bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical management of trigeminal schwannomas
Authors: Ramina Ricardo , Mattei Tobias A. , Sória Marília G. , da Silva Erasmo B. , Leal André G. , Neto Maurício C. , Fernandes Yvens B. 
Published: November 2008

Object
The authors provide a detailed review of the surgical management of trigeminal schwannomas (TSs) and also discuss the best surgical approach based on the surgical anatomy and tumor extension.

Methods
A series of 17 patients with TSs who were surgically treated between 1987 and 2008 at the authors' institution is reported. The lesions were small (< 3 cm) in 2, medium (between 3 and 4 cm) in 5, large (> 4 cm) in 6, and giant (> 5 cm) in 4 cases. Preoperative symptoms included trigeminal hypesthesia (53%), facial pain (53%), headaches (35.3%), hearing impairment (17.6%), seizures (17.6%), diplopia (11.8%), ataxia (11.8%), and hemiparesis and increased intracranial pressure with papilledema (5.9%). The mean follow-up duration was 10.5 years (121.6 months), with an average of 0.8 patients per year.

Results
Total tumor excision was possible in 16 patients, with no surgery-related deaths. Postoperative trigeminal anesthesia was observed in 7; trigeminal motor function was preserved in 7. Two developed cerebrospinal fluid leakage, 2 presented with mild facial palsy, and 1 patient with neurofibromatosis Type 2 had recurrence of the tumor, which was uneventfully removed. Of the 9 who reported facial pain, only 1 remained symptomatic postoperatively.

Conclusions
The best treatment for TSs is complete microsurgical removal. Postoperative preservation of trigeminal nerve function is possible when resection of the lesion is performed at well-established skull base neurosurgical centers. Although good results have been reported with radiosurgery, no cure can be obtained with this therapeutic modality. Instead, this treatment should be reserved only for nonresectable and residual tumors within the cavernous sinus.
Contralateral far-lateral approach for clipping of a ruptured vertebral artery–posterior inferior cerebellar artery aneurysm
Authors: Bragg Taryn McFadden , Duckworth Edward A. M. 
Published: November 2008

Numerous nuanced approaches have been used to access posterior inferior cerebellar artery (PICA) aneurysms for microsurgical clipping. The authors report the case of a patient with a right vertebral artery (VA)–PICA aneurysm that was reached via a contralateral far-lateral approach. The wide-necked saccular/fusiform aneurysm arose from the lateral aspect of the right V4 segment just proximal to the PICA origin, anterior to the jugular tubercle at the level of the hypoglossal canal. Computed tomography angiograms demonstrated the size and configuration of the aneurysm, and 3D reconstructions revealed the tortuosity of the right VA, defining its location just left of the midline adjacent to the lower clivus.
A contralateral far-lateral approach to VA–PICA aneurysms should be considered when aneurysms cross the midline. Computed tomography angiography with volume rendering and interactive software capabilities can help identify the relationship of such an aneurysm to an individual's particular skull base osseous anatomy and is paramount in selecting the optimal microsurgical approach.
Conversion of external ventricular drains to ventriculoperitoneal shunts after aneurysmal subarachnoid hemorrhage: effects of site and protein/red blood cell counts on shunt infection and malfunction
Authors: Rammos Stylianos , Klopfenstein Jeffrey , Augsburger Lori , Wang Huan , Wagenbach Anne , Poston Jennifer , Lanzino Giuseppe 
Published: November 2008

Object
The purpose of this study was to determine the incidence of shunt infection in patients with subarachnoid hemorrhage (SAH) after converting an external ventricular drain (EVD) to a ventriculoperitoneal (VP) shunt using the existing EVD site. The second purpose was to assess the risk of shunt malfunction after converting the EVD to a permanent shunt irrespective of the cerebrospinal fluid (CSF) protein and red blood cell (RBC) counts.

Methods
Data obtained in 80 consecutive adult patients (18 men and 62 women, mean age 60.8 years, range 33–85 years) who underwent direct conversion of an EVD to a VP shunt for post-SAH hydrocephalus between August 2002 and March 2007 were retrospectively reviewed. In each patient, the existing EVD site was used to pass the proximal shunt catheter. In no patient was VP shunt insertion delayed based on preoperative RBC or protein counts.

