bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of anterior odontoid screw fixation in elderly patients with Type II odontoid fractures
Authors: Harrop James S. , Przybylski Gregory J. , Vaccaro Alexander R. , Yalamanchili Kennedy 
Published: January 2008

Object
Type II odontoid fractures are the most common trauma-related dens fracture. Although Type III odontoid fractures have a high union rate when external immobilization is applied, Type II fractures are associated with high rates of nonunion, particularly in elderly patients and those with posteriorly displaced fractures or fractures displaced by more than 6 mm. Because elderly patients may not also tolerate external immobilization in a halo vest, alternative techniques should be explored to identify a method for managing these higher-risk patients. In this study the authors examine the efficacy of anterior odontoid screw fixation in a high-risk group of 10 elderly patients (> 65 years of age) treated for Type II odontoid fractures.

Methods
A retrospective review of all patients with Type II odontoid fractures treated at two institutions between September 1997 and March 2000 was performed. Demographic data, neurological examination, fracture type and degree of displacement, treatment method, and outcome data were examined at discharge. Ten patients older than 65 years who had sustained a trauma-related odontoid fracture and had undergone an anterior odontoid screw placement procedure were retrospectively reviewed. Fracture displacement (mean 6.6 mm) was observed in all but one patient, and in seven there were posteriorly displaced fractures. Seven were successfully treated with anterior screw fixation and external orthosis alone; in one patient in whom poor intraoperative screw purchase had been observed, the fracture healed after undergoing halo vest therapy. Only one patient was shown to develop a nonunion requiring a subsequent posterior fusion procedure.

Conclusions
Odontoid screw fixation can be safely performed in elderly patients, and frequent bone union is demonstrated. However, osteopenia may preclude adequate screw fixation in some patients.
Cerebrospinal fluid volume depletion and its emerging clinical/imaging syndromes
Authors: Mokri Bahram 
Published: January 2008

Cerebrospinal fluid (CSF) volume depletion, due to CSF leakage or CSF shunt overdrainage, is typically indicated when patients present with orthostatic headaches, with or without several other symptoms: neck or interscapular pain, nausea, emesis, diplopia, changes in hearing, visual blurring, facial numbness or weakness, and radicular upper-limb symptoms. Cerebrospinal fluid pressures typically are quite low and head magnetic resonance images typically reveal diffuse pachy-meningeal gadolinium enhancement, with or without evidence of sagging of the brain and less frequently with subdural fluid collections, enlarged cerebral venous sinuses or pituitary gland or decreased ventricular size.
Magnetic resonance imaging has revolutionized detection of spontaneous CSF leaks, leading to identification of far more cases and recognition of several clinical/imaging forms of presentation of the disorder. These forms, which are different from the “typical” presentation, include a group with consistently normal CSF pressures (normal pressure), another group without abnormal meningeal enhancement (normal meninges), and a group without headache (acephalic). Each of these forms can be seen in a setting of documented and ongoing CSF volume depletion. Awareness of CSF volume depletion is increasing, and its clinical and imaging spectrum is broadening.
Stereotactic radiosurgery in patients with multiple brain metastases
Authors: Chang Steven D. , Lee Elizabeth , Sakamoto Gordon T. , Brown Nalani P. , Adler John R. 
Published: January 2008

Object
Patients with multiple brain metastases are often treated primarily with fractionated whole-brain radiation therapy (WBRT). In previous reports the authors have shown that patients with four or fewer brain metastases can benefit from stereotactic radiosurgery in addition to fractionated WBRT. In this paper the authors review their experience using linear accelerator stereotactic radiosurgery to treat patients with multiple brain metastases.

