bluuebunny/crossref_metadata_2025_split huggingface dataset:
Applications and limitations of perfusion-dependent functional brain mapping for neurosurgical guidance
Authors: Pouratian Nader , Sheth Sameer , Bookheimer Susan Y. , Martin Neil A. , Toga Arthur W. 
Published: January 2008

Perfusion-dependent brain mapping modalities, such as functional magnetic resonance imaging, positron emission tomography, and optical imaging of intrinsic signals, have become increasingly popular for neurosurgical guidance because they offer a relatively rapid and noninvasive means of mapping brain function. These modalities are unique because they rely on perfusion-related signals that are coupled with neuronal activity to map the brain instead of measuring electrophysiological responses. They consequently present unique challenges to the clinician in terms of understanding the significance and limitations of the maps they produce. In particular, one must be aware of limitations of the modalities with respect to spatial specificity, sensitivity, and reliability of these maps and how the presence of intracranial lesions may further complicate these issues.
The authors review the evolution, interpretation, and limitations of perfusion-based brain mapping techniques, with special attention to clinical implications of the brain maps.
Nerve sheath tumors involving the sacrum
Authors: Klimo Paul , Rao Ganesh , Schmidt Richard H. , Schmidt Meic H. 
Published: January 2008

Nerve sheath tumors that involve the sacrum are rare. Delayed presentation is common because of their slow-growing nature, the permissive surrounding anatomical environment, and nonspecific symptoms. Consequently, these tumors are usually of considerable size at the time of diagnosis.
The authors discuss a case of a sacral nerve sheath tumor. They also propose a classification scheme for these tumors based on their location with respect to the sacrum into three types (Types I–III). Type I tumors are confined to the sacrum; Type II originate within the sacrum but then locally metastasize through the anterior and posterior sacral walls into the presacral and subcutaneous spaces, respectively; and Type III are located primarily in the presacral/retroperitoneal area. The overwhelming majority of sacral nerve sheath tumors are schwannomas. Neurofibromas and malignant nerve sheath tumors are exceedingly rare. Regardless of their histological features, the goal of treatment is complete excision. Adjuvant radiotherapy may be used in patients in whom resection was subtotal. Approaches to the sacrum can generally be classified as anterior or posterior. Type I tumors may be resected via a posterior approach alone, Type III may require an anterior approach, and Type II tumors usually require combined anterior–posterior surgery.
CyberKnife frameless single-fraction stereotactic radiosurgery for tumors of the sacrum
Authors: Gerszten Peter C. , Ozhasoglu Cihat , Burton Steven A. , Welch William C. , Vogel William J. , Atkins Barbara A. , Kalnicki Shalom 
Published: January 2008

Object
The role of stereotactic radiosurgery for the treatment of intracranial lesions is well established. The experience with radiosurgery for the treatment of spinal and sacral lesions is more limited. Sacral lesions should be amenable to radiosurgical treatment similar to that used for their intracranial counterparts. The authors evaluated a single-fraction radiosurgical technique performed using the CyberKnife Real-Time Image-Guided Radiosurgery System for the treatment of the sacral lesion.

Methods
The CyberKnife is a frameless radiosurgery system based on the coupling of an orthogonal pair of x-ray cameras to a dynamically manipulated robot-mounted linear accelerator possessing six degrees of freedom, which guides the therapy beam to the intended target without the need for frame-based fixation. All sacral lesions were located and tracked for radiation delivery relative to fiducial bone markers placed percutaneously. Eighteen patients were treated with single-fraction radiosurgery. Tumor histology included one benign and 17 malignant tumors.
Dose plans were calculated based on computerized tomography scans acquired using 1.25-mm slices. Planning treatment volume was defined as the radiographically documented tumor volume with no margin. Tumor dose was maintained at 12 to 20 Gy to the 80% isodose line (mean 15 Gy). Tumor volume ranged from 23.6 to 187.4 ml (mean 90 ml). The volume of the cauda equina receiving greater than 8 Gy ranged from 0 to 1 ml (mean 0.1 ml). All patients underwent the procedure in an outpatient setting. No acute radiation toxicity or new neurological deficits occurred during the mean follow-up period of 6 months. Pain improved in all 13 patients who were symptomatic prior to treatment. No tumor progression has been documented on follow-up imaging.

