bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endovascular treatment of blood blister–like aneurysms of the internal carotid artery
Authors: Park Jae Hyo , In Sung Park , Han Dae Hee , Kim Seong Hyun , Oh Chang Wan , Kim Jeong-Eun , Kim Hyun Jib , Han Moon Hee , Kwon O-Ki 
Published: January 2008

Object
Because of its thin wall, an aneurysm arising from the posterior wall of the internal carotid artery (ICA), the so-called blood blister–like aneurysm (BBA), is difficult to manage surgically and is often associated with high morbidity and mortality rates. The authors treated these aneurysms endovascularly. In this paper, they present angiographic and clinical results obtained in patients with ICA BBAs treated endovascularly.

Methods
In seven patients with ICA BBAs who presented with subarachnoid hemorrhage, a total number of 12 endovascular treatments were performed, including seven endosaccular coil embolizations (four conventional, two stent-assisted and one balloon-assisted procedure) in four patients and five endovascular ICA trapping procedures in five patients. Repeated endovascular treatments were undertaken in four patients. In two patients, the endovascular treatment was performed after failure of surgical treatment (one case of rebleeding after clip placement and one aneurysmal regrowth after wrapping). A balloon occlusion test (BOT) was performed in all patients prior to ICA trapping.
All four patients treated by endosaccular coil embolization showed aneurysmal regrowth. Neither stents nor balloons helpfully prevented aneurysmal regrowth. Of these four patients, two experienced rebleeding. These two patients remained vegetative at the last follow-up examination. After the BOT, ICA trapping was performed with coils and balloons without complication in five patients; excellent outcomes were achieved in all cases but one in which the patient had been in poor neurological condition due to rebleeding after surgical clip therapy.

Conclusions
All ICA BBAs that were treated by endosaccular coil embolization exhibited regrowth of the aneurysm. Some of the lesions rebled. The majority of patients who underwent ICA trapping experienced excellent outcomes. Based on the authors' experiences, they suggest that ICA trapping including the lesion segment should be considered as a first option for definitive treatment if a BOT reveals satisfactory results. Regarding trapping methods, endovascular treatment may be preferred because of its convenience and safety.
Variations in the response of interleukins in neurosurgical intensive care patients monitored using intracerebral microdialysis
Authors: Hillman Jan , Åneman Oscar , Persson Mikael , Andersson Chris , Dabrosin Charlotte , Mellergård Pekka 
Published: January 2008

Object
The aim of this study was to make a preliminary evaluation of whether microdialysis monitoring of cytokines and other proteins in severely diseased neurosurgical patients has the potential of adding significant information to optimize care, thus broadening the understanding of the function of these molecules in brain injury.

Methods
Paired intracerebral microdialysis catheters with high-cutoff membranes were inserted in 14 comatose patients who had been treated in a neurosurgical intensive care unit following subarachnoidal hemorrhage or traumatic brain injury. Samples were collected every 6 hours (for up to 7 days) and were analyzed at bedside for routine metabolites and later in the laboratory for interleukin (IL)–1 and IL-6; in two patients, vascular endothelial growth factor and cathepsin-D were also checked.
Aggregated microprobe data gave rough estimations of profound focal cytokine responses related to morphological tissue injury and to anaerobic metabolism that were not evident from the concomitantly collected cerebrospinal fluid data. Data regarding tissue with no macroscopic evidence of injury demonstrated that IL release not only is elicited in severely compromised tissue but also may be a general phenomenon in brains subjected to stress. Macroscopic tissue injury was strongly linked to IL-6 but not IL-1b activation. Furthermore, IL release seems to be stimulated by local ischemia. The basal tissue concentration level of IL-1b was estimated in the range of 10 to 150 pg/ml; for IL-6, the corresponding figure was 1000 to 20,000 pg/ml.

