bluuebunny/crossref_metadata_2025_split huggingface dataset:
Continuous hemodialysis for the management of acute renal failure in the presence of cerebellar hemorrhage
Authors: Caruso Daniel M. , Vishteh A. Giancarlo , Greene Karl A. , Matthews Marc R. , Carrion Carlos A. 
Published: June 2009

✓ In this report the authors describe the use of continuous venovenous hemodialysis (CVVHD) in a medically unstable patient who suffered from a spontaneous cerebellar hemorrhage.
Conventional dialysis techniques carry the risk of developing the dialysis disequilibrium syndrome (DDS) when performed in the presence of a variety of intracranial diseases. The CVVHD technique was used successfully in a morbidly obese, short-statured woman with a spontaneous hypertensive intraparenchymal cerebellar hemorrhage. The woman experienced acute renal failure several days after her hemorrhage and her general medical condition prevented her from undergoing surgical evacuation. The CVVHD did not result in elevations in intracranial pressure (ICP) and the patient made a full recovery from both acute renal failure and life-threatening posterior fossa hemorrhage.
This case is noteworthy because of the absence of abnormally high ICP elevations or development of DDS in a patient with a large acute posterior fossa intraparenchymal brain hemorrhage and acute renal failure whose case was managed with CVVHD in the acute period.
Death from a malignant cerebellopontine angle triton tumor despite stereotactic radiosurgery
Authors: Comey Christopher H. , McLaughlin Mark R. , Jho Hae Dong , Martinez A. Julio , Lunsford L. Dade 
Published: June 2009

✓ Malignant vestibular nerve tumors are rare: to date, only three cases have been reported in the literature. The authors report a case of an eighth cranial nerve tumor that progressed 5 years after stereotactic radiosurgery. The patient was a 44-year-old man who underwent stereotactic radiosurgery for a 27-mm cerebellopontine angle tumor that was discovered on investigation of tinnitus and hearing loss. He developed facial weakness after 5 years, and repeated imaging revealed tumor enlargement. Despite complete microsurgical excision, the tumor rapidly recurred locally and subsequently disseminated within the neuraxis. The patient died 1 year after tumor progression was detected.
Histopathological analysis revealed a malignant spindle cell neoplasm with frequent mitotic figures. The presence of positive rhabdoid elements on immunohistochemical studies confirmed that it was a triton tumor. The authors review the relevant literature concerning the classification and management of malignant vestibular nerve tumors and discuss the implications of tumor progression after stereotactic radiosurgery.
Cavernous sinus syndrome during balloon test occlusion of the cervical internal carotid artery
Authors: Lopes Demetrius K. , Mericle Robert A. , Wakhloo Ajay K. , Guterman Lee R. , Hopkins L. Nelson 
Published: June 2009

✓ The authors report the occurrence of ipsilateral transient cavernous sinus syndrome during balloon test occlusion (BTO) of the cervical internal carotid artery (ICA) and discuss the involved pathomechanisms.
The authors reviewed their series of 129 BTOs of the ICA performed between 1989 and 1996. Two patients developed facial paresthesias and transient palsies of the third through sixth cranial nerves during test occlusion of the cervical ICA. The tests were performed prior to planned permanent carotid artery occlusion for the treatment of a neck sarcoma in one patient and a giant cavernous carotid artery aneurysm in the other. The patients' symptoms resolved with deflation of the balloon. When the balloon was subsequently inflated above the inferior cavernous sinus artery (ICSA), one of the patients complained of mild facial discomfort. There was no contralateral weakness or mental status change during test occlusion in either patient. Angiography demonstrated good filling of the ipsilateral intracranial circulation via collateral vessels of the circle of Willis.
In these two cases, the cranial nerves in the cavernous sinus were likely supplied by the ICA via the meningohypophyseal trunk and the ICSA. In each case, there was excellent blood supply to the ipsilateral cerebral hemisphere; however, there was probably inadequate retrograde filling of the cranial nerve collateral vessels located where the meningohypophyseal trunk and ICSA originated. These cases emphasize the importance of a patent external carotid artery—ICA connection for successful cervical carotid artery occlusion. Neurological examination during BTO was critical to interpret the clinical manifestations caused by the hemodynamic changes.
Surgical management of ulnar nerve compression at the elbow: an analysis of the literature
Authors: Bartels Ronald H. M. A. , Menovsky Thomas , Van Overbeeke Jacobus J. , Verhagen Wim I. M. 
Published: June 2009

