bluuebunny/crossref_metadata_2025_split huggingface dataset:
Phase II Trial of Bexarotene Capsules in Patients With Advanced Non–Small-Cell Lung Cancer After Failure of Two or More Previous Therapies
Authors: Govindan Ramaswamy , Crowley John , Schwartzberg Lee , Kennedy Peter , Williams Charles , Ekstrand Bradley , Sandler Alan , Jaunakais Dinah , Bolejack Vanessa , Ghalie Richard 
Published: October 2006

Purpose To evaluate the effect of bexarotene on survival in patients with relapsed non–small-cell lung cancer (NSCLC). Patients and Methods Patients with stage IIIB NSCLC with pleural effusion or stage IV NSCLC, who had Eastern Cooperative Oncology Group performance status 0 to 2, and were previously treated with ≥ two different regimens that must have included a platinum and a taxane, received oral bexarotene 400 mg/m2/d plus concomitant levothyroxine and a lipid-lowering agent. Primary efficacy end point was survival. Results For the 146 assessable patients treated with bexarotene, median age was 66 years (range, 34 to 87 years), 51% were men, and the median number of prior regimens was three (range, one to seven). The overall median survival was 5 months (95% CI, 4 to 7 months) and the 1-year survival was 23% (95% CI, 16% to 31%). Survival was significantly longer in patients with bexarotene-induced hypertriglyceridemia and/or skin rash. In 26 patients who had both adverse effects, the median and 1-year survival rates were 12 months (95% CI, 8 to 15 months) and 48%, respectively. In 40 patients who had neither adverse effect, median and 1-year survival rates were 2 months (95% CI, 2 to 5 months) and 15%, respectively (P = .0002). Twenty patients (14%) discontinued therapy because of bexarotene-related toxicity. For the remaining patients, adverse reactions to bexarotene were generally mild to moderate. Conclusion In the intent-to-treat population, bexarotene given as third or subsequent line of therapy for relapsed NSCLC did not achieve the intended median survival of 6 months. Survival may have been extended in patients who developed bexarotene-induced hypertriglyceremia and/or skin rash. It is important to confirm these observations in a randomized controlled trial.
Hemorrhagic Complications Of External Ventricular Drainage
Authors: Maniker Allen H. , Vaynman Artem Y. , Karimi Reza J. , Sabit Aria O. , Holland Bart 
Published: October 2006

Abstract

OBJECTIVE:
Despite the widespread use of external ventricular drainage (EVD), the frequency of associated hemorrhagic complications remains unclear. This retrospective study examined the frequency of hemorrhagic complications of EVD and attempted to discern associated risk factors.

METHODS:
Treatment records from 160 patients admitted during a 2.5-year period who required EVD placement were reviewed. Indications for placement of EVD included acute complications of cerebrovascular disease (n = 94), traumatic brain injury (n = 36), primary hydrocephalus (n = 16), and tumor (n = 14). Patients received either a 3.0 or 2.5-mm outer diameter ventricular catheter (n = 82 and 78, respectively). Postinsertion computed tomographic scans were obtained within 24 hours on all patients and were analyzed for any new hemorrhage related to the ventricular catheter. Patient age, sex, catheter type, and dimensions of hemorrhage were also analyzed.

RESULTS:
The incidence of EVD-related hemorrhage was 33 ± 0.04%. However, the incidence of detectable change in the clinical neurological examination was 2.5%. A significant proportion of EVD-related hemorrhages were small (&lt;4 cm3), punctate, intraparenchymal hematomas. Patients with cerebrovascular disease exhibited an increased incidence (39%) of hemorrhage. The mean volume of intraparenchymal hemorrhage was larger in patients who received the 2.5-mm ventricular catheter, as well as those admitted for cerebrovascular disease.

