bluuebunny/crossref_metadata_2025_split huggingface dataset:
Blood blister–like aneurysms of the internal carotid artery trunk causing subarachnoid hemorrhage: treatment and outcome
Authors: Meling Torstein R. , Sorteberg Angelika , Bakke Søren J. , Slettebø Haldor , Hernesniemi Juha , Sorteberg Wilhelm 
Published: March 2008

Object
The object of this study was to evaluate cases of subarachnoid hemorrhage (SAH) from ruptured blood blister–like aneurysms (BBAs) of the internal carotid artery (ICA) trunk.

Methods
The authors performed a single-center, retrospective study. Data analyzed were patient age, sex, Hunt and Hess grade, Fisher grade, time from SAH to hospitalization, aneurysm size and location, collateral capacity of the circle of Willis, time from hospitalization to aneurysm repair, type of aneurysm repair, complications, and Glasgow Outcome Scale (GOS) score at follow-up.

Results
A total of 211 patients suffered SAH from ICA aneurysms. Of these, 14 patients (6.6%) had ICA trunk BBAs; 6 men and 8 women. The median age was 47.8 years (range 29.9–67.7 years). The Hunt and Hess grade was IV or V in 7 cases, and SAH was Fisher Grade 3 + 4 in 6. All aneurysms were small (< 1 cm), without relation to vessel bifurcations, and usually located anteromedially on the ICA trunk. Three patients were treated with coil placement and 11 with clip placement. Of the 7 patients in whom the ICA was preserved, only 1 had poor outcome (GOS Score 2). In contrast, cerebral infarcts developed in all patients treated with ICA sacrifice, directly postoperatively in 2 and after delay in 5. Six patients died, 1 survived in poor condition (GOS Score 3; p < 0.001).

Conclusions
Internal carotid BBAs are rare, small, and difficult to treat endovascularly, with only 2 of 14 patients successfully treated with coil placement. The BBAs rupture easily during surgery (ruptured in 6 of 11 surgical cases). Intraoperative aneurysm rupture invariably led to ICA trap ligation. Sacrifice of the ICA within 48 hours of an SAH led to very poor outcome, even in patients with adequate collateral capacity on preoperative angiograms, probably because of vasospasm-induced compromise of the cerebral collaterals.
Microvascular decompression for trigeminal neuralgia in elderly patients
Authors: Sekula Raymond F. , Marchan Edward M. , Fletcher Lynn H. , Casey Kenneth F. , Jannetta Peter J. 
Published: March 2008

Object
Although microvascular decompression (MVD) for patients with medically refractory trigeminal neuralgia (TN) is widely accepted as the treatment of choice, other “second-tier” treatments are frequently offered to elderly patients due to concerns regarding fitness for surgery. The authors sought to determine the safety and effectiveness of MVD for TN in patients older than 75 years of age.

Methods
The authors performed a retrospective review of medical records and conducted follow-up telephone interviews with the patients. The outcome data from 25 MVD operations for TN performed in 25 patients with a mean age of 79.4 years (range 75–88 years) were compared with those of a control group of 25 younger patients with a mean age of 42.3 years (range 17–50 years) who underwent MVDs during the same 30-month period from July 2000 to December 2003.

Results
Initial pain relief was achieved in 96% of the patients in both groups (p = 1.0). There were no operative deaths in either group. After an average follow-up period of 44 and 52 months, 78 and 72% of patients in the elderly and control groups, respectively, remained pain free without medication (p = 0.74).

Conclusions
Microvascular decompression is an effective treatment for elderly patients with TN. The authors' experience suggests that the rate of complications and death after MVD for TN in elderly patients is no different from the rate in younger patients.
Long-term recurrence and mortality after surgery and adjuvant radiotherapy for nonfunctional pituitary adenomas
Authors: Chang Edward F. , Zada Gabriel , Kim Sang , Lamborn Kathleen R. , Quinones-Hinojosa Alfredo , Tyrrell J. Blake , Wilson Charles B. , Kunwar Sandeep 
Published: March 2008

Object
Long-term outcomes following surgery for nonfunctional pituitary adenomas (NFPAs) are unclear. The role of adjuvant radiation therapy is therefore controversial because it is associated with higher tumor control but also carries known long-term morbidity. The authors' aim was to determine predictors of recurrence and overall survival and to define patient subgroups that may benefit from radiotherapy.