Conclusions
Stereotactic radiosurgery was found to be feasible, safe, and effective for the treatment of both benign and malignant sacral lesions. The major potential benefits of radiosurgical ablation of sacral lesions are relatively short treatment time in an outpatient setting and minimal or no side effects. This new technique offers a new and important therapeutic modality for the primary treatment of a variety of sacral tumors or for lesions not amenable to open surgical techniques.
Recurrent lumbar disc herniation
Authors: Swartz Karin R. , Trost Gregory R. 
Published: January 2008

Recurrent lumbar disc herniation is a common disease process. It has been noted to occur in 5 to 15% of cases surgically treated for primary lumbar disc herniation. Outcomes in one series approached those after the initial operations, although this is not the case in the experience of most surgeons.
The removal of recurrent lumbar disc herniations requires meticulous surgical technique. Great care is taken to identify the osseous margins of the previous surgical site. Identification and dissection of scar from the dura mater is greatly aided with the use of a microscope.
Lumbar myofascial flap for pseudomeningocele repair
Authors: Misra Sanjay N. , Morgan Howard W. , Sedler Ross 
Published: January 2008

Object
Initial management for lumbar pseudomeningoceles entails the closed external drainage of cerebrospinal fluid (CSF) with or without blood patch application. The presence of longstanding pseudomeningoceles and those associated with nonmicroscopic dural tears can be more problematic. Additionally the failure of nonoperative measures may necessitate surgery. Ideally the procedure should involve repairing the dural defect, removing the encapsulated cavity of the pseudomeningocele, and obliterating the extraspinal dead space to minimize the recurrence of the problem.

Methods
The authors describe a technique performed in 12 patients with large (> 5-cm-diameter) pseudomeningoceles referred for management following the failure of less aggressive measures. Diagnosis was based on symptoms of lumbar wound swelling, postural headaches, back and leg pain, and was confirmed by imaging studies. In all patients subarachnoid CSF drainage and initial operative attempts to obliterate the pseudomeningocele had failed. They were treated between July 1990 and July 1998. The cause of the pseudomeningoceles was lumbar discectomy (four patients), lumbar decompression (one patient), lumbar decompression and placement of instrumentation (five patients), and intradural procedures (two patients). Their mean age was 47.9 years (range 20–67 years), and they presented at a mean of 5.5 months postoperatively (range 3 weeks–37 months). In all cases there was a satisfactory repair of the pseudomeningocele, dead space obliteration, and long-term symptomatic resolution.

Conclusions
Lumbar myofascial advancement for this problem is a useful technique in cases of symptomatic pseudomeningoceles. This technique requires the medial advancement of the musculofascial units of the paravertebral muscles for a layered closure over the exposed spinal canal with obliteration of the pseudomeningocele.
Is spinal instrumentation a risk factor for late-onset infection in cases of distant infection or surgery?
Authors: Naderi Sait , Acar Feridun , Mertol Tansu 
Published: January 2008

As a cause of revision spinal surgery, spinal epidural abscess after instrumentation-assisted fusion is rare in neurosurgical practice. Postoperative infections are frequently seen in the time period soon after surgery.
The authors report on the case of a 45-year-old woman who had undergone posterior instrumentation-augmented fusion for L4–5 degenerative spondylolisthesis. Ten months after the operation she presented to the neurosurgery clinic with complaints of severe low-back pain and radicular right lower-extremity pain. She had undergone laparoscopic surgery for acute cholecystitis 1 month prior to readmission. Radiological study revealed a spinal epidural abscess in communication with a right psoas abscess at L4–5. The abscess was drained percutaneously with the aid of C-arm fluoroscopic guidance, and a 6-week course of parenteral antibiotic therapy was administered.
Retrograde lymphatic bacterial translocation, hematopoietic spread, and the suitable charectaristics in the host may facilitate the development of infection around the implant. Thus, distant surgery and infection may be a risk factor in cases in which spinal instrumentation is placed. In such cases a prolonged antibiotic therapy for distant infection after surgery is recommended.
Deferoxamine-induced attenuation of brain edema and neurological deficits in a rat model of intracerebral hemorrhage
Authors: Nakamura Takehiro , Keep Richard F. , Hua Ya , Schallert Timothy , Hoff Julian T. , Xi Guohua 
Published: January 2008