CONCLUSION:
Hemorrhagic complications of EVD placement are more common than previously suspected. Admitting diagnosis seems to have an effect on the development of an associated hemorrhage and its size. Catheter gauge has an effect on hematoma volume. Most of the hemorrhages seen on postinsertion computed tomographic scans do not cause detectable changes in the clinical examination.
Meyer's Loop and the Optic Radiations in the Transsylvian Approach to the Mediobasal Temporal Lobe
Authors: Choi Chanyoung , Rubino Pablo A. , Fernandez-Miranda Juan C. , Abe Hiroshi , Rhoton Albert L. 
Published: October 2006

AbstractOBJECTIVE:In the transsylvian approach to the mediobasal temporal structures, the temporal horn is approached through the floor of the sylvian fissure. The anterior bundle of the optic radiations (Meyer's loop) courses between the floor of the sylvian fissure and roof of the temporal horn and could be damaged in this approach. This study was designed to define the route through the floor of the sylvian fissure least likely to damage the optic pathways.METHODS:Meyer's loop was dissected by applying Klingler's fiber dissection technique in 10 formalin-fixed human hemispheres. Several measurements quantified the relationship of the Meyer's loop to surgically important structures.RESULTS:This study identified a triangular safe area below the floor of the sylvian fissure through which the temporal horn could be accessed in the transsylvian approach with a low risk of damaging the optic radiations. An incision in the floor of the sylvian fissure directed downward at the level of limen insula and the adjacent 5 mm of the inferior insular sulcus would avoid the optic radiations. An incision directed straight downward 10, 15, and 20 mm behind the limen in the inferior insular sulcus would cross Meyer's loop and would need to be directed downward and medially as much as 80 degrees from the sagittal plane to avoid Meyer's loop.CONCLUSION:In the transsylvian approach to the temporal horn, incisions at the level of the limen, or adjacent 5 mm of the inferior insular sulcus, are less likely to damage Meyer's loop and the optic radiations than more posterior incisions along the inferior insular sulcus. Incision at this safe level commonly opens into the amygdala, a portion of which is removed to provide entry into the temporal horn for removal of the mediobasal structures.
Minimally Invasive Transmuscular Pedicle Screw Fixation of the Thoracic and Lumbar Spine
Authors: Ringel Florian , Stoffel Michael , Stüer Carsten , Meyer Bernhard 
Published: October 2006

Abstract

OBJECTIVE:
This study assessed the feasibility and safety of percutaneous posterior pedicle screw fixation for instabilities of the thoracic and lumbar spine, using standard instruments designed for the open approach and fluoroscopy.

METHODS:
All patients who underwent percutaneous posterior pedicle screw fixation of the thoracic and lumbar spine were studied retrospectively. Charts and operative notes were analyzed for epidemiological data, underlying spinal pathological features, and indications for stabilization, stabilized segments, number of implanted pedicle screws, surgical time, and complications. Postoperative computed tomographic scans were analyzed for screw position.

RESULTS:
From May 2002 through May 2005, 115 internal fixators were implanted percutaneously in 104 patients. A total of 488 pedicle screws were implanted, stabilizing 1 to 5 spinal motion segments. Median surgical time was 93 minutes. On postoperative computed tomographic scans, 87% of screw positions were rated good, 10% were rated acceptable, and 3% were rated unacceptable. A total of 11 revisions were necessary, 9 for misplaced screws and 2 for loosening of anchor bolts. Only two of the patients experienced new clinical symptoms (i.e., radicular pain) because of screw misplacement. No patients experienced new neurological deficits or other surgery-related morbidity. @@@@CONCLUSION:@@ This study shows that percutaneous internal pedicle screw fixation using standard instruments is feasible and safe for posterior stabilization of the thoracic and lumbar spine. It is a straightforward alternative for open approaches or minimally invasive ones using navigation in conjunction with customized instruments. Accuracy of screw placement is similar to that reported for other techniques.
Extended Bifrontal Craniotomy for Midline Anterior Fossa Meningiomas:Minimization of Retraction-Related Edema and Surgical Outcomes
Authors: Chi John H. , Parsa Andrew T. , Berger Mitchel S. , Kunwar Sandeep , McDermott Michael W. 
Published: October 2006

Abstract

OBJECTIVE:
Meningiomas of the anterior cranial base can be approached with a variety of techniques. The extended bifrontal approach is often thought to be associated with increased morbidity because of the need for extensive removal of the bone and longer surgical times. The authors have attempted to quantitate retraction-related edema occurring after surgery to determine whether the extra bone removal limits retraction and reduces the chance of brain injury.

