bluuebunny/crossref_metadata_2025_split huggingface dataset:
Convection-enhanced delivery in clinical trials
Authors: Hall Walter A. , Rustamzadeh Edward , Asher Anthony L. 
Published: January 2008

The poor prognosis associated with the current management of malignant gliomas has led investigators to develop alternative treatments such as targeted toxin therapy. The optimal method for administering these agents is under development but appears to be convection-enhanced delivery (CED).
The direct intratumoral infusion of targeted toxins was first performed in nude mouse flank tumor models of human malignant glioma. After the demonstration of in vivo efficacy, these potent cytotoxic compounds were tested in Phase I and Phase II clinical trials.
Using a high-flow microinfusion technique, volumes of up to 180 ml were infused by CED through catheters placed directly into brain tumors. Minor systemic toxicity was seen in the form of hepatic enzyme elevation. Neural toxicity manifested as seizure activity and hemiparesis resulted from peritumoral edema that followed the completion of the infusion. Peritumoral toxicity was believed to be more related to the concentration of the infused immunotoxin than to the infusion volume. In approximately half of patients treated with CED a stable disease course, a partial response, or a complete response was demonstrated in some clinical trials.
Targeted toxin therapy has clinical efficacy in patients with malignant gliomas. Convection-enhanced delivery appears to represent an effective method for administering these agents in patients with malignant brain tumors.
Complications associated with lumbar stenosis surgery in patients older than 75 years of age
Authors: Wang Michael Y. , Green Barth A. , Shah Sachin , Steven Vanni D.O. , Levi Allan D. O. 
Published: January 2008

Object
An aging population will require that surgeons increasingly consider operative intervention in elderly patients. To perform this surgery safely will require an understanding of the factors that predict successful outcomes as well as complications.

Methods
Records of patients older than the age of 75 years who underwent lumbar spinal stenosis surgery were retrospectively reviewed. Preexisting medical illnesses were analyzed using the Charlson Weighted Comorbidity Index. Ambulatory function was rated on a four-point scale. Statistical analysis was performed using a one-tailed t-test with unpaired variance.
Eighty-eight patients treated between 1994 and 2001 were identified. Forty-five percent were women and 52 patients underwent spinal fusion. The follow-up period averaged 21 months. Back pain was present preoperatively in 89%; after surgery 43% experienced complete relief and 33% partial improvement. Leg pain was present preoperatively in 98%; after surgery 43% experienced complete relief and 42% partial improvement. Of the 33 patients with preoperative gait disturbances, 61% improved at least one point on the ambulatory scale. Wound complications and systemic complications were demonstrated in 24 and 16 patients, respectively. There were no deaths. Age (p = 0.322), number of fused levels (p = 0.371), and the number of laminectomy levels (p = 0.254) were not predictive of complications. Length of operative time (p = 0.003) and the CharlsonWeighted Comorbidity Index score (p = 0.088) were associated with both systemic and wound complications.

Conclusions
Surgery in patients older than age 75 years can be conducted safely and with similar outcome rates as in younger patients. The CharlsonWeighted Comorbidity Index score and operative time were predictive of the risk of complications.
Current neurosurgical indications for saphenous vein graft bypass
Authors: Friedman Jonathan A. , Piepgras David G. 
Published: January 2008

Object
Vascular bypass is performed in neurosurgery for a variety of pathological entities, including extracranial atherosclerotic disease, extra- and intracranial aneurysms, and tumors involving the carotid artery (CA) at the skull base or cervical regions. Creation of an interposition saphenous vein graft (SVG) is the typical method of choice when the superficial temporal artery is not an option.

Methods
One hundred thirty consecutive patients treated with SVG between July 1988 and December 2002 at the Mayo Clinic were studied. A total of 130 procedures were performed in 130 patients. The indications were intracranial aneurysm in 51 patients (39%), CA occlusive disease in 36 (28%), extracranial CA aneurysm in 17 (13%), tumors involving the cervical CA in 11 (8%), vertebral artery occlusive disease in eight (6%), and other indications in six patients (5%). Among patients treated for intracranial aneurysms, 43 harbored giant aneurysms (> 25 mm in widest diameter) whereas the remaining eight patients harbored aneurysms that were large (15–25 mm in widest diameter). Among patients with CA occlusive disease, high-grade stenosis at the CA bifurcation was present in 29 and CA occlusion was demonstrated in seven.

