bluuebunny/crossref_metadata_2025_split huggingface dataset:
Median to radial nerve transfer for treatment of radial nerve palsy
Authors: Mackinnon Susan E. , Roque Brandon , Tung Thomas H. 
Published: January 2008

✓The purpose of this study is to report a surgical technique of nerve transfer to restore radial nerve function after a complete palsy due to a proximal injury to the radial nerve. The authors report the case of a patient who underwent direct nerve transfer of redundant or expendable motor branches of the median nerve in the proximal forearm to the extensor carpi radialis brevis and the posterior interosseous branches of the radial nerve. Assessment included degree of recovery of wrist and finger extension, and median nerve function including pinch and grip strength.
Clinical evidence of reinnervation was noted at 6 months postoperatively. The follow-up period was 18 months. Recovery of finger and wrist extension was almost complete with Grade 4/5 strength. Pinch and grip strength were improved postoperatively. No motor or sensory deficits related to the median nerve were noted, and the patient is very satisfied with her degree of functional restoration.
Transfer of redundant synergistic motor branches of the median nerve can successfully reinnervate the finger and wrist extensor muscles to restore radial nerve function. This median to radial nerve transfer offers an alternative to nerve repair, graft, or tendon transfer for the treatment of radial nerve palsy.
Lack of value of routine analysis of cerebrospinal fluid for prediction and diagnosis of external drainage–related bacterial meningitis
Authors: Schade Rogier P. , Schinkel Janke , Roelandse Freek W. C. , Geskus Ronald B. , Visser Leo G. , van Dijk Marc C. , Voormolen Joan H. C. , van Pelt Hans , Kuijper Ed J. 
Published: January 2008

Object
Routine microbiological and chemical analysis of cerebrospinal fluid (CSF) is often performed to diagnose external drainage–related bacterial meningitis (ED-BM) at an early stage. A cohort study was performed to investigate the value of several commonly used CSF parameters for the prediction and diagnosis of ED-BM.

Methods
In a cohort of 230 consecutive patients in whom external drains had been placed, CSF samples were collected daily, prospectively evaluated for the presence of bacteria using Gram stain and microbiological culture, and analyzed for leukocyte count, protein concentration, glucose concentration, and ratio of CSF glucose to blood glucose. In addition, the CSF concentration of interleukin-6 (IL-6) was determined. The definition of ED-BM was based on positive culture results in combination with clinical symptoms. A matched case–control study was performed to evaluate the cohort longitudinally and to control for biasing factors such as duration of external drainage.
External drainage–related bacterial meningitis developed in 22 patients (9.6%). Results from analyses of 1516 CSF samples showed no significant differences between the patients in whom ED-BM developed and a control group without ED-BM during the first 3 days of infection or during the 3 days preceding the infection with regard to leukocyte count, protein concentration, glucose concentration, and CSF/blood glucose ratio. No significant difference between groups was found for the CSF IL-6 concentration during the 3 days preceding the infection. In the matched case–control study, none of the parameters had significant predictive or diagnostic value for ED-BM in analyses using absolute values, ratios, and differences between the current and previous day’s values. A comparison of the results from Gram stains and CSF cultures showed that the Gram staining had a very high specificity (99.9%) but a low sensitivity (18% [four of 22 patients] on the 1st day of infection and 60% [nine of 15 patients] on the 2nd day).

Conclusions
Severe disturbances in the CSF of patients with external drains limit the value of routine CSF analysis for prediction or diagnosis of ED-BM. Routine Gram stain of CSF has also limited predictive or diagnostic value due to its low sensitivity in screening for ED-BM.
Custom-tailored transdural anterior transpetrosal approach to ventral pons and retroclival regions
Authors: Steiger Hans-Jakob , Hänggi Daniel , Stummer Walter , Winkler Peter A. 
Published: January 2008

Object
The extradural anterior petrosectomy approach to the pons and midbasilar artery (mid-BA) has the main disadvantage that the extent of resection of the petrous apex cannot be as minimal as desired given that the surgical target field is not visible during bone removal. Unnecessary or excessive drilling poses the risk of injury to the internal carotid artery, vestibulocochlear organ, and seventh and eighth cranial nerves. The use of a custom-tailored transdural anterior transpetrosal approach can potentially avoid these pitfalls.