Methods
The authors performed a retrospective cohort analysis of 663 patients who underwent surgery between 1975 and 1995 for treatment of primary NFPAs. The main outcome measures were disease progression after surgery, defined by clinical and/or imaging criteria, and all-cause mortality.

Results
Over a median clinical follow-up of 8.4 years, there were 64 (9.7%) recurrences after treatment, with a median time to recurrence of 5.6 years. The 5-, 10-, and 15-year recurrence-free probabilities were 0.93, 0.87, and 0.81, respectively. Multivariate Cox proportional hazard regression analysis identified the following predictors as associated with increased recurrence: cavernous sinus invasion (hazard ratio [HR] 3.6, 95% confidence interval [CI] 1.5–6.4; p < 0.001) and subtotal resection (STR) without radiotherapy (HR 3.6, 95% CI 1.4–14; p = 0.01). Using time-to-event estimates to adjust for differences in follow-up between groups, radiotherapy was found to reduce tumor recurrence in only those patients who received an STR (p < 0.001, log-rank test) but not gross-total resection (GTR; p = 0.63, log-rank test). Median follow-up for overall survival was 14.0 years. The 5-, 10-, 15- and 20-year overall survival estimates were 0.91, 0.81, 0.69, and 0.55, respectively. Within the study cohort and in age- and sex-adjusted comparison with the general US population, increased relative mortality was observed in patients who underwent radiotherapy or STR.

Conclusions
Cavernous sinus invasion is an important prognostic variable for long-term control of NFPAs. Radiotherapy results in long-term tumor control for patients who undergo STR but does not affect recurrence rates and may increase the risk of death after GTR. Given the risks associated with radiotherapy, there is no role for its routine application in patients who have undergone GTR of their NFPA. In all patients, long-term monitoring is required.
The claustrum and its projection system in the human brain: a microsurgical and tractographic anatomical study
Authors: Fernández-Miranda Juan C. , Rhoton Albert L. , Kakizawa Yukinari , Choi Chanyoung , Álvarez-Linera Juan 
Published: March 2008

Object
The goal in this study was to examine the microsurgical and tractographic anatomy of the claustrum and its projection fibers, and to analyze the functional and surgical implications of the findings.

Methods
Fifteen formalin-fixed human brain hemispheres were dissected using the Klingler fiber dissection technique, with the aid of an operating microscope at × 6–40 magnification. Magnetic resonance imaging studies of 5 normal brains were analyzed using diffusion tensor (DT) imaging–based tractography software.

Results
Both the claustrum and external capsule have 2 parts: dorsal and ventral. The dorsal part of the external capsule is mainly composed of the claustrocortical fibers that converge into the gray matter of the dorsal claustrum. Results of the tractography studies coincided with the fiber dissection findings and showed that the claustrocortical fibers connect the claustrum with the superior frontal, precentral, postcentral, and posterior parietal cortices, and are topographically organized. The ventral part of the external capsule is formed by the uncinate and inferior occipitofrontal fascicles, which traverse the ventral part of the claustrum, connecting the orbitofrontal and prefrontal cortex with the amygdaloid, temporal, and occipital cortices. The relationship between the insular surface and the underlying fiber tracts, and between the medial lower surface of the claustrum and the lateral lenticulostriate arteries is described.