Conclusions
The use of SVG bypass remains a valuable component of the neurosurgical armamentarium for a variety of pathological entities. Despite a general trend toward decreased use because of improved endovascular technology, surgical facility with this procedure should be maintained.
Salvage of advanced squamous cell carcinomas of the head and neck: internal carotid artery sacrifice and extracranial–intracranial revascularization
Authors: Feiz-Erfan Iman , Han Patrick P. , Spetzler Robert F. , Lanzino Giuseppe , Ferreira Mauro A. T. , Gonzalez L. Fernando , Porter Randall W. 
Published: January 2008

Object
Squamous cell carcinoma (SCC) of the head and neck may involve the carotid artery (CA) in the neck or skull base. Whether tumor resection should be associated with sacrifice of the CA is debatable.

Methods
Records obtained in five consecutive patients (three men, and two women; mean age 58 years, range 47–69 years) treated for recurrent or progressive SCC involving the internal carotid artery (ICA) at the skull base were reviewed retrospectively. The ICA was sacrificed, an extracranial–intracranial (EC–IC) bypass was performed using a saphenous vein graft, and the tumor and involved ICA segment were resected.
Gross-total resection of the SCC was achieved in four cases. One patient died of an acute postoperative stroke due to bypass occlusion and did not undergo tumor resection. No other permanent ischemic or neurological deficits were noted. The other four patients died of tumor progression (survival range 2–40 months, mean 14 months). One patient survived for more than 2 years (2-year overall survival rate 20%). Histological tumor invasion of the CA wall was verified in one of the three evaluated specimens.

Conclusions
A high rate of morbidity and mortality is associated with cases in which skull base CA sacrifice and an EC–IC bypass are performed. Not all resected arteries are shown to have malignant infiltration on histological examination. Better preoperative imaging criteria are needed to define malignant infiltration of the ICA at the skull base. Chemotherapy and radiotherapy without aggressive tumor resection may be an option for these patients.
Radiosurgery for nonfunctioning pituitary adenoma
Authors: Sheehan Jason P. , Kondziolka Douglas , Flickinger John , Lunsford L. Dade 
Published: January 2008

Object
Nonfunctioning pituitary adenomas comprise approximately 30% of all pituitary tumors. The purpose of this retrospective study was to evaluate the efficacy and role of gamma knife surgery (GKS) in the treatment of these lesions.

Methods
The authors conducted a review of cases in which GKS was performed at the University of Pittsburgh between 1987 and 2001. Forty-six patients with nonfunctioning pituitary adenomas and with at least 6 months of follow-up data were identified. In 41 of these patients some form of prior treatment such as transsphenoidal resection, craniotomy and resection, or conventional radiation therapy had been conducted. Five patients were deemed ineligible for microsurgery, and GKS served as the primary treatment modality. Endocrinological, ophthalmological, and radiological responses were evaluated. The mean radiation dose to the margin was 16 Gy.
In all patients with microadenomas and 91% of those with macroadenomas tumor control was demonstrated after radiosurgery. Gamma knife surgery had essentially equal efficacy in terms of achieving tumor control in cases of adenomas with cavernous sinus invasion and suprasellar extension. No new endocrinopathies were noted following radiosurgery. In two patients, however, tumor growth and decline in visual function occurred.

Conclusions
Gamma knife surgery is safe and effective in treating nonfunctioning pituitary adenomas. Radiosurgery may serve as a primary treatment modality in some or as a salvage treatment in others. Treatment must be tailored to meet the patient's symptoms, overall health, and tumor morphometry.
Stereotactic radiosurgery for hypersecreting pituitary tumors: part of a multimodality approach
Authors: Jane John A. , Vance Mary Lee , Woodburn C. J. , Laws Edward R. 
Published: January 2008

Object
Surgical and medical therapies successfully achieve biochemical remission in the majority of patients with secretory pituitary adenomas. Nevertheless, continued hypersecretion after first-line therapy occurs and requires adjunctive therapy to prevent morbidity and premature mortality. For patients in whom medical and surgical therapy have failed, gamma knife surgery (GKS) is performed with the goal of controlling tumor growth and excess growth hormone (GH) production. The authors report their experience with GKS in patients in whom surgical and medical therapies failed.