Object
In the authors' previous studies they found that brain iron accumulation and oxidative stress contribute to secondary brain damage after intracerebral hemorrhage (ICH). In the present study they investigated whether deferoxamine, an iron chelator, can reduce ICH-induced brain injury.

Methods
Male Sprague–Dawley rats received an infusion of 100 μl of autologous whole blood into the right basal ganglia and were killed 1, 3, or 7 days thereafter. Iron distribution was examined histochemically (enhanced Perl reaction). The effects of deferoxamine on ICH-induced brain injury were examined by measuring brain edema and neurological deficits. Apurinic/apyrimidinic endonuclease/redox effector factor–1 (APE/Ref-1), a repair mechanism for DNA oxidative damage, was quantitated by Western blot analysis.
Iron accumulation was observed in the perihematoma zone beginning 1 day after ICH. Deferoxamine attenuated brain edema, neurological deficits, and ICH-induced changes in APE/Ref-1.

Conclusions
Deferoxamine and other iron chelators may be potential therapeutic agents for treating ICH. They may act by reducing the oxidative stress caused by the release of iron from the hematoma.
Intracerebral hematoma from aneurysm rupture
Authors: Abbed Khalid M. , Ogilvy Christopher S. 
Published: January 2008

Object
Patients who present with an intraparenchymal hematoma associated with a ruptured aneurysm usually require urgent clot evacuation and aneurysm obliteration. The impact of the presence of hematoma on outcome has been poorly characterized. The authors report on 460 patients who had dense subarachnoid hemorrhage (SAH) (Fisher Grades 3 and 4) with and without associated hematoma.

Methods
Of the 959 consecutive patients who presented with SAH, 460 patients with Fisher Grade 3 and 4 SAH were analyzed and divided into two groups: those with (Group 1) and those without (Group 2) hematoma. The presenting Hunt and Hess grade and 6-month outcomes of the two groups were compared.
Of the 460 patients, 116 (25%) had intraparenchymal hematomas and admission Hunt and Hess grades were worse in Group 1 compared with Group 2. Outcome scores were worse for Group 1 compared with Group 2; however, when comparing Group 1 and Group 2 within the same initial Hunt and Hess score, there was no statistical difference in outcome.

Conclusions
Intraparenchymal hematoma in association with SAH does not differ significantly from those patients without associated hematomas. We therefore recommend aggressive clot evacuation and aneurysm obliteration.
Treatment of metastatic spinal epidural disease: a review of the literature
Authors: Klimo Paul , Kestle John R. W. , Schmidt Meic H. 
Published: January 2008

Object
Spinal cord compression is one of the most dreaded complications of metastatic cancer. It can lead to a number of sequelae, including pain, spinal instability, neurological deficits, and a reduction in the patient's quality of life. Except in selected circumstances, treatment is palliative. Treatment options include surgery, radiation, and chemotherapy. The goal of this study was to summarize the existing data on the outcomes of various treatment methods for metastatic spinal epidural disease and to make appropriate recommendations for their use.

Methods
The authors used a search strategy that included an electronic database search, a manual search of journals, analysis of bibliographies in relevant review papers, and consultation with the senior author. There is good evidence, including Class I data, that steroid drugs constitute a beneficial adjunctive therapy in patients with myelopathy from epidural compression. Historically, conventional radiation therapy has been viewed as the first-line treatment because it has been shown to be as effective as a decompressive laminectomy, with a lower incidence of complications (Class II data). Nevertheless, in the last 20 years there has been remarkable progress in surgical techniques and technology. Currently, the goals of surgery are to achieve a circumferential decompression of the spinal cord, and to reconstruct and immediately stabilize the spinal column. Results in a large body of literature support the belief that surgery is better at retaining or regaining neurological function than radiation and that surgery is highly effective in relieving pain. Most of the data on the treatment of metastatic spinal disease are Class II or III, but the preliminary results of a well-designed, randomized controlled trial in which surgery is compared with standard radiation therapy represents the first Class I data.