METHODS:
Charts were reviewed for patients who underwent extended bifrontal craniotomies performed for meningiomas at the University of California, San Francisco, between 1997 and 2005. Magnetic resonance imaging scans obtained before and after surgery were reviewed for brain edema as indicated by fluid-attenuated inversion recovery/T2 abnormality and grouped into four categories: A, no edema; B, edema restricted to the gyrus rectus; C, edema beyond the gyrus rectus; and D, extensive bifrontal edema.

RESULTS:
Forty-five patients were identified. Fifty-four percent of patients had tumors with a diameter of more than 4 cm. Simpson Grade 2 or 3 resection was achieved in 82% of patients, and the average operative time was 12.3 hours. Vision outcome was favorable in 74% of patients. Extent of fluid-attenuated inversion recovery abnormality remained unchanged in 87.5%, with 91% of patients in categories A or B edema remaining in those categories after surgery. There were no infections and there were two cerebrospinal fluid leaks.

CONCLUSION:
The extended bifrontal approach is a safe surgical procedure with limited morbidity that the authors think: 1) prevents secondary brain injury from excessive retraction; 2) offers great flexibility of view for the surgeon; and 3) should be considered the preferred approach compared with the standard bifrontal craniotomy for large tumors of the anterior cranial base.
The Subtemporal Interdural Approach to Dumbbell-Shaped Trigeminal Schwannomas: Cadaveric Prosection
Authors: Youssef Samy , Kim Eun-Young , Aziz Khaled M.A. , Hemida Salah , Keller Jeffrey T. , van Loveren Harry R. 
Published: October 2006

Abstract

OBJECTIVE:
Successful resection of dumbbell-shaped trigeminal schwannomas via a subtemporal interdural approach requires an understanding of both the anatomy related to the bone dissection of the petrous apex (Kawase's triangle or quadrilateral) and meningeal anatomy. We studied the meningeal anatomy related to this approach and describe the dural incisions and stepwise mobilization.

METHODS:
Meningeal anatomy around Meckel's cave and porus trigeminus was examined during the subtemporal interdural anterior transpetrosal approach in both sides of 15 cadaveric heads. Histological study of the Meckel's cave region was performed in two cadaveric heads.

RESULTS:
The Gasserian ganglion and trigeminal roots have two layers of dura propria on their dorsolateral surface: an inner layer from the posterior fossa dura propria that constitutes the dorsolateral wall of Meckel's cave and an outer layer from the dura propria of the middle fossa. The cleavage plane between these two layers continues distally as the cleavage plane between the epineural sheaths of the trigeminal divisions and the dura propria of the middle fossa. This cleavage plane serves as the anatomic landmark for the interdural exposure of the contents of Meckel's cave. The superior petrosal sinus is sectioned at the medial aspect of Kawase's triangle and reflected along with the porus trigeminus roof.

CONCLUSION:
Understanding the critical meningeal architecture in and around Meckel's cave allows experienced cranial neurosurgeons to develop a subtemporal interdural approach to dumbbell-shaped trigeminal schwannomas that effectively converts a multiple-compartment tumor into a single-compartment tumor. Dural incisions and stepwise mobilization complements our previous description of the bony dissection for this approach.
Training in Cerebrovascular Disease: Do We Need to Change the Way We Train Residents?
Authors: Sauvageau Eric , Hopkins L Nelson 
Published: October 2006

Abstract
WITH THE ONGOING development of endovascular techniques and technologies, treatment of cerebrovascular disease is evolving at a fast pace. For neurosurgery to maintain a leadership role in the treatment of these disorders, modifications in neurosurgical training programs are essential. In this article, we discuss the changes perceived to enable residents to acquire the multifaceted understanding and skill set necessary to meet the new clinical reality and prepare to become the leaders of tomorrow in the management of cerebrovascular disease.
Giant Intracranial Aneurysms: Endovascular Challenges
Authors: Parkinson Richard J. , Eddleman Christopher S. , Batjer H Hunt , Bendok Bernard R. 
Published: October 2006