Object.Surgical treatment for cubital ulnar nerve compresson includes medial epicondylectomy, simple decompression, or anterior transposition (subcutaneous, intramuscular, or submuscular). There is a dearth of prospective randomized studies on which to base guidelines for choosing one operative treatment over another. The authors review the literature on this subject and present their findings.Methods.The authors reviewed the literature from January 1970 to July 1997. Two authors decided independently whether an article should be included for review based on previously formulated inclusion and exclusion criteria. In addition to demographic information, data concerning preoperative status and outcome were extracted. For statistical analyses chi-square and Kruskal—Wallis tests were performed.Irrespective of their preoperative status, patients with simple decompression had the best outcome, whereas those with anterior subcutaneous and submuscular transposition had the worst. If outcome was related to the patient's preoperative status, a significant difference was not found among the various groups for those patients with a preoperative McGowan Grade 2. However, for those with McGowan Grade 3 (severe) symptoms, patients with anterior intramuscular transposition had the best outcome followed by those with simple decompression and anterior submuscular transposition. Statistical analysis was not possible for patients with McGowan Grade 1 because of the small numbers of patients in several treatment modality groups.Conclusions.Formulating a uniform guideline for operative treatment is not possible based on the results of this study. However, the authors believe that support is given to their policy, which is primarily to perform a simple decompression. Its surgical simplicity with preservation of the anatomy, especially the vascularization, and the possibility of rapid postoperative rehabilitation are also taken into consideration. If subluxation is found intraoperatively, anterior transposition is proposed.
Falcine sinus and occipital encephalocele: a magnetic resonance venography study
Authors: Bartels Ronald H. M. A. , Merx Johannes L. , van Overbeeke Jacobus J. 
Published: June 2009

Object.Occipital encephaloceles are relatively frequently encountered. Many investigators have addressed the embryogenesis of these formations, but the dural system has never before been studied. In this retrospective analysis the authors sought to gain a better understanding of the origins of these defects.Methods.The charts and radiological examinations, especially the magnetic resonance venography studies, were reviewed in seven patients. In six patients the straight sinus was absent. Drainage of the galenic system took place through a sinus within the falx, also known as a falcine sinus. The tentorium was not seen in five patients.Conclusions.The combination of an absent straight sinus and dysplastic tentorium is no coincidence: both develop within the same mesenchyme in the mesencephalic flexure. Distortion of the mesenchyme by a neural tube defect, causing an occipital encephalocele, will lead not only to disorders of the tentorium but also of the straight sinus.
Focal dilation and paradoxical collapse of cortical fissures and sulci in patients with normal-pressure hydrocephalus
Authors: Holodny Andrei I. , George Ajax E. , de Leon Mony J. , Golomb James , Kalnin Andrew J. , Cooper Paul R. 
Published: June 2009

Object.The authors describe a subgroup of patients with shunt-proven normal-pressure hydrocephalus (NPH) who presented with focal fissural and sulcal dilation on imaging studies. The specific radiological features and methods of differentiating this condition from cortical atrophy are delineated.Methods.Normal-pressure hydrocephalus has been described as dilation of the ventricles that is out of proportion to the sulci. Sulcal dilation has been taken as evidence of cortical atrophy and has even been used as a criterion to exclude patients from undergoing a shunting procedure. The authors describe five cases of patients with shunt-proven NPH who presented with focal dilation of cortical fissures and sulci. In three of the cases, there was a paradoxical decrease in the size of the dilated fissures and sulci that paralleled the decrease in the size of the lateral ventricles following successful shunting.Conclusions.This study demonstrates that focal fissural and sulcal dilation may represent reservoirs of cerebrospinal fluid analogous to the ventricular system. Patients should not be denied a shunting procedure solely on the basis of focally dilated fissures of sulci.
Oxidative stress in the human brain after subarachnoid hemorrhage
Authors: Gaetani Paolo , Pasqualin Alberto , Rodriguez y Baena Riccardo , Borasio Elena , Marzatico Fulvio 
Published: June 2009

