bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison between motor evoked potential recording and fiber tracking for estimating pyramidal tracts near brain tumors
Authors: Mikuni Nobuhiro , Okada Tsutomu , Nishida Namiko , Taki Junya , Enatsu Rei , Ikeda Akio , Miki Yukio , Hanakawa Takashi , Fukuyama Hidenao , Hashimoto Nobuo 
Published: January 2008

Object
The utility of subcortical electrical stimulation and fiber tracking were compared to estimate the pyramidal tract near brain tumors.

Methods
In 22 patients, the white matter at the bottom of a tumor was electrically stimulated near the fiber tracking of the pyramidal tract shown on a neuronavigation system. The distance between the center of the fiber tracking of these tracts and the stimulated region was measured and defined as the motor evoked potential (MEP) response. The MEP was consistently produced at distances less than 7 mm (six patients), but was consistently absent at distances more than 13 mm (seven patients) from the fiber tracking of the pyramidal tracts. In the nine patients in whom the distance was between 8 and 12 mm, an MEP was elicited when stimulation was applied at the level of the corona radiata. Motor function was preserved or even improved with appropriate tumor resection in all patients.

Conclusions
The anteroposteriorly running superior longitudinal fasciculus could cause complications in the fiber tracking of upper-extremity motor pathways at the level of the corona radiata. During resection of tumors located near the corona radiata, subcortical electrical stimulation should be applied at some distance from the pyramidal tract, as estimated by fiber tracking.
Selective subtemporal amygdalohippocampectomy for refractory temporal lobe epilepsy: operative and neuropsychological outcomes
Authors: Hori Tomokatsu , Yamane Fumitaka , Ochiai Taku , Kondo Shinji , Shimizu Satoru , Ishii Kenji , Miyata Hajime 
Published: January 2008

Object
The authors evaluated operative, neuropathological, and neuropsychological results after selective subtemporal amygdalohippocampectomy for refractory temporal lobe epilepsy in patients who were observed for at least 2 years after surgery.

Methods
Twenty-six consecutive patients underwent selective subtemporal amygdalohippocampectomy for nonlesional, medically refractory temporal lobe epilepsy. Neuropsychological evaluation using the Wechsler Adult Intelligence Scale was done before surgery in all patients, 2 months after surgery in 24 patients, and at 2-year follow up in 19 patients. A verbal paired associates learning test was administered before surgery and 2 months after surgery in 19 patients. The data were compared between the 13 patients in whom the language-dominant hemisphere was surgically treated and the six patients in whom the language-nondominant hemisphere was treated.
After surgery, 84% of the patients attained either Engel Class I or II seizure outcome. There were no permanent subjective complications except postoperative memory impairment in one patient. Neuropathological examination confirmed hippocampal sclerosis in 19 patients. No significant differences in IQ and verbal memory test scores were observed between the patients in whom the language-dominant hemisphere was treated and those in whom the language-nondominant hemisphere was treated. Significant postoperative increases in verbal IQ, performance IQ, and full-scale IQ were observed over time. No significant differences were found between pre- and postoperative verbal memory test scores, and no subjective visual field loss was marked in any patient.

Conclusions
Subtemporal selective amygdalohippocampectomy provides favorable surgical and neuropsychological outcomes and does not cause significant postoperative decline of verbal memory if performed on the language-dominant side.
A microsurgical study of the anatomy and course of the ophthalmic artery and its possibly dangerous anastomoses
Authors: Perrini Paolo , Cardia Andrea , Fraser Kenneth , Lanzino Giuseppe 
Published: January 2008

Object
The authors studied the microsurgical anatomy of the ophthalmic artery (OphA), paying particular attention to its possibly dangerous anastomoses with the middle meningeal artery (MMA).

Methods
The microsurgical anatomy of the OphA and its anastomoses with the MMA were studied in 14 vessels from seven adult cadaveric heads. The origination order of the OphA branches varies in relation to whether the artery, along its intraorbital course, crosses above or below the optic nerve (ON). The central retinal artery is the first branch to course from the OphA when it crosses over the ON, and it is the second branch to course from the OphA when the artery crosses under the ON. Anastomoses between branches of the MMA and the OphA were present in the majority of the specimens examined.