Results
The mean period of external ventricular drainage before VP shunt placement was 14.1 days (range 3–45 days). No patient suffered ventriculitis. The mean perioperative CSF protein level was 124 mg/dl (range 17–516 mg/dl). The mean and median perioperative RBC values in CSF were 14,203 RBCs/mm3 and 4600 RBCs/mm3 (range 119–290,000/mm3), respectively. No patient was lost to follow-up. The mean follow-up duration was 24 months (range 2–53 months). Three patients (3.8%) had shunt malfunction related to obstruction of the shunt system after 15 days, 2 months, and 18 months, respectively. There were no shunt-related infections. No patient suffered a clinically significant hemorrhage from ventricular catheter placement after VP shunt insertion.

Conclusions
In adult patients with aneurysmal SAH, conversion of an EVD to a VP shunt can be safely done using the same EVD site. In this defined patient population, protein and RBC counts in the CSF do not seem to affect shunt survival adversely. Thus, conversion of an EVD to VP shunt should not be delayed because of an elevated protein or RBC count.
Clipping of very large or giant unruptured intracranial aneurysms in the anterior circulation: an outcome study
Authors: Hauck Erik F. , Wohlfeld Bryan , Welch Babu Guai , White Jonathan A. , Samson Duke 
Published: November 2008

Object
Patients with very large or giant unruptured intracranial aneurysms present with ischemic stroke and progressive disability. The aneurysm rupture risk in these patients is extreme—up to 50% in 5 years. In this study the authors investigated the outcome of surgical treatment for these very large aneurysms in the anterior circulation.

Methods
Clinical data on 62 patients who underwent surgery for unruptured aneurysms (20–60 mm) between 1998 and 2006 were reviewed.

Results
Complete aneurysm occlusion (100%) was achieved in 90% of cases, near complete occlusion (90–99%) in 5%. The surgical risk in patients younger than 50 years of age was 8% (Glasgow Outcome Scale score of 1 or 3 within 1 year after surgery). In older patients, the risk increased with advancing age.

Conclusions
The treatment of very large or giant unruptured intracranial aneurysms is hazardous and complex and thus best performed only at major cerebrovascular centers with an experienced team of neurosurgeons, interventional neuroradiologists, neurologists, and neuroanesthesiologists. Surgery, with acceptable risks and excellent occlusion rates, is typically the treatment of choice in patients younger than 50 years of age. In older patients, the benefits of endovascular treatment versus surgery versus no treatment must be carefully weighed individually. Minimizing temporary occlusion and the consequent use of intraoperative angiography may help reduce surgical complications.
Brain oxygen tension and outcome in patients with aneurysmal subarachnoid hemorrhage
Authors: Ramakrishna Rohan , Stiefel Michael , Udoteuk Joshua , Spiotta Alejandro , Levine Joshua M. , Kofke W. Andrew , Zager Eric , Yang Wei , LeRoux Peter 
Published: November 2008

Object
Poor outcome is common after aneurysmal subarachnoid hemorrhage (SAH). Clinical studies suggest that cerebral hypoxia after traumatic brain injury is associated with poor outcome. In this study we examined the relationship between brain oxygen tension (PbtO2) and death after aneurysmal SAH.

Methods
Forty-six patients, including 34 women and 12 men (Glasgow Coma Scale Score ≤ 8 and median age 58.5 years) who underwent PbtO2 monitoring were studied prospectively during a 2-year period in a neurosurgical intensive care unit at a University Level I Trauma Center. Brain oxygen tension, intracranial pressure (ICP), mean arterial pressure, cerebral perfusion pressure (CPP), and brain temperature were continuously monitored, and treatment was directed toward ICP, CPP, and PbtO2 targets. The relationship between PbtO2 and 1-month survival was examined.

Results
Data were available from 5424 hours of PbtO2 monitoring. For the entire cohort the mean ICP, CPP, and PbtO2 were 13.85 ± 2.40, 84.05 ± 3.41, and 30.79 ± 1.91 mm Hg, respectively. Twenty-five patients died (54%). The mean daily PbtO2 was higher in survivors than nonsurvivors (33.94 ± 2.74 vs 28.14 ± 2.59 mm Hg; p = 0.05). In addition, survivors had significantly shorter episodes of compromised PbtO2 (defined as 15–25 mm Hg) than nonsurvivors (125.85 ± 15.44 vs 271.14 ± 55.23 minutes; p < 0.01). Intracranial pressure was similar in survivors and nonsurvivors. In contrast, the average CPP was significantly lower in nonsurvivors than survivors (76.96 ± 5.50 vs 92.49 ± 2.75 mm Hg; p = 0.01). When PbtO2 was stratified according to CPP level, survivors had higher PbtO2 levels. Following logistic regression, the number of episodes of compromised PbtO2 (odds ratio 1.1, 95% confidence interval 1.003–1.2) and number of episodes of cerebral hypoxia (< 15 mm Hg; odds ratio 1.3, 95% confidence interval 1.0–1.7) were more frequent in those who died.

