bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hemodynamic instability after carotid artery angioplasty and stent placement: a review of the literature
Authors: Gupta Rishi , Horowitz Michael , Jovin Tudor G. 
Published: January 2008

In this review of the literature the goal was to determine the frequency and relevance of hemodynamic instability after carotid artery (CA) angioplasty and stent placement.
Hemodynamic instability after CA angioplasty and stent placement is a well-recognized phenomenon that occurs in 29 to 51% of patients undergoing the procedure. In some patients this problem is severe enough to warrant treatment with vasopressor agents. Features observed on clinical and angiographic evaluation can help clinicians identify patients who are at risk. Hemodynamic fluctuations encountered as a result of CA angioplasty and stent placement may have adverse clinical consequences, including a higher incidence of myocardial infarction and stroke. Proposed measures to prevent this complication include prophylactic placement of transvenous pacemakers or pretreatment with atropine. Unfortunately, no randomized trials are currently available to assess the efficacy of these approaches.
Hemodynamic instability is a common finding after CA angioplasty and stent placement. Clinicians can predict which patients are at risk by considering angiographic and clinical features.
Nondysraphic intramedullary spinal cord lipomas: a review
Authors: Bhatoe Harjinder Singh , Singh Prakash , Chaturvedi Aarti , Sahai Kavita , Dutta Vibha , Sahoo P. K. 
Published: January 2008

Object
Lipomas of the spinal cord are often a component of spinal dysraphic states. Nondysraphic intramedullary spinal cord lipomas are rare, and their presentation, in the form of gradually worsening myelopathy, is nonspecific. The authors report on the methods used for diagnosis and treatment in patients presenting with these lesions at their institution, and they review the relevant literature.

Methods
The authors treated 14 patients who presented with intramedullary lipomas over a period of 12 years. None of these patients had segmentation anomaly or dysraphism of the spine, or any hindbrain anomaly. Admission magnetic resonance images were diagnostic in all patients. All tumors were located dorsally in the spinal cord, the majority of them in the cervicodorsal cord. The lipomas were partially excised with the help of a carbon dioxide laser in all patients in an attempt to preserve neurological function. All patients attained improvement in their sensory and motor symptoms.

Conclusions
Because these lesions do not have a clear-cut margin, it is vital to preserve neurological function at the time of surgery, even if it entails incomplete resection.
Prospective analysis of self-perceived quality of life before and after posterior fossa decompression in 112 patients with Chiari malformation with or without syringomyelia
Authors: Mueller Diane , Oro' John J. 
Published: January 2008

Object
The purpose of this prospective study was to determine if there was a difference in the self-perceived quality of life (QOL) before and after surgery among patients with Chiari I malformations with or without syringomyelia. Most patients with Chiari I malformations report improvement in their QOL after decompression surgery; however, specific outcome data have not been empirically studied in this patient population.

Methods
One hundred seventy-two consecutive patients who underwent posterior fossa decompression based on neuroimaging evidence of a Chiari I malformation with or without syringomyelia were prospectively offered participation in the study. The Sickness Impact Profile (SIP) was chosen as the instrument for data collection.
Completed questionnaires were returned by 112 patients. A statistically significant improvement (p < 0.0001) in SIP scores (self-reported QOL) was noted in 84% of participants after decompression surgery. Patient age, amount of tonsillar herniation, and evidence of syringomyelia before surgery did not correlate with or adversely affect outcomes. Among 16 participants who reported worsening in their QOL, anecdotal information revealed extraneous factors unrelated to the Chiari I malformation that they perceived as negatively influencing their outcome. Among the extraneous variables noted by the participants were general health status, unrelated injury, other illnesses, and significant stress.

