bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcome following decompressive craniectomy for malignant swelling due to severe head injury
Authors: Aarabi Bizhan , Hesdorffer Dale C. , Ahn Edward S. , Aresco Carla , Scalea Thomas M. , Eisenberg Howard M. 
Published: January 2008

Object
The aim of this study was to assess outcome following decompressive craniectomy for malignant brain swelling due to closed traumatic brain injury (TBI).

Methods
During a 48-month period (March 2000–March 2004), 50 of 967 consecutive patients with closed TBI experienced diffuse brain swelling and underwent decompressive craniectomy, without removal of clots or contusion, to control intracranial pressure (ICP) or to reverse dangerous brain shifts. Diffuse injury was demonstrated in 44 patients, an evacuated mass lesion in four in whom decompressive craniectomy had been performed as a separate procedure, and a nonevacuated mass lesion in two. Decompressive craniectomy was performed urgently in 10 patients before ICP monitoring; in 40 patients the procedure was performed after ICP had become unresponsive to conventional medical management as outlined in the American Association of Neurological Surgeons guidelines. Survivors were followed up for at least 3 months posttreatment to determine their Glasgow Outcome Scale (GOS) score.
Decompressive craniectomy lowered ICP to less than 20 mm Hg in 85% of patients. In the 40 patients who had undergone ICP monitoring before decompression, ICP decreased from a mean of 23.9 to 14.4 mm Hg (p < 0.001). Fourteen of 50 patients died, and 16 either remained in a vegetative state (seven patients) or were severely disabled (nine patients). Twenty patients had a good outcome (GOS Score 4–5). Among 30-day survivors, good outcome occurred in 17, 67, and 67% of patients with postresuscitation Glasgow Coma Scale scores of 3 to 5, 6 to 8, and 9 to 15, respectively (p < 0.05). Outcome was unaffected by abnormal pupillary response to light, timing of decompressive craniectomy, brain shift as demonstrated on computerized tomography scanning, and patient age, possibly because of the small number of patients in each of the subsets. Complications included hydrocephalus (five patients), hemorrhagic swelling ipsilateral to the craniectomy site (eight patients), and subdural hygroma (25 patients).

Conclusions
Decompressive craniectomy was associated with a better-than-expected functional outcome in patients with medically uncontrollable ICP and/or brain herniation, compared with outcomes in other control cohorts reported on in the literature.
Surgical treatment and outcomes in 45 cases of posterior interosseous nerve entrapments and injuries
Authors: Kim Daniel H. , Murovic Judith A. , Kim Yong-Yeon , Kline David G. 
Published: January 2008

Object
The authors report data in 45 surgically treated posterior interosseous nerve (PIN) entrapments or injuries.

Methods
Forty-five PIN entrapments or injuries were managed surgically between 1967 and 2004 at Louisiana State University Health Sciences Center (LSUHSC) or Stanford University Medical Center. Patient charts were reviewed retrospectively. The LSUHSC grading system was used to assess PIN-innervated muscle function.
Injuries were caused by nontraumatic (21 PIN entrapments and four tumors) and traumatic (nine lacerations, eight fractures, and three contusions) mechanisms. Presentations included weakness in the extensor carpi ulnaris muscle, causing compromised wrist extension and radial drift; extensor digitorum, indicis, and digiti minimi muscles with paretic finger extension; extensor pollicis brevis and longus muscles with weak thumb extension; and abductor pollicis longus muscle with rare decreased thumb abduction due to substitutions of the median nerve–innervated abductor pollicis brevis muscle and, at 90°, the extensor pollicis brevis and longus muscles. Preoperative evaluations consisted of electromyography and nerve conduction studies, elbow and forearm plain x-ray films, and magnetic resonance imaging for tumor detection.
At surgery, in continuity lesions were found in 21 entrapments and three fracture-related and three contusion injuries; all transmitted nerve action potentials (NAPs) and were treated with neurolysis. Five fracture-related PIN injuries, one of which was a lacerating injury, were in continuity and transmitted no NAPs; graft repairs were performed in all of these cases. Among nine lacerations, three PINs appeared in continuity, although intraoperative NAPs were absent. Two of these nerves were treated with secondary end-to-end suture anastomosis repair and one with secondary graft repair. There were six transected lacerations: three were treated with primary suture anastomosis repair, two with secondary suture anastomosis, and one with graft repair. Four tumors involving the PIN were resected. Most muscles innervated by 45 PINs had LSUHSC Grade 3 or better functional outcomes.

