bluuebunny/crossref_metadata_2025_split huggingface dataset:
Syringomyelia associated with intradural arachnoid cysts
Authors: Holly Langston T. , Batzdorf Ulrich 
Published: January 2008

Object
Intradural arachnoid cysts are relatively uncommon pouches of cerebrospinal fluid (CSF) found within the subarachnoid space. The authors present a series of eight symptomatic patients in whom syrinx cavities were associated with arachnoid cysts, and they discuss treatment strategies for this entity.

Methods
The population comprised eight men whose mean age was 50 years (range 35–81 years). All patients experienced gait difficulty, and it was the chief complaint in seven; arm pain was the primary complaint in one. No patient had a history of spinal trauma, meningitis, or previous spinal surgery at the level of the syrinx cavity or arachnoid cyst. In each patient imaging revealed a syrinx cavity affecting two to 10 vertebral levels. Posterior thoracic arachnoid cysts were found in proximity to the syrinx cavity in each case. There was no evidence of cavity enhancement, Chiari malformation, tethered cord, or hydrocephalus.
All patients underwent thoracic laminectomy and resection of the arachnoid cyst wall, and postoperative neurological improvement was documented in each case. The mean follow-up duration was 19 months (range 4–37 months). Follow-up magnetic resonance imaging demonstrated the disappearance of the arachnoid cyst and a significant decrease in syrinx cavity size in each patient.

Conclusions
Spinal arachnoid cysts can be associated with syringomyelia, likely due to alterations in normal CSF dynamics. In symptomatic patients these cysts should be resected and the normal CSF flow restored. The results of the present series indicate that neurological improvement and reduction in syrinx cavity size can be achieved in patients with syringomyelia associated with intradural arachnoid cysts.
Helical TomoTherapy in the treatment of central nervous system metastasis
Authors: Baisden Joseph M. , Benedict Stanley H. , Sheng Ke , Read Paul W. , Larner James M. 
Published: January 2008

✓In this report the authors review the use of radiotherapy in the treatment of central nervous system (CNS) metastasis. They comment on different treatment methods for both intracranial and extracranial CNS metastasis and discuss some of the evidence supporting the use of radiotherapy in these settings. Recent advancements in radiation oncology technology are briefly reviewed with a focus on the advantages and disadvantages of helical TomoTherapy–based treatment strategies.
A review of pertinent current literature was performed. TomoTherapy research currently underway at the University of Virginia Health System is discussed and a representative case is presented.
Radiotherapy for CNS metastasis is an effective treatment that provides palliation of symptoms and confers a survival advantage on selected patients. Advances in radiotherapy techniques continue to improve the therapeutic ratio for patients with CNS metastases.
Helical TomoTherapy offers distinct advantages for patients with CNS metastatic disease by sparing normal tissue when intracranial or extracranial disease is targeted.
Continuous intracranial pressure monitoring via the shunt reservoir to assess suspected shunt malfunction in adults with hydrocephalus
Authors: Geocadin Romergryko G. , Varelas Panayiotis N. , Rigamonti Daniele , Williams Michael A. 
Published: January 2008

Object
The authors attempted to determine whether continuous intracrnial pressure monitoring via the shunt resevoir identifies ventriculoperitoneal (VP) shunt malfunctions that are not identified by radionuclide shunt patency study or shunt tap in adults with hydrocephalus.

Methods
During a 2-year period, 26 adults underwent 32 in-hospital continuous intracranial pressure (ICP) monitoring evaluations via needle access of a shunt reservoir. Monitoring was performed for 26.8 ± 13.8 hours (mean ± standard deviation). No ICP waveform abnormality was detected in 31% of the evaluations (10 of 32). In contrast, abnormalities were detected in 69% (22 of 32 evaluations), including B waves (nine of 22 evaluations), siphoning (nine of 22 evaluations), and variable ICP (two of 22 evaluations). In 20 (91%) of these 22 evaluations, the ICP abnormality was detected only after continuous ICP monitoring; in the other two evaluations, ICP became abnormal immediately on accessing the shunt reservoir. On the basis of the ICP monitoring results, shunt revision was performed in 66% (21 of 32 evaluations) and medical therapy was administered in 34% (11 of 32 evaluations). Shunt revision led to symptom improvement in 82% (18 of 22 patients) and no change in 18% (four of 22 patients); medical therapy led to improvement in 18% (two of 11 patients), worsening in 18% (two of 11 patients), and no change in 64% (seven of 11 patients; p < 0.05).