Conclusions
As the number of treatment options for metastatic spinal disease has grown, it has become clear that effective implementation of these treatments can only be achieved by a multidisciplinary approach.
Stereotactic radiosurgery for hemangiomas and ependymomas of the spinal cord
Authors: Ryu Stephen I. , Kim Daniel H. , Chang Steven D. 
Published: January 2008

Object
The optimal treatment for intramedullary spinal tumors is controversial, because both resection and conventional radiation therapy are associated with potential morbidity. Stereotactic radiosurgery can theoretically deliver highly conformal, high-dose radiation to surgically untreatable lesions while simultaneously mitigating radiation exposure to large portions of the spinal cord. The purpose of this study was to evaluate the authors' initial experience with frameless stereotactic radiosurgery for intramedullary spinal tumors.

Methods
Between 1998 and 2003, 10 intramedullary spinal tumors were treated with stereotactic radiosurgery at the authors' institution. Seven hemangioblastomas and three ependymomas were treated in four men and three women. These patients either had recurrent tumors, had undergone several previous surgeries, had medical contraindications to surgery, or had declined open resection. Conformal treatment planning delivered a prescribed dose of 1800 to 2500 cGy (mean 2100 cGy) to the lesions in one to three stages. No significant treatment-related complications have been recorded. The mean radiographic and clinical follow-up duration was 12 months (range 1–24 months). One ependymoma and two hemangioblastomas were smaller on follow-up neuroimaging. The remaining tumors were stable at the time of follow-up imaging.

Conclusions
Stereotactic radiosurgery for intramedullary spinal tumors is feasible and safe in selected cases and may prove to be another therapeutic option for these challenging lesions.
Lumbosacral ependymomas: a review of the management of intradural and extradural tumors
Authors: Fassett Daniel R. , Schmidt Meic H. 
Published: January 2008

Object
The goal of this study was to review the management of intra- and extradural ependymomas. Spinal ependymomas most commonly occur as intramedullary tumors throughout the spinal axis. In the lumbosacral region, ependymomas are most commonly associated with the conus medullaris and cauda equina, but can also occur extradurally in the sacrum, presacral tissues, or subcutaneous tissues over the sacrum. These two tumor locations produce different management concerns. Intradural ependymomas, especially those in the lumbosacral region, are now recognized for their potential to spread throughout the central nervous system (CNS), whereas extradural tumors elicit more concern for their association with extraneural metastases.

Methods
The authors have reviewed the literature regarding both of these distinct tumors and have summarized recommendations for the management of intra- and extradural lumbosacral ependymomas. For both tumors, it appears that gross-total resection is the treatment of choice when feasible. The role of radiation therapy has not been adequately studied for either tumor location, but most clinicians use this modality in patients with subtotal resection of intradural ependymomas, local recurrence, or CNS dissemination. Data supporting the use of radiation therapy for extradural ependymomas are lacking. There does not appear to be a significant role for chemotherapy in either tumor location.

Conclusions
Despite the risk for local recurrence and CNS dissemination, the prognosis for intradural lumbosacral ependymomas is good, with a greater than 90% 10-year patient survival in most series. The prognosis for extradural ependymomas does not appear to be as good. Much depends on extradural tumor location, however; the outlook is better for dorsal sacral tumors than presacral tumors.
En bloc spondylectomy for spinal metastases: a review of techniques
Authors: Yao Kevin C. , Boriani Stefano , Gokaslan Ziya L. , Sundaresan Narayan 
Published: January 2008

Object
Spinal metastases are prevalent in the population of patients with cancer. Effective cancer therapy must incorporate treatment strategies for these lesions. Increasingly, surgery is being recognized as an effective treatment modality both for the patient's quality of life and potential oncological cure. En bloc spondylectomy is the surgical procedure of choice to obtain these goals. The purpose of this study was to examine critically the rationale, indications, and outcomes of en bloc spondylectomy for spinal metastases.