Conclusions
Detailed knowledge of the microanatomy of the OphA and recognition of anastomoses between the external carotid artery and the OphA are critically important in avoiding disastrous complications during endovascular procedures.
Anatomical study of the pterygopalatine fossa using an endoscopic endonasal approach: spatial relations and distances between surgical landmarks
Authors: Solari Domenico , Magro Francesco , Cappabianca Paolo , Cavallo Luigi M. , Samii Amir , Esposito Felice , Paternò Vincenzo , de Divitiis Enrico , Samii Madjid 
Published: January 2008

Object
The pterygopalatine fossa is an area that lies deep within the skull base. The recent extensive use of the endoscopic endonasal approach has provided neurosurgeons with a method to reach various areas of the skull base through a less invasive approach than traditional transcranial or transfacial approaches. This study aims to provide neurosurgeons with new data concerning direct endoscopic measurements and precise anatomical topography features of the pterygopalatine fossa.

Methods
An anatomical dissection of six fixed cadaver heads (12 pterygopalatine fossae) was performed to analyze spatial relationships and distances between the most important neurovascular structures in this region, and to estimate the size of the endoscopic surgical field for operations in this area. The endoscopic endonasal approach offers direct access to the pterygopalatine fossa through its anteromedial walls.

Conclusions
Using an endoscopic endonasal approach makes it possible to identify all of the anatomical landmarks of the pterygopalatine fossa and almost all of the contiguous skull base areas.
Anatomical variations in pneumatization of the anterior clinoid process
Authors: Mikami Takeshi , Minamida Yoshihiro , Koyanagi Izumi , Baba Takeo , Houkin Kiyohiro 
Published: January 2008

Object
An anterior clinoidectomy can provide enormous benefits, facilitating the management of paraclinoid and upper basilar artery lesions, but it also carries the potential risk of cerebrospinal fluid leaks. The aim of this study was to assess the variation in the pneumatization of the anterior clinoid process (ACP) in an attempt to reduce the complications associated with an anterior clinoidectomy.

Methods
The authors analyzed the anatomical variations in the pneumatization of the ACP and optical strut (OS) in 600 sides of 300 consecutive patients by using multidetector-row computed tomography (CT). Computed tomography scans with a 0.5-mm thickness were obtained, and coronal and sagittal reconstructions of the images were displayed in all cases. Pneumatization of the ACP was found in 9.2% of all sides. The origin of pneumatization was the sphenoid sinus in 81.8% of all the sides, the ethmoid sinus in 10.9%, and both of these sinuses in 7.3%. Pneumatized patterns were divided into three groups according to the route: 74.5% were Type I, in which pneumatization occurred via the OS; 14.5% were Type II, pneumatization via the anterior root (AR); and 10.9% were Type III, pneumatization via both the OS and the AR. The origin of pneumatization and the pneumatization pattern showed statistical dependence (p < 0.001). Pneumatization of the OS beyond its narrowest point was found in 6.8% of all sides.

Conclusions
An awareness of the different variations in pneumatization can prevent destruction of the mucous membrane and facilitate orientation during reconstruction with cranialization. During an anterior clinoidectomy, preoperative CT assessments are necessary to evaluate pneumatization of the ACP.
Inside and somewhat outside Charity
Authors: Kline David G. 
Published: January 2008

✓On August 29, 2005, a hurricane named Katrina struck the Gulf Coast. Many feared the consequences of such a storm, but very few believed that it could ever happen. This article is a narrative written shortly after the evacuation of patients and personnel from the flooded Charity Hospital.
The days at Charity hospital were hot and humid following Katrina, and as time passed the air was permeated by a stench that was inescapable. Rendering care to patients without electricity, and thus light and air conditioning, with a temperature in the 90°s and no running water was a challenge. Trying to cool patients with central fever and providing adequate ventilation for unconscious patients was extremely difficult. Without elevators, climbs up to and down from the 14th floor—where the author and his colleagues had their sleeping rooms—and the 12th (surgical intensive care unit [ICU]), seventh (neuro ICU and step-down units), and sixth (medical ICU) floors were tedious. The descent to check the emergency department and obtain a closer look at flooding in the streets around the hospital, which maintained a 4- to 5-foot water level, became prohibitive because of the contemplation of the necessary return ascent.
There were 21 patients, mostly neurosurgical, in the neuro ICU and step-down units and wards. This is their story.
Radiosurgery for facial schwannoma
Authors: Kida Yoshihisa , Yoshimoto Masayuki , Hasegawa Toshinori 
Published: January 2008

Object
The aim of this study was to evaluate the results of radiosurgery in patients with facial schwannoma.