Abstract
THE TREATMENT OF giant aneurysms remains a formidable challenge for endovascular and surgical strategies. The use of endovascular techniques in a deconstructive (e.g., parent vessel occlusion) and reconstructive (e.g., stent coiling) methodology is reviewed. The results of endovascular coiling as a primary therapy for giant aneurysm occlusion have been disappointing. Hunterian strategies have had more success in published series, but recent developments in coil, glue, and stent technology show great promise in allowing parent vessel reconstruction as a primary endovascular target, with acceptable morbidity, mortality, and durability. A literature review of giant aneurysm endovascular treatment strategies was undertaken after 1994, when Guglielmi detachable coils were approved by the Food and Drug Administration. Where possible, follow-up, durability, and occlusion rates are also reviewed.
Targeting Cerebral Arteriovenous Malformations for Minimally Invasive Therapy
Authors: Alexander Michael J. , Tolbert Marshall E. 
Published: October 2006

AbstractOBJECTIVE:Cerebral arteriovenous malformation (AVM) embolization has been performed for nearly 40 years to reduce the risk of hemorrhage, to reduce symptomatic arteriovenous shunting, and to pretreat patients for surgical excision or radiosurgery. In some cases, embolization alone may be able to angiographically cure an AVM, although this is a small percentage of all AVMs.METHODS:This report reviews the current limitations of embolic therapy of cerebral AVMs from the standpoint of AVM angioarchitecture and the physical limitations of current embolic materials. In addition, it seeks to identify the areas in which embolization therapy may make advancements both as a pretreatment and as a sole therapy.RESULTS:Currently, liquid embolic agents, ethylene vinyl alcohol, and n-butylcyanoacrylate seem to provide the greatest resistance to recanalization in AVM embolization. These agents, however, elicit only a weak, nonspecific, bioactive inflammatory response by histopathology.CONCLUSION:The further evaluation and understanding of the vascular biology of AVM vessels and the endothelium cell wall biology will help us devise more bioactive material solutions to AVM nidus obliteration. Targeting specific receptors in AVMs with the embolic material delivered may additionally enhance the effects of radiosurgery in these patients.
Workforce Needs for Endovascular Neurosurgery
Authors: Ecker Robert D. , Levy Elad I. , Hopkins L Nelson 
Published: October 2006

Abstract
DURING THE PAST decade, endovascular techniques and clinical experience have matured to the point that all or a significant part of the treatment of acute ischemic stroke, cerebral aneurysms, brachiocephalic occlusive disease, and arteriovenous fistulae or malformations is performed in angiography suites by neuroradiologists, vascular surgeons, peripheral interventionists, cardiologists, neurologists, and neurosurgeons worldwide. With improvements in technology and lower morbidity rates, the scope of endovascular techniques will only increase. Currently, in the United States alone, this amounts to a volume of more than 500,000 patients annually. Neurosurgeons currently provide only a small portion of the care of these patients. The workforce needs for endovascular surgeons in neurosurgery will be determined by the patients, the willingness of neurosurgeons to embrace endovascular techniques, and the broad scope of cerebrovascular disorders that can be treated.
Intracranial Head and Neck Tumors: Endovascular Considerations, Present and Future
Authors: Gupta Rishi , Thomas Ajith J. , Horowitz Michael 
Published: October 2006

AbstractTO REVIEW THE literature on endovascular therapies available to clinicians to aid in the management of head, neck, and intracranial tumors. Hypervascular tumors of the head and neck region, as well as the intracranial region, are associated with large amounts of blood loss intraoperatively. Preoperative embolization of selected hypervascular tumors has been proposed in the literature as a method of reducing blood loss intraoperatively. This technique involves superselective catheterization of the feeding arteries to the tumor bed and then by infusion of embolic particles to saturate the tumor bed in the hopes of inducing necrosis. For less vascular tumors, selective infusion of chemotherapeutic agents has been reported as a method of reducing the systemic toxic effects of these medications. Endovascular therapies for hypervascular and less vascular tumors hold promise, although multicenter randomized controlled trials are required to help identify the patients that will benefit the most.
Endovascular Management of Cerebral Vasospasm
Authors: Zwienenberg-Lee Marike , Hartman Jonathan , Rudisill Nancy , Muizelaar Jan Paul 
Published: October 2006