Methods
Fifty-three patients with 149 brain metastases underwent stereotactic radiosurgery. The mean age of patients was 53.1 years (range 20–78 years). There were 23 men and 30 women. The primary tumor location was lung (27 patients), melanoma (10), breast (six), ovary (six), and other (four). All patients harbored at least two metastatic tumors treated with radiosurgery; 27 patients (51%) harbored two lesions, 17 (32%) three lesions, eight (15%) four lesions, and one patient (2%) harbored five lesions. The mean radiation dose administered was 19.6 Gy (range 14–30 Gy), and the mean secondary collimator size was 15.7 mm (range 7.5–40 mm). One hundred thirty-two (89%) of the 149 treated tumors were available for review on magnetic resonance (MR) imaging at 3 months posttreatment. Fifty-two percent were smaller in size, 31% were stable, 9% had increased in size, and 8% had disappeared. New metastatic tumors appeared in 12 (23%) of the 53 patients on MR imaging within 6 months posttreatment. Radiation-induced necrosis occurred at the site of eight (5.4%) of the 149 tumors at 6 months. Seven tumors (4.7%) subsequently required surgical resection for either tumor progression (four cases) or worsening edema from radiation-induced necrosis (three cases). Median actuarial survival was 9.6 months.

Conclusions
Stereotactic radiosurgery can be used to treat patients with up to four brain metastases with a 91% rate of either decrease or stabilization in tumor size and a low rate of radiation-induced necrosis. In the authors' study only a small number of patients subsequently required surgical resection of a treated lesion.
Endoscopic thoracic discectomy
Authors: Patrick Johnson J. , Filler Aaron G. , McBride Duncan Q. 
Published: January 2008

Object
Thoracoscopic discectomy is a minimally invasive procedure simulating a thoracotomy and is an alternative to the costotransversectomy and transpedicular approaches. In recent studies authors have concluded that thoracoscopic discectomy is the preferred procedure; however, relative historical comparisons were difficult to interpret.
The authors conducted a prospective nonrandomized study in which they compared data on 36 patients undergoing thoracoscopic discectomy with eight patients undergoing thoracotomy between 1995 and 1999.

Methods
Patients affected with one- or two-level lesions underwent a thoracoscopic discectomy, and patients with three-level lesions or more underwent thoracotomy and discectomy. Data were collected on operative time, blood loss, chest tube duration, narcotic agent use, and hospital length of stay (LOS). Longer-term follow-up study of pain-related symptoms and neurological function was conducted.
Patients who underwent thoracoscopic discectomy had shorter operative times, less blood loss, a shorter period of chest tube drainage dependence, less narcotic usage, and a shorter LOS. These findings were statistically significant (p < 0.05) for narcotic usage and shorter LOS. Pain related to radiculopathy was improved by means of 75%, and no patients exprienced worsened pain. In patients with myelopathy there was an improvement of two Frankel grades in the thoracoscopic group and one Frankel grade in the thoracotomy discectomy group, but patients in the thoracotomy group were significantly worse preoperatively. One myelopathic patient from each group suffered a worsened outcome postoperatively, although this was not attributed to the method of surgery. The incidence of complications (minor and major) was 31% in the thoracoscopic group and greater than 100% (that is, more than one complication per patient) in the thoracotomy/discectomy group.

Conclusions
One advantage to thoracoscopic discectomy is its reduced incidence of morbidity compared with thoractomy, but its steep learning curve and unfamiliar surgical techniques make this procedure less practical for surgeons not performing it frequently. The more familiar costotransversectomy, transpedicular, and thoracotomy procedures remain viable alternatives for surgeons more experienced in these procedures.
Treatment of thoracic disc herniation: evolution toward the minimally invasive thoracoscopic technique
Authors: Burke Timothy G. , Caputy Anthony J. 
Published: January 2008

Thoracic disc herniation has always carried with it the potential for serious adverse neurological consequences if not treated appropriately. The authors review the historical evolution of treatment for thoracic disc herniation from the early surgical series using dorsal approaches (which were known to involve a significant risk of paraplegia) to later surgical series in which lateral and then ventral approaches to the disc were increasingly emphasized, with significant improvement in patient outcome.
The evolution of minimally invasive thoracoscopic techniques is discussed, together with the results of several surgical series demonstrating significant reductions in morbidity compared with more traditional methods. The technique of thoracoscopic discectomy is presented in detail.
Adoptive immunotherapy in patients with recurrent malignant glioma: preliminary results of using autologous whole-tumor vaccine plus granulocyte-macrophage colony–stimulating factor and adoptive transfer of anti-CD3–activated lymphocytes
Authors: Sloan Andrew E. , Dansey Roger , Zamorano Lucia , Barger Geoffrey , Hamm Caroline , Diaz Fernando , Baynes Roy , Wood Gary 
Published: January 2008

Object
This trial was designed to determine the ability of autologous whole–tumor cell vaccines to induce cell-mediated immune responses in patients with recurrent malignant glioma, as well as to determine whether combining such vaccination with adoptive transfer of in vitro activated T lymphocytes prolongs patient survival.