Methods
The study population consisted of 14 patients, six men and eight women, with a mean age of 45.4 years. Most of the patients had presented with facial palsy (11 of 14 patients) and/or hearing disturbance (nine of 14 patients). Prior treatment in nine of the 14 cases consisted of tumor resection or tumor biopsy. Tumor volume ranged from 0.98 to 20.8 cm3, and the mean tumor volume was 5.5 cm3. The mean maximum radiation dose and mean tumor margin dose used for radiosurgery were 24.0 and 12.9 Gy, respectively.
During the mean follow-up period of 31.4 months (range 12–120 months), 10 of the tumors shrank and four remained unchanged. The tumor response and tumor control rates were 57 and 100%, respectively. None of the tumors progressed, and no subsequent resection was required. Facial nerve function improved in five cases, remained unchanged in eight, and became worse in one. There was no change in hearing function in any of the patients. Complications developed in only one patient: the onset of facial palsy immediately after treatment, which subsequently recovered to House–Brackmann Grade III.

Conclusions
In summary, radiosurgery was found to be a very useful method of treating facial schwannoma, for both tumor control and functional control. Radiosurgery should therefore be the treatment of first choice for facial schwannomas.
Patterns of skull base meningioma progression after failed radiosurgery
Authors: Couldwell William T. , Cole Chad D. , Al-Mefty Ossama 
Published: January 2008

Object
Stereotactic radiosurgery has been reported to be an effective alternative to surgical removal of small to medium benign meningiomas as well as an adjuvant treatment modality to reduce the risk of tumor progression after subtotal resection. Its efficacy has been proved by excellent short-term radiosurgically demonstrated control rates, which have been reported to approach or exceed 90% in many contemporary studies involving the use of either linear accelerator–based systems or the Gamma Knife. Little is known, however, regarding the growth patterns of meningiomas that fail to stabilize after radiosurgery.

Methods
The authors report 13 cases of benign skull base meningiomas (World Health Organization Grade I) that demonstrated progression after radiosurgical treatment as a primary or an adjuvant therapy. Several tumors demonstrated rapid growth immediately after radiosurgical treatment, whereas other lesions progressed in a very delayed manner in some patients (up to 14 years after treatment). Regardless of the interval after which it occurs, tumor growth can be quite aggressive once it has begun.

Conclusions
Skull base meningioma growth can be aggressive after failed radiosurgery in some patients, and treatment failure can occur at long intervals following treatment. Special attention must be devoted to such significant occurrences given the increasing number of patients undergoing stereotactic radiosurgery for benign tumors, and careful extended (> 10 years) follow up must be undertaken in all patients after radiosurgery.
Collagen matrix duraplasty for cranial and spinal surgery: a clinical and imaging study
Authors: Narotam Pradeep K. , Reddy Kesava , Fewer Derek , Qiao Fan , Nathoo Narendra 
Published: January 2008

Object
The repair of dural defects is controversial in contemporary neurosurgery. To date, collagen-based products remain a continued area of interest in the development of dural grafts. The authors conducted a prospective case–control study in which they evaluated collagen matrix in the repair of dural defects following cranial and spinal surgery by using specific clinical and magnetic resonance (MR) imaging outcome measures.

