bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gliosarcoma with infratemporal fossa extension
Authors: Sade Burak , Prayson Richard A. , Lee Joung H. 
Published: January 2008

✓ Gliosarcomas are bimorphic intraaxial tumors. Involvement of the skull base is highly unexpected. The authors present the case of a temporal lobe gliosarcoma with significant infratemporal fossa extension. This 55-year-old man presented with a 1-month history of severe progressive headache. Neurological examination was unremarkable except for bilateral papilledema. Magnetic resonance imaging revealed a 6-cm right temporal mass with extension into the infratemporal fossa. The patient underwent a right frontotemporal craniotomy together with drilling of the sphenoid ridge and middle fossa floor. The tumor consisted of intraaxial, intracranial as well as extradural, and extracranial components with extension to the posterolateral wall of the sphenoid sinus. It had a relatively well-circumscribed dissection plane. Gross-total resection was achieved, and the middle fossa floor was reconstructed using a rotated temporalis muscle flap. The postoperative course was uneventful except for hypesthesia in the distribution of the maxillary division of the right trigeminal nerve. The histopathological diagnosis was consistent with gliosarcoma. Radiotherapy and chemotherapy consisting of temozolomide were administered subsequently, and the patient was recurrence free 12 months after his initial diagnosis.
In the presence of a mass lesion with both intraaxial and extracranial involvement, gliosarcoma should be considered among the differential diagnoses. Aggressive resection should be attempted, including the use of skull base surgical techniques to ensure an optimal outcome. The effect of skull base involvement to the overall treatment and outcome of patients with gliosarcomas would be difficult to determine given the rare occurrence of these lesions in such locations.
Granulocytic sarcoma: an unusual complication of acute promyelocytic leukemia causing cerebellar hemorrhage
Authors: Fukushima Shintaro , Terasaki Mizuhiko , Tajima Yutaka , Shigemori Minoru 
Published: January 2008

✓Granulocytic sarcomas are rare tumors that occur primarily in patients with acute myelogenous leukemia or other myeloproliferative disorders, are seldom seen in patients with acute promyelocytic leukemia (APL), and have never been reported to occur in the cerebellum. The authors describe the case of a patient with APL who harbored a hemorrhagic granulocytic sarcoma in the cerebellum. This 39-year-old woman presented with cerebellar ataxia. Magnetic resonance images revealed an intraaxial tumor in the cerebellum. Bone marrow samples showing infiltration by leukemic blast cells and data from hematological tests led to a diagnosis of APL. The patient was treated with chemotherapy and surgery. She had no response to chemotherapy and died of progressive intratumoral hemorrhage. Results of histopathological studies and immunohistochemical staining of the cerebellar tumor confirmed a granulocytic sarcoma. Flow cytometry showed that the blast cells were positive for leukocyte common antigen, CD13, and CD33 markers. Bone marrow cytogenetics revealed that the patient had a 46, XX karyotype. Although no cytogenetic abnormality was present, fluorescence in situ hybridization detected a chimeric fusion of PML and RARA.
This is the first report to document a granulocytic sarcoma in the cerebellum as the primary presentation in a patient with APL and abnormal coagulation. As predicted by the unusual clinical manifestations and radiological findings, the patient’s survival was short. Although central nervous system complications in patients with APL are rare, the data in this case highlight the need for individualized treatment when such conditions occur.
Statistical determination of the optimal subthalamic nucleus stimulation site in patients with Parkinson disease
Authors: Guehl Dominique , Edwards Roderick , Cuny Emmanuel , Burbaud Pierre , Rougier Alain , Modolo Julien , Beuter Anne 
Published: January 2008

Object
The subthalamic nucleus (STN) is currently recognized as the preferred target for deep brain stimulation (DBS) in patients with Parkinson disease (PD). If there is agreement in the literature that DBS improves motor symptoms significantly, the situation is less clear with respect to the side effects of this procedure. The goal of this study was to correlate the coordinate values of active electrode contacts with the amplitude of residual clinical symptoms and side effects using a mathematical approach.

