bluuebunny/crossref_metadata_2025_split huggingface dataset:
Decision making for patients with multiple brain metastases: radiosurgery, radiotherapy, or resection?
Authors: Kondziolka Douglas , Patel Atul , Lunsford L. Dade , Flickinger John C. 
Published: January 2008

Object
Multiple brain metastases are a common health problem, frequently found in patients with cancer. The prognosis, even after treatment with whole-brain radiation therapy (WBRT), is poor, with an average expected survival time of less than 6 months. Investigators at numerous centers have evaluated the role of stereotactic radiosurgery in retrospective case series of patients harboring solitary or multiple tumors. Tumor resection is used mainly for patients with large tumors that cause acute neurological syndromes. The authors conducted a randomized trial in which they compared radiosurgery combined with WBRT with WBRT alone.

Methods
Twenty-seven patients were randomized (14 to recieve WBRT alone and 13 to receive WBRT combined with radiosurgery). The rate of local failure at 1 year was 100% after WBRT alone but only 8% in patients in whom boost radiosurgery was performed. The median time to local failure was 6 months after WBRT alone (95% confidence interval (CI) 3.5–8.5) in comparison to 36 months (95% CI 15.6–57) after WBRT and radiosurgery (p = 0.0005). The median time to the development of any brain failure was improved in the combined modality group (p = 0.002). Survival was shown to be related to the extent of extracranial disease (p = 0.02).

Conclusions
Combined WBRT and radiosurgery for the treatment of patients with two to four brain metastases significantly improves control of brain disease. Whole-brain radiation therapy alone does not provide lasting and effective care when treating most patients. Surgical resection remains important for patients with large symptomatic tumors and in whom limited extracranial disease has been demonstrated.
Analysis of aqueductal cerebrospinal fluid flow after endoscopic aqueductoplasty by using cine phase-contrast magnetic resonance imaging
Authors: Schroeder Henry W. S. , Schweim Christiane , Schweim Klaus H. , Gaab Michael R. 
Published: January 2008

Object
The purpose of this prospective study was to evaluate aqueductal cerebrospinal fluid (CSF) flow after endoscopic aqueductoplasty. In all patients, preoperative magnetic resonance (MR) imaging revealed hydrocephalus caused by aqueductal stenosis and lack of aqueductal CSF flow.

Methods
In 14 healthy volunteers and in eight patients with aqueductal stenosis who had undergone endoscopic aqueductoplasty, aqueductal CSF flow was investigated using cine cardiac-gated phase-contrast MR imaging. For qualitative evaluation of CSF flow, the authors used an in-plane phase-contrast sequence in the midsagittal plane. The MR images were displayed in a closed-loop cine format. Quantitative through-plane measurements were performed in the axial plane perpendicular to the aqueduct. Evaluation revealed no significant difference in aqueductal CSF flow between healthy volunteers and patients with regard to temporal parameters, CSF peak and mean velocities, mean flow, and stroke volume. All restored aqueducts have remained patent 7 to 31 months after surgery.

Conclusions
Aqueductal CSF flow after endoscopic aqueductoplasty is similar to aqueductal CSF flow in healthy volunteers. The data indicate that endoscopic aqueductoplasty seems to restore physiological aqueductal CSF flow.
Distraction osteogenesis for craniosynostosis
Authors: Akizuki Tanetaka , Komuro Yuzo , Ohmori Kitaro 
Published: January 2008

Object
The authors describe the use of distraction devices and surgical techniques of distraction osteogenesis for the treatment of patients with craniosynostosis.

Methods
Since 1994, the authors have performed distraction procedures in 23 patients with craniosynostosis in whom osteogenesis was achieved. Thirteen of the 23 patients underwent a complete Le Fort III midface osteotomy and distraction. In 10 patients the distraction osteogenesis involved the cranial bone; six underwent combined forehead and midface distraction (Le Fort IV distraction) in which multiple internal devices were used after performing a Le Fort IV osteotomy.
An external distraction procedure was used to treat the first two cases. Since 1996, the authors have used internal devices developed in their unit.
Distraction was initiated 1 week after the osteotomy at the rate of 0.5 mm per day for the cranium and 1.0 mm per day for the midface. The consolidation phase after distraction was initiated was 2 to 3 months.
No major complications such as intracranial infection or neurological deficits were observed during the course of distraction osteogenesis. The osteogenesis generated at the distraction site was considerably satisfactory; and recurrence of the deformity in the follow-up period was minimal.

Conclusions
Distraction osteogenesis for craniofacial deformity has numerous advantages: 1) bone grafting is unnecessary; 2) the procedure is less invasive, has short operating time, and less blood loss occurs than in conventional craniofacial procedures; 3) no intracranial dead space is created; 4) there is a good amount of blood flow to the bone segment; and 5) soft-tissue expansion occurs. The authors believe that distraction osteogenesis is a versatile and stable option for the treatment of patients with craniosynostosis.
Laminotomy/medial facet approach in the excision of thoracic disc herniation
Authors: Black Perry 
Published: January 2008

Object
The author describes a technique of thoracic discectomy that has evolved from the posterolateral transfacet and the transpedicular approaches but that spares the pedicle and most of the facet joint.

