bluuebunny/crossref_metadata_2025_split huggingface dataset:
Relationship of intraoperative electrophysiological criteria to outcome after selective functional posterior rhizotomy
Authors: Steinbok Paul , Gustavsson Bengt , Kestle John R. W. , Reiner Ann , Cochrane D. Doug 
Published: June 2009

✓ At British Columbia's Children's Hospital, the criteria used in selective functional posterior rhizotomy (SFPR) evolved in three distinct phases. In Phase 1 the electrophysiological criteria for abnormality included a low threshold to a single stimulation, a sustained response to 50-Hz stimulation, and spread outside the segmental level being stimulated. In Phase 2 the electrophysiological criteria were unchanged, but fewer L3–4 nerve roots were cut. In Phase 3, fewer L3–4 nerve roots were cut, as in Phase 2, but based on the results of posterior nerve root stimulation in nonspastic controls, the only electrophysiological criterion used was contralateral and suprasegmental spread. The present study examined the relationship between the criteria used in each phase and patient outcome.
The records of 77 consecutive children who underwent SFPR and had a minium follow-up period of 1 year were reviewed, comprising 25, 19, and 33 patients in Phases 1, 2, and 3, respectively. Outcome parameters included quantitative assessments of lower-limb spasticity and range of motion, and qualitative assessments of lower-limb function.
In Phase 3, 52% of the nerve roots were cut, compared to 66% in Phases 1 and 2. In all three phases there was a significant decrease in lower-limb spasticity and an increase in range of movement, with the smallest decrease in spasticity in Phase 3. Over 90% of children in each phase improved with respect to lower-limb function, and excluding independent walkers and quadriplegics confined to a wheelchair, improvement in the level of ambulation occurred in 87.5%, 71.4%, and 73.7% of patients, in Phases 1, 2, and 3, respectively.
Use of fluorescence in situ hybridization to detect loss of chromosome 10 in astrocytomas
Authors: Dalrymple Stephen J. , Herath John F. , Ritland Steven R. , Moertel Cheryl A. , Jenkins Robert B. 
Published: June 2009

✓ Models describing progression in the genetic derangement of glial tumors have shown loss of chromosome 10 to occur most frequently in high-grade lesions, suggesting that identification of this loss may be prognostically significant. Fluorescence in situ hybridization (FISH) analysis may be a valuable adjunct to histological grading if it can accurately detect this loss. In this paper the authors correlate results obtained from FISH, cytogenetic, molecular genetic, and flow cytometric analyses of a series of 39 brain specimens, including seven normal, two gliotic, and 30 neoplastic (one Grade II, one Grade III, and 28 Grade IV astrocytoma) specimens.
Contiguous section of freshly resected surgical tissue were submitted for tissue culturing (karyotype) and touch preparation (FISH), snap-frozen (molecular genetic), or paraffin-embedded (histology and flow cytometry). Centromere-specific probes for chromosomes 10 and 12 were used for FISH analysis, and 19 restriction fragment length polymorphisms (two p-arm and 17 q-arm) and four microsatellite sequence polymorphisms (three p-arm and one q-arm) were used for molecular genetic analysis of chromosome 10. Findings showed FISH and loss of heterozygosity (LOH) analyses to be concordant in 33 of 38 specimens (sensitivity 94%, specificity 81%), with one specimen indeterminate on LOH analysis. Both FISH and LOH analyses were more sensitive at detecting chromosome 10 loss than conventional cytogenetic (karyotype) analysis. The authors conclude that FISH is a sensitive test for detecting chromosome 10 loss and ploidy in astrocytic tumors.
Clinical study of enlarged infundibular dilation of the origin of the posterior communicating artery
Authors: Endo Shunro , Furuichi Susumu , Takaba Michiyasu , Hirashima Yutaka , Nishijima Michiharu , Takaku Akira 
Published: June 2009