Conclusions
Patient deaths after SAH may be associated with a lower mean PbtO2 and longer periods of compromised cerebral oxygenation than in survivors. This knowledge may be used to help direct therapy.
In vivo assessment of rapid cerebrovascular morphological adaptation following acute blood flow increase
Authors: Hoi Yiemeng , Gao Ling , Tremmel Markus , Paluch Rocco A. , Siddiqui Adnan H. , Meng Hui , Mocco J 
Published: November 2008

Object
Pathological extremes in cerebrovascular remodeling may contribute to basilar artery (BA) dolichoectasia and fusiform aneurysm development. Factors regulating cerebrovascular remodeling are poorly understood. To better understand hemodynamic influences on cerebrovascular remodeling, we examined BA remodeling following common carotid artery (CCA) ligation in an animal model.

Methods
Rabbits were subjected to sham surgery (3 animals), unilateral CCA ligation (3 animals), or bilateral CCA ligation (5 animals). Transcranial Doppler ultrasonography and rotational angiography were used to compute BA flow, diameter, wall shear stress (WSS), and a tortuosity index on Days 0, 1, 4, 7, 14, 28, 56, and 84. Basilar artery tissues were stained and analyzed at Day 84. Statistical analysis was performed using orthogonal contrast analysis, repeated measures analysis of variance, or mixed regression analysis of repeated measures. Statistical significance was defined as a probability value < 0.05.

Results
Basilar artery flow and diameter increased significantly after the procedure in both ligation groups, but only the bilateral CCA ligation group demonstrated significant differences between groups. Wall shear stress significantly increased only in animals in the bilateral CCA ligation group and returned to baseline by Day 28, with 52% of WSS correction occurring by Day 7. Only the bilateral CCA ligation group developed significant BA tortuosity, occurring within 7 days postligation. Unlike the animals in the sham and unilateral CCA ligation groups, the animals in the bilateral CCA ligation group had histological staining results showing a substantial internal elastic lamina fragmentation.

Conclusions
Increased BA flow results in adaptive BA remodeling until WSS returns to physiological baseline levels. Morphological changes occur rapidly following flow alteration and do not require chronic insult to affect substantial and significant structural transformation. Additionally, it appears that there exists a flow-increase threshold that, when surpassed, results in significant tortuosity.
Endothelial molecular changes in a rodent model of arteriovenous malformation
Authors: Karunanyaka Athula , Tu Jian , Watling Amy , Storer Kingsley P. , Windsor Apsara , Stoodley Marcus A. 
Published: November 2008

Object
The cellular and molecular processes underlying arteriovenous malformation (AVM) development and response to radiosurgery are largely unknown. An animal model mimicking the molecular properties of AVMs is required to examine these processses. This study was performed to determine whether the endothelial molecular changes in an animal model of arteriovenous fistula (AVF) are similar to those in human AVMs.

Methods
Arteriovenous fistulas were created in 18 Sprague–Dawley rats by end-to-side anastomosis of the left jugular vein to the common carotid artery creating a model “nidus” of arterialized branching veins that coalesce into a “draining vein” (sigmoid sinus). Six control animals underwent sham operations.

Results
After 1 or 3 days, or 1, 3, 6, or 12 weeks, fresh-frozen sections of the fistula, nidus vessels, and contralateral vessels were studied immunohistochemically for thrombomodulin, von Willebrand factor, E-selectin, P-selectin, and vascular endothelial growth factor.

