bluuebunny/crossref_metadata_2025_split huggingface dataset:
Morbidity and Mortality of Carotid Endarterectomy under Local Anesthesia: A Retrospective Study
Authors: Zuccarello Mario , Yeh Hwa-shain , Tew John M. 
Published: May 2010

Abstract
It has been shown that carotid endarterectomy reduces the incidence of stroke in patients with symptomatic extracranial occlusive vascular disease in the absence of major perioperative complications such as stroke or death. We present a retrospective study of 106 carotid endarterectomies performed under local anesthesia in 100 patients in whom transient ischemic attack (TIA) or minor stroke had occurred. Nonfatal stroke occurred in 2%, and TIA occurred in 1%. There was no perioperative mortality. Our study suggests that, under local anesthesia, even high risk patients can be operated safely and the majority of carotid endarterectomies can be performed without the use of an indwelling shunt. Meticulous surgical technique is of great importance for achieving low perioperative complications.
Optic Nerve Decompression for Osteopetrosis in Early Childhood
Authors: Haines Stephen J. , Erickson Donald L. , Wirtschafter Jonathan D. 
Published: May 2010

Abstract
Visual failure in osteopetrosis may result from retinal degeneration or compression of the optic nerve in the narrowed optic canals. We report the evaluation and treatment of five children with osteopetrosis whose optic nerve dysfunction seems to have been related to the latter etiology. Evaluation of visual function was carried out by means of behavioral observation and flash visual evoked responses. Of six nerves evaluated both pre- and postoperatively, the visual evoked responses seemed to improve in four. Three nerves were serially evaluated without an operation, and one showed changes consistent with maturation. One nerve was evaluated with serial postoperative evoked potentials and showed no change. We conclude that surgical decompression of the optic nerve in patients with documented optic nerve dysfunction and osteopetrosis allows improvement in visual function and is, therefore, an important consideration in the evaluation and management of patients with this disease.
Intraoperative Development of Contralateral Epidural Hematoma during Evacuation of Traumatic Extraaxial Hematoma
Authors: Feuerman Tony , Wackym Phillip Ashley , Gade George F. , Lanman Todd , Becker Donald 
Published: May 2010

Abstract
Intraoperative development of an epidural hematoma contralateral to a craniotomy for acute traumatic extraaxial hematoma has been previously reported. This entity, however, has never been distinctly defined and differentiated from either the delayed or the bilateral acute epidural hematoma. We present 3 new cases of intraoperative contralateral acute epidural hematoma and review the 14 previously reported cases. The typical clinical presentation is a severe head injury with an acute extraaxial hematoma and severe ipsilateral brain displacement during craniotomy. If brain displacement is not noted at craniotomy, then the contralateral hematoma is manifested by immediate postoperative neurological deterioration or intractable elevated intracranial pressure. The presence of any of these signs makes an immediate postoperative CT scan or burr holes contralateral to the original craniotomy mandatory for early diagnosis. In addition to defining “intraoperative contralateral epidural hematoma,” stricter definitions of the terms “delayed epidural hematoma” (no hematoma present on the initial CT scan but one present on a later scan) and “bilateral epidural hematomas” (present on the initial scan) are proposed.
Three-Dimensional Computed Tomographic Reconstructions of Intracranial Meningiomas
Authors: Chalif David J. , Dufresne Craig R. , Ransohoff Joseph , McCarthy Joseph A. 
Published: May 2010

Abstract
In a series of four patients with intracranial meningiomas, three-dimensional computed tomographic (CT) reconstructions were a useful diagnostic and surgical adjunct. Three-dimensional images are created from standard CT data by a boundary-detecting computer software program. Three-dimensional images of tumor invading or adjacent to the bony calvarium are projected about the x, y, and z axes. Axial and sagittal sections delineate the lesions. The images created allow a surgical view of the meningiomas in three-dimensional space and demonstrate the relationship of these masses to the skull. The use of three-dimensional reconstructions in craniofacial surgery and in neurosurgery is reviewed.
Haemophilus paraphrophilus Frontal Lobe Abscess: Case Report
Authors: Pajeau Aurora K. , Yu Pauline K. W. , Ebersold Michael J. , Anhalt John P. 
Published: May 2010

