bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcome after Operative Treatment of Intramedullary Spinal Cord Tumors in Adults: Intermediate and Long-Term Results in 51 Patients
Authors: Cooper Paul R. 
Published: April 2011

Abstract
The reported results of treatment of intramedullary spinal cord tumors (IMSCT) are difficult to interpret because of heterogeneous management strategies, small numbers of patients, and short periods of follow-up. In 1985 we published the early results of operative treatment of 29 patients with IMSCT and were cautiously optimistic that aggressive operative management would have a salutary effect on long-term outcome. In this report, the most recent clinical status of these 29 original patients is reviewed, along with that of 22 additional ones, to assess the intermediate and long-term results of treatment of IMSCT in 51 patients who underwent microsurgical resection between 1981 and 1987. Of these 51 patients, 24 had ependymomas, 18 had astrocytomas, and the remainder had a variety of less common lesions. Thirty-seven patients survive and have been followed for periods up to 72 months (mean 38 months). The neurological conditions of 21 patients are improved or have stabilized following operation. The conditions of 16 patients are worse postoperatively: 11 from operation and 5 from progression of disease. Eight patients are neurologically intact, 7 walk independently but abnormally, 9 ambulate with the aid of a cane or walker, and the remaining 13 are not ambulatory. Twelve of 18 patients with astrocytomas and 2 of 24 patients with ependymomas have died after a mean survival of 10 months from operation. Patients with ependymomas who had gross total resection have fared the best, with no deaths or recurrences, but no relationship could be discerned between the extent of resection and outcome in patients with astrocytomas. The author concludes that radical resection of IMSCT may be performed with initial stabilization or improvement of neurological function in the majority of patients. In patients with ependymomas the extent of resection correlated well with long-term outcome. In patients with astrocytomas. however, there was no such relationship. All 7 patients with astrocytomas of Grades III and IV have died, as have 4 of 11 patients with astrocytomas of Grades I and II.
Proliferation Activity in Pituitary Adenomas: Measurement by Monoclonal Antibody Ki-67
Authors: Knosp Engelbert , Kitz Klaus , Perneczky Axel 
Published: April 2011

Abstract
The monoclonal antibody (MAb) Ki-67 detects a nuclear antigen expressed by proliferating cells during the entire cell cycle. In contrast to conventional histological techniques, the use of MAb Ki-67 on frozen sections or cytological smear preparations allows direct determination of the growth rate of tumors routinely. Sixty-two pituitary adenomas were investigated by use of the MAb Ki-67 in a two-step avidin-biotin-peroxidase complex technique. The proliferation activity ranged from 0.1 to 2.8%. There was no significant difference between the proliferation and hormonal state of the adenomas. Adenomas for which there was histological evidence of dural infiltration, however, showed a statistically significant higher proliferation activity (P&gt; 0.05) compared to noninvasive adenomas.
Hyperperfusion Syndrome after Carotid Endarterectomy: A Transcranial Doppler Evaluation
Authors: Powers Alexandros D. , Smith Robert R. 
Published: April 2011

Abstract

Transcranial Doppler ultrasonography was used to evaluate 2 patients who developed hyperperfusion syndromes after carotid endarterectomy. During the initial postoperative period, each patient had symptoms that were associated with elevated flow velocities in the ipsilateral cerebral vasculature. In addition, vascular resistance of these vessels was found to be abnormally low, as reflected by the Gosling pulsatility index. As the patients' symptoms improved, flow velocities decreased to normal levels and pulsatilities were noted to increase proportionately. (Neurosurgery 26:56-60, 1990)
Endoscopic Third Ventriculostomy
Authors: Jones R. F. C. , Stening W. A. , Brydon M. 
Published: April 2011