Conclusions
The combination of the fiber dissection technique and DT imaging–based tractography supports the presence of the claustrocortical system as an integrative network in humans and offers the potential to aid in understanding the diffusion of gliomas in the insula and other areas of the brain.
Internal carotid artery dissection following wooden arrow injury to the posterior pharynx
Authors: Lubarsky Michael , Helmer Robert , Knight Charles , Mullins Mark E. 
Published: March 2008

✓ In this report the authors describe a case of internal carotid artery (ICA) dissection following a blunt posterior pharynx injury and review current literature on the identification and treatment of such disorders. An ICA dissection developed in a 6-year-old boy who had suffered blunt injury to the posterior pharynx and who was followed up via computed tomography (CT) angiography and clinic visits for 6 months. The ICA dissection healed with pseudoaneurysm development and was treated with anticoagulation therapy.
The authors searched the January 1996 through March 2007 MEDLINE database by using the Ovid search engine. They requested all English-language articles with the term “carotid dissection.” Reference lists from these articles were retrieved and searched for additional relevant sources. The authors found that given its availability and speed of acquisition, CT angiography typically is the preferred initial diagnostic method. Magnetic resonance angiography is usually recommended for follow-up examination especially in pediatric cases. According to the available literature, the current preferred treatment for ICA dissection is anticoagulation.
Pediatric Neurosurgery in a Non-Academic City Hospital
Authors: Grabb Paul 
Published: March 2008

Introduction
Creation of a pediatric neurosurgical service in the community has challenges unique from establishing such a service in an academic setting. I outline the challenges in creating a pediatric neurosurgical service within a large city-owned hospital. Critical equipment system-related and man-power issues were identified.

Methods
The NACHRI designated children's hospital (Memorial Hospital for Children) serves southern Colorado. Coverage was not provided by the community neurosurgeons. Therefore, children requiring neurosurgical management traveled to Denver or elsewhere. A pediatric neurosurgeon was hired to establish a clinical service in 2004.

Results
Equipment such as endoscopy, frameless stereotaxy, ICP monitors, and shunt components were obtained easily. Familiarizing the OR/ICU staff with the equipment, however, required months as this technology was rarely utilized by the other surgeons. System-related concerns were many and mostly educational involving the ER, PICU, NICU, and floor. Identifying anesthesiologists with pediatric expertise and desire was critical. Unexpected system-related benefits compared to a university-based Children's Hospital were lack of resistance for imaging studies requiring sedation or invasive studies (angiography), outstanding intraoperative support for spinal instrumentation cases, very rapid transport to OR of trauma patients, and speed of anesthesia. Man-power issues of no cross-coverage remain problematic primarily because of insurance premium increases to provide pediatric coverage. Any increased burden by nonresidents is offset by the support of other specialties (emergency room physicians, intensivists, and trauma surgeons). Physician extenders require a large amount of education and oversight before reducing clinical burden.

Conclusion
Creating a pediatric neurosurgical service within a community hospital requires financial support from the hospital, a system capable of and willing to care for children with complex problems and other specialties, and physician extenders competent to assist with the service. The medicolegal/insurance landscape hinders more complete coverage within our system. A tremendous educational effort is required to establish and maintain a safe and functional service.
Technical Aspects of Ventriculogallbladder Shunts: The Surgical Team Preoperative Assessment. Operative Intervention and Postoperative Assessment: A Clinical Report
Authors: James Hector , Aldana Philipp , Postlethwait Richard 
Published: March 2008

Introduction
Ventriculogallbladder shunts (VGBSs) have been employed when there is a contraindication for intraperitoneal shunt placement or when CSF is no longer absorbed by the peritoneum. We report our clinical experience with 19 patients (1986–2006) with particular emphasis on perioperative management.

Methods
In 18 patients VGBS placement was indicated because of failure of abdominal absorption of CSF and in one patient due to multiple intraperitoneal general surgery operative interventions. An absolute preoperative requirement is documenting the presence and status of the gallbladder by ultrasonography or CT. The proximal portion was similar to a ventriculoperitoneal shunt with emphasis in a proximal one-way valve; the distal end was performed by open laparotomy to adequately anchor the distal end to the distal pole of the gallbladder wall and verify the length inside the gallbladder. Additional redundant distal shunt tubing was placed in the abdomen, allowing for subsequent patient growth. Prior to hospital discharge, the gallbladder status was evaluated by ultrasound to document function.