Methods
Nineteen patients with recurrent malignant glioma, in whom previous external beam radiotherapy and at least one course of chemotherapy had failed were vaccinated twice with irradiated autologous whole tumor cells by using granulocyte-marcrophage colony–stimulating factor as an adjuvant. Patients then underwent leukapheresis followed by adoptive transfer of peripheral blood lymphocytes activated in vitro with anti-CD3 and interleukin-2. In vivo immune response, radiological response, clinical outcome, and survival were monitored.
Seventeen patients developed a delayed-type hypersensitivity (DTH) response to vaccination that appeared to be directed against the autologous tumor. In eight patients there was radiological evidence of a response and in five there was evidence of clinical improvement. Median survival was 12 months (range 6–28 months), and both the presence of a DTH response and the radiological response correlated with survival (p < 0.02 and p < 0.04, respectively).

Conclusions
These preliminary results suggest that autologous whole–tumor cell vaccines induce a cell-mediated immune response, which appears to be tumor specific in most patients. Furthermore, vaccination combined with adoptive immunotherapy with in vitro activated cells may induce a radiologically demonstrated tumor response and improved survival despite a condition of advanced disease and immunosuppression resulting from previous treatment or tumor burden. Further studies of immunotherapy are warranted.
Subgaleal shunting: A 20-year experience
Authors: Savitz Martin H. , Malis Leonard I. 
Published: January 2008

Object
The authors undertook a retropective study to evaluate the effectiveness of diverting intracranial fluid into the subgaleal space for temporary absorption by the membranes of the scalp.

Methods
Eighty-one patients were treated over a 20-year period. There were 22 cases of hypertensive hydrocephalus, 52 cases of acute head trauma, and seven cases of chronic subdural hematoma. The simple surgical technique is described.
Subgaleal shunting provided effective short-term treatment of hydrocephalus and increased intracranial pressure, which was monitored directly in 22 cases of cerebral contusion and edema.

Conclusions
The closed method for drainage of cerebrospinal fluid avoids the complications of open ventriculostomy or open drainage of the subdural space.
Practice parameters for the management of single brain metastasis
Authors: Rock Jack P. , Haines Stephen , Recht Lawrence , Bernstein Mark , Sawaya Raymond , Mikkelsen Tom , Loeffler Jay 
Published: January 2008

Object
In January 1998 the Guidelines and Outcomes Committee of the American Association of Neurological Surgeons (AANS) issued a charge for the development of evidence-based practice parameters focusing on the treatment of patients with single metastasis to the brain. The charge was imposed in response to the significant controversy surrounding questions relating to the optimal management strategies for patients with single brain metastasis.

Methods
A team consisting of physicians from the AANS, the American Academy of Neurology, and the American Association of Therapeutic Radiation Oncology convened and the literature was reviewed. Methodically drawing from the best of Class I, II, and III levels of available evidence, authors sought to determine how the literature addressed and disposed of the question of the optimal management for an adult with a known history of cancer and a single meta-static brain lesion. Framing the question in this specific manner allowed researchers to focus directly on treatment issues, without having to consider diagnostic issues.

Conclusions
The results of the evidence-based analysis demonstrated that there was insufficient information to establish standards of care. Data from the literature does, however, support a guideline stating that surgical resection accompanied by whole brain radiation therapy is associated with the best survival rate. Additional lower-quality evidence supports an option for management with radiosurgery.
Recombinant adenovirus-transduced dendritic cell immunization in a murine model of central nervous system tumor
Authors: Broder Howard , Anderson Andrea , Odesa Sylvia K. , Kremen Thomas J. , Liau Linda M. 
Published: January 2008

Object
Dendritic cells (DCs) are potent antigen-presenting cells that have been shown to play a critical role in the initiation of host immune responses against tumor antigens. In this study, a recombinant adenovirus vector encoding the melanoma-associated antigen, MART-1, was used to transduce murine DCs, which were then tested for their ability to activate cytotoxic T lymphocytes (CTLs) and induce protective immunity against B16 melanoma tumor cells implanted intracranially.