Abstract

Long-term extracranial shunting for hydrocephalus has numerous drawbacks related to shunt malfunction and infection. In some cases outcome has been very disappointing. We successfully managed 5 patients with acquired aqueductal stenoses with no significant morbidity by the use of an intracranial cerebrospinal fluid diversion, namely a third ventriculostomy. First advocated by Dandy, ventriculostomy was largely passed over in favor of extracranial procedures. With improved surgical techniques, however, ventriculostomy is now considered to be a viable alternative in selected cases. In a further 19 patients, we subsequently broadened our patient selection to include those with Arnold-Chiari malformations, congenital noncommunicating hydrocephalus, and tumors. Two thirds of these children remain without shunts and apart from 1 child developing hemiplegia postoperatively, there has been no significant morbidity. Although the best results have been seen in the late onset groups, even early onset, noncommunicating hydrocephalus has been successfully managed. Even in patients in whom third ventriculostomy has failed and who have subsequently required ventriculoperitoneal shunts, we anticipate that they will remain less dependent on shunts because their hydrocephalus is now communicating, which tends not to have such a rapid onset or extreme levels of raised intracranial pressure. (Neurosurgery 26:86-92, 1990)
Intracerebral Arteriovenous Fistulas Associated with Intraparenchymal Varix in Childhood: Case Reports
Authors: Barnwell Stanley L. , Ciricillo Samuel F. , Halbach Van V. , Edwards Michael S. B. , Cogen Philip H. 
Published: April 2011

Abstract

This report describes three children, each of whom developed an unusual malformation consisting of one or more intracerebral arteriovenous fistulas and a large intraparenchymal venous varix. Their clinical symptoms were similar to those produced by aneurysms of the vein of Galen: increasing head circumference, seizures, hemorrhage, and developmental delay. We treated each child with endovascular embolization and/or surgery and obtained complete closure of all fistulas without mortality. (Neurosurgery 26:122-125, 1990)
Cerebral Aspergillosis after Burr-Hole Surgery for Chronic Subdural Hematoma: Case Report
Authors: Morioka Takato , Tashima Takatoshi , Nagata Shinji , Fukui Masashi , Hasuo Kanehiro 
Published: April 2011

Abstract
We report a case of aspergillosis in the subdural space and frontal lobe in an 83-year-old man. The clinical course simulated that of a brain tumor. The source for the infection was considered to be the previous burr-hole surgery for chronic subdural hematoma, which was performed 2.5 years before the onset of symptoms. The patient was treated by removal of the abscess and granuloma. The clinical features and treatment of aspergillosis after neurosurgical procedures are discussed.
Interstitial Brachytherapy for Malignant Brain Tumors: Preliminary Results
Authors: Bernstein Mark , Laperriere Normand , Leung Phil , McKenzie Stephen 
Published: April 2011

Abstract
The authors report their experience with interstitial brachytherapy in 46 patients with malignant brain tumors. Twentythree patients received implants after external radiation for newly diagnosed malignant astrocytoma, as part of a randomized study (Group I). Eighteen patients received implants for recurrent malignant astrocytoma (Group II) and 3 for recurrent solitary cerebral metastasis from adenocarcinoma of the lung (Group III). Two additional patients received implants as part of their initial therapy for a radiation-induced malignant astrocytoma and a malignant fibrous histiocytoma. In all patients high-activity iodine-125 sources were implanted temporarily by a stereotactic technique. To date 50 patients have been entered in the randomized study with a maximum follow-up of 31 months. The small numbers and short follow-up preclude any conclusions regarding the efficacy of brachytherapy used as part of initial therapy. The median survival to date in the 23 patients in this group who received implants is 60 weeks. The median survival to date for the 18 patients who received implants for recurrent malignant astrocytoma is 44 weeks postimplant. Two of the three patients who received implants for recurrent solitary metastasis are alive at 41 and 49 weeks postimplant; a third died at 39 weeks postimplant. Significant complications attributable to interstitial brachytherapy have been observed in 10 of 46 patients (21.7%). A second operation for clinical and radiological deterioration was performed in 12 patients (26.1%) 8 to 105 weeks after brachytherapy. The authors conclude that interstitial brachytherapy is beneficial for selected patients with recurrent malignant astrocytoma and solitary recurrent metastasis. The role for this therapy as part of the initial management of patients with malignant astrocytoma remains to be adequately determined in ongoing randomized studies.
Pericyte Degeneration and Thickening of Basement Membranes of Cerebral Microvessels in Complex Partial Seizures: Electron Microscopic Study of Surgically Removed Tissue
Authors: Liwnicz Boleslaw H. , Leach James L. , Yeh Hwa-Shain , Privitera Michael 
Published: April 2011