Methods
The neuroendocrine service at the University of Virginia has treated 220 patients with secretory adenomas. The authors evaluated the biochemical results in patients with acromegaly followed for greater than 18 months (64 patients) as well as those with Cushing disease (45 patients), Nelson syndrome (14 patients with adequate follow up [27 overall]), and prolactinomas (19 patients) followed for at least 12 months posttreatment. Biochemical remission occurred in 36% of patients with GH-secreting adenomas, 73% of those with Cushing disease, 14% of those with Nelson syndrome, and 11% of those harboring prolactinomas. Recurrence after biochemical remission was documented in four patients with Cushing disease. New hormonal deficits have occurred in 28% of patients with acromegaly, 31% with Cushing disease, 36% with Nelson syndrome, and 21% with prolactinomas. Minor visual deterioration developed in one patient with Cushing disease.

Conclusions
Gamma knife surgery offers an important treatment modality in patients with secretory adenomas refractory to surgical and medical interventions.
Linear accelerator–based radiosurgery for vestibular schwannoma
Authors: Friedman William A. , Foote Kelly D. 
Published: January 2008

Despite major advances in skull base surgery and microsurgical techniques, surgery for vestibular schwannoma (VS) carries a risk of complications. Some are inherent to general anesthesia and surgery of any type and include myocardial infarction, pneumonia, pulmonary embolism, and infection. Some are specific to neurosurgery in this area of the brain, and include hydrocephalus, cerebrospinal fluid leak, facial nerve paralysis, facial numbness, hearing loss, ataxia, dysphagia, and major stroke. Even in the hands of very experienced acoustic surgeons, these risks cannot be eliminated.
Radiosurgery provides an outpatient, noninvasive alternative for the treatment of small acoustic schwannomas. Initially radiosurgery was undertaken in “high-risk” patients, including the elderly, those with severe medical comorbidities, and those in whom tumors recurred after surgery. Additionally, a high rate of cranial nerve morbidity was reported. With improvements in dosimetry planning and dose selection, however, authors practicing at radiosurgical centers now report very low complication rates, as well as high tumor control rates.
In this report the authors specifically review the results of linear accelerator–based radiosurgery for VS and compare these outcomes with the best surgical alternatives.
Stereotactic radiosurgery for intracranial meningiomas: indications and results
Authors: Pollock Bruce E. 
Published: January 2008

Object
Stereotactic radiosurgery (SRS) has become an important treatment option for patients with intracranial meningiomas. The author reviews the 12-year experience at a single institution and discusses the relative strengths and weakness of this management approach.

Methods
Between January 1990 and December 2002, 330 patients (with 356 tumors) underwent radiosurgery for intracranial meningiomas. One hundred thirty-eight patients (42%) harbored recurrent/residual tumors after having already undergone resection; 192 patients (58%) underwent radiosurgery as primary treatment. The majority of patients (70%) harbored skull base tumors. The median tumor volume was 7.3 cm3 (range 0.5–50.5 cm3). The median tumor margin dose was 16 Gy (range 12–20 Gy). In 278 patients with 297 lesions the mean clinical and imaging follow-up period was 43 months (range 2–138 months). Two hundred seventy-eight tumors (94%) remained stable or decreased in size, and 19 tumors progressed in size. Factors associated with progression were tumor histological type and prior surgery. Treatment-related complications occurred in 8% of the patients and included cranial neuropathies, symptomatic edema, cyst formation, and stenosis of the internal carotid artery. In three patients (1%) tumor dedifferentiation was noted after SRS.