Conclusions
The majority of participants who underwent posterior fossa surgery for a Chiari I malformation reported significant improvement in their QOL after surgery.
Combined surgical and endovascular treatment of a recurrent A3–A3 junction aneurysm unsuitable for standalone clip ligation or coil occlusion
Authors: Kim Louis J. , Albuquerque Felipe C. , McDougall Cameron , Spetzler Robert F. 
Published: January 2008

Recurrent aneurysms of the anterior circulation that are distal to the anterior communicating artery (ACoA) but proximal to the callosomarginal–pericallosal bifurcation can pose a treatment challenge. The authors present one such case, in which the patient was treated with pericallosal artery–pericallosal artery (PerA–PerA) side-to-side bypass, followed by endovascular obliteration of the proximal A2 parent vessel. This patient, in whom an ACoA aneurysm had been treated with clip ligation 5 years previously, presented with a new, mid-A2, right-sided aneurysm with the out-flow artery arising from the dome of the lesion.
The treatment plan included two steps: an interhemispheric transcallosal approach for PerA–PerA side-to-side anastomosis; and endovascular coil embolization of the right A2 branch feeding the aneurysm. Postprocedure angiography demonstrated no ipsilateral aneurysm filling and excellent bilateral distal outflow from the anterior cerebral artery (ACA).
The use of PerA–PerA side-to-side bypass for the treatment of an ACA aneurysm, followed by parent vessel occlusion, offers an elegant solution for the treatment of A2 aneurysms that are not amenable to stand-alone clip ligation or coil occlusion. Such combined methods are invaluable in the management of complex cerebral aneurysms.
Kyphoplasty-augmented short-segment pedicle screw fixation of traumatic lumbar burst fractures: initial clinical experience and literature review
Authors: Acosta Frank L. , Aryan Henry E. , Taylor William R. , Ames Christopher P. 
Published: January 2008

Object
Surgical intervention for thoracolumbar burst fractures is indicated for patients with neurological deficits and/or evidence of severe spinal instability. The goals of surgery are decompression, deformity correction, and stabilization. Nevertheless, the optimal surgical strategy to achieve these goals remains a subject of debate. Short-segment pedicle screw fixation is associated with a 20 to 50% incidence of pedicle screw failure and progressive spinal deformity. Initial biomechanical and clinical studies have shown that reinforcement of short-segment pedicle screw fixation with vertebroplasty improves spinal stability and decreases instrument failure rates. In this study, the authors describe their initial clinical experience with kyphoplasty used to augment short-segment pedicle screw fixation of traumatic lumbar burst fractures.

Methods
Five patients with traumatic burst fractures of the lumbar spine were included in this retrospective review of patients treated for this disorder at the University of California, San Diego and the University of California, San Francisco between 2002 and 2004. All patients underwent transpedicular kyphoplasty and short-segment pedicle screw fixation. The mean follow-up period was 10.6 months (range 6–18 months). All patients underwent short-segment pedicle screw fixation reinforced with polymethyl methacrylate kyphoplasty. The preoperative, postoperative, and follow-up plain x-ray films were evaluated. Radiographic analysis included measurements of kyphotic angulation, anterior vertebral body height, and evidence of bone fusion. Clinical evaluation was performed postoperatively and at follow-up review.

Conclusions
Based on the authors' initial experience, kyphoplasty supplementation may improve the long-term integrity of short-segment pedicle screw constructs and allow for improved rates of fusion and better clinical outcomes in patients with traumatic lumbar burst fractures.
A novel percutaneous system for bone graft delivery and containment for elevation and stabilization of vertebral compression fractures
Authors: Lam Sandi , Khoo Larry T. 
Published: January 2008

Object
Vertebroplasty and kyphoplasty are minimally invasive procedures used to treat persistently symptomatic vertebral compression fractures (VCFs). Both interventions usually involve injection of polymethyl methacrylate (PMMA). The purpose of this technical note was to review the theory and surgical technique for a novel percutaneous system for fracture reduction and stabilization of VCFs by using bone graft.

Methods
This technical note highlights the Optimesh system as an alternative method of minimally invasive VCF reduction and stabilization with the delivery of a bone graft containment device. Instead of using PMMA as in vertebroplasty or kyphoplasty, this system allows the delivery of allograft and/or autograft bone, with its osteoinductive, osteoconductive, and osteogenic properties.

Conclusions
This system allows for restoration of sagittal alignment of the spine with direct control of bone graft delivery by using a mesh graft containment device that allows for ingrowth of new bone and vascular tissue.
Endoscopic thoracic microdiscectomy
Authors: Oskouian Rod J. , Johnson J. Patrick 
Published: January 2008

Object
The purpose of this investigation was to evaluate surgical and neurological outcomes in thoracic disc surgery in a prospective fashion.