Conclusions
Forty-five PIN entrapments or injuries responded well to PIN release and/or repair.
Quantitation of and superficial surgical landmarks for the anterior interosseous nerve
Authors: Tubbs R. Shane , Custis James W. , Salter E. George , Wellons John C. , Blount Jeffrey P. , Oakes W. Jerry 
Published: January 2008

Object
There are scant data regarding the anterior interosseous nerve (AIN) in the neurosurgical literature. In the current study the authors attempt to provide easily identifiable superficial osseous landmarks for the identification of the AIN.

Methods
The AIN in 20 upper extremities obtained in adult cadaveric specimens was dissected and quantified. Measurements were obtained between the nerve and surrounding superficial osseous landmarks.
The AIN originated from the median nerve at mean distances of 5.4 cm distal to the medial epicondyle of the humerus and 21 cm proximal to the ulnar styloid process. The distance from the origin of the AIN to its branch leading to the flexor pollicis longus muscle and to the point it travels deep to the pronator quadratus (PQ) muscle measured a mean 4 and 14.4 cm, respectively. The mean distance from the AIN branch leading to the flexor pollicis longus muscle to the proximal PQ muscle was 12.1 cm, and the mean distance between this branch and the ulnar styloid process was 7.2 cm. The mean diameter of the AIN was 1.6 mm at the midforearm.

Conclusions
Additional landmarks for identification of the AIN can aid the neurosurgeon in more precisely isolating this nerve and avoiding complications. Furthermore, after quantitation of this nerve, the AIN branches can be easily used for neurotization of the median and ulnar nerves, and with the aid of a transinterosseous membrane tunneling technique, passed to the posterior interosseous nerve.
Use of an intact sensory nerve to bridge a motor nerve defect: an experimental study
Authors: Tirelioğlu Serçin , Özbek Serhat , Özcan Mesut , Kurt M. Ayberk , Noyan Bezhat 
Published: January 2008

Object
End-to-side neurorrhaphy has recently became popular for peripheral nerve repair. Although this method is mainly indicated in nerve defects in which there is an absent proximal nerve stump, bridging a motor nerve defect by coapting the proximal and distal ends of the defect to a neighboring mixed nerve in an end-to-side fashion has been another experimental use of this method. In this situation, however, the source of the regenerating axons is unclear because the axons in both the proximal end of the defect and the bridging intact nerve have the capacity for regeneration. The goal of this study was to identify the source of the regenerating axons.

Methods
In this experimental study, the authors used a sensory nerve to bridge a motor nerve defect so that they could elucidate the source of the regenerating motor axons in the distal part of the motor nerve. One advantage of using a sensory nerve was that it eradicated the risk of damaging another motor nerve. Tests used in the analysis included gait evaluation, electrophysiological tests, and histological assessment.

Conclusions
Results of this study showed that, in the rat model, a sensory nerve can be used to bridge a motor nerve defect, thereby eliminating the need for nerve grafting.
Amplitude and phase of cerebrospinal fluid pulsations: experimental studies and review of the literature
Authors: Wagshul Mark E. , Chen John J. , Egnor Michael R. , McCormack Erin J. , Roche Patricia E. 
Published: January 2008

Object
A recently developed model of communicating hydrocephalus suggests that ventricular dilation may be related to the redistribution of pulsations in the cranium from the subarachnoid spaces (SASs) into the ventricles. Based on this model, the authors have developed a method for analyzing flow pulsatility in the brain by using the ratio of aqueductal to cervical subarachnoid stroke volume and the phase of cerebrospinal fluid (CSF) flow, which is obtained at multiple locations throughout the cranium, relative to the phase of arterial flow.

Methods
Flow data were collected in a group of 15 healthy volunteers by using a series of images acquired with cardiac-gated, phase-contrast magnetic resonance imaging.
The stroke volume ratio was 5.1 ± 1.8% (mean ± standard deviation). The phase lag in the aqueduct was −52.5 ± 16.5° and the phase lag in the prepontine cistern was −22.1 ± 8.2°. The flow phase at the level of C-2 was +5.1 ± 10.5°, which was consistent with flow synchronous with the arterial pulse. The subarachnoid phase lag ventral to the pons was shown to decrease progressively to zero at the craniocervical junction. Flow in the posterior cervical SAS preceded the anterior space flow.