Methods
Enrolled in the study were 79 patients, 36 male (45.6%) and 43 female (54.4%), with a mean age of 53 ± 15.8 years. The pathological diagnosis was brain tumor in 49 cases (62%), vascular conditions in 16 (20.2%), degenerative spine in 10 (12.7%), trauma in two (2.5%), and other in two (2.5%). Most of the patients underwent supratentorial craniotomy (57; 72.2%), whereas 11 patients (13.9%) each underwent posterior fossa and spinal surgery. Sixty-three patients (79.7%) completed the study, which included clinical and MR imaging evaluations at 3 months postsurgery. There were no cerebrospinal fluid (CSF) leaks or delayed hemorrhages. The neurosurgical wound infection rate was 3.8%: superficial wound infection in two cases and deep infection and brain abscess in one case (recurrent brain tumor following radiation therapy).
Among the 63 patients in whom 3-month postsurgery imaging data were available, asymptomatic small pseudomeningoceles were detected on MR imaging in two (3.2%); a minor subgaleal fluid collection, which resolved spontaneously, was apparent in another patient (1.6%). Nonspecific dural enhancement was demonstrated on images obtained in seven patients (11.1%), and asymptomatic spinal epidural enhancement was observed on images obtained in two of three patients who had undergone lumbar laminectomy for spinal stenosis.

Conclusions
When used as a dural onlay graft, collagen matrix had a 100% CSF containment rate but might be associated with occult radiological abnormalities.
Recognition and management of delayed hyponatremia following transsphenoidal pituitary surgery
Authors: Zada Gabriel , Liu Charles Y. , Fishback Dawn , Singer Peter A. , Weiss Martin H. 
Published: January 2008

Object
The goal of this study was to assess the incidence of symptomatic and occult hyponatremia in patients who had undergone transsphenoidal pituitary surgery.

Methods
Patients who underwent transsphenoidal surgery at the University of Southern California University Hospital between 1997 and 2004 had serum sodium levels drawn on an outpatient basis on postoperative Day 7. Patient records were retrospectively reviewed to determine the incidence of, and risk factors for, symptomatic and asymptomatic hyponatremia.
Two hundred forty-one patients had routine serum sodium levels drawn as outpatients on postoperative Day 7. Twenty-three percent of these patients were found to be hyponatremic (Na ≤ 135 mEq/L). The overall incidence rate of symptomatic hyponatremia in the 241 patients was 5%. The majority of hyponatremic patients (80%) remained asymptomatic, whereas 20% became symptomatic. In patients with symptomatic hyponatremia, the mean sodium level at diagnosis was 120.5 mEq/L, compared with 128.4 mEq/L in asymptomatic, hyponatremic patients (p < 0.0001). Female patients were more likely to develop hyponatremia than male patients (33% compared with 22%, p < 0.03). Fifty-two percent of patients who had transient diabetes insipidus (DI) early in their postoperative course subsequently developed hyponatremia, compared with 21% of those who did not have DI (p < 0.001). Patient age, tumor type, and tumor size did not correlate with development of delayed hyponatremia. Outpatients with moderately and severely low sodium levels were 5 and 12.5 times more likely, respectively, to be symptomatic than were patients with mild hyponatremia.

Conclusions
Delayed hyponatremia occurs more frequently than was previously suspected in patients who have undergone transsphenoidal surgery, especially in female patients and those who have previously had transient DI. The majority of hyponatremic patients remain asymptomatic. Obtaining a serum sodium value on an outpatient basis 1 week after pituitary surgery is helpful in recognition, risk stratification, and subsequent intervention, and may prevent potentially serious complications.
The diagnostic utility of brain biopsy procedures in patients with rapidly deteriorating neurological conditions or dementia
Authors: Josephson S. Andrew , Papanastassiou Alexander M. , Berger Mitchel S. , Barbaro Nicholas M. , McDermott Michael W. , Hilton Joan F. , Miller Bruce L. , Geschwind Michael D. 
Published: January 2008

Object
Obtaining brain biopsy specimens is often the diagnostic test of last resort for patients with unexplained neurological conditions, particularly those with a rapidly deteriorating neurological course. The goals of this analysis were to determine the diagnostic sensitivity of brain biopsy specimens in these types of patients and retrospectively identify features of these disorders that may have enabled an earlier diagnosis, which may prevent the need for diagnostic brain biopsy procedures in the future.