Conclusions
Data in the present study indicate that catheters with high-cutoff membranes have the potential of expanding microdialysis to the study of protein chemistry as a routine bedside method in neurointensive care.
Surgical and endovascular management of symptomatic posterior circulation fusiform aneurysms
Authors: Coert Bert A. , Chang Steven D. , Do Huy M. , Marks Michael P. , Steinberg Gary K. 
Published: January 2008

Object
Patients with fusiform aneurysms can present with subarachnoid hemorrhage (SAH), mass effect, ischemia, or unrelated symptoms. The absence of an aneurysm neck impedes the direct application of a clip and endovascular coil deployment. To evaluate the effects of their treatments, the authors retrospectively analyzed a consecutive series of patients with posterior circulation fusiform aneurysms treated at Stanford University Medical Center between 1991 and 2005.

Methods
Forty-nine patients (mean age 53 years, male/female ratio 1.2:1) treated at the authors' medical center form the basis of the analysis. Twenty-nine patients presented with an SAH. The patients presenting without SAH had cranial nerve dysfunction (five patients), symptoms of mass effect (eight patients), ischemia (six patients), or unrelated symptoms (one patient). The aneurysms were located on the vertebral artery (VA) or posterior inferior cerebellar artery (PICA) (21 patients); vertebrobasilar junction (VBJ) or basilar artery (BA) (18 patients); and posterior cerebral artery (PCA) (10 patients). Pretreatment clinical grades were determined using the Hunt and Hess scale; for patients with un-ruptured aneurysms (Hunt and Hess Grade 0) functional subgrades were added. Outcome was evaluated using the Glasgow Outcome Scale (GOS) score during a mean follow-up period of 33 months.
Overall long-term outcome was good (GOS Score 4 or 5) in 59%, poor (GOS Score 2 or 3) in 16%, and fatal (GOS Score 1) in 24% of the patients. In a univariate analysis, poor outcome was predicted by age greater than 55 years, VBJ location, pretreatment Hunt and Hess grade in patients presenting with SAH, and incomplete aneurysm thrombosis after endovascular treatment. In a multivariate analysis, age greater than 55 years was the confounding factor predicting poor outcome. Stratification by aneurysm location removed the effect of age. Of 13 patients with residual aneurysm after treatment, five (38%) subsequently died of SAH (three patients) or progressive mass effect/brainstem ischemia (two patients).

Conclusions
Certain posterior circulation aneurysm locations (PCA, VA–PICA, and BA–VBJ) represent separate disease entities affecting patients at different ages with distinct patterns of presentation, treatment options, and outcomes. Favorable overall long-term outcome can be achieved in 90% of patients with PCA aneurysms, in 60% of those with VA–PICA aneurysms, and in 39% of those with BA–VBJ aneurysms when using endovascular and surgical techniques. The natural history of the disease was poor in patients with incomplete aneurysm thrombosis after treatment.
Cystic vestibular schwannomas: a possible role of matrix metalloproteinase–2 in cyst development and unfavorable surgical outcome
Authors: Moon Kyung-Sub , Jung Shin , Seo Seung-Kwon , Jung Tae-Young , Kim In-Young , Ryu Hyang-Hwa , Jin Yong-Hao , Jin Shu-Guang , Jeong Young-Il , Kim Kyung-Keun , Kang Sam-Suk 
Published: January 2008

Object
The authors evaluated the clinical manifestations and surgical results in patients with cystic vestibular schwannoma (VS), and investigated the matrix metalloproteinase (MMP) expression of the cyst fluid and wall in an attempt to elucidate the pathogenesis and characteristics of this disease.

Methods
The clinical and neuroimaging features, perioperative findings, and surgical outcomes in 24 cases of cystic VS and 82 cases of solid VS, all of which were treated using the suboccipital approach, were retrospectively compared. To evaluate the role of MMP in cystic VS, gelatin zymography and immunohistochemical studies of the cyst fluid, wall, and solid portion were performed in nine cases of this disease.
The mean duration of symptoms was shorter (14.0 months compared with 26.1 months; p = 0.04) and the mean size of the tumor was larger (43.8 mm compared with 34.2 mm; p = 0.048) in the cystic than the solid VS group. Although gross-total resection was easier to accomplish in this group (100% compared with 84.1%), adhesion to the facial nerve was more frequent (62.5% compared with 48.8%; p = 0.042). On gelatin zymography studies, MMP-2 expression was ubiquitously observed in all cyst fluids. Immunohistochemical analysis of the cyst wall showed that MMP-2 was apparently localized to the tumor cells on the luminal inner surface, adjacent to the cyst cavity.