Conclusions
Under normal conditions, pulsatile ventricular CSF flow is a small fraction of the net pulsatile CSF flow in the cranium. A thorough review of the literature supports the view that modified intracranial compliance can lead to redistribution of pulsations and increased intraventricular pulsations. The phase of CSF flow may also reflect the local and global compliance of the brain.
Presurgical treatment with somatostatin analogs in patients with acromegaly: effects on the remission and complication rates
Authors: Losa Marco , Mortini Pietro , Urbaz Laura , Ribotto Paolo , Castrignanò Tristana , Giovanelli Massimo 
Published: January 2008

Object
The question of whether preoperative therapy with somatostatin analogs can improve surgical outcome in acromegaly has not been definitively answered. In this paper, the authors report the effects of preoperative treatment with somatostatin analogs in a large sample of patients with acromegaly.

Methods
Between 1990 and 2003, 399 consecutive patients with acromegaly underwent surgery at the Istituto Scientifico San Raffaele. Thirty-three patients who had previously undergone surgery or radiation treatment, 48 patients treated with somatostatin analogs for fewer than 3 months, and patients who had stopped therapy for too long a time before surgery were excluded from the study. One hundred forty-three patients who had received somatostatin analogs prior to surgery (Group 1) were randomly matched to 143 patients who had never been treated with somatostatin analogs (Group 2). Matching criteria were tumor size and invasiveness into the cavernous sinus. Before surgery, Group 1 patients showed reduction of growth hormone levels to less than 50% of baseline in 64% of cases, but insulin-like growth factor–I was normalized in only 19.5%. Surgical remission occurred in 81 Group 1 patients (56.6%) and in 91 Group 2 patients (63.6%; p = 0.28). No significant difference in the remission rate was observed when cases were analyzed according to tumor size or invasiveness. Logistic regression analysis confirmed that pretreatment with somatostatin analogs was not associated with surgical outcome. Surgical morbidity was mild and similar in Group 1 and Group 2 patients (7 and 5.6%, respectively; p = 0.81). Surgical remission and complication rates in patients with acromegaly who received treatment with somatostatin analogs prior to surgery were not significantly different from those of matched patients who did not receive these agents.

Conclusions
At present, the routine use of presurgical therapy with somatostatin analogs for patients with acromegaly cannot be recommended.
Local control of brain metastases by stereotactic radiosurgery in relation to dose to the tumor margin
Authors: Vogelbaum Michael A. , Angelov Lilyana , Lee Shih-Yuan , Li Liang , Barnett Gene H. , Suh John H. 
Published: January 2008

Object
The maximal tolerated dose (MTD) for stereotactic radiosurgery (SRS) for brain tumors was established by the Radiation Therapy Oncology Group (RTOG) in protocol 90-05, which defined three dose groups based on the maximal tumor diameter. The goal in this retrospective study was to determine whether differences in doses to the margins of brain metastases affect the ability of SRS to achieve local control.

Methods
Between 1997 and 2003, 202 patients harboring 375 tumors that met study entry criteria underwent SRS for treatment of one or multiple brain metastases. The median overall follow-up duration was 10.7 months (range 3–83 months). A dose of 24 Gy to the tumor margin had a significantly lower risk of local failure than 15 or 18 Gy (p = 0.0005; hazard ratio 0.277, confidence interval [CI] 0.134–0.573), whereas the 15- and 18-Gy groups were not significantly different from each other (p = 0.82) in this regard. The 1-year local control rate was 85% (95% CI 78–92%) in tumors treated with 24 Gy, compared with 49% (CI 30–68%) in tumors treated with 18 Gy and 45% (CI 23–67%) in tumors treated with 15 Gy. Overall patient survival was independent of dose to the tumor margin.

Conclusions
Use of the RTOG 90-05 dosing scheme for brain metastases is associated with a variable local control rate. Tumors larger than 2 cm are less effectively controlled than smaller lesions, which can be safely treated with 24 Gy. Prospective evaluations of the relationship between dose to the tumor margin and local control should be performed to confirm these observations.
Pituitary apoplexy: do histological features influence the clinical presentation and outcome?
Authors: Semple Patrick L. , de Villiers Jacques C. , Bowen Robert M. , Lopes M. Beatriz S. , Laws Edward R. 
Published: January 2008

Object
A retrospective analysis of a contemporary series of patients with pituitary apoplexy was performed to ascertain whether the histopathological features influence the clinical presentation or the outcome.

