bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endonasal transsphenoidal approach to treat pituitary adenomas and other sellar lesions: an assessment of efficacy, safety, and patient impressions of the surgery
Authors: Zada Gabriel , Kelly Daniel F. , Cohan Pejman , Wang Christina , Swerdloff Ronald 
Published: May 2009

Object. The direct endonasal approach performed with the aid of an operating microscope for removal of pituitary tumors has the potential advantage over the traditional sublabial route of minimizing postoperative rhinological complications, yet maintaining a high degree of efficacy and safety. To assess the effectiveness of this procedure, tumor remission rates and surgical complications were documented, and patients' postoperative complaints were recorded using a questionnaire.
Methods. One hundred consecutive patients underwent 109 endonasal operations for tumor removal. At a median follow-up period of 16 months (range 3–45 months), surgical remission rates were as follows: in 40 patients with endocrine-inactive macroadenomas, 95% for noninvasive and 40% for invasive tumors; in the 20 patients with prolactinomas, 75% for prolactinomas with an initial prolactin (PRL) level lower than 200 ng/ml, 33% for those with a PRL level between 200 and 600 ng/ml, and 0% for those with a PRL level higher than 1400 ng/ml; in the 15 patients with Cushing disease, 73% for microadenomas and 25% for macroadenomas; in the 10 patients with acromegaly, 75% for microadenomas and 50% for macroadenomas; in the five patients with Rathke cleft cysts, 80%; and in the five patients with craniopharyngiomas, 40%. There were seven major surgical complications and no operative deaths. Among the 78 patients who completed questionnaires (response rate 89%), the most common complaints concerned nasal packing (39%), removal of packing (36%), and mouth breathing (35%). At 3 months or longer after surgery, patients quantified sinonasal problems as follows: for facial pain, no problem in 83% and severe difficulty in 4%; for nasal congestion, no problem in 74%, and severe difficulty in 3%; for decreased nasal airflow, no problem in 77% and severe difficulty in 4%; for decreased sense of smell, no problem in 73% and severe difficulty in 4%; and for upper-lip numbness, no problem in 87% and severe difficulty in 1%. Twelve (86%) of 14 patients who had undergone sublabial surgery previously preferred the endonasal approach in terms of pain and ease of recovery.
Conclusions. The direct endonasal route for pituitary tumor removal has efficacy and complication rates comparable to those of the sublabial route. Patients generally recover rapidly from this minimally invasive procedure and have no or minimal sinonasal complaints. For patients requiring a repeated operation, the endonasal route appears to be less painful and easier to recover from than the sublabial route. Given the minimal nasal mucosal dissection required and the frequent patient complaints related to nasal packing, use of packing is no longer used for this procedure.
Surgical handling characteristics of an ethylene vinyl alcohol copolymer compared with N-butyl cyanoacrylate used for embolization of vessels in an arteriovenous malformation resection model in swine
Authors: Akin Eric D. , Perkins Eddie , Ross Ian B. 
Published: May 2009

Object. There have been significant improvements in neurovascular technology and implants over the past decade. One such material, N-butyl cyanoacrylate (NBCA), is now commercially available for cerebral arteriovenous malformation (AVM) embolization in the US. An ethylene vinyl alcohol copolymer preparation, Onyx, which is currently being evaluated, is approved for use outside North America. Although reports indicate that Onyx may be superior to NBCA from an endovascular perspective, little information exists about its surgical handling characteristics. The purpose of this study was to compare the surgical handling characteristics of Onyx-treated vessels with those of NBCA-embolized vessels in an AVM resection model.
Methods. Fourteen pigs (two groups of seven) were anesthetized. A femoral artery was cannulated, followed by selective catheterization of the ascending pharyngeal arteries. Nidal rete mirabile (RM) embolizations were performed using either 6% Onyx or 20% NBCA. After angiographically confirmed obliteration of flow in the right RM, microsurgical resection of this structure was performed. Surgical handling characteristics of the embolized RM were rated on a scale of 1 to 5 and blood loss was recorded. Different surgeons performed the embolizations and resections. The surgeon who performed resections was blinded to the embolization agent used, and the data analysis was also performed in a blinded fashion. The surgical handling scores were superior (p < 0.05) in the Onyx-treated group. Although there was also less blood loss in this group, the difference was not significant. Subjectively, the surgeon who performed the resections believed that Onyx was softer and handled better than NBCA.
Conclusions. Onyx, which may offer endovascular advantages, also seems to provide benefits for the surgeon.
Cytotoxicity in glioma cells due to interleukin-12 and interleukin-18—stimulated macrophages mediated by interferon-γ regulated by nitric oxide
Authors: Kito Tomohiro , Kuroda Etsushi , Yokota Akira , Yamashita Uki 
Published: May 2009

