical outcome are explored.
Magnetic resonance imaging versus ultrasonography for the in utero evaluation of central nervous system anomalies
Authors: Peruzzi Pierpaolo , Corbitt Rebecca J. , Raffel Corey 
Published: October 2010

Object
The use of fetal MR imaging for the in utero evaluation of pathological conditions of the CNS is widely accepted as an adjunct to fetal ultrasonography studies. Magnetic resonance imaging is thought to characterize CNS anomalies better, and to provide a more exact diagnosis and accurate prognosis. The purpose of this study was to determine the role of and indications for fetal MR imaging in evaluating fetuses with different CNS abnormalities that were seen initially on prenatal sonograms.

Methods
Over a 3-year period, fetuses with prior sonographic evidence of CNS abnormalities who consequently received prenatal MR imaging at Columbus Nationwide Children's Hospital within 2 weeks of the fetal ultrasonography study were included in this study. For each patient, radiological reports from both studies were reviewed, analyzed, and compared with the findings at postnatal imaging or physical examination. Results of the 2 modalities were then compared in terms of diagnostic accuracy.

Results
Twenty-six fetuses were included in this study on the basis of an in utero sonogram showing a CNS anomaly. Their gestational age ranged from 17 to 35 weeks, with a mean of 25 weeks at the time of fetal ultrasonography. Hydrocephalus was identified in 16 fetuses, 6 had evidence of a spinal dysraphic defect, 2 had holoprosencephaly, 1 had an encephalocele, and 1 had multiple body abnormalities requiring detailed CNS evaluation. Twenty-five of the fetuses were correctly evaluated as having abnormal CNS findings on both fetal ultrasonography and fetal MR imaging. Fetal ultrasonography provided a correct prenatal diagnosis in 20 cases, whereas fetal MR imaging was correct in 22 cases. There were 9 cumulative false-positive results for fetal ultrasonography and 7 for fetal MR imaging, whereas for false-negative results there were a total of 34 and 19, respectively.

Conclusions
Fetal MR imaging is more sensitive in detecting fetal CNS abnormalities, but its ability to provide a correct prenatal diagnosis is only marginally superior to fetal ultrasonography. Moreover, fetal MR imaging is not exempt from misdiagnosis, and still shows a significantly high rate of false-negative results. Particularly for spinal dysraphic defects, fetal MR imaging does not seem to add important diagnostic or prognostic details when compared with fetal ultrasonography.
Correlation of thin fibrous cap possessing adipophilin-positive macrophages and intraplaque hemorrhage with high clinical risk for carotid endarterectomy
Authors: Hao Hiroyuki , Iihara Koji , Ishibashi-Ueda Hatsue , Saito Fumio , Hirota Seiichi 
Published: October 2010

Object
Preoperative clinical risk classification of carotid artery (CA) stenosis anticipates the outcome of CA intervention. A higher incidence of neurological morbidity was noted after CA stenting (CAS) in patients with medical risks than in those without risks. However, little is known about the correlation between clinical risks and plaque composition. The purpose of this study was to characterize the CA plaque histology in 3 groups of patients who were classified based on clinical risks for carotid endarterectomy (CEA). Furthermore, the authors examined whether the plaque with high embolic potential after CA intervention, particularly CAS, could be predicted based on clinical risks for CEA.

Methods
Patients were divided into 4 groups, according to the CEA risk classification system, and 3 groups with more than 10 cases were enrolled in this study as follows: absence of all angiographic, medical, and neurological risks (Grade I, 27 cases); presence of medical risk, but no neurological risk (Grade III, 31 cases); and presence of neurological risk (Grade IV, 17 cases). Histopathological characteristics of CA plaques, including fibrous cap thickness, plaque disruption, thrombus formation, intraplaque hemorrhage (IPH), and adipophilin expression were examined without information regarding clinical status.

Results
Plaques in patients in Grades III and IV demonstrated a thin fibrous cap and enhanced IPH, compared with those in Grade I. Plaques in patients in Grade IV showed more adipophilin-expressing macrophages in the fibrous cap than in those of the other groups.

Conclusions
Plaques in Grades III and IV patients were characterized by thin fibrous cap atheroma with IPH. Adipophilin-positive macrophage infiltration in the fibrous cap might be correlated with instability in neurological status. The plaque morphology in patients with medical and neurological risks needs to be examined carefully with the aid of imaging modalities. In plaques demonstrating a thin fibrous cap and IPH, the CAS procedure should be avoided and CEA should be performed instead.
Anatomical triangles defining surgical routes to posterior inferior cerebellar artery aneurysms
Authors: Rodríguez-Hernández Ana , Lawton Michael T. 
Published: October 2010

Object
Surgical routes to posterior inferior cerebellar artery (PICA) aneurysms are opened between the vagus (cranial nerve [CN] X), accessory (CN XI), and hypoglossal (CN XII) nerves for safe clipping, but these routes have not been systematically defined. The authors describe 3 anatomical triangles and their relationships with PICA aneurysms, routes for surgical clipping, outcomes, and angiographically demonstrated anatomy.

Methods
The vagoaccesory triangle is defined by CN X superiorly, CN XI laterally, and the medulla medially. It is divided by CN XII into the suprahypoglossal triangle (above CN XII) and the infrahypoglossal triangle (below CN XII). From a consecutive surgical series of 71 PICA aneurysms in 70 patients, 51 aneurysms were analyzed using intraoperative photographs.