Methods
Genetic modification of murine bone marrrow–derived DCs to express MART-1 was achieved through the use of an E1-deficient, recombinant adenovirus vector (AdVMART1). Sixty-two C57BL/6 mice were immunized by subcutaneous injection of AdVMART-1-transduced DCs (23 mice), untransduced DCs (17 mice), or sterile saline (22 mice). Using the B16 murine melanoma, which naturally expresses the MART-1 antigen, all the mice were then challenged intracranially with viable, unmodified syngeneic B16 tumor cells 7 days later. Splenocytes obtained from representative animals in each group were harvested for standard cytotoxicity and enzyme-linked immunospot assays. The remaining mice were followed for survival.
Immunization of C57BL/6 mice with DCs transduced with AdVMART1-DC elicited the development of antigen-specific CTL responses. As evidenced by a prolonged survival curve when compared with control-immunized mice harboring intracranial B16 tumors, AdMART1-DC vaccination was able to elicit partial protection against central nervous system (CNS) tumor challenge in vivo. However, this CNS antitumor immunity was weaker than that previously demonstrated against subcutaneous B16 tumors in which the same vaccination strategy was used.

Conclusions
These data suggest that immune responses generated against CNS tumors by DC-based vaccines may be different from those obtained against subcutaneous tumors.
Comparison of intraoperative MR imaging and 3D-navigated ultrasonography in the detection and resection control of lesions
Authors: Tronnier Volker M. , Bonsanto Matteo M. , Staubert Andreas , Knauth Michael , Kunze Stefan , Wirtz Christian R. 
Published: January 2008

Object
The authors undertook a study to compare two intraoperative imaging modalities, low-field magnetic resonance (MR) imaging and a prototype of a three-dimensional (3D)–navigated ultrasonography in terms of imaging quality in lesion detection and intraoperative resection control.

Methods
Low-field MR imaging was used for intraoperative resection control and update of navigational data in 101 patients with supratentorial gliomas. Thirty-five patients with different lesions underwent surgery in which the prototype of a 3D-navigated ultrasonography system was used. A prospective comparative study of both intraoperative imaging modalities was initiated with the first seven cases presented here.
In 35 patients (70%) in whom ultrasonography was performed, accurate tumor delineation was demonstrated prior to tumor resection. In the remaining 30% comparison of preoperative MR imaging data and ultrasonography data allowed sufficient anatomical localization to be achieved. Detection of metastases and high-grade gliomas and intra-operative delineation of tumor remnants were comparable between both imaging modalities. In one case of a low-grade glioma better visibility was achieved with ultrasonography. However, intraoperative findings after resection were still difficult to interpret with ultrasonography alone most likely due to the beginning of a learning curve.

Conclusions
Based on these preliminary results, intraoperative MR imaging remains superior to intraoperative ultrasonography in terms of resection control in glioma surgery. Nevertheless, the different features (different planes of slices, any-plane slicing, and creation of a 3D volume and matching of images) of this new ultrasonography system make this tool a very attractive alternative. The intended study of both imaging modalities will hopefully allow a comparison regarding sensitivity and specificity of intraoperative tumor remnant detection, as well as cost effectiveness.
Intraoperative microvascular Doppler monitoring of blood flow within a spinal dural arteriovenous fistula: a precious surgical tool
Authors: Iacopino Domenico Gerardo , Giusa Maria , Conti Alfredo , Cardali Salvatore , Tomasello Francesco 
Published: January 2008

