bluuebunny/crossref_metadata_2025_split huggingface dataset:
Carotid angioplasty and stenting for recurrent and radiation-induced stenosis: preliminary experience
Authors: Benitez Ronald P. , Armonda Rocco A. , Harrop James , Thomas Jeffrey E. , Rosenwasser Robert H. 
Published: January 2008

Carotid endarterectomy for atherosclerotic occlusive disease has become the standard of care for the treatment of symptomatic and asymptomatic occlusive disease of the carotid bifurcation, based on the results of the North American Symptomatic Carotid Endarterectomy Trial, as well as the Asymptomatic Carotid Atherosclerosis Study. For surgical treatment to be of benefit, the perioperative complication rate for neurological events should be 6% or less in the symptomatic population and 3% or less in the asymptomatic group. The performance of carotid endarterectomy for recurrent stenosis and radiation-induced stenosis has reported neurological events ranging from 4 to 10%. It is in this particular population that carotid angioplasty and stent placement may play a role.
The authors performed a retrospective analysis of 11 patients who underwent carotid angioplasty and stent placement for recurrent or radiation-induced stenosis. One patient in whom endarterectomy was performed by the vascular surgery service had a critical stenosis distal to the endarterectomy site and awoke with a neurological deficit. This patient underwent reexploration and placement of a stent in the artery distal to the arteriotomy site.
The follow-up period ranged from 7 to 12 months. Patient age ranged from 65 to 77 years (mean 75 years). Five of eight patients underwent angioplasty and stent placement for recurrent atherosclerotic disease. Two patients had radiation-induced stenosis, and one patient had a stent placed intraoperatively. All patients, with the exception of the one who underwent intraoperative stent placement, had posttreatment stenoses of less than 15%. The surgical patient had a 30% residual stenosis distally. There were no intra- or postoperative transient ischemic attacks, major or minor strokes, or deaths.
Patients who have recurrent or radiation-induced stenosis are potential candidates for angioplasty and stent placement. Before this can be recommended as an alternative to surgical correction, a longer follow-up period is required.
Endovascular embolization of 150 basilar tip aneurysms with Guglielmi detachable coils: results of the Food and Drug Administration multicenter clinical trial
Authors: Eskridge Joseph M. , Song Joon K. , _ _ 
Published: January 2008

To assess the safety and efficacy of aneurysm embolization performed using Guglielmi detachable coils (GDCs), the authors reviewed the results of a cohort of 150 patients with either ruptured (83 patients) or unruptured (67 patients) basilar tip aneurysms treated with these detachable platinum coil devices in the early part of the United States multicenter GDC clinical trial that led to Food and Drug Administration approval for the device.
The most common presentation in this cohort of patients was headache (53%). All patients were entered into the trial after neurosurgical assessment excluded them as candidates for surgical clipping of their aneurysms. Greater than 90% coil packing was achieved in 75% of the patients. For those patients in whom follow-up information was available, the mean angiographic and clinical evaluation follow-up time for 61 patients with ruptured aneurysms was 13.7 months (range 0-43 months) and that for the 49 patients with unruptured aneurysms was 9.8 (range 0-40 months). Conservative mortality rates included up to 23% for the ruptured aneurysm group and up to 12% for the unruptured aneurysm group; the rebleeding rate for treated ruptured aneurysms was up to 3.3% and the bleeding rate for unruptured aneurysms up to 4.1%. Permanent deficits due to stroke in patients with ruptured or unruptured aneurysms occurred in up to 5% and 9%, respectively. Vasospasm occurred in 8% of the patients; it was associated with two deaths. Periprocedural mortality was 2.7% (four patients with ruptured aneurysms).
Detachable platinum coil embolization is a promising treatment for ruptured basilar tip aneurysms that are not surgically clippable; in selected patients it offers lower incidences of morbidity and mortality compared with conservative medical management. The role of this procedure in unruptured basilar tip aneurysms is unclear with less supportive results. More long-term follow-up evaluation is necessary and results are expected to improve.
Intravascular stents for intracranial internal carotid and vertebral artery aneurysms: preliminary clinical experience
Authors: Lanzino Giuseppe , Wakhloo Ajay K. , Fessler Richard D. , Mericle Robert A. , Guterman Lee R. , Hopkins L. Nelson 
Published: January 2008