Methods
In this study the investigators examined a cohort of 41 patients with PD who received clinical benefits from DBS after stimulating electrodes had been implanted bilaterally into the STN. The combined scores of residual clinical symptoms plus side effects, including speech disturbance, postural instability, and weight gain, were fitted by using either inverted ellipsoidal exponentials or smooth splines.
These analyses showed evidence of lower combined scores for stimulating contacts at an x coordinate approximately 12.0 to 12.3 mm lateral to the anterior commissure–posterior commissure (AC–PC) line and at a z coordinate approximately 3.1 to 3.3 mm under the AC–PC line. There was insufficient evidence for a preferred y coordinate location.

Conclusions
The authors propose a “best” therapeutic ellipse area that is centered at an x, z location of 12.5 mm, −3.3 mm and characterized by an extension of 1.85 mm in the x direction and 2.22 mm in the z direction. Therapeutic electrode contacts located within this area are well correlated with the lowest occurrence of residual symptoms and the lowest occurrence of side effects independent of STN anatomical considerations. The lack of a significant result in the y direction remains to be explored further.
Probabilistic cortical surface map of the middle cerebral artery territory for single-photon emission computed tomography studies
Authors: Hosoda Kohkichi , Ishii Kazunari , Minoshima Satoshi , Kohmura Eiji 
Published: January 2008

Object
The middle cerebral artery (MCA) is the intracranial vessel most frequently affected by cerebrovascular diseases. A more accurate knowledge of the topography of this vessel may have an impact on treatment strategies for ischemic cerebrovascular diseases. The aim of this study was to construct a topographic map of the MCA territory for single-photon emission computed tomography (SPECT) using statistical brain mapping.

Methods
The margin of the perfusion deficit associated with infarction due to arterial occlusion, as seen on SPECT imaging, is presumed to approximate the borders of the territory of the artery. Basing the study on this hypothesis, SPECT images obtained in 12 patients with large MCA infarctions due to angiographically confirmed MCA trunk occlusion were selected, anatomically standardized, and compared with SPECT images obtained in healthy volunteers to construct probabilistic cortical surface maps of the MCA territory. Crossed cerebellar diaschisis was used as a primary cutoff marker for creation of the map. This MCA map (Method C) was compared with the conventional region of interest (ROI) method (Method A) and previously reported predefined cortical templates (Method B) for preliminary clinical application.
The probabilistic cortical surface map of the MCA territory showed that regions with the highest ratio of MCA territory included the transverse temporal gyrus (100%), supramarginal gyrus (100%), and inferior parietal lobule (91–92%). For preliminarily clinical application, this map (Method C) was compared with the conventional ROI method (Method A) in predicting hyperperfusion after carotid endarterectomy by performing a receiver operating characteristic (ROC) analysis, which demonstrated the statistically significant superiority of the MCA map (area under the ROC curve [Az] = 0.91) to the ROI method (Az = 0.75; p = 0.025). The ROC analysis also demonstrated a diagnostic value of the MCA map (Az = 0.95) that equaled predefined cortical templates (Method B) (Az = 0.93).

Conclusions
The probabilistic cortical surface map of the MCA territory used for SPECT, which was created using statistical brain mapping techniques, would be useful for an objective assessment of the cerebral perfusion status of patients with cerebrovascular diseases.
Trigeminal schwannomas: results of Gamma Knife surgery in 37 cases
Authors: Hasegawa Toshinori , Kida Yoshihisa , Yoshimoto Masayuki , Koike Jouji 
Published: January 2008

Object
Information on outcomes of Gamma Knife surgery (GKS) for patients harboring trigeminal schwannomas is limited because these tumors are rare. The authors evaluated tumor control and functional outcomes in patients who underwent GKS for trigeminal schwannomas to clarify the efficacy of this treatment.