Object. The aim of this study was to verify the patterns of antioxidant enzymatic activity of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) in the human brain after subarachnoid hemorrhage (SAH) to verify whether an “oxidative stress situation” characterizes the brain response to subarachnoid bleeding.
Methods. Forty samples of gyrus rectus or temporal operculum that were obtained during a surgical approach to anterior circulation aneurysms were used for this study. The activity of total SOD, GSH-Px, and the SOD/GSH/Px ratio (which expresses the balance between the production of hydrogen peroxides by dismutation of superoxide radicals and the scavenging potential) were calculated in each case. Twelve samples were obtained from patients who underwent surgery for unruptured aneurysms (control group); 13 samples were obtained during surgical procedures performed within 72 hours of SAH; and 15 samples were obtained during delayed surgical procedures (> 10 days post-SAH). Ten patients presented with clinical deterioration caused by arterial vasospasm. In both SAH groups, the mean total SOD activity was significantly higher than in the control group (p = 0.029). The mean activity of GSH-Px did not differ significantly between the SAH and control groups (p = 0.731). There was a significant increase in the SOD/GSH-Px ratio in both SAH groups, as compared with controls (p < 0.05). There was a significant correlation between the enzymatic activity and the clinical severity of the hemorrhage, with findings of lower values of SOD and, mainly, of the SOD/GSH-Px ratio in the poor-grade patients. The SOD/GSH-Px ratio was 2.14 ± 0.44 in patients who presented with clinical vasospasm and 1.24 ± 0.2 in cases without vasospasm.
Conclusions. The results of this study show an imbalance of the antioxidant enzymatic activities in the human brain after SAH, which is linked to the severity of the initial bleeding and possibly modified by the development of arterial vasospasm.
Dural arteriovenous shunts at the craniocervical junction
Authors: Kinouchi Hiroyuki , Mizoi Kazuo , Takahashi Akira , Nagamine Yoshihide , Koshu Keiji , Yoshimoto Takashi 
Published: June 2009

Object. A retrospective analysis was conducted of 10 patients (three women and seven men) who were treated for spinal dural arteriovenous shunts (AVSs) located at the craniocervical junction. This analysis was performed to evaluate the characteristics of this unusual location in contrast with those of the more common thoracic and lumbar AVSs.
Methods. Seven patients presented with subarachnoid hemorrhage (SAH) and one with slowly progressive quadriparesis and dyspnea due to myelopathy. The other two cases were detected incidentally and included a transverse—sigmoid dural AVS and a cerebellar arteriovenous malformation. Angiographic studies revealed that the spinal dural AVSs at the C-1 and/or C-2 levels were fed by the dural branches of the radicular arteries that coursed from the vertebral artery and drained into the medullary veins. Venous drainage was caudally directed in the patient with myelopathy. In contrast, the shunt flow drained mainly into the intracranial venous system in patients with SAH. Furthermore, in four of these patients a varix was found on the draining vein. In all patients, the draining vein was interrupted surgically at the point at which this vessel entered the intradural space, using intraoperative digital subtraction angiography to monitor flow. The postoperative course was uneventful in all patients and no recurrence was confirmed on follow-up angiographic studies obtained in seven patients at 6 months after discharge.
Conclusions. If computerized tomography scanning shows SAH predominantly in the posterior fossa and no abnormalities are found on intracranial four-vessel angiographic study, proximal vertebral angiography should be performed to detect dural AVS at the craniocervical junction. The results of surgical intervention for this disease are quite satisfactory.
Cavernous sinus sampling in patients with adrenocorticotrophic hormone—dependent Cushing's syndrome with emphasis on inter- and intracavernous adrenocorticotrophic hormone gradients
Authors: Teramoto Akira , Yoshida Yoichi , Sanno Naoko , Nemoto Shigeru 
Published: June 2009