Conclusions
Resection of cystic VS is complicated by severe adhesion of the tumor capsule to the facial nerve and the large size of the lesion. The authors believe that MMP-2 may be involved in the pathogenesis of cyst formation or in its enlargement and may aggravate adhesion to the facial nerve, either by promoting the enlargement of the tumor or engendering the degradation of the tumor–nerve barrier proteolytically.
Progressive perianeurysmal edema induced after endovascular coil embolization
Authors: Horie Nobutaka , kitagawa Naoki , Morikawa Minoru , Tsutsumi Keisuke , Kaminogo Makio , Nagata Izumi 
Published: January 2008

✓The authors report three cases of progressive vasogenic brain edema surrounding a cerebral aneurysm after endovascular coil embolization. In all three cases embolization was incomplete due to the aneurysms' large sizes and wide necks. Follow-up magnetic resonance imaging revealed de novo vasogenic brain edema surrounding the aneurysms 3 to 6 months after the initial treatment. The edema progressed in parallel with regrowth of the aneurysms. All three aneurysms were deep in the brain parenchyma and showed intramural enhancement, suggesting hemorrhage or inflammation. Each patient underwent a second embolization for the aneurysm regrowth, which resulted in improvement of the edema.
Based on the findings in these cases and review of the literature, it is suggested that incomplete occlusion of larger aneurysms that are deep within the brain may lead to a disorganized intraluminal thrombosis, aneurysm pulsing, and intramural hemorrhage or inflammation, all of which are associated with brain edema following aneurysm recanalization and regrowth. It should be kept in mind that incomplete embolization of larger aneurysms may cause such malignant change and that this complication may occur after endovascular treatment.
Postoperative cranial fasciitis
Authors: Summers Lori E. , Florez Luisa , Berberian John M. , Bhattacharjee Meena , Walsh John W. 
Published: January 2008

✓The authors report two cases of cranial fasciitis occurring at prior craniotomy sites. They review the presentation and pathological features associated with cranial fasciitis and describe two unusual cases and their treatment. The first case is that of a 16-year-old girl who underwent suboccipital craniectomy for resection of medulloblastoma and 14 months later was found to have a 4-cm nontender mass at the incision site, with evidence of skull erosion on neuroimaging. Resection of the mass revealed cranial fasciitis. The patient later developed two more lesions in the cranial region, as well as lesions on the chest wall and abdomen consistent with nodular fasciitis; all of the lesions were resected. The second case is that of a 61-year-old man who underwent suboccipital craniectomy for hypertensive hemorrhage and 2 years later was found to have an enlarging mass at the incision site, causing compression of the cerebellum. The mass was resected and found to be consistent with cranial fasciitis.
Cranial fasciitis is a rare, benign lesion of the cranial region. It is histologically identical to nodular fasciitis, a self-limiting fibroblastic process of the superficial and deep fascia. Although most cases of cranial fasciitis are reported to occur spontaneously in the very young, the two cases reported here involved older patients and lesions that developed at prior craniotomy sites in a delayed fashion, a phenomenon not previously reported. Interestingly, one patient exhibited lesions in other areas as well.
Large ophthalmic segment aneurysms with anterior optic pathway compression: assessment of anatomical and visual outcomes after endosaccular coil therapy
Authors: Heran Navraj S. , Song Joon K. , Kupersmith Mark J. , Niimi Yasunari , Namba Katsunari , Langer David J. , Berenstein Alejandro 
Published: January 2008

Object
The optimal therapy for ophthalmic segment aneurysms with anterior optic pathway compression (AOPC) is undecided. Surgical results have been described, but the results of endovascular coil therapy have not been well documented.