Abstract
Complex partial seizures are associated with alterations in regional cerebral blood flow in abnormally spiking foci, as shown by positron emission tomography and single photon emission computed tomography, with an increase in flow ictally and a decrease interictally. Alterations of vasoregulation during ictal periods have also been described in animal seizure models. An electron microscopic study on human brain tissue from seven patients undergoing resections for the treatment of intractable complex partial seizures was performed to examine ultrastructural changes of the microvasculature and their locations within the microvessel wall. Biopsies were obtained intraoperatively from temporal lobe regions with electrocorticographically detected abnormal spiking and from regions without abnormality on electrocorticograms (control samples) removed as part of the therapeutic resection. A total of 539 microvessels from three regions were evaluated: spiking mesial temporal lobe, spiking lateral temporal cortex, and nonspiking (control) cortex. Evidence of pericyte degeneration (aggregates of cellular debris within the basement membrane) was noted in the majority of spiking area microvessels (76.7% in spiking mesial temporal cortex; 69.8% in spiking lateral temporal cortex) as compared with 37.8% of control microvessels (P&lt; 0.0005). Morphometric studies revealed a significant increase in total wall thickness, pericyte-basement membrane unit thickness, pericyte cytoplasmic density, basement membrane density, and basement membrane thickness in microvessels from spiking (mesial and lateral temporal cortex), as compared to control areas (P&lt; 0.01). No statistically significant difference was noted in pericyte coverage or pericyte or endothelial mitochondrial densities between microvessels in spiking and control regions. This study shows degeneration of pericytes, cells thought to play an essential role in microvascular hemodynamics, and thickening of microvessel walls in abnormally spiking brain regions in patients with intractable complex partial seizures. The pericyte degeneration and basement membrane thickening in abnormally spiking areas may explain alterations in vasoregulation, by a decrease in the microvascular compliance and in cross-capillary diffusion.
Early Aneurysm Surgery and Preventive Therapy with Intravenously Administered Nimodipine: A Multicenter, Double-Blind, Dose-Comparison Study
Authors: Gilsbach Joachim M. , Reulen Hans J. , Ljunggren Bengt , Brandt Lennart , Holst Hans v. , Mokry Michael , Essen Claes v. , Conzen Michael A. 
Published: April 2011

Abstract
A European, multicenter. prospective, randomized. double-blind, dose-comparison study on preventive therapy with intravenously administered nimodipine was performed to evaluate the efficacy and tolerability of two different doses: 2 and 3 mg/h. Two hundred four patients fulfilled the criteria for enrollment in the study; surgery within 72 hours after the last subarachnoid hemorrhage, and age between 16 and 72 years. All patients who had Hunt and Hess grades of I to III were operated upon: patients who had poor Hunt and Hess grades (IV-V) were operated on according to the surgeon's choice. This treatment regimen was associated with a low incidence of delayed neurological dysfunction with no significant difference between the two dosage groups: three patients (1.5%) remained severely disabled and two (1%) moderately disabled due to vasospasm with or without additional complications. Among the patients with Hunt and Hess grades of IV or V. the long-term outcome was favorable (good-fair) for 40% and unfavorable for 60%. Among the patients with grades of I to III, the long-term outcome was favorable for 89% and unfavorable for 11%.
Patterns of Failure of Aspirin Treatment in Symptomatic Atherosclerotic Carotid Artery Disease
Authors: Chyatte Douglas , Chen Terence L. 
Published: April 2011

Abstract
Over a 24-month period, 291 patients were consecutively admitted to the West Haven Veterans Administration Medical Center with new ischemic neurological symptoms. Of these, 90 patients (31%) developed ischemic neurological symptoms while taking aspirin (aspirin treatment failure). Of those in whom aspirin treatment failed. 66 patients had ischemic symptoms in the distribution of the carotid artery. Aspirin treatment failed in 21 patients with severe carotid stenosis (&gt;75% stenosis). Eleven of these 21 patients had cerebral infarctions while taking aspirin, and 7 of these 11 infarcts occurred without the prior warning of transient ischemic attacks. Aspirin treatment failed in 45 patients with lesser degrees of carotid stenosis. Transient ischemic attack without permanent ischemia was the most common manifestation of failure in these patients. Infarction occurred in only 12 of these 45 patients and in only 4 patients did infarction occur without warning. We conclude that patients with symptomatic high-grade carotid stenosis (&gt;75%) in whom aspirin treatment failed are likely to suffer an infarct without warning as the first sign of treatment failure (P&lt; 0.033). We suggest that this subgroup of patients should be considered for alternative forms of therapy.
Social Outcome Related to Cognitive Performance and Computed Tomographic Findings after Surgery for a Ruptured Intracranial Aneurysm
Authors: Vilkki J. , Holst P. , öhman J. , Servo A. , Heiskanen O. 
Published: April 2011