Object. As an alternative method to inferior petrosal sinus sampling with administration of corticotropin-releasing hormone (CRH), the authors have developed a method of selective venous sampling directly from the cavernous sinus, which is performed using a superselective catheterization technique. The goal of this study is to assess this method.
Methods. Catheterization to the cavernous sinus was performed in 44 patients with clinical and biochemical features of Cushing's syndrome. Forty of these patients in whom there was a definite clinical and/or histological diagnosis were evaluated. In 35 patients, a pituitary microadenoma was detected on magnetic resonance imaging and/or during surgery. Ectopic lesions were suspected in five patients, who later developed nonpituitary tumors.
The central/peripheral (C/P) ratios of adrenocorticotrophic hormone (ACTH) without CRH administration ranged from 5.2 to 448.1 (mean ± standard deviation, 66.7 ± 91.2) in cavernous sinuses and from 1.1 to 52 (mean ± standard deviation, 8.5 ± 9.9) in the inferior petrosal sinuses. The petrosal sinus sampling contained false negative results in eight patients (23%) based on a cutoff point of 2. On the contrary, patients with ectopic lesions did not show any increase in ACTH levels in either sampling portion.
The intercavernous gradients of ACTH, ranging from 1.2 to 506.4, indicated the correct lateralization of microadenoma in the lateral wing in all 30 patients. The interpetrosal gradients, ranging from 1 to 31.4, did not give a sufficient value (≥ 1.4) in four patients (13%) with a lateral lesion. In five cases of midline tumors, the intercavernous and interpetrosal gradients indicated false laterality in three and four cases, respectively.
The intracavernous (posterior—anterior) gradients, ranging from 1.04 to 60.7 (mean 14.9), showed a higher concentration of ACTH in the posterior portion of the sinus in all patients.
Conclusions. These results suggest that 1) cavernous sinus sampling without CRH administration can demonstrate hypersecretion of ACTH from the pitutary gland with a high diagnostic accuracy; 2) intercavernous gradients will indicate the correct lateralization in laterally localized microadenomas; and 3) sampling should be performed from the posterior portion of the cavernous sinus.
Microsurgical anatomy of the artery of Adamkiewicz and its segmental artery
Authors: Alleyne Cargill H. , Cawley C. Michael , Shengelaia George G. , Barrow Daniel L. 
Published: June 2009

Object. The blood supply of the lower spinal cord is heavily dependent on the artery of Adamkiewicz, which characteristically originates from one of the thoracolumbar segmental arteries. The aforementioned artery is of enormous clinical, surgical, and radiological importance, and the goal of this study was to elucidate the course and branches of the segmental artery that gives rise to this important vessel.
Methods. In this cadaveric, microsurgical anatomical study, the authors investigate and describe the course and branches of the artery of Adamkiewicz and the segmental branch from which it ultimately originates. A review of the literature is provided.
Conclusions. By documenting the microsurgical anatomy of these important vessels, this study facilitates an understanding of the anatomy that will aid in treatment planning for surgery of various lesions in this area.
Bilateral vocal cord paralysis following anterior cervical discectomy and fusion
Authors: Manski Thomas J. , Wood Michael D. , Dunsker Stewart B. 
Published: June 2009