Results
The following highlights the importance of the preoperative assessment: one patient had congenital agenesis of the gallbladder. One patient had “sludge” formation on preoperative ultrasound that in the immediate postoperative period developed an obstruction of the common duct that required shunt removal. Two patients had shunt infections (S. epidermis, H. influenzae) and 15 patients had successful long-term shunt function.

Conclusion
We conclude that VGBSs should be considered an important tool in the armamentarium of pediatric neurosurgery.
Tissue Engineering: Growing Skull with In Situ Osteogenesis
Authors: Flannery Ann Marie 
Published: March 2008

Introduction
Acquired skull defects are common as a result of trauma infection and calvarial expansion among other causes. The techniques available to repair these defects have included a variety of foreign body implants or bone grafting from proximal or distant sites. Tissue engineering using bone morphogenetic protein (rBMP) and an absorbable mesh scaffold offers a unique opportunity to fill defects with in situ osteogenesis.

Methods
Bony calvarial defects in 19 children ranging in age from 11 months to 15 years were repaired using rBMP and a collagen scaffold plus a synthetic hydroxyapatite ceramic in a granular or matrix form. The construct is held with poly D,L-lactide acid resorbable mesh. The skull defects were a result of trauma (n = 5) craniotomy for tumor (n = 2), congenital absence (n = 1), infection (n = 4), and calvarial expansion for synostosis (n = 7). The reconstruction technique varied with the size and geometry of the defect. The defects repaired ranged from 10 to 60 cm2. Results of the repair were judged by physical exam and 3D computed tomography.

Results
In 18 patients followed for at least 6 months, the calvarium was completely ossified in 15 cases and had a small residual defect (2 cm2) in 3 from early in the series. Two surgeries were required to completely reconstruct a bifrontal bone flap.

Conclusion
BMP shows promise for repairing significant calvarial defects by promoting the growth of the patient's own bone in situ osteogenesis, thereby avoiding the need for foreign body implants or bone grafts from other sites.
Timing of surgery in cauda equina syndrome with urinary retention: meta-analysis of observational studies
Authors: DeLong W. Bradford , Polissar Nayak , Neradilek Blažej 
Published: March 2008

ObjectThe authors performed exploratory meta-analyses of observational cohort studies, evidence level III, examining whether earlier surgery makes a difference in outcome in terms of urinary function once cauda equina syndrome (CES) from a herniated lumbar disc has progressed to urinary retention (CESR).MethodsLiterature search identified 27 studies of CESR patients with clear definition of surgical timing. Relative risk (RR) could not be calculated in 11 studies, leaving 16 for meta-analysis. Urinary retention related to surgical timing at 5 breakpoints: 12, 24, 36, 48, or 72 hours. Urinary outcome was classified as Normal, Fair, or Poor. Meta-analysis was performed for “Event = Fair/Poor” or “Event = Poor.” Eight studies allowed separation into CESR and incomplete CES (CESI), and 5 of these had enough data for meta-analysis to compare CESR and CESI. A random effects meta-analysis model was used because of heterogeneity across the studies. A best-evidence synthesis was performed for the 4 largest studies that had 24- and 48-hour breakpoints.ResultsFor “Event = Fair/Poor,” meta-analyses using the 5 breakpoints predicted a more likely Fair/Poor outcome for later surgery (RR range 1.77–2.19). The RR for later timing of surgery was statistically significant for 24-and 72-hour breakpoints and was elevated but not statistically significant for the other 3. For “Event = Poor,” the RR range was 1.09–5.82, statistically significant for the 36 hour breakpoint only. Meta-analysis comparing CESR patients with CESI patients predicted a Fair/Poor result for CESR (RR 2.58, 95% confidence interval 0.59–11.31). The best-evidence synthesis did not disclose reasons for differences in the results of the 4 studies.ConclusionsThis study supports early surgery for CES and indicates that CESR and CESI cases should not be analyzed together.
Anatomical relationship of the internal carotid artery to C-1: clinical implications for screw fixation of the atlas
Authors: Hoh Daniel J. , Maya Marcel , Jung Alexander , Ponrartana Skorn , Lauryssen Carl L. 
Published: March 2008