Object. Interleukin (IL)-12 and IL-18 synergistically mediate antitumor responses through the production of interferon-γ (IFNγ) by T and natural killer (NK) cells. Recently, it has been reported that macrophages stimulated with these cytokines also produce IFNγ, which led the authors to investigate the antiglioma activity of macrophages stimulated by the combination of these cytokines in vitro.
Methods. Dish-adherent peritoneal exudate cells, which had been elicited in thioglycollate broth as a source of macrophages, were used in the experiment. The murine glioma cell lines VM-glioma and 203G were labeled with [3H]thymidine for a cytotoxicity assay of macrophages. In response to the combined stimulation by IL-12 and IL-18, macrophages expressed potent cytotoxic activity against glioma cells in association with increasing production of IFNγ and nitric oxide (NO). Inhibitors of NO abrogated the cytotoxic activity of the macrophages, which had been induced by IL-12 and IL-18, despite the increase in IFNγ production. Neutralization of IFNγ or use of macrophages obtained from IFNγ gene-knockout mice markedly reduced not only cytotoxic activity, but also NO production. Depletion of T and NK cells from the macrophage population, which was achieved using antibody plus complement treatment, slightly reduced macrophage activities, suggesting that these are the main effector cells, although T and NK cells may partially participate in this cytotoxicity.
Conclusions. Macrophages stimulated with IL-12 and IL-18 produced IFNγ and NO, which in turn mediated the antiglioma response. Therefore, macrophages as well as T and NK cells play an important role in antitumor responses stimulated by IL-12 and IL-18.
Pathophysiology of headache associated with cough in patients with Chiari I malformation
Authors: Sansur Charles A. , Heiss John D. , DeVroom Hetty L. , Eskioglu Eric , Ennis Robert , Oldfield Edward H. 
Published: May 2009

Object. The aim of this study was to evaluate the pathophysiology underlying headache associated with cough in patients with Chiari I tonsillar abnormality. The authors hypothesized that peak intrathecal pressure during coughing is higher in patients with headache aggravated by cough than in patients without or in healthy volunteers. In addition, the authors evaluated the use of intrathecal pressure during cough as a means of assessing obstruction to the free flow of cerebrospinal fluid (CSF) at the craniocervical junction.
Methods. Twenty-six adult patients with Chiari I malformation and syringomyelia, four adult patients with Chiari I malformation without syringomyelia, and 15 healthy volunteers were prospectively studied. Testing before surgery included the following: 1) clinical evaluation for the presence of headache associated with cough; and 2) evaluation of lumbar subarachnoid pressure at rest, during three to five coughs, while performing the Valsalva maneuver, during jugular compression, and after removal of CSF. Patients underwent suboccipital craniectomy, C-1 laminectomy, and duraplasty. Testing was repeated 6 months after surgery.
Conclusions. Peak intrathecal pressures during cough and at baseline were elevated in patients with headache associated with cough compared with either patients without headache or healthy volunteers. After surgery, intrathecal pressures during cough were significantly lower than preoperative values and headache aggravated by cough was resolved partially or completely. Headache linked to coughing in patients with Chiari I malformation is associated with sudden increased intrathecal pressure caused by obstruction to the free flow of CSF in the subarachnoid space.
Symptom-based assessment of the severity of a concussion
Authors: Erlanger David , Kaushik Tanya , Cantu Robert , Barth Jeffrey T. , Broshek Donna K. , Freeman Jason R. , Webbe Frank M. 
Published: May 2009

Object. Current grading systems of concussion and return-to-play guidelines have little empirical support. The authors therefore examined the relationships of the characteristics and symptoms of concussion and the history of concussion to three indicators of concussion severity—number of immediate symptoms, number of symptoms at the initial follow-up examination, and duration of symptoms—to establish an empirical basis for grading concussions.
Methods. Forty-seven athletes who sustained concussions were administered alternate forms of an Internet-based neurocognitive test until their performances were within normal limits relative to baseline levels. Assessments of observer-reported and self-reported symptoms at the sideline of the playing field on the day of injury, and at follow-up examinations were also obtained as part of a comprehensive concussion management protocol.
Although loss of consciousness (LOC) was a useful indicator of the initial severity of the injury, it did not correlate with other indices of concussion severity, including duration of symptoms. Athletes reporting memory problems at follow-up examinations had significantly more symptoms in general, longer durations of those symptoms, and significant decreases in scores on neurocognitive tests administered approximately 48 hours postinjury. This decline of scores on neurocognitive testing was significantly associated with an increased duration of symptoms. A history of concussion was unrelated to the number and duration of symptoms.
Conclusions. This paper represents the first documentation of empirically derived indicators of the clinical course of postconcussion symptom resolution. Self-reported memory problems apparent 24 hours postconcussion were robust indicators of the severity of sports-related concussion and should be a primary consideration in determining an athlete's readiness to return to competition. A decline on neurocognitive testing was the only objective measure significantly related to the duration of symptoms. Neither a brief LOC nor a history of concussion was a useful predictor of the duration of postconcussion symptoms.
Framework for bioethical assessment of an article on therapy
Authors: Bernstein Mark , Upshur Ross E. G. 
Published: May 2009