Methods
A technique for a transdural anterior petrosectomy was developed in the operating theater and anatomy laboratory. Following a subtemporal craniotomy and basal opening of the dura mater, the vein of Labbé is first identified and protected. Cerebrospinal fluid ([CSF] 50–100 ml) is drained via a spinal catheter. The tent is incised behind the entrance of the trochlear nerve toward the superior petrosal sinus (SPS), which is coagulated and divided. The dura is stripped from the petrous pyramid. Drilling starts at the petrous ridge and proceeds laterally and ventrally. The trigeminal nerve is unroofed. The internal acoustic meatus is identified and drilling is continued laterally as needed. The bone of the Kawase triangle toward the clivus can be removed down to the inferior petrosal sinus if necessary. Anterior exposure can be extended to the carotid artery if required. It is only exceptionally necessary to follow the greater superior petrosal nerve toward the geniculate ganglion and to expose the length of the internal acoustic canal.
The modified transdural anterior petrosectomy exposure has been used in nine patients—two with a mid-BA aneurysm, two with a dural arteriovenous fistula, one with a pontine glioma, three with a pontine cavernoma, and one with a pontine abscess. In one patient with a mid-BA aneurysm, subcutaneous CSF collection occurred during the postoperative period. No CSF fistula or approach-related cranial nerve deficit developed in any of these patients. There was no retraction injury or venous congestion of the temporal lobe nor any venous congestion due to the obliteration of the SPS or the petrosal vein.

Conclusions
The custom-made transdural anterior petrosectomy appears to be a feasible alternative to the formal extradural approach.
Falcotentorial meningioma: surgical outcome in 14 patients
Authors: Goto Takeo , Ohata Kenji , Morino Michiharu , Takami Toshihiro , Tsuyuguchi Naohiro , Nishio Akimasa , Hara Mitsuhiro 
Published: January 2008

Object
The authors evaluated their surgical experience over 20 years with 14 treated falcotentorial meningiomas.

Methods
In the past 20 years, 14 patients with falcotentorial junction meningiomas were surgically treated. There were seven men and seven women, whose ages ranged from 34 to 79 years. On the basis of neuroimaging studies, the authors analyzed the influence of the anatomical relationship of the tumor to the vein of Galen, patency of the vein of Galen, tumor size, and the signal intensities on the magnetic resonance images to determine possible difficulties that might be encountered during surgery and to prognosticate the outcome of surgery. Depending on the relationship with the vein of Galen, tumors were labeled as either a superior or an inferior type. All tumors were resected via an occipital transtentorial approach.
The surgical outcome in eight patients was excellent; in the remaining six patients, it was fair. Of the prognostic factors, tumor location especially seemed to be the most important (p < 0.01, Fisher exact test). The outcome associated with the inferior type of tumor was significantly less optimal probably due to the relationship to the deep veins and the brainstem. In this series, the occlusion of deep veins did not significantly influence outcome.

Conclusions
Classification of the tumor location by preoperative neuroimaging studies can be helpful in estimating the surgical difficulty that might be encountered in treating the falcotentorial junction meningioma.
Long-term seizure outcome following surgery for dysembryoplastic neuroepithelial tumor
Authors: Chan Chow Huat , Bittar Richard G. , Davis Gavin A. , Kalnins Renate M. , Fabinyi Gavin C. A. 
Published: January 2008

Object
Resection of dysembryoplastic neuroepithelial tumor (DNET) is thought to result in favorable seizure outcome, but long-term follow-up data are scarce. The authors present a review of 18 patients who underwent surgical removal of a DNET: 12 via temporal lobectomy and six via lesionectomy.

Methods
The mean long-term follow up was 10.8 years (median 10.4 years, range 7.8 to 14.8 years), and results obtained during this time period were compared with previously reported short-term (mean 2.7 years) seizure outcome data. In the current study, 66.7% patients had an Engel Class I outcome and 55.6% had an Engel Class IA outcome compared with 77.8% and 55.6%, respectively. Temporal lobectomy (Engel Class I, 83.3%; Engel Class IA, 66.7%) led to a better seizure outcome than lesionectomy (Engel Classes I and IA, 33.3%). Two patients (11.1%) required repeated operation and both had an incomplete lesionectomy initially.