Abstract
We report a case of cerebral abscess due to Haemophilus paraphrophilus in a 51-year-old man who was otherwise healthy and had no cardiac abnormality. A source for the infection was not definitively identified; however, the patient had had dental manipulations 2 weeks before the onset of symptoms, and an oral source is probable. The patient was treated successfully with antibiotics after removal of the abscess. Bacteriological studies are discussed.
Tension Pneumocephalus after Clipping of a Carotid-Ophthalmic Artery Aneurysm via an Interhemispheric Approach: Case Report
Authors: Asai Akio , Yamada Hisashi , Tsutsumi Kazuo , Takakura Kintomo 
Published: May 2010

Abstract
A case of postoperative tension pneumocephalus of unusual cause after carotid-ophthalmic artery aneurysm clipping is presented. A second craniotomy for decompression and exploration demonstrated a small fistula in the planum sphenoidale, which presumably had been made when the right optic canal was unroofed during the first operation.
Spinal Epidural Compression Secondary to Osteoblastic Metastatic Vertebral Expansion
Authors: Hirschfeld Alan , Beutler William , Seigle Juliet , Manz Herbert 
Published: May 2010

Abstract
We present two cases in which spinal epidural compression was caused by the expansion of bony elements into the spinal canal as a result of osteoblastic metastases. The precise nature of the compression was appreciated only on computed tomography. One patient had immediate and sustained neurological improvement after laminectomy. The other benefited temporarily, but widespread involvement of his spine ultimately led to paraplegia despite two more decompressive procedures. We think that bony expansion of the spine secondary to osteoblastic metastasis is not reversible with radiation therapy alone and is, therefore, an absolute indication for surgical decompression.
Spinal Cord Compression by a Unifocal Eosinophilic Granuloma: A Case Report of an Adult with Unusual Roentgenological Features
Authors: Kanterewicz Eduardo , Condom Enric , Cañete Juan D. , Del Olmo Josá A. 
Published: May 2010

Abstract
We describe an unusual case of unifocal eosinophilic granuloma of the spine in a 38-year-old woman who presented with spinal cord compression. After 2 years of back pain, x-ray films of the spine were normal, but computed tomography and magnetic resonance imaging demonstrated a lytic lesion of the 1st lumbar vertebral body with cephalic extension in the epidural space. The lesion was later confirmed at operation to be an eosinophilic granuloma spreading into the surrounding tissues.
Ulnar Neuropathy Caused by Fat Necrosis with Cystic Myxoid Degeneration at the Upper Forearm: Case Report
Authors: Segal Ricardo , Saito Reisuke , Sen Chandra 
Published: May 2010

Abstract
The case described is thought to be the first report of ulnar neuropathy caused by a cystic myxomatous degeneration of fat necrosis. The 12-day preoperative duration of symptoms is also the shortest reported for nontraumatic ulnar neuropathy; the average period between onset of symptoms and operation is 10 months. At operation, the patient's nerve was found to be stretched severely over the tumor, which was excised, thus decompressing the ulnar nerve. The procedure relieved the patient's symptoms of tingling and numbness, and he remained asymptomatic at the 12-month follow-up examination.
Endaneurysmal Microendarterectomy in the Treatment of Giant Cerebral Aneurysms: Technical Note
Authors: Hylton Phillip D. , Reichman O. Howard 
Published: May 2010

Abstract
Giant cerebral aneurysms continue to present the surgeon with substantial technical challenges. Operative techniques for managing giant cerebral aneurysms are becoming increasingly sophisticated. We emphasize in this report a technique for direct obliteration of the giant aneurysm with a hard, calcified atheroma at its base that prevents direct clip application without compromise of the parent artery. Temporary trapping of the aneurysm, intramural thrombectomy, and endaneurysmal microendarterectomy allow direct obliteration of the aneurysm neck with preservation of the parent artery.
Early Aneurysm Surgery and Prophylactic Hypervolemic Hypertensive Therapy for the Treatment of Aneurysmal Subarachnoid Hemorrhage
Authors: Solomon Robert A. , Fink Matthew E. , Lennihan Laura 
Published: May 2010