✓ Although some aneurysmal dilations of the origin of the posterior communicating artery (PCoA) that are revealed on carotid angiogram are true aneurysms or preaneurysmal lesions, the authors warn that diagnosis should not be based only on the size and shape of the dilation, especially when the PCoA does not fill.
In the present retrospective study, the authors analyzed intraoperative and angiographic findings in 32 patients with 34 lesions of the PCoA that were preoperatively diagnosed as aneurysms. Only 10 of the lesions were true aneurysms (six cases) or enlarged infundibular dilations with reddish bulges (that is, preaneurysmal bulge; four cases) at the origin of the PCoA. All of the other 24 lesions, including one lesion with PCoA occlusion, were merely enlarged infundibular dilations without any wall abnormality.
A well-developed PCoA was observed only in cases of true aneurysm and dilation with reddish bulge. No other clinical or angiographic characteristics proved useful in identifying the type of lesions. These findings may be helpful to the physician in evaluating the clinical features of such lesions and in determining the diagnosis of enlarged infundibular dilation of the PCoA.
Fast spin—echo magnetic resonance imaging for radiological assessment of neonatal brachial plexus injury
Authors: Francel Paul C. , Koby Myles , Park T. S. , Lee Benjamin C. P. , Noetzel Michael J. , Mackinnon Susan E. , Henegar Martin M. , Kaufman Bruce A. 
Published: June 2009

✓ Neurosurgical management of birth-related brachial plexus palsy involves observing the patient for a period of several months. Operative intervention is usually undertaken at 3 to 6 months of age or more in infants who have shown little or no improvement in affected muscle groups. Ancillary tests such as electromyography and nerve conduction studies are occasionally useful. No radiological study has been consistently helpful in operative planning, except for contrast computerized tomography (CT) myelography, which requires general anesthesia in infants. This is because the infant's small size exceeds the functional resolution of the imaging modalities.This report describes the use of a special sequence of magnetic resonance (MR) imaging entitled “fast spin echo” (FSE-MR). Unlike CT myelography, this technique provides high-speed noninvasive imaging that allows clinicians to evaluate preganglionic nerve root injuries without the use of general anesthesia and lumbar puncture. The utility of this technique is illustrated in three cases, two involving either infraclavicular exploration or a combination of infraclavicular and supraclavicular exposure based on FSE-MR findings. The FSE-MR imaging offers an excellent alternative to contrast CT myelography in evaluation of infants with birth-related brachial plexus injuries.
Direct thrombosis of experimental aneurysms with cellulose acetate polymer (CAP): technical aspects, angiographic follow up, and histological study
Authors: Sugiu Kenji , Kinugasa Kazushi , Mandai Shinya , Tokunaga Koji , Ohmoto Takashi 
Published: June 2009

✓ Experimental aneurysms were created using a microsurgical technique to produce anastomosed venous pouches in the bilateral common carotid arteries of 12 dogs. The 24 aneurysms were then thrombosed via an endovascular approach with injection of a cellulose acetate polymer (CAP) solution that the authors have developed for use as a liquid thrombotic material. Angiography performed 1 to 4 weeks after CAP injection revealed complete thrombosis of the aneurysm with patency of the parent artery in 16 aneurysms. Histological analysis disclosed that the aneurysmal orifice in these cases was completely covered with newly formed endothelial cells 2 weeks after CAP thrombosis. Three other aneurysms exhibited parent artery occlusion caused by protrusion of the CAP mass through the aneurysmal orifice into the parent artery; this was thought to be caused by over-injection of the CAP solution. Histological analysis of the remaining five aneurysms, initially shown to have incomplete occlusion, revealed that they each possessed a residual neck that was partially covered with endothelial cells. No rupture of the aneurysms or migration of CAP into the distal arteries was observed.
These results suggest that using an endovascular approach, direct thrombosis of cerebral aneurysms with CAP is safe and effective. This technique may prove to be an alternative treatment for such aneurysms. However, there is a potential risk of regrowth or rupture of aneurysms that retain a residual neck and long-term follow-up studies will be required to evaluate this issue.
Spinal cord astrocytoma: pathological and treatment considerations
Authors: Minehan Kern J. , Shaw Edward G. , Scheithauer Bernd W. , Davis Dean L. , Onofrio Burton M. 
Published: June 2009