Conclusions
The AVF model has a “nidus” with endothelial molecular changes similar to those observed in human AVMs, supporting its use as a model for studying the effects of radiosurgery on AVMs.
Surgical construction of a novel simulated carotid siphon in dogs
Authors: Tan Hua-Qiao , Li Ming-Hua , Zhu Yue-Qi , Fang Chun , Wu Chun-Geng , Cheng Ying-Sheng , Wang Jue , Xie Jian , Zhang He 
Published: November 2008

Object
The development and preclinical assessment of new endovascular devices necessitate readily available and reproducible animal models. The purpose of this study was to develop an in vivo carotid siphon model for testing the properties of covered stents specially designed for the intracranial vasculature.

Methods
Six carotid siphon–shaped devices were created. Six dogs underwent surgery to expose and isolate both common carotid arteries (CCAs). The right CCA origin was ligated and incised distal to the ligation point after temporary constriction of the distal right CCA. The distal left CCA was ligated and incised proximal to the ligation point after the left CCA origin was temporarily clamped. The proximal isolated left CCA was passed through the shaped device and then anastomosed end-to-end to the distal isolated right CCA. Finally, the shaped device was fixed and embedded in the neck. Intraarterial digital subtraction angiography was performed at 7 days, 2 weeks, and 1 month postprocedure. All models underwent endovascular interventional simulation. The carotid siphon models were evaluated.

Results
The animals tolerated the surgical procedure well. The mean time for surgical construction of the model was 90 minutes. The morphology and endovascular manipulation of the siphon models were similar to those in humans. Stenosis of anastomotic stoma occurred in 2 models, and mural thrombosis of anastomotic stoma occurred in 1 model; however, all models were patent at postprocedural follow-up angiography.

Conclusions
Surgical construction of an in vivo carotid siphon model in dogs with carotid siphon–shaped devices is feasible and potentially useful for testing neurovascular devices.
Circumferential fusion for cervical kyphotic deformity
Authors: Mummaneni Praveen V. , Dhall Sanjay S. , Rodts Gerald E. , Haid Regis W. 
Published: November 2008

ObjectThe treatment of cervical kyphotic deformity is challenging. Few prior reports have examined combined anterior/posterior correction methods, and fusion rates and standardized outcomes are rarely cited in literature examining these techniques. The authors present their midterm results with cervical kyphosis correction.MethodsThe authors retrospectively reviewed the charts of 30 patients with cervical kyphotic deformity who underwent circumferential spine surgery between 2001 and 2007. The causes of the deformity included chronic fracture in 17 patients, degenerative disease in 10, and tumor in 3. Anterior procedures included discectomies and corpectomies/osteotomies at 1 or more levels with fusion. Posterior operations included decompression and/or osteotomies with lateral mass or pedicle fixation. Preoperative and postoperative Ishihara kyphosis indices, modified Japanese Orthopaedic Association (mJOA) scores, and Nurick grades were analyzed. Arthrodesis was assessed via dynamic radiographs, and CT scans were used to assess fusion in questionable cases.ResultsOne patient was lost to follow-up. Two patients died within 1 month of surgery. The follow-up period in the remaining 27 patients ranged from 1 to 6.4 years (mean 2.6 years). Ishihara indices improved from a preoperative mean of −17.7 to a postoperative mean of +11.4. The mean Nurick grades improved from 3.2 preoperatively to 1.3 postoperatively. The mJOA scores improved from a preoperative mean of 10 to 15 postoperatively. All surviving patients who underwent follow-up showed postoperative fusion except 1 patient with renal failure and osteoporosis (95% fusion rate). The overall rate of complications (major and minor) was 33.3%.ConclusionsIn cases of cervical kyphosis, management with decompression, osteotomy, and stabilization from both anterior and posterior approaches can restore cervical lordosis. Furthermore, such surgical techniques can produce measurable improvements in neurological function (as measured with Nurick grades and mJOA scores) and achieve high fusion rates. However, there is a significant rate of complications.
Spatially distributed temperatures at the base of two mountain snowpacks measured with fiber-optic sensors
Authors: Tyler Scott W. , Burak Susan A. , McNamara James P. , Lamontagne Aurele , Selker John S. , Dozier Jeff 
Published: November 2008