Methods
This approach was used to remove a total of 11 discs (T6–12) in seven patients. The follow-up period ranged from 8 months to 3 years. In four patients with axial and/or girdle pain significant improvement was demonstrated. The paraparesis in one patient with myelopathy improved postoperatively; that in another patient improved but recurred 8 months postoperatively. In one patient who experienced preoperative leg weakness, the weakness was slightly increased postoperatively, but this sequela was only transient. There were no other complications, and there were no deaths.

Conclusions
This technique appears safe and effective. It can be adapted to the conventional laminectomy known to spine surgeons and requires no specialized instruments. Further trials appear warranted.
Spinal neurenteric cysts and their relation to more common aspects of occult spinal dysraphism
Authors: Rauzzino Michael J. , Tubbs R. Shane , Alexander Eben , Grabb Paul A. , Oakes W. Jerry 
Published: January 2008

Object
Neurenteric cysts are infrequently reported congenital abnormalities believed to be derived from an abnormal connection between the primitive endoderm and ectoderm. The authors report a series of 13 patients treated over a 50-year period.

Methods
Of the 13 patients, seven were female and six were male. Their ages at presentation ranged widely from 5 weeks to 52 years of age. Children presented more commonly with cutaneous stigmata of occult spinal dysraphism (OSD) whereas adults presented primarily with pain. Neurological deficit as a presenting symptom was less common in our series, a finding that reflects the slow growth of these lesions. In all but one patient some form of vertebral anomaly was associated with the cystic lesions, including two patients with Klippel–Feil abnormalities. There was a high incidence of associated forms of OSD including split cord malformation, lipoma, dermal sinus tract, and tethered spinal cord. In previous reports the authors have suggested that neurenteric cysts are more common in the cervical region and in a position ventral to the cord. In the present series these cysts most commonly occurred as intradural, extramedullary masses in the thoracolumbar region, situated dorsal to the spinal cord. The median follow-up period was 7.5 years, and postoperative outcome reflected a patient's preoperative neurological status; in no patient was outcome worsened due to surgery.

Conclusions
Complete excision of the neurenteric cyst remains the treatment of choice, as subtotal excision is associated with recurrence.
Ventral tethering in split cord malformation
Authors: Pang Dachling 
Published: January 2008

Object
The author studied the specific issue of ventral tethering in cases of type II split cord malformation (SCM). He also discussed the issue of ventral tethering in patients with type I SCM in whom a bony septum and dural sleeve have been resected.

Methods
Eleven (21%) of 52 patients with type II SCM were found to have a ventral fibrous septum tethering the hemicords to the ventral dura. Four categories of ventral septa were noted: 1) pure ventral intradural septa (three patients); 2) complete dorsoventral intradural septa (three patients); 3) dorsoventral septa continuous with a dermal sinus tract (two patients); and 4) ventral or complete septa continuous with ventral intestinal bands causing intestinal malrotation or diverticulum (three patients).
Excluding one autopsy case, all 10 patients had symptoms or progressive neurological syndromes at diagnosis. Magnetic resonance imaging was completely ineffective, and computerized tomography (CT) myelography was only partially effective in detecting ventral tethering in 50% of cases. The only other positive predictor of ventral tethering is the association of dermal sinus tract and intestinal malformations. Combining this predictor with CT myelography, only 60% of the cases of ventral tethering could be suspected before surgery.

Conclusions
The author recommends examining all patients with type II SCM, and at surgery the ventral surface of the split length and reunion site should be thoroughly inspected to reveal a ventral band.
Intraoperative magnetic resonance imaging–augmented transoral resection of axial disease
Authors: Kaibara Taro , Hurlbert R. John , Sutherland Garnette R. 
Published: January 2008

Object
Because transoral decompression of the cervicomedullary junction is compromised by a narrow surgical corridor, the adequacy of decompression/resection may be difficult to determine. This is problematic as spinal hardware may obscure postoperative radiological assessment, or the patient may require reoperation. The authors report three patients in whom high-field intraoperative magnetic resonance (MR) images were acquired at various stages during the transoral resection of C-2 lesions causing craniocervical junction compression.

Methods
In all three patients the lesions involved the cervicomedullary junction: one case each of plasmacytoma and metastatic breast carcinoma involving the odontoid process and C-2 vertebral body, and one case of basilar invagination with a Chiari type I malformation. All three patients presented with progressive myelopathy. Surgery-planning MR imaging studies, performed after the induction of anesthesia, demonstrated the lesion and its relationship to the planned surgical corridor. Transoral exposure was achieved through placement of a Crockard retractor system. In one case the soft palate was divided. Interdissection MR imaging revealed that adequate decompression had been achieved in all cases. In the two patients with carcinoma, posterior instrumentation was placed to achieve spinal stabilization. Planned suboccipital decompression and fixation was averted in the third case because MR imaging demonstrated that excellent decompression had been achieved.