✓ Seventy-nine patients underwent surgery, with or without radiation therapy, for astrocytoma of the spinal cord. There were 43 tumors (54%) classified as pilocytic astrocytoma and 25 (32%) as diffuse fibrillary astrocytoma. Eleven tumors (14%) could not be classified other than as astrocytoma, “type not otherwise specified.” The 10-year overall survival rate for all 79 patients was 50% but significantly differed by histological type: 81% for patients with pilocytic astrocytoma compared to 15% for those with diffuse fibrillary astrocytoma. Tumor grade by the Kernohan, et al., or St. Anne—Mayo methods was also a significant predictor of survival in patients with diffuse fibrillary astrocytoma. The extent of surgical resection (biopsy vs. subtotal resection vs. gross total resection) did not significantly impact survival among patients with pilocytic or nonpilocytic astrocytomas of the spinal cord, although there was a trend toward poorer survival in patients undergoing some degree of resection as opposed to biopsy. Postoperative radiation therapy improved survival but did so more for diffuse fibrillary astrocytoma than pilocytic astrocytoma.
In this series, histological type was the most significant predictor of survival in patients with astrocytoma of the spinal cord. The survival rate was highest in patients who underwent biopsy followed by postoperative radiation therapy.
Posterior cervical spine fusion with tension-band wiring
Authors: Lovely Thomas J. , Carl Allen 
Published: June 2009

✓ In this study the authors detail their experience with posterior tension-band wiring for stabilization of the subaxial cervical spine. Fifty-five patients underwent fusion for trauma (41 patients), degenerative disease (13 patients), and tumor (one patient). The fusion rate was 96% (50 of 52 patients) and postoperative immobilization was accomplished by means of a Philadelphia collar in the majority of cases.Tension-band wiring provides a stable construct that is simple to perform, requires fusion of a minium number of motion segments, and allows early mobilization with only a hard collar needed for support. The details of the technique, which has been modified from preliminary descriptions, are discussed.
Bobble—head doll syndrome and drop attacks in a child with a cystic choroid plexus papilloma of the third ventricle
Authors: Pollack Ian F. , Schor Nina F. , Martinez A. Julio , Towbin Richard 
Published: June 2009

✓ The authors report an unusual case of a 2-year-old boy with a 3-month history of episodic rightward anterolateral head tilt and large-amplitude positional anteroposterior head bobbing reminiscent of bobble—head doll syndrome. This child experienced a sudden onset of drop attacks and then, within several hours, deep coma. The causative lesion was a contrast-enhancing, partially cystic third ventricular mass, which ultimately obstructed the aqueduct, producing profound obstructive hydrocephalus. An emergency ventriculostomy and endoscopic fenestration of the septum pellucidum was performed. Four days later, the tumor was completely resected by a transcallosal—transforaminal approach. The lesion was freely mobile within the third ventricle and contained a large cyst within its posterior pole; following drainage of the cyst, the lesion was easily delivered through the foramen of Monro. The histopathological diagnosis was choroid plexus papilloma.The child's neurological deficits, head tilt, and head bobbing resolved immediately after operation. To the best of the authors' knowledge, this represents the first well-documented report of bobble—head doll syndrome and drop attacks secondary to a choroid plexus papilloma. The highly mobile nature of the cystic lesion presumably led to its intermittent impaction within the foramen of Monro and/or proximal aqueduct; this produced the intermittent head tilt and bobble-head symptoms and, ultimately, resulted in acute obstruction of the aqueduct, causing the child's precipitous neurological decline.
Frontal plagiocephaly secondary to synostosis of the frontosphenoidal suture
Authors: Francel Paul C. , Park T. S. , Marsh Jeffrey L. , Kaufman Bruce A. 
Published: June 2009