Results of previous in vitro and in vivo experimental studies have suggested that the placement of a porous stent within the parent artery across the aneurysm neck may hemodynamically uncouple the aneurysm from the parent vessel, leading to thrombosis of the aneurysm. For complex wide-necked aneurysms, a stent may also aid the packing of the aneurysm with Guglielmi detachable coils (GDCs) by acting as a rigid scaffold that prevents coil herniation into the parent vessel. Recently, improved stent system delivery technology has allowed access to the tortuous vascular segments of the intracranial system. The authors report here the intracranial stenting of aneurysms involving different segments of the internal carotid artery (ICA) and the vertebral artery (VA).
Four patients with intracranial aneurysms located at the petrous, cavernous, and paraclinoid segments of the ICA and at the VA proximal to the origin of the posterior inferior cerebellar artery, respectively, were treated since January 1998. In three of these patients, stent placement across the aneurysm neck was followed by GDC placement, accomplished via a microcatheter through stent mesh. In one patient, the aneurysm was treated solely by stenting.
No periprocedural complications were observed, and at follow up, no patient was found to have suffered symptoms referable to aneurysm growth or thromboembolic complications. More than 90% occlusion of the aneurysm was achieved in the three cases treated by stenting and GDC placement. One of these patients underwent 6-month follow-up angiography that did not reveal any in-stent stenosis. In the case treated solely by stent placement, no evidence of aneurysm thrombosis was observed either immediately postprocedure or on follow-up angiography performed 24 hours later.
A new generation of flexible stents can be used to treat intracranial aneurysms in difficult-to-access areas such as the proximal intracranial segments of the ICA or the VA. The stent allows tight coil packing even in the presence of a wide-necked, irregularly shaped aneurysm and may provide an endoluminal matrix for endothelial growth. Although convincing experimental evidence suggests that stent placement across the aneurysm neck may by itself promote intraluminal thrombosis, the role of this phenomenon in clinical practice may be limited at present by the high porosity of currently available stents.
Safety and efficacy of transluminal balloon angioplasty in the prevention of vasospasm in patients with Fisher Grade 3 subarachnoid hemorrhage: a pilot study
Authors: Muizelaar J. Paul , Zwienenberg Marike , Mini Nancy A. , Hecht Stephen T. 
Published: January 2008

Recent advances in neuroradiology have made it possible to dilate human cerebral arteries that show vasospasm following aneurysmal subarachnoid hemorrhage (SAH), but the time window is short and the success rate for reversal of delayed ischemic neurological deficit (DIND) varies between 31% and 77%. In a canine model of vasospasm, transluminal balloon angioplasty (TBA) performed on Day 0 (the day of aneurysm rupture) has been shown to completely prevent the development of angiographically demonstrated narrowing by Day 7; this effect is better than any pharmacological treatment for vasospasm thus far described.
The authors conducted a pilot trial to assess the safety and efficacy of TBA performed within 3 days post-SAH. Twelve patients with a very high probability of developing vasospasm (Fisher Grade 3) were included. Target vessels for prophylactic TBA were the internal carotid artery, A1 segment, M1 segment, and P1 segment bilaterally, the basilar artery, and the vertebral artery.
No patient developed DIND or more than mild vasospasm, according to transcranial Doppler criteria. At 3 months, seven patients made a good recovery, two patients were moderately disabled, and three patients died; one patient died because of a vessel rupture during TBA and two older patients died of medical complications associated with an already poor clinical condition at admission.
Compared with the results of large series reported in literature of patients with aneurysmal SAH, the results of this pilot study indicate an extremely low incidence of vasospasm and DIND after patients underwent prophylactic TBA. A larger, randomized study, however, is required to determine whether prophylactic TBA is efficacious enough to justify the risks.
Microvascular decompression of cranial nerves: lessons learned after 4400 operations
Authors: McLaughlin Mark R. , Jannetta Peter J. , Clyde Brent L. , Subach Brian R. , Comey Christopher H. , Resnick Daniel K. 
Published: January 2008

Object
Microvascular decompression has become an accepted surgical technique for the treatment of trigeminal neuralgia, hemifacial spasm, glossopharyngeal neuralgia, and other cranial nerve rhizopathies. The senior author (P.J.J.) began performing this procedure in 1969 and has performed more than 4400 operations. The purpose of this article is to review some of the nuances of the technical aspects of this procedure.