Conclusions
Continuous ICP monitoring via the shunt reservoir provides a more accurate assessment of shunt malfunction than transient ICP monitoring with a shunt tap or a radionuclide shunt patency study. It is a safe method for evaluating patients with suspected VP shunt malfunction, provides in vivo assessment of the effect of the shunt system on a patient's ICP, and can lead to more effective shunt revision.
Estimated incidence of normal-pressure hydrocephalus and shunt outcome in patients residing in assisted-living and extended-care facilities
Authors: Marmarou Anthony , Young Harold F. , Aygok Gunes A. 
Published: January 2008

Object
The primary objective of this study was to estimate the prevalence of idiopathic normal-pressure hydrocephalus (NPH), both diagnosed and undiagnosed, among residents of assisted-living and extended-care facilities, by using a practical screening tool. A secondary objective was to evaluate prospectively the diagnosis and outcome of surgical treatment in a subset of patients residing in healthcare facilities who were at risk for idiopathic NPH.

Methods
A retrospective chart analysis was performed using the medical records from four nursing homes. The final analysis included 147 patient records. Symptomatology and comorbidity were evaluated, as was the ability to perform activities of daily living. In a subset of 17 patients residing in healthcare facilities, the authors applied a standard idiopathic NPH diagnostic and management protocol and followed up the patients 1 year after treatment.
The estimated incidence of suspected idiopathic NPH among all patients in the retrospective survey ranged from 9 to 14%, depending on the diagnostic criteria used. Among the cohort of 17 patients available for an in-hospital study and 1-year follow up, 11 received shunts and seven of these showed either transient or sustained improvement.

Conclusions
A valid and practical diagnostic method is needed to identify idiopathic NPH accurately before admitting patients to a healthcare facility. Data from a prospective study of 17 patients residing in healthcare facilities indicated that supplementary tests remain predictive of a positive response to shunt insertion but cannot predict whether a favorable outcome will be sustained in a population of patients who have been confined to a wheelchair for a prolonged period of time. This finding supports the notion of a finite window of opportunity for successful treatment of idiopathic NPH and the imperativeness of an early diagnosis.
Effects of congenital hydrocephalus on the hypothalamic gonadotrophin-releasing hormone system
Authors: McAllister James P. , Abdolvahabi Ramin M. , Walker Marion L. , Mitchell Jerald A. , Jones Hazel C. 
Published: January 2008

Object
Despite the investigations that have linked hydrocephalus to reproductive system abnormalities, no researchers have attempted to identify the pathophysiological mechanism of this relationship. Because the role of the hypothalamic gonadotrophin-releasing hormone (GnRH) system in the regulation of reproductive functions is well established, the authors used immunohistochemical and radioimmunoassay (RIA) techniques to determine the morphological and biochemical effects of hydrocephalus on the hypothalamic GnRH system.

Methods
Hypothalamic GnRH levels, fiber density, and cell types were studied in 21- and 50-day-old control and congenitally hydrocephalic Texas rats. Results of RIA indicated a significant (8.4%) increase in GnRH in 21-day-old hydrocephalic rats (9.17 ± 0.64 pg/ng total protein) compared with that in controls (0.97 ± 0.74 pg/ng total protein). In addition, the 50-day-old hydrocephalic animals had a significantly higher level of GnRH compared with age-matched controls (20.4 pg/ng compared with 1.88 ± 2.1 pg/ng total protein). This increase was accompanied by changes in the fiber appearance and a shift from low GnRH producing cells to high GnRH producing cells in the hydrocephalic animals; however, there was no significant difference in the fiber density between the control and hydrocephalic animals at 21 days. In addition, poor neurological scores correlated with the severity of hydrocephalus.