Conclusions
Results indicated that complete resection of a DNET leads to a favorable seizure outcome, with epilepsy cure in those who had experienced early postoperative seizure relief. Long-term seizure outcome after surgery is predictable based on the result of short-term follow up.
Seizure and memory outcome following temporal lobe surgery: selective compared with nonselective approaches for hippocampal sclerosis
Authors: Paglioli Eliseu , Palmini André , Portuguez Mirna , Paglioli Eduardo , Azambuja Ney , Costa Jaderson Costa da , Filho Hélio Fernandes da Silva , Martinez José Victor , Hoeffel João Rubião 
Published: January 2008

Object
The aim of this study was to compare seizure and memory outcome in patients with medically refractory mesial temporal lobe epilepsy due to hippocampal sclerosis (MTLE/HS) treated using an anterior temporal lobectomy (ATL) or a selective amygdalohippocampectomy (SA).

Methods
Surgical outcome data were prospectively collected for 2 to 11 years in 161 consecutive patients with MTLE/HS. Eighty patients underwent an ATL and 81 an SA. Seizure control achieved with each technique was compared using the Engel classification scheme. Postoperative memory testing was performed in 86 patients (53%). At the last follow up, 72% of the patients who had undergone an ATL (mean follow up 6.7 years) and 71% of those who had undergone an SA (mean follow up 4.5 years) were seizure free (Engle Class IA). Estimated survival in patients in Engel Classes I, IA, and I and II combined did not differ between the two surgical techniques. Preoperatively, 58% of the patients had verbal memory scores one standard deviation (SD) below the normal mean. One third of the patients with preoperative scores in the normal range worsened after surgery, although this outcome was not related to the surgical technique. In contrast, one third of those whose preoperative scores were less than −1 SD experienced improvement after surgery. Nine (18%) of the 50 patients whose left side had been surgically treated improved their verbal memory scores by more than one SD. Seven (78%) of these nine underwent an SA (p = 0.05).

Conclusions
Both ATL and SA can lead to similar favorable seizure control in patients with MTLE/HS. Preliminary data suggest that postoperative verbal memory scores may improve in patients who undergo selective resection of a sclerotic hippocampus in the dominant temporal lobe.
Tissue plasminogen activator in chronic subdural hematomas as a predictor of recurrence
Authors: Katano Hiroyuki , Kamiya Ken , Mase Mitsuhito , Tanikawa Motoki , Yamada Kazuo 
Published: January 2008

Object
Chronic subdural hematomas (CSDHs) recur in 7 to 18% of cases. The present study was conducted to determine whether serum or lesion concentrations of coagulofibrinolytic and angiogenic factors, which have been reported to be potential markers of CSDH development, might predict such recurrences.

Methods
Sixty consecutive patients (mean age 71.5 years) with CSDHs (74 affected sides) were studied. Samples of serum in preoperative peripheral venous blood and of hematomas (obtained during surgery) were collected and analyzed. The CSDH recurred in six (8.1%) of the 74 affected sides in six patients. None of the values of the coagulative factors or tests in serum showed significant variation between cases with and those without recurrence. Among coagulofibrinolytic factors, tissue plasminogen activator (TPA) in hematomas demonstrated significantly greater levels in recurrent than in nonrecurrent cases; a similar tendency was noted for α2-plasmin inhibitor–plasmin complex in hematomas. Both factors were greater in the lesions than in the serum. Among the angiogenic factors, levels of hepatic growth factor (HGF) and vascular endothelial growth factor (VEGF) in hematomas were significantly greater than in serum, whereas those of basic fibroblast growth factor were rather lower. Note that comparisons between recurrent and nonrecurrent cases revealed no significant difference.

Conclusions
Patients harboring CSDHs with high TPA concentrations on sampling at the initial surgery have a relatively high probability of recurrence and require follow up with computerized tomography scanning. Angiogenic factors, such as HGF and VEGF, might be candidate markers of CSDH enlargement but are not useful as predictors of recurrence.
Intraoperative corticomuscular motor evoked potentials for evaluation of motor function: a comparison with corticospinal D and I waves
Authors: Fujiki Minoru , Furukawa Yoshie , Kamida Tohru , Anan Mitsuhiro , Inoue Ryo , Abe Tatsuya , Kobayashi Hidenori 
Published: January 2008

Object
The goal of this study was to compare motor evoked potentials recorded from muscles (muscle MEPs or corticomuscular MEPs) with corticospinal MEPs recorded from the cervical epidural space (spinal MEPs or corticospinal MEPs) to assess their efficacy in the intraoperative monitoring of motor function.