Methods
Forty-two patients with trigeminal schwannomas but no evidence of neurofibromatosis Type 2 were treated with GKS at Komaki City Hospital between November 1991 and December 2003. Of these, 37 patients were assessed. The mean tumor volume in these patients was 10 cm3. The mean maximum radiation dose directed to the tumor was 27.9 Gy and the mean dose directed to the tumor margin was 14.2 Gy. The mean follow-up period was 54 months. In four patients (11%) there was complete tumor remission; in 20 (54%) there was partial tumor remission; in eight (22%) the disease remained stable; and in five (14%) the tumor enlarged or uncontrollable facial pain developed with radiation-induced edema requiring resection. The actuarial 5- and 10-year tumor control rates were both 84%. With respect to functional outcomes, 40% of patients noted an improvement in their symptoms, and one patient experienced new symptoms despite good tumor control.

Conclusions
Gamma Knife surgery was a safe and effective treatment for a select group of patients harboring trigeminal schwannomas. Large tumors that compress the brainstem and cause deviation of the fourth ventricle should first be removed surgically and any remnant should be treated by GKS.
Safety and efficacy of a novel polyethylene glycol hydrogel sealant for watertight dural repair
Authors: Cosgrove G. Rees , Delashaw Johnny B. , Grotenhuis J. Andre , Tew John M. , van Loveren Harry , Spetzler Robert F. , Payner Troy , Rosseau Gail , Shaffrey Mark E. , Hopkins L. Nelson , Byrne Richard , Norbash Alex 
Published: January 2008

Object
The authors prospectively evaluated the safety and efficacy of a novel polyethylene glycol (PEG) hydrogel sealant in patients undergoing elective cranial surgery with documented cerebrospinal fluid (CSF) leakage after sutured dural repair.

Methods
The PEG hydrogel sealant was used at 11 different study sites in 111 patients with documented intraoperative CSF leakage after neurosurgical dural repair for a variety of conditions. Intraoperative CSF leakage was either spontaneous or induced by a Valsalva maneuver. Patients were monitored for 3 months postoperatively with physical examinations, clinical laboratory analyses, and diagnostic imaging.
The PEG hydrogel sealant was 100% effective in stopping CSF leakage in all patients. There were no sealant-related adverse events and all clinical outcomes were consistent with expectations for seriously ill patients undergoing prolonged neurosurgical procedures.

Conclusions
The PEG hydrogel sealant provides a safe and effective watertight closure when used as an adjunct to sutured dural repair during cranial surgery.
Decompressive hemicraniectomy in malignant middle cerebral artery infarction: an analysis of long-term outcome and factors in patient selection
Authors: Pillai Ashok , Menon Sajesh K. , Kumar Satyendra , Rajeev Kariyattil , Kumar Anand , Panikar Dilip 
Published: January 2008

Object
Middle cerebral artery infarction often occurs at a younger age than other strokes and is associated with significant rates of mortality and morbidity. After a period of pessimism regarding decompressive hemicraniectomy in the management of acute stroke, the method has reemerged in the past decade. The present study was undertaken to assess the immediate and long-term outcome of this intervention and to help better define the selection criteria for surgery.

Methods
The authors conducted a nonrandomized prospective study using decompressive hemicraniectomy with duraplasty in patients at various stages of clinical deterioration due to a space-occupying middle cerebral artery infarct. Patients were assessed at 6 and 12 months postinfarction by using functional scales. Subjective reconsideration was assessed using a questionnaire.
Twenty-six patients were included in the study. The mean age was 48.4 ± 11.2 years, and the mean preoperative Glasgow Coma Scale score was 9.9 ± 3.2. The median time from ictus to surgery was 54 hours (range 13–288 hours). The rate of survival at 1 year postsurgery was 73%. Among survivors, 33.3% were independent (Barthel Index [BI] > 95) and 55.6% were partially dependent (BI 60–95) at 1 year postsurgery, with 72% attaining the ability to walk independently by 1 year postsurgery. No patient remained in a vegetative state. The 1-year BI score was inversely related to patient age (r = − 0.47, p = 0.048).