Abstract
The prevailing sentiment of North American neurosurgeons is that there is no significant difference in overall morbidity between patients who are treated with early aneurysm surgery and those who are treated with delayed aneurysm surgery. This concept is based primarily on the high incidence of ischemic events after early intervention. Recent experience, however, indicates that prophylactic hypervolemic hypertensive therapy may be beneficial in reducing delayed ischemia after early aneurysm surgery. During the preceding 21 months, we have performed 125 operations for intracranial aneurysms. Fifty-six patients in this group presented less than 7 days after subarachnoid hemorrhage (SAH) (47 within 3 days) and were treated by a prospective protocol of urgent aneurysm surgery performed within 24 hours after presentation. In all cases, the aneurysm was clipped with the use of mannitol and spinal drainage for brain relaxation. All patients were then treated with prophylactic volume expansion therapy and induced hypertension with a central venous pressure or a Swan-Ganz catheter until the 14th day after SAH. Preoperatively, 17 patients were Hunt and Hess Grade I, 9 were Grade II, 28 were Grade III, and 2 were Grade IV. In this group of 56 patients at risk for delayed ischemia from vasospasm, 5 patients had significant intraoperative complications. Ten patients (18%) had delayed cerebral ischemia, totally reversible in 6 cases, with small infarcts in 3 cases, and with 1 death (2% mortality from delayed ischemia), there were 5 cases of shunted hydrocephalus, and 3 deaths from other complications. Overall, 41 patients (73%) returned to their premorbid occupations without neurological deficit. Four patients (7%) are independent with no neurological deficits, but have not returned to full-time employment. Four patients (7%) are independent, but have permanent deficits. Three patients (5%) are dependent on others for care, and 4 patients (7%) died. These data imply that delayed cerebral ischemia after SAH can be effectively minimized with prophylactic volume expansion therapy. Similar results have been reported for patients treated with calcium channel blocking agents. Given these techniques, perhaps the assumption that early operative intervention holds no advantage over delayed surgical treatment of an aneurysm rupture should be readdressed in a scientifically controlled fashion.
Relationship between Flow Cytometric Features and Clinical Behavior of Meningiomas
Authors: Crone Kerry R. , Challa Venkata R. , Kute Timothy E. , Moody Dixon M. , Kelly David L. 
Published: May 2010

Abstract
Meningiomas have a wide range of biological potential and clinical behavior. Histological findings are helpful in recognizing the malignant potential of a given tumor, but often fail to correlate with gross features, liability of recurrence, and extent of associated cerebral edema. To find alternate approaches to improve the correlation between biological and clinical behavior, 20 meningiomas were studied by flow cytometry (FC), an assessment that has been applied to meningiomas previously. Such FC features as DNA index (DI) and proliferative index (PI, %G2 † %S) were correlated with size, location, brain invasion, associated edema, and recurrence. Tumors with severe edema had significantly higher PIs (19.5 ± 4.1) than those with moderate (12.6 ± 4.5) or minimal (8 ± 0) edema (P &lt; 0.05). The PI was greater than 16 in those tumors that recurred (n = 3) or invaded the brain (n = 3). Six tumors were aneuploid (DI, 1.33 ± 0.17; PI, 17.1 ± 5.3). These were uniformly large when compared with the diploid tumors, which were more variable in size. All of the aneuploid tumors were associated with moderate to severe cerebral edema. Two partly psammomatous tumors with high PIs and foci of high cellularity suggesting recent growth were associated with severe edema. One of these exhibited brain invasion. These preliminary data indicate that FC may have a potential use in the clinical management of meningiomas.
Intrasellar Intercarotid Communicating Artery Associated with Agenesis of the Right Internal Carotid Artery: Case Report
Authors: Udzura Masahiko , Kobayashi Hiroo , Taguchi Yoshio , Sekino Hiroaki 
Published: May 2010

Abstract
A 54-year-old man with a right hemiparesis was found to have an intrasellar intercarotid communicating artery associated with agenesis of the right internal carotid artery. Magnetic resonance imaging (MRI) studies demonstrated the spatial relationship of the anomalous artery to the surrounding structures, thus suggesting an embryonic enlargement of the capsular artery as a source of this anomalous artery.
Evaluation of Prognostic Factors in Cerebral Arteriovenous Malformations
Authors: Steinmeier Ralf , Schramm Johannes , Müller Hans-Georg , Fahlbusch Rudolf 
Published: May 2010