✓ The authors report a rare case of bilateral vocal cord paralysis following anterior cervical discectomy and fusion (ACD/F) in a patient who had a preexisting, clinically silent, and unrecognized unilateral vocal cord paralysis from a remote cardiac surgical procedure. The patient, a 41-year-old woman who developed acute respiratory stridor and respiratory insufficiency at the time of extubation after undergoing a C6–7 ACD/F, required emergency reintubation and ventilation. Otolaryngological evaluation revealed bilateral vocal cord paralysis with one vocal cord showing evidence of acute paralysis and the other showing evidence of chronic paralysis. She eventually required a permanent tracheotomy. The patient had undergone previous cardiac surgical procedures to correct Fallot's tetralogy as a neonate and as a child. At those times, there were no recognized symptoms of transient or permanent vocal cord dysfunction.This case emphasizes the importance of identifying patients with preexisting unilateral vocal cord paralysis before performing neurosurgical procedures such as ACD/F, which can place the only functioning vocal cord at risk for paralysis. Guidelines for identifying patients with preexisting unilateral vocal cord paralysis and for modifying the surgical procedure for ACD/F to prevent the catastrophic complication of bilateral vocal cord paralysis are discussed.
Vestibular schwannoma management
Authors: Pollock Bruce E. , Lunsford L. Dade , Flickinger John C. , Clyde Brent L. , Kondziolka Douglas 
Published: June 2009

Object. The purpose of this study was to analyze patient outcomes and to define the role of radiosurgery in patients who have undergone prior microsurgical resection of their vestibular schwannoma.
Methods. The authors evaluated the pre- and postoperative clinical and neuroimaging characteristics of 76 consecutive patients with 78 vestibular schwannomas who underwent radiosurgery after previous surgical resection. Twenty-nine patients (37% of tumors) had undergone more than one prior resection. Forty-three patients (55% of tumors) had significant impairment of facial nerve function (House—Brackmann Grades III–VI) after their microsurgical procedure; 50% had trigeminal sensory loss, and 96% had poor speech discrimination (< 50%). The median evaluation period following radiosurgery was 43 months (range 12–101 months). Tumor growth control after radiosurgery was achieved in 73 tumors (94%). Six patients underwent additional surgical resection despite radiosurgery (median of 32 months after radiosurgery), and one patient underwent repeated radiosurgery for tumor progression outside the irradiated volume. Eleven (23%) of 47 patients with Grades I to III facial function before radiosurgery developed increased facial weakness after radiosurgery. Eleven patients (14%) developed new trigeminal symptoms.
Conclusions. Radiosurgery proved to be a safe and effective alternative to additional microsurgery in patients in whom the initial microsurgical removal failed. Stereotactic radiosurgery should be considered for all patients who have regrowth or progression of previously surgically treated vestibular schwannomas.
Increase in extracellular glutamate caused by reduced cerebral perfusion pressure and seizures after human traumatic brain injury: a microdialysis study
Authors: Vespa Paul , Prins Mayumi , Ronne-Engstrom Elizabeth , Caron Michael , Shalmon Ehud , Hovda David A. , Martin Neil A. , Becker Donald P. 
Published: June 2009

Object. To determine the extent and duration of change in extracellular glutamate levels after human traumatic brain injury (TBI), 17 severely brain injured adults underwent implantation of a cerebral microdialysis probe and systematic sampling was conducted for 1 to 9 days postinjury.
Methods. A total of 772 hourly microdialysis samples were obtained in 17 patients (median Glasgow Coma Scale score 5 ± 2.5, mean age 39.4 ± 20.4 years). The mean (± standard deviation) glutamate levels in the dialysate were evaluated for 9 days, during which the mean peak concentration reached 25.4 ± 13.7 (µM on postinjury Day 3. In each patient transient elevations in glutamate were seen each day. However, these elevations were most commonly seen on Day 3. In all patients there was a mean of 4.5 ± 2.5 transient elevations in glutamate lasting a mean duration of 4.4 ± 4.9 hours. These increases were seen in conjunction with seizure activity. However, in many seizure-free patients the increase in extracellular glutamate occurred when cerebral perfusion pressure was less than 70 mm Hg (p < 0.001). Given the potential injury-induced uncoupling of cerebral blood flow and metabolism after TBI, these increases in extracellular glutamate may reflect a degree of enhanced cellular crisis, which in severe head injury in humans appears to last up to 9 days.
Conclusions. Extracellular neurochemical measurements of excitatory amino acids may provide a marker for secondary insults that can compound human TBI.