Conclusions
Survival after decompressive hemicraniectomy was better than previously reported using medical management alone. A vegetative state was avoided and functional independence was possible, especially in younger patients. Increasing age was a statistically significant predictor of disability and long-term functional dependence.
Discrimination of capsular stage brain abscesses from necrotic or cystic neoplasms using diffusion-weighted magnetic resonance imaging
Authors: Fertikh Djamil , Krejza Jaroslaw , Cunqueiro Alain , Danish Shabbar , Alokaili Riyadh , Melhem Elias R. 
Published: January 2008

Object
The authors’ aim was to assess the ability of apparent diffusion coefficient (ADC) ratios in distinguishing brain abscesses from cystic or necrotic neoplasms.

Methods
Fifty-three patients with rim-enhancing masses in the brain observed on T1-weighted MR images were included: 26 had abscesses (14 bacterial, six nonbacterial, and six of unknown origin), 11 had glioblastoma multiforme, and 16 had rim-enhancing metastasis.
The ADC values, derived from diffusion-weighted imaging, were measured in the most homogeneous portion of the cystic component of the mass. The ADC ratios were calculated by dividing the ADC values from the nonenhancing cystic portion of the mass by the ADC values from contralateral normal-appearing white matter. Lesions were further differentiated based on presence, absence, or incompleteness of a T2 hypointensity rim.
The mean (± standard deviation) ADC ratios were significantly higher in neoplasms than in abscesses (2.45 ± 0.91 compared with 1.12 ± 0.53, p < 0.01). The accuracy of ADC ratios in discriminating abscesses from neoplasms, determined by the area under the receiver operating characteristic curve (Az), was high: 0.91 ± 0.04 (mean ± standard error of the mean [SEM]). The threshold of 1.7 was associated with highest efficiency (87%) in discriminating abscesses from neoplasms. If only bacterial abscesses were analyzed compared with neoplasms, the Az increased to 0.96 ± 0.03 (SEM). Using ADC ratios and T2 rim characteristics, 50 of 53 lesions were correctly classified (efficiency 94.3%).

Conclusions
The accuracy of ADC ratios in discriminating brain abscesses from cystic or necrotic neoplasms is very high and can be further improved using T2 rim characteristics.
Visualization of the frontotemporal language fibers by tractography combined with functional magnetic resonance imaging and magnetoencephalography
Authors: Kamada Kyousuke , Todo Tomoki , Masutani Yoshitaka , Aoki Shigeki , Ino Kenji , R.T.  , Morita Akio , Saito Nobuhito 
Published: January 2008

Object
There is continuous interest in the monitoring of language function during tumor resection around the fron-totemporal regions of the dominant hemisphere. The aim of this study was to visualize language-related subcortical connections, such as the arcuate fasciculus (AF) by diffusion tensor (DT) imaging–based tractography.

Methods
Twenty-two patients with brain lesions adjacent to the AF in the frontotemporal regions of the dominant hemisphere were studied. The AF tractography was accomplished by placing initiation and termination sites (seed and target points) in the frontal and temporal regions, which were functionally identified by using functional magnetic resonance (fMR) imaging in conjunction with a verb generation task and magnetoencephalography (MEG) in conjunction with a reading task. The combination of fMR imaging and MEG data clearly demonstrated the hemispheric dominance of language functions, which was confirmed by an intracranial amobarbital test (Wada procedure). In all 22 patients, the authors were able to consistently visualize the AF by DT imaging–based tractography, using the functionally identified seed and target points and a fractional anisotropy value of 0.16. In two of 22 cases investigated, the functional information, including the results of AF tractography, fMR imaging, and MEG, was imported to a neuronavigation system and was validated by bipolar electric stimulation of the cortical and subcortical areas during awake surgery. The cortical stimulation to the gyrus that included the area of activation identified in fMR imaging with the language task evoked speech arrest, while the subcortical stimulation close to the AF reproducibly caused paranomia without speech arrest. Postoperative AF tractography showed that the distances between the stimulus points and the AF were within 6 mm.