Methods
Muscle and spinal MEPs were simultaneously recorded during surgery in 80 patients harboring brain tumors. Each case was assigned to one of four groups according to final changes in the MEPs: 1) Group A, in which there was an increased amplitude in the muscle MEP with an increased I3 wave amplitude (12 cases); 2) Group B, in which there was no significant change in the MEP (43 cases); 3) Group C, in which there was a decreased muscle MEP amplitude (< 35% of the control) with a decreased I wave amplitude but an unchanged D wave (15 cases); or 4) Group D, in which there was an absent muscle MEP with a decreased D wave amplitude (10 cases). In patients in Group A, the increase in the amplitude of the muscle MEP (range of increase 128–280%, mean increase 188.75 ± 48.79%) was well correlated with the increase in the I3 wave in corticospinal MEPs. Most of these patterns were observed in patients harboring meningiomas (10 [83.3%] of 12 cases). Patients in Group B displayed no changes in muscle and corticospinal MEPs and no signs of postoperative neurological deterioration. Patients in Group C showed a substantial decrease in the amplitude of the muscle MEP (range of decrease 5.3–34.8% based on the control waveform, mean change 21.81 ± 10.93%) without deterioration in the corticospinal D wave, and exhibited severe immediate postoperative motor dysfunction. This indicates dysfunction of the cortical gray matter, including the motor cortices, which are supposed to generate I waves. Patients in Group D exhibited decreases in the corticospinal D wave (range of decrease 21.5–55%, mean decrease 39.75 ± 11.45%) and an immediate cessation of the muscle MEP as well as severe permanent motor paresis.

Conclusions
These results indicate that, during surgery, monitoring of corticomuscular MEPs (which are related to I waves) is a much more sensitive method for the detection of immediate motor cortical damage than monitoring of corticospinal MEPs (D wave).
Simulation of the natural history of cerebral aneurysms based on data from the International Study of Unruptured Intracranial Aneurysms
Authors: Chang Han Soo 
Published: January 2008

Object
Despite recent publications of large-scale study data, controversy over the management of unruptured cerebral aneurysms continues. The low rupture rates in the International Study of Unruptured Intracranial Aneurysms (ISUIA) apparently contradicted surgeons’ experiences with ruptured aneurysms. In the present study, based on data from the ISUIA, a mathematical model describing the natural history of cerebral aneurysms was developed. With this model, the author aimed to examine the validity of data from the ISUIA and to provide a better treatment guideline for unruptured aneurysms.

Methods
The author made a computer simulation of the natural history of cerebral aneurysms that was used to calculate such figures as the prevalence of unruptured aneurysms, incidence of subarachnoid hemorrhage (SAH), and age and size distribution of both unruptured and ruptured aneurysms. The lifetime lesion rupture probability for individual patients with various ages and aneurysm sizes was also computed, thereby providing a useful index to help patients in the medical decision-making process.
The computer model produced a sample of unruptured aneurysms in the general population with a prevalence of 4.2% and a median diameter of 5.8 mm. These unruptured aneurysms—affected by the rupture rate reported in the ISUIA—had a yearly SAH incidence of 19.6 per 100,000 persons. The median diameter of these aneurysms was 9.4 mm.

Conclusions
Findings in the present study validated the results of the ISUIA by showing that the seemingly low rupture rates could explain the statistical data for ruptured aneurysms. With the featured model, the author calculated the lifetime probability of lesion rupture—a useful measure for deciding on the optimal treatment for unruptured aneurysms.
A mathematical model of the natural history of intracranial aneurysms: quantification of the benefit of prophylactic treatment
Authors: Yoshimoto Yuhei 
Published: January 2008

Object
The International Study of Unruptured Intracranial Aneurysms (ISUIA) data raised new controversy regarding the threshold size that requires treatment. In particular, this study has been criticized for disagreeing with previous epidemiological data.

Methods
The author first used a Markov model to simulate the natural history of intracranial aneurysms, making three key assumptions based on prospective ISUIA data and other recent reports: that the rate of de novo aneurysm formation is constant after the age of 20 years; that unruptured aneurysms gain volume at a constant rate; and that unruptured aneurysms rupture at a volume-dependent rate. Next, he expressed outcomes for patients with unruptured aneurysms in terms of expected number of quality-adjusted life years (QALY) and compared two hypothetical cohorts, one receiving treatment and the other not being treated. These assumptions enabled the construction of a mathematical model with epidemiologically compatible findings. The benefits of treatment for unruptured aneurysms were highly influenced by aneurysm size and were calculated as −0.28, 0.25, and 1.07 QALY for patients having unruptured aneurysms with diameters of 7, 10, and 13 mm, respectively.