Methods
A review of 4415 operations shows that numerous modifications to the technique of microvascular decompression have occurred during the last 29 years. Of the 2420 operations performed for trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia before 1990, cerebellar injury occurred in 21 cases (0.87%), hearing loss in 48 (1.98%), and cerebrospinal fluid (CSF) leakage in 59 cases (2.44%). Of the 1995 operations performed since 1990, cerebellar injuries declined to nine cases (0.45%), hearing loss to 16 (0.8%), and CSF leakage to 37 (1.85%) (p < 0.01, test for equality of distributions). The authors describe slight variations made to maximize surgical exposure and minimize potential complications in each of the six principal steps of this operation. These modifications have led to decreasing complication rates in recent years.

Conclusions
Using the techniques described in this report, microvascular decompression is an extremely safe and effective treatment for many cranial nerve rhizopathies.
Magnetoencephalographic mapping of the language-specific cortex
Authors: Papanicolaou Andrew C. , Simos Panagiotis G. , Breier Joshua I. , Zouridakis George , Willmore L. James , Wheless James W. , Constantinou Jules E. C. , Maggio William W. , Gormley William B. 
Published: January 2008

Object
In this paper the authors introduce a novel use of magnetoencephalography (MEG) for noninvasive mapping of language-specific cortex in individual patients and in healthy volunteers.

Methods
The authors describe a series of six experiments in which normative MEG data were collected and the reliability, validity, and topographical accuracy of the data were assessed in patients who had also undergone the Wada procedure or language mapping through intraoperative cortical stimulation.

Conclusions
Findings include: 1) receptive language-specific areas can be reliably activated by simple language tasks and this activation can be readily recorded in short MEG sessions; 2) MEG-derived maps of each individual are reliable because they remain stable over time and are independent of whether auditory or visual stimuli are used to activate the brain; and 3) these maps are also valid because they concur with results of the Wada procedure in assessing hemispheric dominance for language and with the results of cortical stimulation in identifying the precise topography of receptive language regions within the dominant hemisphere.
Although the MEG mapping technique should be further refined, it has been shown to be efficacious by correctly identifying the language-dominant hemisphere and specific language-related regions within this hemisphere. Further development of the technique may render it a valuable adjunct for routine presurgical planning in many patients who harbor tumors or have epilepsy.
Moyamoya disease in the midwestern United States
Authors: Wetjen Nicholas M. , Garell P. Charles , Stence Nicholas V. , Loftus Christopher M. 
Published: January 2008

There have been few investigations of moyamoya disease in the United States and no systematic description of the management practices or outcome from this population. The authors reviewed their experience with this disease to gain a better understanding and improve the treatment of patients with moyamoya disease in the United States. Over a 25-year period 30 patients with moyamoya disease have been treated at the University of Iowa. The cases were divided into patients who had classic, probable, and akin moyamoya disease.
Results indicated that there was a bimodal age distribution and a female predominance of cases. In estimating the referral pattern of our institution, the authors determined that there were greater numbers of epidemiological characteristics than previously anticipated. Patients were treated either surgically or nonsurgically, and different management strategies were utilized in each of the major groups: superficial temporal artery to middle cerebral artery anastomosis and encephalodurosynangiosis in the surgical group; or antiplatelet, anticoagulation, or nonpharmacological intervention in the nonsurgical group.
The authors conclude that there is a higher prevalence and incidence of moyamoya disease in the United States than previously reported and that there are some clinical characteristics of this disease that differ from the cases reported in southeast Asia. These differences may be due to genetic or environmental factors but can also be partly explained by the lower index of suspicion for this disease and, thus, a delay in or complete absence of the correct diagnosis.
Surgical decompression for traumatic brain swelling: indications and results
Authors: Guerra Waltraud Kleist-Welch , Gaab Michael R. , Dietz Hermann , Mueller Jan-Uwe , Piek Jürgen , Fritsch Michael J. 
Published: January 2008

Object
Decompressive craniectomy has been performed since 1977 in 57 patients with traumatic brain injury. The authors assess the efficacy of this treatment and the indications for its use.