Methods
The authors reviewed the case records of all brain biopsy procedures that had been performed at a single tertiary care institution between January 1993 and April 2002 in 171 patients. Patients with HIV or nonlymphomatous brain tumors were excluded from this analysis because the utility of brain biopsy specimens for these conditions has been determined from previous studies. A subgroup analysis of this cohort was performed in the 64 patients who had comprehensive medical records and a clinical syndrome involving a progressively deteriorating neurological condition of less than 1 year in duration.
The overall sensitivity of brain biopsy procedures for diagnostic purposes in the cohort was 65% (111 of 171 patients). The two most common diagnoses in the subgroup with rapidly deteriorating neurological conditions were primary central nervous system (CNS) B-cell lymphoma in 20.3% (13 patients) and Creutzfeldt–Jakob disease in 15.6% (10 patients), followed by viral encephalitis in 14.1% (nine patients) and CNS vasculitis in 9.4% (six patients). Clinical symptoms and laboratory data were compared among the diagnostic groups.

Conclusions
These results will help guide the evaluation of patients with neurological conditions that are difficult to diagnose and will provide a foundation for further prospective studies.
Thirty-day morbidity and mortality rates for carotid artery intervention by surgeons who perform both carotid endarterectomy and carotid artery angioplasty and stent placement
Authors: Ecker Robert D. , Lau Tsz , Levy Elad I. , Hopkins L. Nelson 
Published: January 2008

Object
There is no known standard 30-day morbidity and mortality rate for high-risk patients undergoing carotid artery (CA) angioplasty and stent (CAS) placement. The high-risk registries and the Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy, Carotid Revascularization using Endarterectomy or Stenting Systems, and European Long-term Carotid Artery Stenting trials report different rates of morbidity and mortality, and each high-risk cohort has a different risk profile. The applicability of carotid endarterectomy (CEA) results from North American Symptomatic Carotid Endarterectomy Trial/Asymptomatic Carotid Atherosclerosis Study (NASCET/ACAS) remains uncertain, as most clinical CAS placement series reported to date typically included patients who would not have qualified for those studies. At the University at Buffalo, the same neurosurgeons perform triage in patients with CA disease and perform both CEA and CAS insertion. The authors review morbidity and mortality rates in this practice model.

Methods
Diagnosis-related group codes were used to search the authors’ practice database for patients who had undergone a completed CA intervention solely for the indication of atherosclerotic disease. One hundred twenty patients (129 vessels) treated with CAS surgery and 95 patients (100 vessels) treated with CEA met these criteria. In the CAS placement group, 78% of the patients would not have met NASCET/ACAS inclusion criteria. Demographic and clinical data for both groups were recorded on a spreadsheet for analysis.
At 30 days, one patient in the CEA group and two in the CAS group had died. Stroke occurred in one patient in the CAS group and none in the CEA group. Myocardial infarction (MI) occurred in one patient who underwent CAS surgery compared with three undergoing CEA. Composite incidence of stroke/death/MI was 3.3% in the CAS group and 3.2% in the CEA group.

Conclusions
In a practice in which surgeons perform both CEA and CAS surgery, the event rates for the CAS surgery equivalent to NASCET and ACAS rates for CEA can be achieved, even in high-risk NASCET/ACAS-ineligible patients in 78% of the CAS cases.
Trends in the incidence of subarachnoid hemorrhage in Akita Prefecture, Japan
Authors: Kozák Norbert , Hayashi Masato 
Published: January 2008

Object
The incidence of subarachnoid hemorrhage (SAH) in Japan has been reported to be among the highest in the world. The aim of this study was to analyze the incidence of SAH and its trends in Akita Prefecture, Japan.

Methods
The incidence rate of SAH between January 1, 1989, and December 31, 1998, was investigated using the prospective Akita Stroke Register. Computed tomography scans were obtained in all suspected cases of SAH. During the study period, 3257 patients with their first SAH were registered. The crude annual incidence rates of SAH in men, women, and both sexes were 20, 33, and 27 per 100,000 population per year, respectively. Age-standardized incidence rates remained stable. Crude incidence rates in women increased. In men the incidence reached a plateau after 55 years of age; in women it peaked in the eighth decade of life. The 28-day case fatality rate was 26.7%, without significant changes. Two diurnal peaks were observed: one at 7 a.m. and another at 5 p.m. The incidence was lowest in summer and highest in spring, in both sexes.

Conclusions
The incidence of SAH in patients in Akita Prefecture is similar to that reported in other Japanese studies. The age-standardized incidence rates are stable. The increasing crude incidence in women is probably attributable to the aging of the Japanese population.