✓ Frontal plagiocephaly may arise from either synostotic or deformational forces. Deformational causes of frontal plagiocephaly can be distinguished from synostotic causes by differences seen on physical examination, which can then be confirmed by skull x-ray films and if necessary three-dimensional computerized tomography (CT). Unilateral coronal synostosis is the main synostotic cause of frontal plagiocephaly, although it has also been seen with fusion of the frontozygomatic suture. In several syndromes presenting with bilateral coronal synostosis, fusion of the frontosphenoidal and frontoethmoidal sutures is also present.
The authors report, for perhaps the first time, a case showing synostotic frontal plagiocephaly secondary to fusion of the frontosphenoidal suture alone. Although the phenotypic appearance is superficially similar to that seen in unilateral coronal synostosis, analysis of the cranial base shows markedly different effects: angulation of the anterior cranial base with respect to the posterior cranial base away from the synostotic side and angulation of the posterior cranial base with respect to the midpalatal suture also away from the synostotic side. In unilateral coronal synostosis, both angulations are toward the synostotic side. These effects on the cranial base alter its relationship to the cranial vault and the facial skeleton. Most important, frontal plagiocephaly secondary to fusion of the frontosphenoidal suture should not be overlooked as being deformational. Because this fusion is difficult or impossible to visualize by skull x-ray films, three dimensional CT must be obtained in cases that are not clearly identified as deformational plagiocephaly by physical examination.
Reduction of hemorrhage risk after stereotactic radiosurgery for cavernous malformations
Authors: Kondziolka Douglas , Lunsford L. Dade , Flickinger John C. , Kestle John R. W. 
Published: June 2009

✓ The benefits of radiosurgery for cavernous malformations are difficult to assess because of the unclear natural history of this vascular lesion, the inability to image malformation vessels, and the lack of an imaging technique that defines “cure.” The authors selected for radiosurgery 47 patients who harbored a hemorrhagic malformation in a critical intraparenchymal location remote from a pial or ependymal surface. Of these, 44 patients had experienced at least two hemorrhages before radiosurgery. The mean patient age was 39 years; six patients had previously undergone attempted surgical removal. The malformation was located in the pons/midbrain in 24 cases, the medulla in three, the thalamus in nine, the basal ganglia in three, deep in a parietal lobe in four, and deep in a temporal lobe in four. Patients had sustained initial hemorrhages from 0.5 to 12 years prior to radiosurgery (mean 4.12 years). In these patients, who were not typical of the majority of patients with cavernous malformations, there were 109 bleeds before radiosurgery in 193 prior observation-years, for a 56.5% annual hemorrhage rate (including the first hemorrhage), or an annual rate of 32% subsequent to the first hemorrhage.
The mean follow-up period after radiosurgery was 3.6 years (range 0.33–6.4 years). The proportion of patients with hemorrhage after radiosurgery was significantly reduced (p < 0.0001), as was the mean number of hemorrhages per patient (p = 0.00004). In the first 2 years after radiosurgery, there were seven bleeds in 80 observation-years (8.8% annual hemorrhage rate). In the 2- to 6-year interval after radiosurgery, the annual rate decreased to 1.1% (one bleed). After radiosurgery, 12 patients (26%) sustained neurological worsening that correlated with imaging changes. In eight patients these deficits were temporary; two underwent surgical resection and died. Two patients had new permanent deficits (4%). A significant reduction was observed in the hemorrhage rate after radiosurgery in patients who had deep hemorrhagic cavernous malformations, especially after a 2-year latency interval. This evidence provides further support to the belief that radiosurgery is an effective strategy for cavernous malformations, especially when located within the parenchyma of the brainstem or diencephalon.
Resolution improvement and noise reduction in human pinhole SPECT using a multi-ray approach and the SHINE method
Authors: Vanhove C. , Defrise M. , Seret A. 
Published: June 2009

Summary
Purpose: This work aimed at quantifying the gains in spatial resolution and noise that could be achieved when using resolution modelling based on a multi-ray approach and additionally the Statistical and Heuristic Noise Extraction (SHINE) method in human pinhole single photon emission tomography (PH-SPECT). Methods: PH-SPECT of two line phantoms and one homogeneous cylinder were recorded using parameters suited for studies of the human neck area. They were reconstructed using pinhole dedicated ordered subsets expectation maximisation algorithm including a resolution recovery technique based on 7 or 21 rays. Optionally, the SPECT data were SHINE pre-processed. Transverse and axial full widths at half-maximum (FWHM) were obtained from the line phantoms. The noise was quantified using the coefficient of variation (COV) derived from the uniform phantom. Two human PHSPECT studies of the thyroid (a hot nodule and a very low uptake) were processed with the same algorithms. Results: Depending on the number of iterations, FWHM decreased by 30 to 50% when using the multi-ray approach in the reconstruction process. The SHINE method did not affect the resolution but decreased the COV by at least 20% and by 45% when combined with the multi-ray method. The two human studies illustrated the gain in spatial resolution and the decrease in noise afforded both by the multi-ray reconstruction and the SHINE method. Conclusion: Iterative reconstruction with resolution modelling allows to obtain high resolution human PH-SPECT studies with reduced noise content. The SHINE method affords an additional noise reduction without compromising the resolution.
The potential value of a pictorial atlas for aid in the visual diagnosis of 123I FP-CIT SPECT scans
Authors: Ham H. , Dobbeleir A. , Santens P. , D'Asseler Y. , Goethals I. 
Published: June 2009