Methods
Outcomes in the authors' series of patients who underwent en bloc spondylectomy for spinal metastases are critically analyzed. The rationale and indications for this procedure are discussed. The Weinstein, Boriani, and Biagini surgical staging system for spinal tumors is described. A review of the literature is performed to examine further the rationale underlying this aggressive surgical approach to metastatic spinal disease.

Conclusions
En bloc spondylectomy is the treatment of choice for solitary and oligometastatic spinal metastases with biologically favorable histological findings. In appropriately selected patients, neurological outcome, pain control, and oncological control are significantly better after en bloc spondylectomy compared with radiation therapy. Oncological outcomes also exceed those of intralesional techniques. The Weinstein, Boriani, and Biagini surgical staging system provides a standard with which to plan surgical approaches and to compare surgical outcomes.
The “tract” of history in the treatment of lumbar degenerative disc disease
Authors: Chedid Khalil J. , Chedid Mokbel K. 
Published: January 2008

In this paper past, present, and future treatments of degenerative disc disease (DDD) of the lumbar spine are outlined in a straight forward manner. This is done to review previous knowledge of the disease, define current treatment procedures, and discuss future perspectives. An analysis of a subject of this magnitude dictates that one describes as accurate a history as possible: an anatomical/historical “tract” with emphasis on all possible deviations.
Although spinal disorders have been recognized for a long time, the view of DDD as a particular disease entity is a more recent development. In this paper, the authors attempt to outline the history of DDD of the lumbar spine in an unbiased and scientific fashion. Physiological, diagnostic, and therapeutic implications will all be addressed in this study.
Anterior cervical plates: a historical perspective
Authors: Moftakhar Roham , Trost Gregory R. 
Published: January 2008

The development of anterior cervical plates (ACPs) represents a rapidly changing aspect of spine surgery. This paper focuses on a historical overview of ACPs. The authors discuss the disadvantages of earlier generations of plates and demonstrate how current plates have been designed to overcome the presumed shortcomings of their predecessors.
This historical review begins with the earliest plates—unrestricted backout plates—and moves on to newer plates—restricted backout plates and their different subcategories.
Virtually all modern ACPs work equally well in cervical stabilization; however, there are differences in design that warrant future studies to understand the long-term performances of different plates.
Intraoperative monitoring for tethered cord surgery: an update
Authors: Kothbauer Karl F. , Novak Klaus 
Published: January 2008

Object
Intraoperative neurophysiological recording techniques have found increasing use in neurosurgical practice. The development of new recording techniques feasible while the patient receives a general anesthetic have improved their practical use in a similar way to the use of digital recording, documentation, and video technology. This review intends to provide an update on the techniques used and their validity.

Methods
Two principal methods are used for intraoperative neurophysiological testing during tethered cord release. Mapping identifies functional neural structures, namely nerve roots, and monitoring provides continuous information on the functional integrity of motor and sensory pathways as well as reflex circuitry. Mapping is performed mostly by using direct electrical stimulation of a structure within the surgical field and recording at a distant site, usually a muscle. Sensory mapping can also be performed with peripheral stimulation and recording within the surgical site. Monitoring of the motor system is achieved with motor evoked potentials. These are evoked by transcranial electrical stimulation and recorded from limb muscles and the external anal sphincter. The presence or absence of muscle responses are the parameters monitored. Sensory potentials evoked by tibial or pudendal nerve stimulation and recorded from the dorsal columns via an epidurally inserted electrode and/or from the scalp as cortical responses are used to access the integrity of sensory pathways. Amplitudes and latencies of these responses are then interpreted. The bulbocavernosus reflex, with stimulation of the pudendal nerve and recording of muscle responses in the external anal sphincter, is used for continuous monitoring of the reflex circuitry. Presence or absence of this response is the pertinent parameter that is monitored.

Conclusions
Intraoperative neurophysiology provides a wide and reliable set of techniques for intraoperative identification of neural structures and continuous monitoring of their functional integrity.