Methods
The clinical status of the patients, their computerized tomography (CT) scans, and intracranial pressure (ICP) levels were documented prospectively in a standard protocol. At the beginning of the study, all patients older than 30 years were excluded. As of 1989 patients older than 40 years were excluded until 1991; since that time patients older than 50 years have been excluded. Primary brain or brainstem injury with fully developed bulbar brain syndrome, loss of auditory evoked potentials (AEPs), and/or oscillation flow in a transcranial Doppler ultrasound examination were contraindications to decompressive craniectomy. A positive indication for decompression was given in the case of progressive therapy-resistant intracranial hypertension in correlation with clinical (Glasgow Coma Scale [GCS] score, decerebrate posturing, dilating of pupils) and electrophysiological (electroencephalography, somatosensory evoked potentials, and AEPs) parameters and with findings on CT scans. Unilateral decompressive craniectomy was performed in 31 patients and bilateral craniectomy in 26 patients. In all cases, a wide frontotemporoparietal craniectomy was followed by a dura enlargement covered with temporal muscle fascia.
The outcomes of the treatment were surprisingly good. Only 11 patients (19%) died, three of whom died of acute respiratory disease syndrome. Five patients (9%) survived, but remained in a persistent vegetative state; six patients (11%) survived with a severe permanent neurological deficit, and 33 patients (58%) attained social rehabilitation. Two patients (3.5%) did not have a follow-up examination. The GCS score on the 1st day posttrauma and the mean ICP turned out to be the best predictors for a good prognosis. The results demonstrate the importance of decompressive craniectomy in the treatment of traumatic brain swelling.

Conclusions
Surgical decompression should be routinely performed when indicated before irreversible ischemic brain damage.
The fate of the compressed deformed spinal cord after decompressive surgery: MR imaging and histopathological findings in experimental studies
Authors: Tanaka Hisato , Nagata Kensei , Inoue Akio , Yoshizuka Mitsuaki 
Published: January 2008

The authors conducted a study in which they applied the spinal cord compression-decompression model in rabbits to investigate the morphological changes and histopathological findings in the deformed spinal cord over a long-term period after performing decompressive surgery.
Throughout the experimental period, mangnetic resonance (MR) images were obtained frequently; after obtaining a final MR image, the spinal cord was dissected and underwent histological examination.
Immediately after decompressive surgery, axial T1-wieighted MR imaging revealed an increase in the cross-sectional area of the spinal cord during the 1st and 2nd weeks. The spinal cord area achieved a peak at an average of 5.9 weeks after decompressive surgery, when it displayed isointensity on T1- and high-intensity on T2-weighted images. The main histological findings were spongy changes in the white matter, which persisted for 4 months postsurgery. There was a significant correlation between the presurgical spinal cord area and the postsurgical decreased number of motor neuron cells.
Based on the MR imaging and histopathological studies, although the deformed spinal cord that underwent compression for 3 months was immediately restored morphologically after decompressive surgery, the change in quality in the spinal cord persisted at least 4 months.
Neural network analysis of preoperative variables and outcome in epilepsy surgery
Authors: Arle Jeffrey E. , Perrine Kenneth , Devinsky Orrin , Doyle Werner K. 
Published: January 2008