Methods
Quantifiable outcome data such as operating time, blood loss, duration of chest tube drainage, narcotic drug use, length of hospital stay (LOS), and long-term follow up of neurological function and pain-related symptoms were collected prospectively.
In patients with myelopathy there was an improvement of two Frankel grades in the thoracoscopic discectomy group and one Frankel grade in the patients treated with thoracotomy; however, patients in the thoracotomy group were significantly worse preoperatively. None of the patients experienced worsened pain, and pain related to radiculopathy was improved by 75% in the thoracoscopic group.

Conclusions
Thoracoscopic discectomy yields acceptable surgical results and has several distinct advantages, with reduced postoperative pain, morbidity, and LOS.
Intraoperative three-dimensional fluoroscopy-based computerized tomography guidance for percutaneous kyphoplasty
Authors: Villavicencio Alan T. , Burneikiene Sigita , Bulsara Ketan R. , Thramann Jeffrey J. 
Published: January 2008

Object
Percutaneous kyphoplasty is an established method for the treatment of pathological vertebral compression fractures (VCFs). This procedure is usually performed with the aid of biplanar fluoroscopic image guidance. There are currently no published clinical studies in which the use of three-dimensional (3D) image guidance to facilitate this technique has been evaluated. The purpose of this study was to evaluate the efficacy of isocentric fluoroscopy-based navigation for the kyphoplasty procedure, with special reference to operating time and the amount of radiation exposure.

Methods
A prospective clinical study was performed in which 11 consecutive patients with painful pathological VCFs that did not respond to conservative treatment underwent the kyphoplasty procedure. During this procedure, cannulation of the pedicle and vertebral body was performed with the aid of isocentric 3D fluoroscopy visualization. Total operating time and intraoperative fluoroscopy time for this group was compared with a cohort of nine patients who underwent the procedure prior to the availability of isocentric fluoroscopy (only biplanar fluoroscopy was used). Possible complications such as cement extravasations were evaluated during the procedure and on postoperative computerized tomography scans.
The mean duration of surgery for the 3D isocentric fluoroscopic guidance group was 60 minutes (range 36–89 minutes) for one-level and 68.5 minutes (range 65–75 minutes) for two-level cases. Because of a learning curve with the equipment, the operating time for the initial cases was significantly longer than with the later ones. Even with the initial cases included, the mean operating time was shorter compared with the biplanar fluoroscopy-assisted procedures, which averaged 69.2 minutes (range 44–113 minutes) for one-level procedures. This difference was not statistically significant. The mean fluoroscopy exposure time was 41.3 seconds (range 25–62 seconds) in the isocentric fluoroscopy-assisted procedures, with an additional 40 seconds of fluoroscopy time used for the 3D fluoroscopy “spin,” compared with 293.2 seconds (range 180–400 seconds) in the biplanar fluoroscopy-assisted procedures. The difference was statistically significant (p = 0.02). All pedicles were accessed without difficulty and no complications were encountered in either group of patients.

Conclusions
The main advantage of isocentric fluoroscopy is the significant reduction in radiation exposure for the patient and surgical staff without an increase in the mean operating time. This technique is a significant advancement over biplanar fluoroscopy in this setting.
Combination kyphoplasty and spinal radiosurgery: a new treatment paradigm for pathological fractures
Authors: Gerszten Peter C. , Germanwala Anand , Burton Steven A. , Welch William C. , Ozhasoglu Cihat , Vogel William J. 
Published: January 2008

Object
Patients with symptomatic pathological compression fractures require a stabilization procedure for mechanical control of back pain as well as radiation therapy for the underlying malignant process. In this study the authors evaluated a treatment paradigm of closed fracture reduction and fixation in which kyphoplasty was used, followed by single-fraction spinal radiosurgery performed with the CyberKnife.

Methods
Twenty-six patients (six men and 20 women, mean age 72 years) with histologically confirmed pathological compression fractures (16 thoracic, 10 lumbar) were prospectively evaluated. For inclusion in the study, the patients' presenting symptoms were limited to pain without neurological deficits. Histological findings included 11 lung, nine breast, and four renal carcinomas, one cholangiocarcinoma, and one ocular melanoma. All patients underwent kyphoplasty of the affected vertebral body, for which a percutaneous transpedicular procedure was used. Fiducial markers that allow image guidance for CyberKnife radiosurgery were placed into the pedicles at the adjacent levels at the time of the kyphoplasty procedure. Patients then underwent single-fraction radiosurgery (at a mean of 12 days after kyphoplasty) in an outpatient setting. The tumor dose was maintained at 16 to 20 Gy to the 80% isodose line (mean 18 Gy). Treated tumor volume ranged from 12.7 to 37.1 cm3. Axial pain improved in 24 (92%) of 26 patients during the follow-up period of 7 to 20 months.