Abstract
In a retrospective study of 48 patients who underwent elective surgery for cerebral arteriovenous malformations, a statistical analysis of demographic, clinical, and neuroradiological data was undertaken in order to discover the best predictors of operative morbidity. In addition, the predictive value of different clinical grading systems as applied to this series was compared. All patients had a computed tomographic scan and a positive angiogram before surgery. Complete resection was proven angiographically. The univariate Mann-Whitney-Wilcoxon rank sum test, the Fisher exact test, Spearman's rank correlation coefficient analysis, and multivariate logistic regression were used as statistical methods. Duration of surgery, the development, of either new deficits or an increase in the preoperative neurological signs immediately after surgery, and rehabilitation (as measured by the Karnofsky index) were taken as target variables for the difficulty of operation and for postoperative morbidity, respectively. The largest diameter of the nidus of the arteriovenous malformation, eloquence of the adjacent brain, and deep venous drainage showed the most consistent correlation with these target variables. Intracerebral hematoma and other single factors, such as the age of the patient or localization of the arteriovenous malformation did not affect the outcome. The clinical grading scale of Spetzler and Martin provided better prediction of surgical risks than other proposed systems.
Treatment of Trigeminal Neuralgia by Thermocoagulation, Glycerolization, and Percutaneous Compression of the Gasserian Ganglion and/or Retrogasserian Rootlets: Long-Term Results and Therapeutic Protocol
Authors: Fraioli Bernardo , Esposito Vincenzo , Guidetti Beniamino , Cruccu Giorgio , Manfredi Mario 
Published: May 2010

Abstract
From 1976 to 1986, 681 patients with drug-refractory trigeminal neuralgia (TN)—typical in 641, symptomatic of multiple sclerosis in 23 and of tumor in 10, atypical in 5, and postherpetic in 2—were treated with various percutaneous procedures. Controlled differential thermocoagulation of the gasserian ganglion and/or retrogasserian rootlets was performed in 533 patients; glycerolization of the trigeminal cistern in 32; and compression of the gasserian ganglion by balloon catheter in 159, Results and complications of each procedure are assessed at a mean follow-up of 6.5 years for thermocoagulation, 5 years for glycerolization, and 3.5 years for compression. The following therapeutic protocol is proposed: 1) in TN patients at first operation: a) gasserian compression (or glycerolization, if experience warrants it) is indicated in all cases of typical TN, unless the 3rd division alone is affected; b) in the latter case and in symptomatic TN, we suggest thermocoagulation; 2) in recurrences: a) after glycerolization or gasserian compression, gasserian compression (or glycerolization) is indicated; b) after thermocoagulation or open surgery, thermocoagulation is suggested.
Influence of Anesthetics—Nitrous Oxide in Particular—on Electromyographic Response Evoked by Transcranial Electrical Stimulation of the Cortex
Authors: Zentner Josef , Kiss Ivan , Ebner Alois 
Published: May 2010

Abstract
The influence of anesthetics usually used for neuroleptic anesthesia—nitrous oxide, fetanyl, flunitrazepam, and thiopental sodium—on motor evoked potentials (MEP) was examined in 15 patients during neurosurgical operations on the spinal cord, in 16 patients in traumatic coma, and in 6 healthy volunteers. MEP were recorded from the contralateral thenar and anterior tibial muscles in response to single transcranial electrical stimuli on the motor cortex. Intraoperatively, during neuroleptic anesthesia we found the amplitudes to be reduced to an average of 11% of the preoperative baselines for the thenar potentials, and to 7% of the preoperative baselines for the anterior tibial muscle potentials, despite a maximum stimulus strength of 750 V. A similar reduction of MEP amplitudes was observed in 6 volunteers during breathing of an oxygen/nitrous oxide mixture (34%/66%), whereas fentanyl, flunitrazepam, and thiopental had only a minor effect on MEP. We conclude that with respect to anesthesia-related suppression of amplitudes, an average of 5 to 15 electromyographic responses should be evaluated for intraoperative monitoring of MEP using the technique described here.
Ruptured S1-S2 Disc Presenting with S2 Radiculopathy
Authors: Nabors Michael W. , Cooney F. Donald 
Published: May 2010

Abstract
We report the case of a 61-year-old man in whom numbness developed on the right side of the penis, scrotum, and perineum after he jumped into a swimming pool. Magnetic resonance imaging and a computed tomographic scan disclosed a lesion at S1-S2 impinging on the right S2 nerve root. At surgery, ruptured disc material originating in an area normally occupied by the fixed fibrocartilaginous plate was identified and excised. Postoperatively, the numbness resolved. We discuss a possible cause of the rupturing of the sacral disc and recommended treatment by laminectomy and excision, as in other cases of ruptured disc at other levels of the spinal column.
Progressive Unilateral Hydrocephalus in Adults
Authors: Venkataramana N. K. , Kolluri V. R. Sastry , Swamy K. S. Narayana , Arya B. Y. T. , Das B. S. , Reddy G. N. Narayana 
Published: May 2010