Conclusions
These results demonstrated that hypothalamic GnRH levels are significantly affected by fetal-onset hydrocephalus and that the mechanisms responsible for these effects may take place at the cellular rather than the gross structural level. Furthermore, they suggest that impairments in the GnRH system may be protracted in neonates and infants with hydrocephalus, and thus may be overcome by relatively early treatment with ventricular diversion. However, the clinical implications of GnRH perturbations in shunt-dependent patients must await a forthcoming study in shunted animals.
Siphon regulatory devices: their role in the treatment of hydrocephalus
Authors: Kurtom Khalid H. , Magram Gary 
Published: January 2008

Object
The management of hydrocephalus can be challenging because of the unique cerebrospinal fluid (CSF) dynamics in each patient. Various shunt systems have been developed for the treatment of hydrocephalus. One of the main issues surrounding these systems is overshunting due to siphoning. In this paper the authors discuss the pathophysiology of CSF siphoning as well as the various devices used to treat this problem. The pros and cons of each device are discussed, as are the key differences among them. Future concepts are also introduced with an emphasis on upcoming device designs.

Methods
The authors performed a literature review of articles addressing CSF dynamics, shunting, and regulatory devices. The literature consisted of original research articles, company literature on each device, and patent information. A number of siphon regulatory devices have been developed over the past two decades. Each device has a distinct design, requiring specific techniques of implantation for optimal function.

Conclusions
For the past two decades, a variety of siphon regulatory devices have been used to help deal with CSF siphoning. With the increasing mobility of the population, every neurosurgeon will be seeing patients with older and newer devices. Familiarity with the various devices will assist in the evaluation and care of these patients.
Surgical approaches to paraspinal nerve sheath tumors
Authors: Cherqui Alice , Kim Daniel H. , Kim Se-Hoon , Park Hyung-Ki , Kline David G. 
Published: January 2008

Object
The goal of this study was to analyze the results of surgical treatment of paraspinal nerve sheath tumors (NSTs) and review the surgical approaches to paraspinal NSTs.

Methods
A retrospective review of the cases of paraspinal NSTs treated surgically by two senior authors during the period between 1970 and 2006 was undertaken. Surgical approaches that allow minimal disruption of normal anatomy and are aimed at complete resection of paraspinal lesions and preservation of spinal stability are reviewed according to the spinal level.

Results
Eighty-eight paraspinal NSTs were treated surgically during the period: 56 schwannomas, seven solitary neurofibromas, 21 neurofibromas associated with neurofibromatosis Type 1 (NF1), and four malignant peripheral NSTs. Schwannomas tended to occur in the cervical and thoracic areas. Neurofibromas were usually associated with NF1 and tended to occur in the cervical area. Pain (79 patients, 90%) and paresthesia (81 patients, 92%) were the predominant clinical presenting symptoms; others included weakness (28 patients) and myelopathy (12 patients). Total resection of the tumor was achieved in 50 patients (89.3%) with schwannomas and 22 patients (78.6%) with neurofibromas. There was a large reduction of pain in 70 (88.6%) of 79 patients who had preoperative pain, and weakness improved in 18 (64.3%) of 28. Postoperative transient weakness occurred in 12 (42.9% ) of these patients, but in 85% of this group, the symptom improved over a 12-month period. Myelopathy was reduced in eight (66.7%) of 12 patients. The average follow-up period was 18 months.

Conclusions
Paraspinal NSTs present unique surgical challenges given their anatomical relationships to the spine, spinal cord, nerve roots, and major vasculature. The surgical technique should take into account the location of the lesion and its relationship to paraspinal anatomy, the extent of resection, sparing of normal anatomy, and spinal instability.
Pelvic plexus tumors
Authors: Dafford Kurtus , Kim Daniel , Reid Natasha , Kline David 
Published: January 2008

Object
Pelvic plexus tumors are unusual entities. These lesions often reach significant size prior to clinical presentation due to vague lower extremity or other symptoms refractory to exhaustive workup and the potential space of the retroperitoneum.

Methods
The authors retrospectively reviewed the charts of 44 patients who presented to Louisiana State University Health Sciences Center with pelvic plexus tumors. All such patients were included in the present study if there was at least 12 months of follow-up. Clinical evaluations were examined, including typical clinical presentation, imaging studies, and other preoperative evaluations. These tumors include 38 peripheral neural sheath tumors (86%), two malignant neural sheath tumors (5%), and four nonneural sheath tumors (9%). The authors also examined the relation of pelvic neural sheath tumors to neurofibromatosis Type 1 (NF1).