Conclusions
A combined kyphoplasty and spinal radiosurgery treatment paradigm was found to be safe and clinically effective for patients with pathological fractures without significant spinal canal compromise. This technique combines two minimally invasive surgical procedures, thereby avoiding the morbidity associated with open surgery while providing immediate fracture fixation as well as a single-fraction tumoricidal radiation dose.
Percutaneous balloon compression for the treatment of trigeminal neuralgia: results in 56 patients based on balloon compression pressure monitoring
Authors: Brown Jeffrey A. , Pilitsis Julie G. 
Published: January 2008

Object
Percutaneous balloon compression is an effective and technically simple method for treating trigeminal neuralgia (TN). Nevertheless, dysesthesias (10–20%) and masseter muscle weakness (66%) following the procedure have been noted. The purpose of this study was to evaluate the results of testing TN with percutaneousballoon compression aided by intraluminal pressure monitoring.

Methods
In this study the authors review the results and complications associated with percutaneous balloon compression by using intraluminal pressure monitoring data obtained in 65 procedures performed in 56 consecutive patients over 4 years. The mean patient age was 71 years (range 37–92 years), and the mean follow-up duration was 17 months (range 3–38 months). The mean intraluminal compression pressure was (1160 ± 62 mm Hg), and the mean duration of compression was 1.15 ± 0.27 minutes. The trigeminal depressor response was observed in 60 (92%) of 65 procedures, and initial pain relief occurred in 92% of patients. The recurrence rate in patients who had initial relief was 16% (nine of 56). The mean time until recurrence in patients who experienced pain relief after surgery was 13 months (range 3–23 months). Mild numbness immediately after surgery was observed in 83% of patients. At the most recent evaluation, 17% of patients reported persistent, nontroublesome numbness and none had moderate or severe numbness. Minor dysesthesia was present in two patients (4%). Mild masseter muscle weakness occurred in 24% of patients and resolved within a maximum period of 1 year. No patient experienced anesthesia dolorosa, corneal keratitis, or other cranial nerve deficits. These morbidity rates are lower than the incidence reported in the literature when pressure monitoring is not used.

Conclusions
These data show that by monitoring compression pressure and limiting the duration of compression, it is possible to reduce the incidence of dysesthesias, severe numbness, and masseter weakness after surgery without increasing the rate of recurrent pain in patients with classic TN.
Comparison of posterior fossa exploration and stereotactic radiosurgery in patients with previously nonsurgically treated idiopathic trigeminal neuralgia
Authors: Pollock Bruce E. 
Published: January 2008

Object
Stereotactic radiosurgery (SRS) is commonly performed in patients with trigeminal neuralgia, and numerous investigators have found that facial pain outcomes after this procedure are better for patients in whom prior surgery did not fail. Researchers in some centers claim that the results of SRS are equivalent to posterior fossa exploration (PFE). The goal in this study was to verify that claim.

Methods
Information was retrieved from a prospectively maintained database of patients less than 70 years old with idiopathic trigeminal neuralgia who underwent PFE (55 patients) or SRS (28 patients) as their initial surgery between 1999 and 2004. Of the two groups, patients who underwent radiosurgery were older (60.5 compared with 50.7 years, p < 0.001). Microvascular decompression was performed in 49 patients (89%) and partial nerve section was performed in six (11%) in the PFE group. The mean maximum dose for SRS was 89.1 Gy. At a mean follow-up duration of 25.5 months, patients who had undergone PFE were more commonly pain free without medications (75% at 1 year, 72% at 3 years) compared with the patients treated with SRS (59% at 1 and 3 years; p = 0.01). Additional surgery was performed in 10 patients (18%) after PFE, compared with eight patients (29%) after SRS (p = 0.4). Eight patients (15%) had either new facial numbness (six cases) or dysesthesias (two cases) after PFE, whereas 12 (43%) had either new facial numbness (eight cases) or dysesthesias (four cases) after SRS. No correlation was noted between the development of facial numbness and facial pain outcome after PFE (p = 0.37), whereas patients in whom trigeminal dysfunction developed after radiosurgery were more frequently free of pain (p = 0.02).