Conclusions
Under the author’s assumptions, the prospective ISUIA data may be consistent with epidemiological findings. Prophylactic treatment for unruptured aneurysms may produce some benefits in large aneurysms if acceptable treatment risks can be assured, but it is not likely to offer improvement over the natural history for patients with small aneurysms.
Long-term functional results of selective peripheral neurotomy for the treatment of spastic upper limb: prospective study in 31 patients
Authors: Maarrawi Joseph , Mertens Patrick , Luaute Jacques , Vial Christophe , Chardonnet Nicole , Cosson Maryse , Sindou Marc 
Published: January 2008

Object
To manage refractory upper-limb spasticity, selective peripheral neurotomy (SPN) is proposed when the spastic muscles to be treated are under the control of a single or a few peripheral nerves. The aim of this study was to assess prospectively the long-term effects of SPN.

Methods
Thirty-one patients with disabling upper-limb spasticity were selected by a multidisciplinary team using clinical, analytical, and functional scales as well as nerve block tests for assessment. Sixty-four SPNs were performed at the level of the musculocutaneous (15 SPNs), the median (25 SPNs), and the ulnar (24 SPNs) nerves. Results of a long term follow up (mean 4.5 years) showed statistically significant improvement on 1) analytical assessment (p < 0.01): resting position, active amplitude, and motor strength; 2) Ashworth Scale scoring (p < 0.01); 3) hand function assessment (p < 0.01); and 4) rating of daily activities. Four patients with severe painful spasticity experienced complete pain relief after surgery. On the basis of a Visual Analog Scale ranging from 0 to 100, the mean degree of patient satisfaction was 61.5. Complications occurred in five patients (15%): two postoperative hematomas, one (temporary) hypesthesia, and one transient paresia of the wrist and finger flexors.

Conclusions
Selective peripheral neurotomy leads to long-term satisfactory improvement in function and/or comfort with a low morbidity rate in appropriately selected patients suffering from severe harmful spasticity of the upper limb that has been refractory to conservative therapy. Patients must be selected after complete assessment by a multidisciplinary team.
Frameless image-guided stereotactic brain biopsy procedure: diagnostic yield, surgical morbidity, and comparison with the frame-based technique
Authors: Woodworth Graeme F. , McGirt Matthew J. , Samdani Amer , Garonzik Ira , Olivi Alessandro , Weingart Jon D. 
Published: January 2008

Object
The gold standard for stereotactic brain biopsy target localization has been frame-based stereotaxy. Recently, frameless stereotactic techniques have become increasingly utilized. Few authors have evaluated this procedure, analyzed preoperative predictors of diagnostic yield, or explored the differences in diagnostic yield and morbidity rate between the frameless and frame-based techniques.

Methods
A consecutive series of 110 frameless and 160 frame-based image-guided stereotactic biopsy procedures was reviewed. Associated variables for both techniques were reviewed and compared. All stereotactic biopsy procedures were included in a risk factor analysis of nondiagnostic biopsy sampling.
Frameless stereotaxy led to a diagnostic yield of 89%, with a total permanent morbidity rate of 6% and a mortality rate of 1%. Larger lesions were fivefold more likely to yield diagnostic tissues. Deep-seated lesions were 2.7-fold less likely to yield diagnostic tissues compared with cortical lesions. Frameless compared with frame-based stereotactic biopsy procedures showed no significant differences in diagnostic yield or transient or permanent morbidity. For cortical lesions, more than one needle trajectory was required more frequently to obtain diagnostic tissues with frame-based as opposed to frameless stereotaxy, although this factor was not associated with morbidity.

Conclusions
With regard to diagnostic yield and complication rate, the frameless stereotactic biopsy procedure was found to be comparable to or better than the frame-based method. Smaller and deep-seated lesions together were risk factors for a nondiagnostic tissue yield. Frameless stereotaxy may represent a more efficient means of obtaining biopsy specimens of cortical lesions but is otherwise similar to the frame-based technique.