Abstract
Unilateral dilatation of the lateral ventricle in adults is rare. We report 2 cases of unilateral hydrocephalus with obstruction at the foramen of Monro. Both patients presented with symptoms of raised intracranial pressure.
Selective Shunting During Carotid Endarterectomy Based on Two-Channel Computerized Electroencephalographic/Compressed Spectral Array Analysis
Authors: Tempelhoff Rene , Modica Paul A. , Grubb Robert L. , Rich Keith M. , Holtmann Barbel 
Published: May 2010

Abstract
The reliability of selective shunting based on computerized electroencephalographic (EEG) monitoring has not been addressed. In this study, 103 carotid endarterectomies were performed with selective shunting based on a two-channel computerized EEG monitor that processed the on-line, raw electroencephalogram (EEG) to produce a compressed spectral array (CSA). Ischemic EEG events were identified by amplitude attenuation of the raw EEG and/or loss of high-frequency activity on the CSA. Fourteen patients (13.6%) received a bypass shunt, and postoperative neurological examinations showed 97 patients (94.2%) to be intact. A correlation between total (cumulative) ischemic EEG time and the postoperative neurological exam was demonstrated (P &lt; 0.0001). Six postoperative deficits (5.8%) occurred, five in patients whose computerized EEGs demonstrated an ischemic EEG event late during carotid clamping, when it was no longer possible to place a shunt. The sixth deficit was found in a patient whose EEG did not demonstrate any signs of cerebral ischemia. Five of these six new deficits resolved within 12 hours, and only one persisted for 72 hours, when the patient died of a pulmonary embolism (cerebral infarction and mortality rate of 1%). These results appear to demonstrate that two-channel monitoring of both the CSA and the unprocessed (raw) EEG simultaneously can be used as a reliable indicator of whether a bypass shunt is required during carotid cross-clamping in all patients, regardless of their preoperative neurological history or angiographic findings.
Intraspinal Extension of an Air Cyst of the Lung: Case Report
Authors: Andrews David W. , Gamache Francis W. , Weingarten Karen , Haimes Alison B. 
Published: May 2010

Abstract
We report the diagnostic evaluation and treatment of a cystic paraspinal and epidural lesion originally thought to be a neurofibroma or an arachnoid cyst. Intraoperatively, the lesion was found to be an air cyst of the lung that was successfully ligated.
Pituitary Hyposecretion and Hypersecretion Produced by a Rathke's Cleft Cyst Presenting as a Noncystic Hypothalamic Mass
Authors: Wenzel Marc , Salcman Michael , Kristt Donald A. , Gellad Fouad E. , Kapcala Leonard P. 
Published: May 2010

Abstract
A 53-year-old man presented with polydipsia, polyuria, lightheadedness on standing, and syncope. Visual field deficits suggesting left optic tract compression and pituitary dysfunction consisting of diabetes insipidus, hyperprolactinemia, and anterior pituitary insufficiency were diagnosed. On the computed tomography scan, an isodense, ring-enhancing, parasellar mass was localized primarily in the suprasellar region and also extended into the sella. It was believed that the pituitary hormone hypersecretion and hyposecretion were due to hypothalamic dysfunction from the mass which was initially believed to be a craniopharyngioma. At surgery a Rathke's cleft cyst was resected. The unusual presentation of this Rathke's cleft cyst presenting as a hypothalamic lesion is discussed.
Successful Combination Chemotherapy (Cisplatinum, Vinblastine, and Bleomycin) in the Treatment of Medulloblastoma Disseminated by Cerebrospinal Fluid: Case Report
Authors: Asai Akio , Matsutani Masao , Kohno Takeshi , Fujimaki Takamitsu , Takakura Kintomo 
Published: May 2010

Abstract
A case of successful combination chemotherapy using cisplatinum, vinblastine, and bleomycin (PVB therapy) to treat medulloblastoma disseminated by cerebrospinal fluid is presented. In this case, a locally recurrent tumor and several disseminated tumors were seen to decrease in size on CT examinations. Pain in the lower extremities and urinary incontinence improved during three courses of PVB therapy administered during a period of 9 weeks. These results suggest that combination PVB therapy may offer one of the treatments of choice for recurrent or disseminated medulloblastoma.
Intracranial Hypoglossal Neurinoma with Extracranial Extension: Review and Case Report
Authors: Odake Genya 
Published: May 2010

ABSTRACT
A case of neurinoma affecting the intracranial part of the hypoglossal nerve is reported. Symptoms and signs, radiological findings, and operative results of other cases are reviewed. The value of computerized tomography and magnetic resonance imaging in local diagnosis and the feasibility of a one-stage operation for total removal of tumors with extracranial extension are discussed.