Results
Forty-three PICA aneurysms were located inside the vagoaccessory triangle and 8 were outside. Of the aneurysms inside the vagoaccessory triangle, 22 (51%) were exposed through the suprahypoglossal triangle and 19 (44%) through the infrahypoglossal triangle; 2 were between triangles. The lesions were evenly distributed between the anterior medullary (16 aneurysms), lateral medullary (19 aneurysms), and tonsillomedullary zones (16 aneurysms). Neurological and CN morbidity linked to aneurysms in the suprahypoglossal triangle was similar to that associated with aneurysms in the infrahypoglossal triangle, but no morbidity was associated with PICA aneurysms outside the vagoaccessory triangle. A distal PICA origin on angiography localized the aneurysm to the suprahypoglossal triangle in 71% of patients, and distal PICA aneurysms were localized to the infrahypoglossal triangle or outside the vagoaccessory triangle in 78% of patients.

Conclusions
The anatomical triangles and zones clarify the borders of operative corridors to PICA aneurysms and define the depth of dissection through the CNs. Deep dissection to aneurysms in the anterior medullary zone traverses CNs X, XI, and XII, whereas shallow dissection to aneurysms in the lateral medullary zone traverses CNs X and XI. Posterior inferior cerebellar artery aneurysms outside the vagoaccessory triangle are frequently distal and superficial to the lower CNs, and associated surgical morbidity is minimal. Angiography may preoperatively localize a PICA aneurysm's triangular anatomy based on the distal PICA origin or distal aneurysm location.
Libres propos sur l’efficacité des systèmes de droit civil
Authors: Mallet-Bricout Blandine 
Published: October 2010

Le Bicentenaire du Code civil français offre l’occasion à l’ensemble de la communauté des juristes de réfléchir, plus largement, sur l’avenir des systèmes de droit civil. Les débats sur la mondialisation du droit se multiplient, la concurrence de la
common law s’avère forte au sein même des pays traditionnellement rattachés aux systèmes de droit civil: certains s’en inquiètent, d’autres s’y résolvent... Dans ce contexte, peut-être faudrait-il davantage promouvoir l’efficacité des systèmes de droit romano-germanique, en s’interrogeant sur la notion même d’efficacité, qui ne se confond pas forcément avec une analyse économique du droit, et en défendant le pluralisme des systèmes juridiques, gage de modernité: la concurrence des droits permet l’émulation juridique et n’empêche pas une convergence raisonnée ou spontanée des droits, dans certains domaines spécifiques. A cet égard, l’influence des systèmes de droit civil passe aussi certainement par la construction d’instruments juridiques internationaux, dans le respect des diverses traditions juridiques. Les systèmes de droit civil, en particulier le droit français, sont performants; leurs qualités intrinsèques, leur rayonnement toujours actuel et leur souci renouvelé de suivre les évolutions -notamment technologiques -les plus récentes, en sont la preuve. Loin d’être moribonds, c’est d’un soutien positif dont ils ont besoin.
Roost Selection by Male Indiana Myotis Following Forest Fires in Central Appalachian Hardwoods Forests
Authors: Johnson Joshua B. , Ford W. Mark , Rodrigue Jane L. , Edwards John W. , Johnson Catherine M. 
Published: October 2010

AbstractDespite the potential for prescribed fire and natural wildfire to increase snag abundance in hardwood forests, few studies have investigated effects of fire on bat roosting habitat, particularly that of the endangered Indiana myotis Myotis sodalis. From 2001 to 2009, we examined roost selection of Indiana myotis in burned and unburned forests in Tucker County, West Virginia. We radiotracked 15 male Indiana myotis to 50 roost trees; 16 in burned stands and 34 in unburned stands. Indiana myotis roosted in stands that had initially been burned 1–3 y prior to our observations. In burned stands, Indiana myotis roosted exclusively in fire-killed maples (Acer spp.). In unburned stands, they roosted in live trees, predominately hickories (Carya spp.), oaks (Quercus spp.), and maples. Roost trees in burned stands were surrounded by less basal area and by trees in advanced stages of decay, creating larger canopy gaps than at random trees in burned stands or actual roost trees located in unburned stands. Compared to random trees in unburned stands, roost trees in unburned stands were less decayed, had higher percent bark coverage, and were surrounded by less basal area, also resulting in larger canopy gaps. Roost-switching frequency and distances moved by Indiana myotis among roost trees were similar between burned and unburned stands. Our research indicates that use of fire for forest management purposes, at minimum provoked no response from Indiana myotis in terms of roost tree selection, and may create additional roost resources, depending on spatial context.
Effectiveness of School-Based Occupational Therapy Intervention on Handwriting
Authors: Case-Smith Jane 
Published: October 2010

Abstract
OBJECTIVE. This study investigated the effects of school-based occupational therapy services on students’ handwriting.
METHOD. Students 7 to 10 years of age with poor handwriting legibility who received direct occupational therapy services (n = 29) were compared with students who did not receive services (n = 9) on handwriting legibility and speed and associated performance components. Visual-motor, visual-perception, in-hand manipulation, and handwriting legibility and speed were measured at the beginning and end of the academic year. The intervention group received a mean of 16.4 sessions and 528 min of direct occupational therapy services during the school year. According to the therapists, visual-motor skills and handwriting practice were emphasized most in intervention.
RESULTS. Students in the intervention group showed significant increases in in-hand manipulation and position in space scores. They also improved more in handwriting legibility scores than the students in the comparison group. Fifteen students in the intervention group demonstrated greater than 90% legibility at the end of the school year. On average, legibility increased by 14.2% in the students who received services and by 5.8% in the students who did not receive services. Speed increased slightly more in the students who did not receive services.
CONCLUSION. Students who received occupational therapy services demonstrated improved letter legibility, but speed and numeral legibility did not demonstrate positive intervention effects.