SummaryThe aim of our study was to evaluate the value of a pictorial atlas of 123I FP-CIT SPECT images for aid in the visual diagnosis. Patients, materials, methods: Sixty patients, of whom 20 were clinically diagnosed as ‘non-parkinsonian’ and 40 as having Parkinson's disease or any related disorder, were included in the study. An atlas consisting of 12 123I FP-CIT SPECT images was constructed first. Validity of the atlas was investigated by performing a receiver operating characteristic (ROC) analysis with the clinical diagnosis as the gold standard. The remaining 48 SPECT images were visually assessed twice by 5 observers, first with and secondly without consulting the atlas, or vice versa. The added value of the atlas was investigated by comparing the diagnostic accuracy and the interobserver variability for both methods. Results: ROC analysis performed on the atlas yielded an area under the curve of 1 for a threshold discriminating between clinically non-parkinsonian and parkinsonian patients that was situated between image 4 and 5 of the atlas. For the diagnostic accuracy, we found that the area under the ROC curve was systematically higher if observers had access to the atlas compared to when they had not (Wilcoxon's test, p<0.05). Also, the interobserver variability was significantly lower when observers used the atlas when compared to when they did not (p = 0.05). Conclusion: Diagnostic accuracy was significantly higher and interobserver variability significantly lower if observers had access to the atlas compared to when they had not. Hence, having a pictorial atlas available may facilitate the visual assessment of 123I FP-CIT SPECT scans.
MIBI scintigraphy in hypofunctioning thyroid nodules
Authors: Schmidt M. , Ivanova T. , Dietlein M. , Schicha H. , Theissen P. 
Published: June 2009

Summary
Aim: Several authors have investigated the value of technetium-MIBI scanning to predict the dignity of hypofunctioning, cold thyroid nodules (HTN) in regions with differing levels of iodine supply. They concluded that an MIBI scan can exclude thyroid malignancy, although comparisons between the studies are of limited value owing to differences in methodology and wide variations in patient selection criteria. The present study investigates whether the above claim is also valid in Germany, a country with a long-standing and persistent, mild iodine deficiency and a high incidence of nodules in large goiters with a low prevalence of malignancy. Patients, methods: The study compares the results of 99mTc-MIBI scintigraphy (incl. SPECT and planar images) in HTN (MIBI) with those of fine-needle aspiration biopsy (FNAB) and histology. Of 154 consecutive patients (121 women, 33 men; mean age 56 ± 12 years), 73 underwent thyroid surgery from which the results of FNAB and MIBI were assessed. Selection criteria were risk estimation or conditions limiting the feasibility of FNAB. The mean thyroid volume was 42 ± 25 ml, with 2.1 ± 1.4 nodules per patient. Results: Histology revealed thyroid malignancies in 8 out of 73 patients (11.0%). The negative predictive value for MIBI was 97%, which is comparable to FNAB (94%). However, in 19.5% of patients FNAB was indeterminate. Lower specificity (54%) and low positive predictive value (19%) showed that MIBI accumulation cannot differentiate between malignant and benign thyroid nodules. However, comparison with cytological and/or histological findings indicated that it could distinguish between lesions with differing rates of mitochondrial metabolism. Conclusion: Even in areas of former or mild iodine deficiency MIBI forms a basis for choosing between wait-and-see and surgical strategies if FNAB is unfeasible or not representative. However, even for pathological MIBI results, the prevalence of malignancy is not very high.