The authors describe a case of spinal arteriovenous fistula (AVF) treated by a microvauscular Doppler–assisted surgical interruption of the arterialized vein. Microvascular Doppler monitoring represents a valid, widely available, non-invasive tool that enables identification, through flow spectrum analysis, of components of this type of vascular malformation. In this case because the location of the fistula was identified prior to opening the dura only minimally invasive surgery was required. Direct recordings of the arterialized draining vein and the nidus of the fistula demonstrated a pathological spectrum caused by the arterial supply and the disturbed venous outflow in which a high-resistance flow pattern and low diastolic flow resembling an arterial-like flow velocity were observed. The fistula was obliterated by interruption of the draining vein, and Doppler measurements provided information on flow velocity changes in the medullary veins from an arterial to a venous pattern. The absence of any residual flow in the AVF confirmed successful hemodynamic treatment.
Intraoperative microvascular Doppler recording during surgical closure of spinal AVF is a widely available and reliable monitoring modality that helps to produce excellent clinical results.
Influence of early posttraumatic hypothermia therapy on local cerebral blood flow and glucose metabolism after fluid-percussion brain injury
Authors: Zhao Weizhao , Alonso Ofelia F. , Loor Judith Y. , Busto Raul , Ginsberg Myron D. 
Published: January 2008

Object
Using autoradiographic image averaging, the authors recently described prominent foci of marked glucose metabolism-greater-than-blood-flow uncoupling in the acutely traumatized rat brain. Because hypothermia is known to ameliorate injury in this and other injury models, the authors designed the present study to assess the effects of post-traumatic therapeutic hypothermia on the local cerebral metabolic rate of glucose (LCMRglu) and local cerebral blood flow (LCBF) following moderate parasagittal fluid-percussion head injury (FPI) in rats.

Methods
Either cranial hypothermia (30°C) or normothermia (37°C) was induced for 3 hours in matched groups of rats immediately after FPI; LCMRglu and LCBF were assessed 3 hours after concluding these temperature manipulations.
In rats subjected to FPI, regardless of whether normothermia or hypothermia ensued, LCBF was reduced relative to the sham-injury groups. In addition, when FPI was followed by hypothermia (FPI–30°C group), the subsequent LCBF was significantly lower (35–38% on average) than in FPI–37°C rats. Statistical mapping of LCBF difference imaging data revealed confluent cortical and subcortical zones of significantly reduced LCBF (largely ipsilateral to the prior injury) in FPI–30°C rats relative to the FPI–37°C group. Local glucose utilization was reduced in both hemispheres of FPI–37°C rats relative to the sham-injury group and was lower in the right (traumatized) hemisphere than in the left. However, LCMRglu values were largely unaffected by temperature manipulation in either the FPI or sham-injury groups. The LCMRglu/LCBF ratio was nearly doubled in FPI–30°C rats relative to the FPI–37°C group, in a diffuse and bihemispheric fashion. Linear regression analysis comparing LCMRglu and LCBF revealed that the FPI–37°C and FPI–30°C data sets were completely nonoverlapping, whereas the two sham-injury data sets were intermixed.

Conclusions
Despite its proven neuroprotective efficacy, early posttraumatic hypothermia (30°C for 3 hours) nonetheless induces a moderate decline in cerebral perfusion without the (anticipated) improvement in cerebral glucose utilization, so that a state of mild metabolism-greater-than-blood-flow dissociation is perpetuated.
Management of metastatic tumors of the spine: strategies and operative indications
Authors: Steinmetz Michael P. , Mekhail Anis , Benzel Edward C. 
Published: January 2008

The spinal column is the most frequent site of bone metastasis in the body. Spine surgeons are often involved in the care of these patients only after nonoperative management has failed. Because surgery has been viewed as no better than radiotherapy in the treatment of metastasis of the spine, it has only been used as a salvage approach. These views are based on a body of literature in which laminectomy combined with radiotherapy was compared with radiotherapy alone. Anterior approaches to the spine are now popular and familiar to most surgeons. These approaches allow direct access to the metastatic lesion, reconstruction of the anterior vertebral column, and the placement of anterior instrumentation. Outcomes are frequently much better when this combined treatment is used instead of radiotherapy alone. In selected patients, surgery may be desired as first-line therapy before radio- or chemotherapy has been initiated.
The controversy surrounding surgery for metastatic spinal disease is reviewed. Treatment strategies, both operative and nonoperative, are presented. Indications and strategies for surgery are also presented, and the supporting literature is reviewed.