Conclusions
Radiosurgical treatment of meningioma is safe and it has become the primary treatment for patients with small skull base tumors. Further study is needed to determine the long-term tumor control rates after such treatment, especially for patients treated with doses of 14 Gy or less.
Radiosurgery and stereotactic radiotherapy for intracranial meningiomas
Authors: Torres Rodrigo Couto , Frighetto Leonardo , De Salles Antonio A. F. , Goss Brian , Medin Paul , Solberg Timothy , Ford Judith Marianne , Selch Michael 
Published: January 2008

Object
The authors report the evolution of linear accelerator (LINAC)–based radiosurgery in the treatment of patients with intracranial meningiomas. They describe the technical aspects as well as clinical and radiological outcomes.

Methods
The authors performed a retrospective review of 161 patients harboring 194 intracranial meningiomas treated with various types of stereotactic irradiation at their institution between May 1991 and July 2002. Clinical and radiological follow-up data (mean follow-up period 32.5 months, range 6–125 months) were obtained in 128 patients (79.5%) with 156 meningiomas (80.4%). There were 88 women and 40 men whose mean age was 57.2 years (range 18–87 years). Stereotactic irradiation was the primary treatment in 44 patients, and 84 patients underwent resection prior to radiosurgery. Stereotactic radiosurgery (SRS) was used to treat 79 lesions and fractionated stereotactic radiotherapy (SRT) was used to treat 77. The mean dose for SRS was 1567 cGy (range 1200–2285 cGy) prescribed to a mean isodose line of 66.6% (range 50–90%). Stereotactic radiotherapy was delivered using a mean dose of 4839 cGy (range 2380–5400 cGy), prescribed to a mean isodose line of 89% (range 50–90%).
The mean follow-up periods were 40 and 24 months in SRS- and SRT-treated patients, respectively. Tumor control was achieved in 58 SRT-treated benign meningiomas (90%) and in 70 SRT-treated lesions (97.2%). In patients with atypical meningiomas a considerably poorer prognosis was seen. Clinical improvement or stabilization of symptoms was observed in the majority of patients. Symptomatic complications were limited to four patients (5%) treated with SRS and four (5.2%) treated with SRT.

Conclusions
Stereotactic irradiation techniques have changed the neurosurgical approach to intracranial meningiomas. Either SRS or SRT delivered as a primary treatment in selected cases of skull base lesions or as an adjuvant after conservative resection has improved the management of these complex intracranial tumors.
Spinal congenital dermal sinus associated with upper thoracic meningocele
Authors: Kara Niyazi Nefi 
Published: January 2008

The congenital dermal sinus is an abnormal epithelium-lined sinus tract between the skin surface and deeper tissues. It occurs during neurulation when the neural groove closes to form the neural tube on Day 26 of gestation and results from a failure of neuroectoderm to separate from the cutaneous ectoderm. The most frequent location is the lumbosacral area; an upper thoracic location is quite rare.
This 37-year-old man presented with headache and numbness in both arms. No specific neurological findings were observed. Physical examination revealed a dimple at T-2. Radiography and magnetic resonance imaging of the thoracic spine revealed spina bifida at T1–3, a meningocele, and a dermal sinus tract complex. The treatment approach and outcome in this unusual case are presented.
A locus-driven mechanism for rapid and automated atlas-assisted analysis of functional images by using the Brain Atlas for Functional Imaging
Authors: Nowinski Wieslaw L. , Thirunavuukarasuu Arumugam 
Published: January 2008

Object
Functional imaging is an established neurosurgical modality for studying the brain in health and disease. Identifying numerous activation loci on many functional images and reading their underlying cortical and subcortical anatomy, coordinates, and anatomical and functional values is a tedious, time-consuming, and error-prone task. In this study the authors propose a novel approach to this problem by using an electronic brain atlas in conjunction with a locus-driven mechanism.

Methods
The Brain Atlas for Functional Imaging containing an enhanced and extended electronic version of the Talairach–Tournoux brain atlas was used for analysis. It enables loading of anatomical and functional data, correlation of these data, identification of activation loci, and their labeling with Brodmann areas, gyri, and subcortical structures by means of the atlas. The Talairach proportional grid system transformation is used to register the anatomical and functional data with the atlas. The availability of numerous tools supports this process.
A locus-driven mechanism for analysis of activation loci is implemented. Locus placement within the activation region is supported by thresholding, and its location can be further edited in three dimensions on any orthogonal plane. Once all loci are identified and edited, their labels, coordinates, and anatomical/functional values are read automatically and saved in an external file. This mechanism enables the analysis to be performed in an automated, rapid, explicit, three-dimensionally consistent, and user-friendly way.