ObjectVarious C1–2 instrumentation techniques have been developed to treat atlantoaxial instability. Screw fixation of C1–2 poses a risk of injury to the vertebral artery and internal carotid artery (ICA). Injury to the ICA caused by C-1 screws is extremely rare, but has been described. To characterize this risk, the authors studied the anatomical relationship of the ICA to the lateral mass of C-1.MethodsThe authors studied 100 patients who had undergone computed tomography scanning and magnetic resonance imaging of the neck to assess the position of the ICA in association with the C-1 lateral mass. Each ICA was classified into 1 of the following 4 zones: Zone 1 (medial to lateral mass), Zone 2 (medial half of lateral mass), Zone 3 (lateral half of lateral mass), and Zone 4 (lateral to lateral mass). For patients with an ICA ventral to the lateral mass, the shortest distance between the ICA and lateral mass was measured to determine the margin of error with an overpenetrated bicortical screw.ResultsOf the 100 patients, 58% had a left ICA in Zones 2 and 3 with a mean distance from the anterior cortex of 3.5 ± 1.5 mm (± standard deviation), and 74% had a right ICA in Zones 2 and 3 with a mean distance from the anterior cortex of 3.9 ± 1.6 mm. Both ICAs anterior to the lateral mass were noted in 47% of patients, and 84% had ≥ 1 ICA anterior to the lateral mass. When the ICA was anterior to the lateral mass, it was more commonly in the lateral half (left ICA in 91% and right ICA in 92%). The left ICA was in Zone 1 in 1% and Zone 4 in 41%. The right ICA was in Zone 1 in 1% and Zone 4 in 25%.ConclusionsA high percentage of patients demonstrate an ICA directly ventral to the C-1 lateral mass, which poses a risk of ICA injury caused by an overpenetrated bicortical screw.
Biomechanical comparison of three fixation techniques for unstable thoracolumbar burst fractures
Authors: Acosta Frank L. , Buckley Jenni M. , Xu Zheng , Lotz Jeffrey C. , Ames Christopher P. 
Published: March 2008

ObjectIncreased structural stability is considered sufficient justification for higher-risk surgical procedures, such as circumferential fixation after severe spinal destabilization. However, there is little biomechanical evidence to support such claims, particularly after traumatic lumbar burst fracture. The authors sought out to compare the biomechanical performance of the following 3 fixation strategies for spinal reconstruction after decompression for an unstable thoracolumbar burst fracture: 1) short-segment anterolateral fixation; 2) circumferential fixation; and 3) extended anterolateral fixation.MethodsThoracolumbar spines (T10–L4) from 7 donors (mean age at death 64 ± 6 years; 1 female and 6 males) were tested in pure moment loading in flexion–extension, lateral bending, and axial rotation. Thoracolumbar burst fractures were surgically induced at L-1, and testing was repeated sequentially for each of the following fixation techniques: short-segment anterolateral, circumferential, and extended anterolateral. Primary and coupled 3D motions were measured across the instrumented site (T12–L2) and compared across treatment groups.ResultsCircumferential and extended anterolateral fixations were statistically equivalent for primary and off-axis range-of-motions in all loading directions, and short-segment anterolateral fixation offered significantly less rigidity than the other 2 methods.ConclusionsThe results of this study strongly suggest that extended anterolateral fixation is biomechanically comparable to circumferential fusion in the treatment of unstable thoracolumbar burst fractures with posterior column and posterior ligamentous injury. In cases in which an anterior procedure may be favored for load sharing or canal decompression, extension of the anterior instrumentation and fusion one level above and below the unstable segment can result in near equivalent stability to a 2-stage circumferential procedure.