AbstractCEREBRAL VASOSPASM REMAINS a leading cause of death and disability in patients with ruptured cerebral aneurysms. The development of endovascular intervention in the past two decades has shown promising results in the treatment of vasospasm. Endovascular techniques that have been used in humans include intra-arterial infusion of vasorelaxants and direct mechanical dilation with transluminal balloon angioplasty. This article reviews the current indications and role of endovascular therapy in the management of cerebral vasospasm, its clinical significance, and potential future therapies.
Ontogeny of air-motion sensing in cricket
Authors: Dangles O. , Pierre D. , Magal C. , Vannier F. , Casas J. 
Published: October 2006

SUMMARY
Juvenile crickets suffer high rates of mortality by natural predators that they can detect using extremely sensitive air-sensing filiform hairs located on their cerci. Although a huge amount of knowledge has accumulated on the physiology, the neurobiology and the biomechanics of this sensory system in adults, the morphological and functional aspects of air sensing have not been as well studied in earlier life history stages. Using scanning electronic microscopy, we performed a survey of all cercal filiform hairs in seven instars of the wood cricket (Nemobius sylvestris). Statistical analyses allowed us to quantify profound changes in the number, the length and the distribution of cercal hairs during development. Of particular importance,we found a fivefold increase in hair number and the development of a bimodal length-frequency distribution of cercal hairs from the second instar onwards. Based on theoretical estimations of filiform hair population coding, we found that the cercal system is functional for a wide range of frequencies of biologically relevant oscillatory flows, even from the first instar. As the cricket develops, the overall sensitivity of the cercal system increases as a result of the appearance of new hairs, but the value of the best tuned frequency remains fixed between 150 and 180 Hz after the second instar. These frequencies nicely match those emitted by natural flying predators, suggesting that the development of the cercal array of hairs may have evolved in response to such signals.
Aquatic turning performance of painted turtles (Chrysemys picta)and functional consequences of a rigid body design
Authors: Rivera Gabriel , Rivera Angela R. V. , Dougherty Erin E. , Blob Richard W. 
Published: October 2006

SUMMARYThe ability to capture prey and avoid predation in aquatic habitats depends strongly on the ability to perform unsteady maneuvers (e.g. turns), which itself depends strongly on body flexibility. Two previous studies of turning performance in rigid-bodied taxa have found either high maneuverability or high agility, but not both. However, examinations of aquatic turning performance in rigid-bodied animals have had limited taxonomic scope and, as such, the effects of many body shapes and designs on aquatic maneuverability and agility have yet to be examined. Turtles represent the oldest extant lineage of rigid-bodied vertebrates and the only aquatic rigid-bodied tetrapods. We evaluated the aquatic turning performance of painted turtles, Chrysemys picta (Schneider, 1783) using the minimum length-specific radius of the turning path (R/L) and the average turning rate(ωavg) as measures of maneuverability and agility,respectively. We filmed turtles conducting forward and backward turns in an aquatic arena. Each type of turn was executed using a different pattern of limb movements. During forward turns, turtles consistently protracted the inboard forelimb and held it stationary into the flow, while continuing to move the outboard forelimb and both hindlimbs as in rectilinear swimming. The limb movements of backward turns were more complex than those of forward turns, but involved near simultaneous retraction and protraction of contralateral fore- and hindlimbs, respectively. Forward turns had a minimum R/L of 0.0018 (the second single lowest value reported from any animal) and a maximum ωavg of 247.1°. Values of R/L for backward turns (0.0091-0.0950 L) were much less variable than that of forward turns (0.0018-1.0442 L). The maneuverability of turtles is similar to that recorded previously for rigidbodied boxfish. However, several morphological features of turtles (e.g. shell morphology and limb position) appear to increase agility relative to the body design of boxfish.