Conclusions
The results support PFE as a more effective primary surgery than SRS in patients with idiopathic trigeminal neuralgia. Moreover, injury to the trigeminal nerve during PFE is not required to achieve excellent facial pain outcomes.
A novel brainstem tumor model: guide screw technology with functional, radiological, and histopathological characterization
Authors: Lee James , Jallo George I. , Guarnieri Michael , Carson Benjamin S. , Penno Margret B. 
Published: January 2008

Object
Survival rates for high-grade brainstem tumors are approximately 10% and optimal therapy has yet to be determined. Development of a satisfactory brainstem tumor model is necessary for testing new therapeutic paradigms that may prolong survival. The authors report the technique, functional progression, radiological appearance, and histopathological features of a novel brainstem tumor model in rats.

Methods
Thirty female Fischer 344 rats were randomized (10 animals/group) to receive an injection of either 3 μl of 9L gliosarcoma cells (100,000 cells), 3 μl of F98 glioma cells (100,000 cells), or 3 μl of medium (Dulbecco modified Eagle medium) into the pontine tegmentum of the brainstem. Using a cannulated guide screw system implanted in the skull of the animal, rats in each group were injected at coordinates 1.4 mm to the right of the sagittal and 1 mm anterior to the lambdoid sutures, at a depth of 7 mm from the dura mater. The angle of the syringe during injection was anteflexed 5° from the vertical. Postoperatively, the rats were evaluated for neurological deficits by using an automated rotarod test. High-resolution [18F]fluorodeoxyglucose–positron emission tomography (FDG-PET) fused with computerized tomography (CT) scans were acquired pre- and postoperatively through the onset of hemiparesis and correlated accordingly. Kaplan–Meier curves were generated for survival and disease progression, and brains were processed postmortem for histopathological investigation.
The 9L and F98 tumor cells grew in 95% of the animals in which they were injected and resulted in a statistically significant mean onset of hemiparesis of 16.5 ± 0.56 days (p = 0.001, log-rank test), compared with animals in the control group, which had no neurological deficits by Day 45. The FDG-PET studies coregistered with CT scans demonstrated space-occupying brainstem lesions, and this finding was confirmed by histological studies. Animals in the control group showed no functional, radiological, or pathological signs of tumor.

Conclusions
Progression to hemiparesis was consistent in all tumor-injected animals, with predictable onset of symptoms occurring approximately 17 days postsurgery. The histopathological and radiological characteristics of the 9L and F98 brainstem tumors were comparable to those of aggressive primary human brainstem tumors. Establishment of this animal tumor model will facilitate the testing of new therapeutic paradigms for the treatment of these lesions.
Endoscopic management of pediatric brain tumors
Authors: Souweidane Mark M. 
Published: January 2008

Object
Primary endoscopic procedures for children with intraventricular brain tumors include endoscopic tumor biopsy and endoscopic tumor removal. The simultaneous treatment of hydrocephalus with endoscopic third ventricu-lostomy (ETV) or endoscopic septostomy increases the appeal of a minimally invasive endoscopic approach.

Methods
Eighty-five patients who underwent endoscopic management of an intraventricular brain tumor were identified from a prospective database. Of these patients, 26 were younger than 21 years of age at the time of diagnosis. The surgical technique, its success rate, and patient outcome were assessed. Illustrative cases are used in this study to detail the procedure of endoscopic tumor biopsy and resection.
Endoscopic tumor procedures were successful in 96% of cases (23 of 24 endoscopic tumor biopsy samples and both endoscopic tumor removals). Fourteen simultaneous procedures were performed to treat hydrocephalus successfully. There was no recognized morbidity from the surgical procedures.

Conclusions
Endoscopic surgery in children with intraventricular brain tumors is an effective and safe method for sampling of the lesion and, in select cases, its resection. This minimally invasive technique should be considered in situations in which the patient might thereby avoid a more conventional procedure, given the high rate of success and low morbidity associated with endoscopic management.