Abstract
A series of 83 patients was examined with a battery of cognitive tests, a clinical interview, and computed tomography 1 year after surgery for a ruptured intracranial aneurysm. Disability on the Glasgow Outcome Scale (33%), failure to return to work (25%), impaired social relations (25%), and subjective or clinical mental impairment (56%) were found to be related to each other and to poor performance on cognitive tests, especially to verbal impairments in patients with left lateral infarctions and to memory deficits and cognitive inflexibility in patients with frontal medial infarctions. Furthermore, cognitive deficits and poor outcome were associated with diffuse brain damage. Depression and anxiety were unrelated to test performances, but were frequently reported by patients with right lateral infarctions.
Recurrent Intracerebral Hemorrhage Due to Hypertension
Authors: Lee Kyeong Seok , Bae Hack Gun , Yun H Gyu 
Published: April 2011

Abstract
We report a series of 14 patients who had recurrent intracerebral hemorrhage due to hypertension. These patients comprise 2.7% of all those admitted to the Soonchunhyang University Chonan Hospital for hypertensive intracerebral hemorrhage from 1985 to 1988. Women outnumbered men by 13 to 1. The mean age of the patients was 54.5 years at the time of the first hemorrhage and 55.4 years at the time of the second hemorrhage. The mean interval between attacks was 13.1 months. All patients were hypertensive on admission, and in 10 patients hypertension had been diagnosed previously. None of the patients had received regular antihypertensive therapy, even after the first hemorrhage. Hemiplegia was the most common deficit seen after both the first and second attacks. The site of the first hemorrhage was ganglionic in 9 patients, cerebellar in 3 patients, and lobar in 2 patients. The site of the second hemorrhage was ganglionic in 9 patients and lobar in 5. The site of recurrent hemorrhage was different from the initial site in all patients except one. The most common pattern of recurrence was “ganglionic-ganglionic.” The “lobar-lobar” pattern was noted in only 1 patient. The hypertensive changes of the cerebral arteries are considered to be the major cause of these recurrent hemorrhages. We believe that recurrent intracerebral hemorrhages in hypertensive patients are not rare as previously thought. Possible reasons for the increased frequency of recurrent intracerebral hemorrhage are discussed.
Relationship of Invasiveness to Proliferating Activity and to Cytoskeletal Protein Production in Human Neuroepithelial Tumors Maintained in an Organ Culture System: Use of Human Cortex and Dura as Supporting Matrices
Authors: Ibayashi Norihiro , Herman Mary M. , Boyd James C. , Rubinstein Lucien J. 
Published: April 2011

Abstract
The proliferation and invasiveness of cultured human neuroepithelial tumors were studied. A human malignant astrocytic glioma cell line (U-251 MG) and a medulloblastoma cell line (D283 Med) were maintained for 3 weeks in an organ culture system using adult human brain cortex, dura mater, or Gelfoam sponge as growth matrices. The cells were labeled with bromodeoxyuridine (BrdU) at different time points, and immunohistochemistry was performed for BrdU, glial fibrillary acidic (GFA) protein (in U-251 MG), and neurofilament (NF) protein (in D283 Med). In the U251 MG line, the cells grew successfully in each matrix, forming a fibrillated solid area and a peripheral zone of invasion. The labeling index (LI) expressed as the percentage of BrdU-labeled cells and the percentage of GFA protein-positive cells in the two zones of the explants were analyzed. The LIs in all cultures were significantly higher in the peripheral than in the central zones. On the other hand, the percentage of GFA protein-positive cells in each matrix was greater in the central zone than in the periphery. The LI was inversely correlated with the percentage of GFA protein-positive cells over the areas counted in each growth matrix. GFA protein production in cells grown on cortex and on dura mater was significantly higher than that in cells grown on Gelfoam. In the D283 Med line, the cells formed an aggregated zone, with peripheral cells infiltrating the Gelfoam. This line showed poor growth on human cortex. Cells grown on the dura demonstrated an LI similar to that on Gelfoam, and cells often infiltrated the dura. The LI of these cells was higher in the peripheral than in the central zone of the explants, both on dura and on Gelfoam. The cells showed variable immunopositivity for each NF protein subunit. No apparent difference in the percentage of immunopositive cells for each NF protein subunit was detected between cells grown on dura and on Gelfoam; however, cells grown on dura often demonstrated neurite-like processes. The results indicate that an organ culture system using human brain cortex or dura mater as matrices for in vitro growth is a promising tool for the study of neuroglial differentiation and of the invasiveness of cultured human neuroepithelial tumors.
Use of Vicryl (Polyglactin 910) Mesh to Limit Epidural Scar Formation after Laminectomy
Authors: Nussbaum Charles E. , McDonald Joseph V. , Baggs Raymond B. 
Published: April 2011