Results
Histopathological examination confirmed 18 solitary neurofibromas (41%), 12 NF1-associated neurofibromas (27%), eight schwannomas (18%), two malignant nerve sheath tumors (5%), and four other nonneural sheath tumors (9%). The other nonneural sheath tumors consisted of one each of desmoid, ganglioma, lipoma, and an unspecified calcified mass.

Conclusions
The optimal treatment for retroperitoneal lesions remains operative excision with adjunctive therapy specific to the lesion encountered.
Malignant peripheral nerve sheath tumors
Authors: Gupta Gaurav , Maniker Allen 
Published: January 2008

Malignant peripheral nerve sheath tumors (MPNSTs) are rare soft tissue sarcomas of ectomesenchymal origin. The World Health Organization coined the term MPNST to replace previous heterogeneous and often confusing terminology, such as “malignant schwannoma,” “malignant neurilemmoma,” “neurogenic sarcoma,” and “neurofibrosarcoma.” Malignant peripheral nerve sheath tumors arise from major or minor peripheral nerve branches or sheaths of peripheral nerve fibers, and are derived from Schwann cells or pluripotent cells of neural crest origin.
The Schwann cell is thought to be the major contributor to the formation of benign as well as malignant neoplasms of the nerve sheath. While this fact remains essentially true, the identity of cell of origin of the MPNST remains elusive, and has not yet been conclusively identified. It has been suggested that these tumors may have multiple cell line origins. In this review, the authors discuss the epidemiology, diagnosis, management, and treatment of MPNSTs.
Pancoast tumor resection with preservation of brachial plexus and hand function
Authors: Davis Gavin A. , Knight Simon 
Published: January 2008

Object
Pancoast tumors are aggressive bronchogenic lesions of the lung apex that are rapidly fatal if untreated. Modern treatment includes induction chemotherapy and radiotherapy prior to resection, but many authors also resect the T-1 nerve root (with or without the C-8 nerve root and the lower trunk of the brachial plexus) as part of the therapy, causing significant loss of hand function in many patients. The current authors determined whether a different approach allowing preservation of the brachial plexus and hand function could be adopted without compromising patient survival. An extensive historical review of Pancoast tumors is presented as a baseline for clinical comparison.

Methods
Five patients harboring Pancoast tumors with brachial plexus involvement underwent surgery performed by both a neurosurgeon and thoracic surgeon. In all cases the tumor was resected from the brachial plexus using neurolysis while preserving the C-8 and T-1 nerve roots and lower trunk of the brachial plexus.

Results
One patient died 3 years posttreatment; the other four patients remain alive and well 2 to 5 years postoperatively. Hand function improved or remained normal in all four survivors, with postoperative intrinsic hand muscle function being Louisiana State University Medical Center Grade 5 in each patient. These results (2-year survival rate of 100%) compare favorably with the Southwest Oncology Group Data (overall 2-year survival rate of 55%; 70% in patients who had undergone complete resection). With a minimum 2-year follow-up, 80% of patients remained alive and well, with normal hand function.

Conclusions
Although this patient series is small, the findings are extremely encouraging and suggest that the described treatment paradigm preserves survival as well as hand function in patients with Pancoast tumors.
The genetic predisposition to and histogenesis of neurofibromas and neurofibrosarcoma in neurofibromatosis Type 1
Authors: Riccardi Vincent M. 
Published: January 2008

The author addresses the issue of neurofibroma classification and implications for treatment. He emphasizes the importance of understanding that not all neurofibromas are the same and that the key differences between the types of neurofibromas involve which portions of the nerve sheath contribute to the distinctive behavior of the different types of lesions.
Endoneurial neurofibromas derive from cellular elements ordinarily restricted to the endoneurium. Perineurial neurofibromas arise within individual fascicles of a nerve and are largely confined thereby, precluding a breach of the epineurium. Epineurial neurofibromas are contained only by the epineurium, and ultimately that portion of the nerve sheath is breached by these lesions.
Whether the perineurium is present or breached becomes the key element for exploiting this approach to neurofibroma origins, behaviors, and treatment, surgical and medical. With respect to surgical treatment, perineurial neurofibromas will have clean planes of dissection about the involved nerve. In contrast, endoneurial and epineurial neurofibromas infiltrate adjacent tissues, leading to surgical challenges. With respect to pharmaceutical approaches, the integrity of the perineurium is likely to prove critical: a specific function of the perineurium is to serve as a barrier to various materials, microbiological or chemical. Thus, drugs that might be effective when the perineurium is absent or rent may be less effective (or not effective at all) if the perineurium is intact, as is expected in cases of perineurial neurofibromas.
Current state of the art in the diagnosis and surgical treatment of Cushing disease: early experience with a purely endoscopic endonasal technique
Authors: Dehdashti Amir R. , Gentili Fred 
Published: January 2008