Conclusions
The electronic brain atlas with locus-driven mechanism is a useful tool for localization analysis of functional images.
Preoperative magnetic source imaging for brain tumor surgery: a quantitative comparison with intraoperative sensory and motor mapping
Authors: Schiffbauer Hagen , Berger Mitchel S. , Ferrari Paul , Freudenstein Dirk , Rowley Howard A. , Roberts Timothy P. L. 
Published: January 2008

Object
The aim of this study was to compare quantitatively the methods of preoperative magnetic source (MS) imaging and intraoperative electrophysiological cortical mapping (ECM) in the localization of sensorimotor cortex in patients with intraaxial brain tumors.

Methods
Preoperative magnetoencephalography (MEG) was performed while patients received painless tactile somatosensory stimulation of the lip, hand, and foot. The early somatosensory evoked field was modeled using a single equivalent current dipole approach to estimate the spatial source of the response. Three-dimensional magnetic resonance image volume data sets with fiducials were coregistered with the MEG recordings to form the MS image. These individualized functional brain maps were integrated into a neuronavigation system. Intraoperative mapping of somatosensory and/or motor cortex was performed and sites were compared.
In two subgroups of patients we compared intraoperative somatosensory and motor stimulation sites with MS imaging–based somatosensory localizations. Mediolateral projection of the MS imaging source localizations to the cortical surface reduced systematic intermodality discrepancies. The distance between two corresponding points determined using MS imaging and ECM was 12.5 ± 1.3 mm for somatosensory–somatosensory and 19 ± 1.3 mm for somatosensory–motor comparisons. The observed 6.5 mm increase in site separation was systematically demonstrated in the anteroposterior direction, as expected from actual anatomy. In fact, intraoperative sites at which stimulation evoked the same patient response exhibited a spatial variation of 10.7 ± 0.7 mm.

Conclusions
Preoperative MS imaging and intraoperative ECM show a favorable degree of quantitative correlation. Thus, MS imaging can be considered a valuable and accurate planning adjunct in the treatment of patients with intraaxial brain tumors.
Diffuse large B-cell lymphoma presenting as a sacral tumor
Authors: Liu James K. , Kan Peter , Schmidt Meic H. 
Published: January 2008

Primary lymphomas of the sacrum are rare tumors, reported only in a few cases in the literature. The authors describe two patients with diffuse large B-cell lymphomas presenting as a sacral tumor.
In the first case a 52-year-old man presented with progressive back pain, bilateral radicular pain, and saddle block anesthesia secondary to a lytic, expansile soft-tissue mass. The mass arose from the sacrum and eroded through the right S-1 to S-4 foramina and extended into the epidural space of the spinal canal. On magnetic resonance imaging, the sacral mass enhanced homogeneously with Gd. In the second case a 64-year-old man presented with left-sided radicular pain, paresthesias, and progressive weakness due to a lytic soft-tissue mass in the left sacral ala extending into the left L-5 and S-1 foramina. Metastatic workup in each patient demonstrated unremarkable findings. In both cases, an open biopsy procedure was performed after nondiagnostic examination of needle biopsy samples. Histopathological examination showed evidence consistent with diffuse large B-cell lymphoma in both patients. In the first case the disease was classified as Stage IAE, and the patient subsequently underwent four cycles of cyclophosphamide/doxorubicin/vincristine/prednisone (CHOP)– and rituximab-based chemotherapy followed by consolidation radiotherapy. In the second case the disease was also classified as Stage IAE, and the patient underwent CHOP-based chemotherapy and consolidation radiotherapy. In both cases radiography demonstrated a decrease in size of the sacral lymphomas.
The authors review the clinical, radiological, and histological features of sacral lymphomas. Lymphoma should be considered in the differential diagnosis of sacral tumors.