Conclusions
The combination of these techniques facilitated accurate identification of the location of the AF and verification of the language fibers.
Prospective evaluation of pain and analgesic use following major elective intracranial surgery
Authors: Gottschalk Allan , Berkow Lauren C. , Stevens Robert D. , Mirski Marek , Thompson Richard E. , White Elizabeth D. , Weingart Jon D. , Long Donlin M. , Yaster Myron 
Published: January 2008

Object
Opioid administration after major intracranial surgery is often limited by a presumed lack of need and a concern that opioids will adversely affect the postoperative neurological examination. The authors conducted a prospective study to evaluate the incidence, severity, and treatment of postoperative pain in patients who underwent major intracranial surgery.

Methods
One hundred eighty-seven patients (77 men and 110 women, mean age 52 ± 15 years, mean weight 78.1 ± 19.9 kg) underwent either supratentorial (129 patients) or infratentorial (58 patients) procedures. Sixty-nine percent of the patients reported experiencing moderate to severe pain (≥ 4 on a 0–10 scale) during the 1st postoperative day. Pain scores greater than or equal to 4 persisted in 48% on the 2nd postoperative day. Approximately 80% of patients were treated with acetaminophen on the 1st postoperative day, whereas opioids (primarily intravenous fentanyl) were administered to 58%. Compared with patients who underwent supratentorial procedures, those who underwent infratentorial procedures reported more severe pain at rest (mean score 4.9 ± 2.2 compared with 3.8 ± 2.6; p = 0.015) and with movement (mean score 6.3 ± 2.6 compared with 4.5 ± 2.7; p < 0.001) on the 1st postoperative day. On both the 1st and 2nd postoperative days, patients who underwent infratentorial procedures received greater quantities of opioid (p ≤ 0.019) and nonopioid (p ≤ 0.013) analgesics than those who underwent supratentorial procedures. Patients’ dissatisfaction with analgesic therapy was significantly associated with elevated pain levels on the first 2 postoperative days (p < 0.001).

Conclusions
In contrast to prevailing assumptions, the study findings reveal that most patients undergoing elective major intracranial surgery will experience moderate to severe pain for the first 2 days after surgery and that this pain is often inadequately treated.
Optimal reverse Trendelenburg position in patients undergoing craniotomy for cerebral tumors
Authors: Tankisi Alp , Cold Georg Emil 
Published: January 2008

Object
To the authors’ knowledge, repeated measurements of intracranial pressure (ICP), cerebral perfusion pressure (CPP), and the degree of dural tension during different positions on the operating table (reverse Trendelenburg position [rTp]) have not been studied in patients undergoing craniotomy.

Methods
In the present study 53 patients with supratentorial cerebral tumors who underwent craniotomy in the supine position were included. Subdural ICP, mean arterial blood pressure (MABP), CPP, and jugular bulb (JB) pressure were recorded, and the degree of dural tension was analyzed while patients were in the neutral operating position and at 5, 10, and 15° rTp. The optimal operating position was defined as the one at which subdural ICP was as low as possible, and CPP was greater than or equal to 60 mm Hg or as high as possible.
Subdural ICP, MABP, and JB pressure decreased significantly after each 5° change in rTp compared with the preceding position. Dural tension decreased significantly up to 10° rTp, but was unchanged at 15° rTp. At 5° rTp CPP remained unchanged, but it decreased significantly during 10 and 15° rTp. The optimal position in the majority of patients was determined to be 15° rTp.

Conclusions
Before opening the dura mater for craniotomy, repeated measurements of ICP and CPP, in the neutral position and at 5, 10, and 15° rTp, provide valuable information regarding the optimal level of ICP and CPP.