Methods
A retrospective analysis was performed in 59 patients treated for pituitary apoplexy at the University of Virginia Health System, Charlottesville, Virginia, or Groote Schuur Hospital, University of Cape Town, South Africa. The patients were divided into two groups according to the histological features of their disease: one group with infarction alone, comprising 22 patients; and the other with hemorrhagic infarction and/or frank hemorrhage, comprising 37 patients. The presenting symptoms, clinical features, endocrinological status, and outcome were compared between the two groups.

Conclusions
The patients who presented with histological features of pituitary tumor infarction alone had less severe clinical features on presentation, a longer course prior to presentation, and a better outcome than those presenting with hemorrhagic infarction or frank hemorrhage. The endocrine replacement requirements were similar in both groups.
Prospective analysis of prevalence, distribution, and rate of recovery of left ventricular systolic dysfunction in patients with subarachnoid hemorrhage
Authors: Banki Nader , Kopelnik Alexander , Tung Poyee , Lawton Michael T. , Gress Daryl , Drew Barbara , Dae Michael , Foster Elyse , Parmley William , Zaroff Jonathan 
Published: January 2008

Object
Subarachnoid hemorrhage (SAH) has been associated with cardiac injury and left ventricular (LV) dysfunction. The incidence and natural history of neurocardiogenic injury after SAH remains poorly understood. The objective of this study was to describe the incidence, time course, recovery rate, and segmental patterns of LV dysfunction after SAH.

Methods
Echocardiography was performed three times over a 7-day period in 173 patients with SAH. The incidence of global (ejection fraction [EF] < 50%) and segmental (any regional wall-motion abnormality [RWMA]) LV dysfunction was measured. The time course of LV dysfunction was determined by comparing the prevalence of LVEF less than 50% and RWMA at 0 to 2, 3 to 5, and 6 to 8 days after SAH. The recovery rate was defined as the proportion of patients with partial or complete normalization of function. The distribution of RWMAs among 16 LV segments was also determined. An LVEF less than 50% was found in 15% of patients, and 13% had an RWMA with a normal LVEF. There was a trend toward increased dysfunction at 0 to 2 days after SAH, compared with 3 to 8 days after SAH. Recovery of LV function was observed in 66% of patients. The most frequently abnormal LV segments were the basal and middle ventricular portions of the anteroseptal and anterior walls. The apex was rarely affected.

Conclusions
Left ventricular systolic dysfunction occurs frequently after SAH and usually improves over time. The observed segmental patterns of LV dysfunction often do not correlate with coronary artery distributions.
Altered expression of connexin subtypes in mesial temporal lobe epilepsy in humans
Authors: Collignon Frederic , Wetjen Nicholas M. , Cohen-Gadol Aaron A. , Cascino Gregory D. , Parisi Joseph , Meyer Fredric B. , Marsh W. Richard , Roche Patrick , Weigand Stephen D. 
Published: January 2008

Object
The causes of epileptic events remain unclear. Much in vitro and in vivo experimental evidence suggests that gap junctions formed by connexins (Cxs) between neurons and/or astrocytes contribute to the generation and maintenance of seizures; however, few experiments have been conducted in humans, and those completed have shown controversial data. The authors designed a study to compare the level of expression of Cxs in hippocampi from epileptic and nonepileptic patients to assess whether an alteration of gap junction expression in epileptic tissue plays a role in seizure origin and propagation.

Methods
The expression of Cxs32, -36, and -43 was studied in 47 consecutive samples of hippocampi obtained from epileptic patients who had undergone an amygdalohippocampectomy for the treatment of intractable seizure. These expression levels were compared with those in hippocampi obtained in nonepileptic patients during postmortem dissection. Immunostaining was performed to create one slide for each of the three Cxs. Each slide demonstrated multiple cells from each of six regions (CA1, CA2, CA3, CA4, dentate gyrus, and subiculum). Two independent reviewers rated each Cx–region combination according to an immunoreactive score.
Across all three measures—that is, staining intensity, percentage of positively stained cells, and immunoreactive score—Cx32 appeared to be expressed at a significantly lower level in the epileptic patients compared with controls (p < 0.001 for each measure), whereas Cx43 appeared to be expressed more among the epileptic patients (p < 0.001 for each measure). There was no evidence of any differential expression of Cx36. There was, however, regional variation within each Cx subtype. For Cx36, the staining intensity was higher in the CA2 region in the epilepsy group.