Methods
The authors retrospectively reviewed data obtained in all patients who harbored unruptured ophthalmic segment aneurysms with AOPC who underwent endovascular coil therapy at their institution. They analyzed baseline and outcome visual function, aneurysm features, extent of aneurysm closure, internal carotid artery (ICA) occlusion, additional interventions, and neurological outcome.
In 17 patients (16 women), age 38 to 83 years, there were 28 affected eyes. All aneurysms were greater than 10 mm in diameter. In the initial procedures 16 of 17 patients received endosaccular coils and the ICA was preserved; in one patient the aneurysm was trapped and the ICA occluded. Patients then underwent follow up for a mean of 2.90 years (range 1 month–11.2 years) after the last procedure. One patient died of subarachnoid hemorrhage (SAH) 1 month postoperatively and thus no follow-up data were available for this case. Vision worsened in six patients, stabilized in four, and improved in six. Twelve patients underwent 13 subsequent procedures, including endovascular ICA occlusion in seven, repeated coil therapy in five, and optic nerve decompression in one; vision improved in 83% of these cases after ICA occlusion. A second patient died of SAH 5 months after repeated coil treatment. At the final follow up, vision had improved in eight patients (50%), stabilized in four (25%), and worsened in four (25%). In 16 patients with follow-up studies, aneurysm closure was complete in eight (50%) and incomplete in eight (50%).

Conclusions
The authors found that in patients with ophthalmic segment aneurysms causing chronic AOPC, endosaccular platinum coil therapy, with ICA preservation, may not benefit vision and that additional procedures may be needed. Evaluation of their results suggests that endovascular trapping of the aneurysm and sacrifice of the ICA appear to result in good visual, clinical, and anatomical outcomes.
Changes in adjacent-level disc pressure and facet joint force after cervical arthroplasty compared with cervical discectomy and fusion
Authors: Chang Ung-Kyu , Kim Daniel H. , Lee Max C. , Willenberg Rafer , Kim Se-Hoon , Lim Jesse 
Published: January 2008

Object
The authors of previous in vitro investigations have reported an increase in adjacent-level intradiscal pressures (IDPs) and facet joint stresses following cervical spine fusion. This study was performed to compare adjacent-level IDPs and facet force following arthroplasty with the fusion model.

Methods
Eighteen human cadaveric cervical spines were tested in the intact state for different modes of motion (extension, flexion, bending, and rotation) up to 2 Nm. The specimens were then divided into three groups: those involving the ProDisc-C cervical artificial disc, Prestige cervical artificial disc, and cervical fusion. They were load tested after application of instrumentation or surgery at the C6–7 level. During the test, IDPs and facet forces were measured at adjacent levels.

Results
In arthroplasty-treated specimens, the IDP showed little difference from that of the intact spine at both proximal and distal levels. In fusion-treated specimens, the IDP increased at the posterior anulus fibrosus on extension and at the anterior anulus fibrosus on flexion at the proximal level. At the distal level, the IDP change was not significant. The facet force changes were minimal in flexion, bending, and rotation modes in both arthroplasty- and fusion-treated spines. Significant changes were noted in the extension mode only. In extension, arthroplasty models exhibited significant increases of facet force at the treated level. In the fusion model the facet forces decreased at the treated segment and increased at the adjacent segment.

Conclusions
The two artificial discs of the semiconstrained systems maintain adjacent-level IDPs near the preoperative values in all modes of motion, but with respect to facet force pressure tended to increase after arthroplasty.
Traumatic C6–7 subluxation with anomalous course of vertebral arteries treated with pedicle screw/rod fixation
Authors: Yamazaki Masashi , Koshi Takana , Mannoji Chikato , Okawa Akihiko , Koda Masao 
Published: January 2008

✓ The authors report the case of a 62-year-old woman who suffered an accidental fall and complained of severe neck pain and right C-7 radiculopathy. A right C6–7 facet fracture–subluxation was diagnosed. Bone fragments impinged on the right C-7 nerve root at the neural foramen. The bilateral vertebral arteries (VAs) ascended at the anterior aspect of C-6 and C-5 and entered the transverse foramen at the C-4 level.
Based on findings of anomalous VAs, the authors applied a pedicle screw (PS)/rod system to effect surgical correction of the deformity. Intraoperatively, they successfully performed reduction of the subluxation, decompression of the impinged nerve root, and minimum single-segment fusion involving the placement of a PS/rod system. After surgery, the patient's neurological deficit dramatically improved and spinal fusion was completed without any loss of deformity correction.
Prior to surgery for cervical injuries, the possible presence of an abnormal VA course should be considered. Preoperative detection of anomalous VAs will affect decisions on the appropriate corrective surgery option in cases of cervical spine injuries.
Factors influencing segmental range of motion after lumbar total disc replacement using the ProDisc II prosthesis
Authors: Kim Dong-Hyun , Ryu Kyeong-Sik , Kim Moon-Kyu , Park Chun-Kun 
Published: January 2008