Object
Transsphenoidal pituitary surgery is the primary therapy for Cushing disease because of its potential to produce lasting remission without the need for long-term drug or hormone replacement therapy. The authors evaluated the current role of pure endoscopic endonasal pituitary surgery in the treatment of Cushing disease.

Methods
Twenty-five patients underwent pure endoscopic surgery for confirmed Cushing disease. Thirteen patients had microadenomas and seven had macroadenomas; magnetic resonance images obtained in five patients were only suspicious or nondiagnostic, and thus they underwent inferior petrosal sinus sampling. Two patients had evidence of cavernous sinus involvement. Final histological results were consistent with adrenocorticotropin hormone (ACTH)–secreting adenoma in 20 patients.

Results
Twenty patients (80%) had clinical remission and laboratory confirmation of hypocortisolemia (serum cortisol < 100 nmol/L requiring substitution therapy), suppression to low-dose dexamethasone, and normal 24-hour urinary free cortisol. The median follow-up period was 17 months (range 3–32 months). There was no recurrence at the time of the last follow-up. Three patients presented with new anterior pituitary deficiency, but no one had permanent diabetes insipidus. In one patient a cerebrospinal fluid leak developed but later resolved following lumbar drainage. Treatment failure was attributable to involvement of the cavernous sinus in two patients, incomplete tumor removal in one, negative exploration in one, and nodular corticotroph hyperplasia of the pituitary gland in one.

Conclusions
Early results indicated that endoscopic endonasal surgery is a safe and effective treatment for ACTH-producing adenomas. The rate of remission in this study is comparable to those in previous series, and the rate of major postoperative complications is extremely low. Further studies with a larger number of patients and longer follow-ups are required to determine whether this more minimally invasive pure endoscopic approach should become the standard of care for the surgical treatment of Cushing disease.
Immediate and midterm follow-up results of using an electrodetachable, fully retrievable SOLO stent system in the endovascular coil occlusion of wide-necked cerebral aneurysms
Authors: Yavuz Kivilcim , Geyik Serdar , Pamuk Almila Gulsun , Koc Osman , Saatci Isil , Cekirge H. Saruhan 
Published: January 2008

Object
Stent-assisted embolization is an alternative endovascular treatment method for wide-necked intracranial aneurysms. Currently available stents have the limitations of poor radial force, difficult delivery systems, and lack of full retrievability. The authors report on their preliminary experience with the use of a new, fully retrievable, self-expanding neurovascular stent, which has a high radial force and easy delivery system, combined with coil or Onyx embolization for the treatment of wide-necked aneurysms, including 6-month follow-up data.

Methods
Fifteen patients with 18 wide-necked intracranial aneurysms were treated using the SOLO stent system and detachable platinum coils. Aneurysms were located at the posterior communicating artery (seven lesions), midbasilar artery (one lesion), internal carotid artery (ICA) bifurcation (one lesion), ICA–ophthalmic artery segment (eight lesions), and posterior cerebral artery (one lesion). Eleven aneurysms were small, six were large, and one was giant. Only one of these aneurysms was in the acute stage of subarachnoid hemorrhage; balloon remodeling alone failed to keep the coils in the aneurysm sac.

Results
Only one stent required retrieving and repositioning after it had been fully deployed, and retrieval was easy and successful. No thromboembolic complication, dissection/rupture, or vasospasm occured during stent placement. Follow-up angiograms obtained at 6 months posttreatment in the 18 aneurysms demonstrated that all stents were patent with no evidence of intimal hyperplasia or stenosis. In all cases but one, 100% lesion occlusion was observed at the 6-month control angiography examination. Only one aneurysm had recanalized.

Conclusions
The fully retrievable self-expandible SOLO stent is a feasible, secure, and effective system with a high radial force and ease of delivery in treating wide-necked intracranial aneurysms in combination with coil embolization.