Conclusions
The increase in Cx43, decrease in Cx32, and preservation of Cx36 expression in hippocampi from epileptic persons could play a role in the development of seizures in patients with temporal sclerosis. Additional studies must be completed to understand this mechanism better.
Results of a phase II trial of the GliaSite Radiation Therapy System for the treatment of newly diagnosed, resected single brain metastases
Authors: Rogers Lisa R. , Rock Jack P. , Sills Allen K. , Vogelbaum Michael A. , Suh John H. , Ellis Thomas L. , Stieber Volker W. , Asher Anthony L. , Fraser Robert W. , Billingsley Judith S. , Lewis Paul , Schellingerhout Dawid , _ _ , Shaw Edward G. 
Published: January 2008

Object
The aim of this study was to evaluate the effectiveness of brachytherapy using the GliaSite Radiation Therapy System in patients with a newly diagnosed resected single brain metastasis. The primary end point of the study was local tumor control. The secondary end points included patient survival, distant brain recurrence, quality of life, and treatment toxicity.

Methods
The authors conducted a prospective multiinstitutional phase II study of GliaSite brachytherapy prescribed at a 60-Gy dose administered to a 1-cm depth after resection of a single brain metastasis. No whole-brain radiation therapy was given. Patients were assessed at 1 and 3 months after brachytherapy and every 3 months thereafter for up to 2 years.
Seventy-one patients were enrolled at 13 centers. A GliaSite balloon catheter was implanted in 62 patients. Fifty-four patients received brachytherapy. The median patient age was 60 years. The most common tumor (54%) was non–small cell lung cancer. Fifty-seven percent of patients had brain metastasis only, whereas 43% had extracranial metastasis. The median final administered dose was 60 Gy. The magnetic resonance imaging–determined local control rate, based on several different methods, was 82 to 87%. Both the median patient survival time and the median duration of functional independence were 40 weeks. Among the 35 patients who died, the cause of death was neurological in 11%. Thirteen patients underwent reoperation for suspected tumor recurrence or radiation necrosis, and histological diagnoses included radiation necrosis without tumor (nine patients), radiation necrosis mixed with tumor (two patients), and tumor only (two patients). Extracranial metastasis, tumor size, and radiation necrosis were significant factors affecting patient survival.

Conclusions
In patients with a resected single brain metastasis, GliaSite brachytherapy leads to a local control rate, median patient survival time, and duration of functional independence similar to those achieved with resection plus whole-brain radiation therapy.
Lysis of intracerebral hematoma with stereotactically implanted tissue plasminogen activator polymers in a rabbit model
Authors: Thai Quoc-Anh , Pradilla Gustavo , Legnani Federico G. , Kretzer Ryan M. , Hsu Wesley , Tamargo Rafael J. 
Published: January 2008

Object
Currently no adequate surgical treatment exists for spontaneous intracerebral hemorrhage (ICH). Implantable polymers can be used effectively to deliver therapeutic agents to the local site of the pathological process, thus reducing adverse systemic effects. The authors report the use of stereotactically implanted polymers loaded with tissue plasminogen activator (tPA) to induce lysis of ICH in a rabbit model.

Methods
Ethylene vinyl acetate (EVAc) polymers were loaded with bovine serum albumin (BSA) only or with BSA plus tPA. In vitro pharmacokinetic (three polymers) and thrombolysis (12 polymers) studies were performed. For the in vivo study, 12 rabbits were fixed in a stereotactic frame, and 0.2 ml of clotted autologous blood was injected into the right frontal lobe parenchyma. After 20 minutes, control BSA polymers were stereotactically implanted at the hemorrhage site in six rabbits, and experimental BSA plus tPA polymers were implanted in six rabbits. Animals were killed at 3 days, and blood clot volume was assessed.
The pharmacokinetic study showed release of 146 ng of tPA over 3 days. The tPA activity correlated with in vitro thrombolysis. In the in vivo study, the six animals treated with tPA polymers had a mean (± standard error of the mean [SEM]) thrombus volume of 1.43 ± 0.29 mm3 at 3 days, whereas the six animals treated with blank (BSA-only) polymers had a mean (± SEM) thrombus volume of 19.99 ± 3.74 mm3 (p < 0.001).

Conclusions
Ethylene vinyl acetate polymers release tPA over the course of 3 days. Stereotactic implantation of tPA-loaded EVAc polymers significantly reduced ICH volume. Polymers loaded with tPA may be useful clinically for lysis of ICH without the side effects of systemic administration of tPA.