Object. Frameworks for scientific assessment of articles on therapy published in the medical literature have become available and will likely enhance the quality of medical research that is published in peer-reviewed journals. Comprehensive frameworks do not exist for the assessment of bioethical issues pertaining to research on human volunteers.
Methods. The authors have developed a framework consisting of ethical dimensions or questions that they suggest should be applied to assess the bioethical integrity of articles on therapy. Thirteen questions were developed and discussed in the context of current bioethical principles, and examples were applied where possible.
Conclusions. The simple framework the authors have developed offers a method to assess key bioethical issues surrounding an article on therapy and probably defines the minimum standard to which such articles should be held. Many ethical questions cannot yet be answered based on available information or bioethical theories. The authors are not suggesting that their framework is comprehensive; refinements and individualization of it to fit specific studies are probably required by each clinician—researcher who designs a therapy trial and reports its results.
Use of a wedged microcatheter for curative transarterial embolization of complex intracranial dural arteriovenous fistulas: indications, endovascular technique, and outcome in 21 patients
Authors: Nelson Peter Kim , Russell Stephen M. , Woo Henry H. , Alastra Anthony J. G. , Vidovich Danko V. 
Published: May 2009

Object. The aim of this study was to describe the application of a novel transarterial approach to curative embolization of complex intracranial dural arteriovenous fistulas (DAVFs). This technique is particularly useful in patients harboring high-grade DAVFs with direct cortical venous drainage or for whom transvenous coil embolization is not possible because of limited sinus venous access to the fistula site due to thrombosis or stenotic changes.
Methods. Twenty-three DAVFs in 21 patients were treated using a transarterial N-butyl cyanoacrylate (NBCA) embolization technique with the aid of a wedged catheter. In all patients, definitive treatment involved two critical steps: 1) a microcatheter was wedged within a feeding artery, establishing flow-arrest conditions within the catheterized vessel distal to the microcatheter tip; and 2) NBCA was injected under these resultant flow-arrest conditions across the pathological arteriovenous connection and into the immediate draining venous apparatus, definitively occluding the fistula. Patient data were collected in a retrospective manner by reviewing office and inpatient charts and embolization reports, and by directly analyzing all procedural and diagnostic angiograms.
Eight patients presented with the principal complaint of tinnitus/bruit, five with intracranial hemorrhage, four with cavernous sinus syndrome, and one each with seizures, ataxia, visual field loss, and hiccups. The parent (recipient) venous structure of the DAVFs in this study included 11 leptomeningeal veins, eight transverse/sigmoid sinuses, three cavernous sinuses, and one sphenoparietal sinus. The NBCA permeated the arteriovenous shunt, perifistulous network, and proximal draining vein in all DAVFs. Occlusion was confirmed on postembolization angiography studies. No complication occurred in any patient in this series. There has been no recurrence during a mean follow up of 18.7 months (range 2–46 months).
Conclusions. Transarterial NBCA embolization with the aid of a wedged catheter in flow-arrest conditions is a safe and an effective treatment for intracranial DAVFs.
Intraoperative monitoring of blood flow insufficiency in the anterior choroidal artery during aneurysm surgery
Authors: Suzuki Kyouichi , Kodama Namio , Sasaki Tatsuya , Matsumoto Masato , Konno Yutaka , Sakuma Jun , Oinuma Masahiro , Murakawa Masahiro 
Published: May 2009

Object. The lack of a specified intraoperative method for monitoring anterior choroidal artery (AChA) blood flow insufficiency (BFI) led the authors to devise a method for checking the BFI in this artery during aneurysm surgery. To this end, the authors relied on the intraoperative motor evoked potentials (MEPs) elicited by electrical stimulation of the hand motor cortex.
Methods. The study population consisted of 108 patients with internal carotid artery (ICA) aneurysms who underwent surgery via a standard frontotemporal craniotomy. After the dura mater had been opened, a grid electrode strip with 16 small electrodes was inserted subdurally into the hand motor cortex from the edge of the craniotomy. To check BFI in the AChA, the hand motor cortex was stimulated at an intensity level between 10 and 18 mA. The MEPs were successfully recorded from the contralateral thenar muscles in all 108 patients. There was no postoperative motor paresis in 88 patients in whom the MEPs remained unchanged during the performance of various surgical maneuvers. Among the other 20 patients, 19 manifested transient MEP changes, but 15 of those patients experienced no postoperative motor paresis. In four patients who exhibited transient MEP changes, either after aneurysm clipping or during temporary occlusion of the ICA and/or AChA, hemiparesis occurred postoperatively but disappeared within 24 hours. In one patient with an ICA—posterior communicating artery aneurysm, the MEP disappeared and did not reappear by the time of dural closure. Severe hemiplegia developed in this patient and a computerized tomography scan obtained postoperatively revealed a new low-density area in the internal capsule.
Conclusions. The findings of this study suggest that the monitoring method that is introduced here is safe and reliable for detecting intraoperative BFI in the AChA.
Monitoring of brain tissue oxygenation during aneurysm surgery: prediction of procedure-related ischemic events
Authors: Jödicke Andreas , Hübner Felix , Böker Dieter-Karsten 
Published: May 2009