Abstract
A variety of substances have been used at laminectomy sites to prevent postoperative epidural scarring. Free grafts of autologous subcutaneous fat are commonly used both clinically and experimentally. The free fat grafts usually survive, but decrease in size by about 50%. Postoperatively, subcutaneous seroma has been observed with the use of fat grafts, as well as recurrent symptoms of neural compression by the graft that required additional operations. When compared to the use of free fat grafts after laminectomy in dogs, Vicryl mesh produced slightly more scarring, but consistently less than that observed in control animals. The Vicryl mesh was resorbed by a minimal chronic inflammatory response over about 45 days. Seven of 11 fat-grafted zones showed signs of necrosis, at times with a greater collection of inflammatory cells than that associated with the Vicryl mesh. Of the 4 fat-grafted zones that showed good survival. 2 had gross evidence of neural compression. No surgical zone treated with Vicryl mesh exhibited evidence of neural compression. In view of these results, the use of Vicryl mesh at laminectomy sites may be a safer method of limiting postoperative epidural scar formation.
Deep Brain Stimulation for Control of Intractable Pain in Humans, Present and Future: A Ten-Year Follow-up
Authors: Kumar Krishna , Wyant Gordon M. , Nath Rahul 
Published: April 2011

Abstract
Deep brain stimulation with chronically implanted electrodes has provided satisfactory control of pain in patients with intractable chronic pain syndromes, which have been refractory to medication and other conventional modalities of management. In this series the authors present their experience with 48 patients who have been followed for periods ranging from 6 months to 10 years. Long-term pain control was achieved in 30 patients (63%). Both the periventricular gray and specific sensory thalamic nuclei have been used as targets. Our results indicate that there is an initial 2-year fall-off of pain control caused by idiopathic tolerance, with stable results thereafter, regardless of site of the implant. This is suggestive of some biochemical modification of tissues around the electrode. Patients with failed-back syndrome secondary to multiple disc operations fared well; those with pain secondary to progressive neurological disorders or cancer had only short-term pain relief, and those with thalamic pain, cauda equina injury, or phantom limb pain usually had a poor result. Deep brain stimulation, in selected patients, appears to provide long-term pain control safely with few side effects or complications.
Disturbed Cerebrospinal Fluid Circulation after Subarachnoid Hemorrhage and Acute Aneurysm Surgery
Authors: Auer Ludwig M. , Mokry Michael 
Published: April 2011

Abstract
In 138 patients with ruptured cerebral aneurysms operated on within 48 to 72 hours after subarachnoid hemorrhage, an external ventricular drainage catheter was inserted before craniotomy and was used intermittently during the first week after surgery. In 51 patients, intracranial pressure (ICP) was measured intraoperatively. The majority of patients showed increased ICP intraoperatively irrespective of the preoperative Hunt and Hess grade and the amount of subarachnoid blood accumulation or intraventricular blood clot. Intraoperative drainage of cerebrospinal fluid allowed easy access for aneurysm dissection by making the brain slack in more than 90% of patients. Postoperative ICP measurements revealed that significant brain swelling did not occur in the majority of patients, In 7 patients, persistently elevated ICP (&gt;20 mm Hg) was recorded. Nine patients (8%) developed shunt-dependent hydrocephalus; all of these patients had suffered an intraventricular hemorrhage. Measurements of the volumes of cerebrospinal fluid drained did not allow prediction of shunt-dependent hydrocephalus.