Object.
The purpose of this prospective controlled study was to evaluate possible factors that could affect postoperative segmental range of motion (ROM) after lumbar total disc replacement (TDR) using the ProDisc II prosthesis.

Methods.
Thirty-two consecutive patients with intractable discogenic pain underwent lumbar TDR using the Pro-Disc II prosthesis, 30 of whom were followed up for at least 24 months. Segmental ROM was assessed preoperatively and every 6 months postoperatively using dynamic x-ray films. Segmental ROM at the reference level was assessed in relation to patient age, sex, body mass index (BMI), levels with implants, preoperative ROM, prosthesis size, and prosthesis position.

Results.
At the last follow-up visit, mean ROM of the disc prostheses was significantly increased from 4.23 ±3.12° to 6.81 ±3.76° at L3–4, and from 3.66 ±2.47° to 6.09 ±2.11° at L4–5. Mean ROM at L5–S1, however, was decreased from 3.12 ±1.56° to 2.86 ±1.26° (p > 0.05). This difference in the changes in postoperative ROM between L5–S1 and the other operated levels was the only statistically significant factor (p = 0.025) among the variables related to the postoperative ROM that the authors assessed, but other factors such as patient age, sex, BMI, disc height, and the size and position of the prosthesis were not related to segmental ROM.

Conclusions.
The data demonstrate that after TDR using the ProDisc II prosthesis, ROM of the prosthesis at L5–S1 is significantly lower compared with ROM at the other levels. In preserving ROM, the advantage of lumbar TDR using the ProDisc II might be minimal at L5–S1. Among the variables related to postoperative ROM, the level at which the ProDisc II prosthesis was implanted was the only one found to be statistically significant.
Mortality rates in geriatric patients with spinal cord injuries
Authors: Fassett Daniel R. , Harrop James S. , Maltenfort Mitchell , Jeyamohan Shiveindra B. , Ratliff John D. , Anderson D. Greg , Hilibrand Alan S. , Albert Todd J. , Vaccaro Alexander R. , Sharan Ashwini D. 
Published: January 2008

Object
The authors undertook this study to evaluate the incidence of spinal cord injury (SCI) in geriatric patients (≥ 70 years of age) and examine the impact of patient age, extent of neurological injury, and spinal level of injury on the mortality rate associated with traumatic SCI.

Methods
A prospectively maintained SCI database (3481 patients) at a single institution was retrospectively studied for the period from 1978 through 2005. Parameters analyzed included patient age, admission American Spinal Injury Association (ASIA) motor score, level of SCI, mechanism of injury, and mortality data. The data pertaining to the 412 patients 70 years of age and older were compared with those pertaining to the younger cohort using a chi-square analysis.

Results
Since 1980, the number of SCI-related hospital admissions per year have increased fivefold in geriatric patients and the percentage of geriatric patients within the SCI population has increased from 4.2 to 15.4%. In comparison with younger patients, geriatric patients were found to be less likely to have severe neurological deficits (greater percentage of ASIA Grades C and D injuries), but the mortality rates were higher in the older age group both for the period of hospitalization (27.7% compared with 3.2%, p < 0.001) and during 1-year follow-up. The mortality rates in this older population directly correlate with the severity of neurological injury (1-year mortality rate, ASIA Grade A 66%, Grade D 23%, p < 0.001). The mortality rate in elderly patients with SCI has not changed significantly over the last two decades, and the 1-year mortality rate was greater than 40% in all periods analyzed.

Conclusions
Spinal cord injuries in older patients are becoming more prevalent. The mortality rate in this patient group is much greater than in younger patients and should be taken into account when aggressive interventions are considered and in counseling families regarding prognosis.