Object. The aim of this study was to evaluate the feasibility of monitoring brain tissue oxygenation (PO2) during aneurysm surgery for the detection of procedure-related ischemia.
Methods. Between 1997 and 1998, PO2 was monitored prospectively in a cohort of 40 patients (42 recordings) during aneurysm surgery in the anterior circulation within the vascular territory of the aneurysm-bearing artery. The position of the probe used to measure oxygenation levels was verified on computerized tomography (CT) scanning on the 1st postoperative day. Because of the mislocation of one probe and the malfunction of another, data from only 38 patients (40 recordings) were suitable for analysis. Relative changes from baseline to absolute nadir values of intraoperative PO2 were correlated with simultaneously recorded somatosensory evoked potentials (SSEPs), and cardiovascular and ventilatory parameters. The frequency of ischemic events was evaluated with the aid of CT on the 1st postoperative day as a substitute parameter for intraoperative ischemia. Clinical outcome was evaluated 30 days postoperatively based on the Glasgow Outcome Scale.
Except for three, all patients underwent surgery for treatment of a symptomatic aneurysm. Mean baseline PO2 was 23.9 mm Hg (range 2–67.2 mm Hg) before clip application. A relative decrease in PO2 (20% decrease in value compared with baseline) occurred in 12 patients and was a sensitive indicator for the risk of ischemia during temporary arterial occlusion, but was less predictive of nonocclusive ischemia (sensitivity 0.5; positive predictive value [PPV] 0.42; p > 0.05). Results of receiver operating characteristic analysis demonstrated a postclipping PO2 nadir of 15 mm Hg as a dichotomizing threshold for the prediction of ischemia. This threshold rendered an improved sensitivity (0.9) and PPV (0.56) for procedure-related ischemia (p = 0.0003). The results of utility analysis revealed this monitoring parameter to be clinically diagnostic. Only PO2 monitoring, and not SSEP at the tibial nerve, was predictive of ischemia within the anterior cerebral artery territory.
Conclusions. Using 15 mm Hg as a dichotomizing threshold, intraoperative PO2 monitoring enables one to identify patients at risk for procedure-related ischemia during aneurysm surgery and surpasses SSEP monitoring. This newly defined threshold based on intraoperative PO2 monitoring provides a basis for studies on treatments for procedure-related ischemia during aneurysm surgery.
Three-dimensional angiography for radiosurgical treatment planning for arteriovenous malformations
Authors: Colombo Federico , Cavedon Carlo , Francescon Paolo , Casentini Leopoldo , Fornezza Umberto , Castellan Lucio , Causin Francesco , Perini Stefano 
Published: May 2009

Object. Radiosurgical treatment of a cerebral arteriovenous malformation (AVM) requires the precise definition of the nidus of the lesion in stereotactic space. This cannot be accomplished using simple stereotactic angiography, but requires a combination of stereotactic biplanar angiographic images and stereotactic contrast-enhanced computerized tomography (CT) scans. In the present study the authors describe a method in which three-dimensional (3D) rotational angiography is integrated into stereotactic space to aid treatment planning for radiosurgery.
Methods. Twenty patients harboring AVMs underwent treatment planning prior to linear accelerator radiosurgery. Planning involved the acquisition of two different data sets, one of which was obtained using the standard method (a combination of biplanar stereotactic angiography with stereotactic CT scanning), and the other, which was procured using a new technique (nonstereotactic 3D rotational angiography combined with stereotactic CT scanning by a procedure of image fusion).
The treatment plan that was developed using the new method was compared with that developed using the standard one. For each patient the number of isocenters and the dimension of selected collimators were the same, based on the information supplied in both methods. Target coordinates were modified in only five cases and by a limited amount (mean 0.7 mm, range 0.3–1 mm).
Conclusions. The new imaging modality offers an easier and more immediate interpretation of 3D data, while maintaining the same accuracy in target definition as that provided by the standard technique. Moreover, the new method has the advantage of using nonstereotactic 3D angiography, which can be performed at a different site and a different time with respect to the irradiation procedure.