AbstractSnowpack base temperatures vary during accumulation and diurnally. Their measurement provides insight into physical, biological and chemical processes occurring at the snow/soil interface. Recent advances in Raman-spectra instruments, which use the scattered light in a standard telecommunications fiber-optic cable to infer absolute temperature along the entire length of the fiber, offer a unique opportunity to obtain basal snow temperatures at resolutions of 1 m, 10 s and 0.1°C. Measurements along a 330 m fiber over 24 hours during late-spring snowmelt at Mammoth Mountain, California, USA, showed basal snow temperatures of 0 ± 0.2°C using 10 s averages. Where the fiber-optic cable traversed bare ground, surface temperatures approached 40°C during midday. The durability of the fiber optic was excellent; no major damage or breaks occurred through the winter of burial. Data from the Dry Creek experimental watershed in Idaho across a small stream valley showed little variability of temperature on the northeast-facing, snow-covered slope, but clearly showed melting patterns and the effects of solar heating on southwest-facing slopes. These proof-of-concept experiments show that the technology enables more detailed spatial and temporal coverage than traditional point measurements of temperature.
Synchronous retreat and acceleration of southeast Greenland outlet glaciers 2000–06: ice dynamics and coupling to climate
Authors: Howat Ian M. , Joughin Ian , Fahnestock Mark , Smith Benjamin E. , Scambos Ted A. 
Published: November 2008

AbstractA large portion of the recent increase in the rate of mass loss from the Greenland ice sheet is from increased outlet glacier discharge along its southeastern margin. While previous investigations of the region’s two largest glaciers suggest that acceleration is a dynamic response to thinning and retreat of the calving front, it is unknown whether this mechanism can explain regional acceleration and what forcing is responsible for initiating rapid thinning and retreat. We examine seasonal and interannual changes in ice-front position, surface elevation and flow speed for 32 glaciers along the southeastern coast between 2000 and 2006. While substantial seasonality in front position and speed is apparent, nearly all the observed glaciers show net retreat, thinning and acceleration, with speed-up corresponding to retreat. The ratio of retreat to the along-flow stress-coupling length is proportional to the relative increase in speed, consistent with typical ice-flow and sliding laws. This affirms that speed-up results from loss of resistive stress at the front during retreat, which leads to along-flow stress transfer. Large retreats were often preceded by the formation of a flat or reverse-sloped surface near the front, indicating that subsequent retreats were influenced by the reversed bed slope. Many retreats began with an increase in thinning rates near the front in the summer of 2003, a year of record high coastal-air and sea-surface temperatures. This anomaly was driven in part by recent warming, suggesting that episodes of speed-up and retreat may become more common in a warmer climate.
Genome scan in sibling pairs with juvenile‐onset mood disorders: Evidence for linkage to 13q and Xq
Authors: Wigg Karen , Feng Yu , Gomez Lissette , Kiss Eniko , Kapornai Krisztina , Tamás Zsuzsa , Mayer László , Baji Ildikó , Daróczi Gabriella , Benák István , Osváth Viola Kothencné , Dombovári Edit , Kaczvinszk Emília , Besnyő Márta , Gádoros Julia , King Nicole , Székely Judit , Kovacs Maria , Vetró Ágnes , Kennedy James L. , Barr Cathy L. 
Published: November 2008

AbstractMood disorders (bipolar and depressive disorders) in children and adolescents are associated with significant morbidity and mortality. Twin and family studies, for the most part, indicate higher familiality and heritability for mood disorders that onset in childhood/adolescence than those that onset in adulthood. To identify the genetic contribution to mood disorders that onset in childhood/adolescence, we performed a genome scan on 146 nuclear families from Hungary containing an affected proband and affected siblings. In total, the pedigrees contained 303 affected children: 146 probands, 137 siblings with a first episode of mood disorder before 14.9 years of age, and 20 siblings with onset of their first episode after 14.9 years of age but before the age of 18. The results of the genome scan using 405 microsatellite markers did not provide evidence for linkage at the recommended genome wide significance level for any novel loci. However, markers on two chromosomes, 13q and Xq, provided evidence for linkage in regions previously identified as linked to bipolar disorder in multiple studies. For the marker on chromosome 13q the peak non‐parametric multipoint LOD score was at the marker D13S779 (LOD = 1.5, P = 0.004). On chromosome Xq, evidence for linkage was observed across a large region spanning two regions previously linked to bipolar disorder; Xq24 to Xq28, with a peak at marker TTTA062 (LOD 2.10, P = 0.0009) in Xq28. Results for these regions exceed the recommended P‐value for a replication study of P < 0.01 and thus provide evidence for these two loci as contributing to mood disorders with juvenile onset. © 2008 Wiley‐Liss, Inc.