Because appropriate patient selection is essential for achieving successful outcomes after epilepsy surgery, the need for more robust methods of predicting postoperative seizure control has been created. Standard multivariate techniques have been only 75 to 80% accurate in this regard. Recent use of artificial intelligence techniques, including neural networks, for analyzing multivariate clinical data, has been successful in predicting medical outcome. The authors applied neural network techniques to 80 consecutive patients undergoing epilepsy surgery in whom demographic, seizure, operative, and clinical variables to predict postoperative seizures data were obtained.
Neural networks were able to predict postoperative seizures in up to 98% of cases. Student's t tests or chi-square analysis performed on individual variables revealed that only the preoperative medication index was significantly different (p = 0.02) between the two outcome groups. Six different combinations of input variables were used to train the networks. Neural network accuracies differed in their ability to predict seizures using all data (96%); all data minus electroencephalography concordance and operative side (93%); all data except intra- or postoperative variables such as tissue pathology (98%); all data excluding pathology, intelligence quotient (IQ) data, and Wada results (84%); only using demographics and tissue pathology (65%); and only using IQ data (63%).
Analysis of the results reveals that several networks that are trained with the usual accepted variables characterizing the typical evaluation of epilepsy patients can predict postoperative seizures with greater than 95% accuracy.
Comparative localization of auditory comprehension using functional magnetic resonance imaging and cortical stimulation
Authors: Schlosser Michael J. , Luby Marie , Spencer Dennis D. , Awad Issam A. , McCarthy Gregory 
Published: January 2008

The authors have previously described a functional magnetic resonance (fMR) imaging procedure for the localization of auditory comprehension in which focal activation of posterior temporal and inferior frontal regions of the left hemisphere was reliably demonstrated. Because this past study was conducted in neurologically normal volunteers, it was not possible to determine whether the activated regions were critical to the performance of language tasks; that is, whether the fMR imaging activations provided a rate measure of language processing. A direct comparison of fMR imaging language activation with cortical stimulation must be completed before the tool can be used with confidence in presurgical planning.
Here the authors report a series of 33 consecutive patients who underwent dominant hemisphere resection in which fMR image mapping of auditory comprehension was performed at the Yale neurosurgical program.
In 23 of the 33 patients reliable fMR imaging activation was shown. In 16 of these 23 patients language mapping was performed using either intra- or extraoperative cortical stimulation. Cortical stimulation failed to localize language areas in two of the 16 patients. Electrical stimulation that was performed in close proximity to the fMR image activations interfered with auditory comprehension, object naming, or speech production in 12 of the remaining 14 patients. Five of the 10 cases in which evocation reliable fMR imaging activation failed were attributable to technical problems and/or patient head movement.
Cortical stimulation results and fMR imaging findings were consistent in all but two patients. However, the spatial extent of the activation produced by fMR imaging and the spatial extent of stimulation-induced language disruption that was caused by direct cortical stimulation did not always correspond. Problems in defining the extent of activation by both methods are discussed.
Functional neuronavigation with magnetoencephalography: outcome in 50 patients with lesions around the motor cortex
Authors: Ganslandt Oliver , Fahlbusch Rudolf , Nimsky Christopher , Kober Helmut , Möller Martin , Steinmeier Ralf , Romstöck Johann , Vieth Jürgen 
Published: January 2008

The authors conducted a study to evaluate the clinical outcome in 50 patients with lesions around the motor cortex who underwent surgery in which functional neuronavigation was performed.
The sensorimotor cortex was identified in all patients with the use of magnetoencephalography (MEG). The MEG-source localizations were superimposed onto a three-dimensional magnetic resonance image, and the image data set was then implemented into a neuronavigation system. Based on this setup, the surgeon chose the best surgical strategy. During surgery, the pre- and postcentral gyrus were identified by neuronavigation, and in addition, the central sulcus was localized using intraoperative recording of somatosensory evoked potentials. In all cases MEG localizations of the sensory or motor cortex were correct. In 30% of the patients preoperative paresis improved, in 66% no additional deficits occurred, and in only 4% (two patients) deterioration of neurological function occurred. In one of these patients the deterioration was not related to the method.
The method of incorporating functional data into neuronavigation systems is a promising tool that can be used in more radical surgery to cause less morbidity around eloquent brain areas.