Conclusions
Intraoperatively acquired MR images were instrumental in determining the adequacy of surgical decompression. In one patient the MR images changed the planned surgical procedure. Importantly, the acquisition of intraoperative MR images did not adversely affect operative time or neurosurgical techniques, including the instrumentation procedure.
Dose response to cerebrospinal fluid drainage on cerebral perfusion in traumatic brain–injured adults
Authors: Kerr Mary E. , Weber Barbara B. , Sereika Susan M. , Wilberger Jack , Marion Donald W. 
Published: January 2008

Object
Intracranial hypertension remains a common complication of traumatic brain injury (TBI). Ventriculostomy drainage is a recommended therapy to decrease intracranial pressure (ICP), but little empirical evidence exists to guide treatment. The authors conducted a study to examine systematically the effect of cerebral spinal fluid (CSF) drainage on ICP and indices of cerebral perfusion.

Methods
Intracranial pressure, cerebral perfusion pressure (CPP), cerebral blood flow velocity (CBFV), and near-infrared spectroscopy–determined regional cerebral oxygenation (rSO2) were measured in 58 patients (with Glasgow Coma Scale scores ≤ 8) before, during, and after ventriculostomy drainage. Three randomly ordered CSF drainage protocols varied in the volume of CSF removed (1 ml, 2 ml, and 3 ml). Physiological variables were time averaged in 1-minute blocks from baseline to 10 minutes after cessation of ventricular drainage.
There was a significant dose–time interaction for ICP with the three-extraction volume protocol, with incremental decreases in ICP (F [20, 1055] = 6.10; p = 0.0001). There was a significant difference in the CPP depending on the amount of CSF removed (F [2, 1787] = 3.22; p = 0.040) and across time (F [10, 9.58] = 11.9; p = 0.0003) without a significant dose–time interaction. A 3-ml withdrawal of CSF resulted in a 10.1% decrease in ICP and a 2.2% increase in CPP, which were sustained for 10 minutes. There was no significant dose, time or dose–time interaction with CBFV or rSO2.

Conclusions
Cerebrospinal fluid drainage (3 ml) significantly reduced ICP and increased CPP for at least 10 minutes. Analysis of these findings supports the use of ventriculostomy drainage as a means of at least temporarily reducing elevated ICP in patients with TBI.
Preoperative silk suture embolization of cerebral and dural arteriovenous malformations
Authors: Dehdashti Amir R. , Muster Michel , Reverdin Alain , De Tribolet Nicolas , Ruefenacht Daniel A. 
Published: January 2008

Object
The aim of this study was to evaluate the use of silk sutures as a medical implant when applied for the embolization of cerebral and dural arteriovenous malformations (AVMs). The facility of surgery and the clinical significance of complications related to preoperative silk suture embolization were evaluated immediately after surgery and at long-term follow up.

Methods
Thirty-four patients harboring 29 cerebral and five dural AVMs underwent embolization in which silk alone or in association with other agents was used. Medical and radiological records obtained in these 34 patients were reviewed retrospectively. The cerebral AVMs were classified according to the Spetzler–Martin grading system and the dural AVMs to the Djindjian grading system. The facility of the resection and the adverse outcomes, including new neurological deficits, hemorrhage, and fever, as well as histopathological evidence of vessel inflammatory changes, were determined in each case.
In all 23 surgical cases, the AVM could be easily manipulated and excised. New temporary neurological deficits occurred in three patients. A high Spetzler–Martin grade was not associated with a higher incidence of new neurological deficits. One delayed-onset hemorrhage was detected after embolization. Fever was present in 24% of the patients. No sign of significant vasculitis or perivascular inflammation was found on radiological or histopathological examination.

Conclusions
Silk sutures are safe embolic agents especially for proximal occlusion of AVM feeding vessels. New permanent neurological deficits were not encountered in this series. Fever was considered to be a minor, temporary side effect of silk suture embolization.
Evaluation and treatment of spinal metastases: an overview
Authors: Jacobs W. Bradley , Perrin Richard G. 
Published: January 2008

Metastases to the spine are a common and somber manifestation of systemic neoplasia. The incidence of spinal metastases continues to increase, likely a result of increasing survival times for patients with cancer. Historically, surgery for spinal metastases has consisted of simple decompressive laminectomy. Results obtained in retrospective case series, however, have shown that this treatment provides little benefit to the patient. With the advent of better patient-related selection practices, in conjunction with new surgical techniques and improved postoperative care, the ability of surgical therapy to play an important and beneficial role in the multidisciplinary care of cancer patients with spinal disease has improved significantly. Controversy remains, however, with respect to the relative merits of surgery, radiotherapy, chemotherapy, or a combination of these treatments.
In this topic review, the literature on spinal column and spinal cord metastases is collated to provide a description of the presentation, investigations, indications for surgical therapy, and the role of adjuvant cancer therapies for patients with spinal metastases. In addition, the authors discuss the different surgical strategies available in the armamentarium of the neurosurgeon treating patients with spinal metastasis.
Camptocormia treated with bilateral pallidal stimulation
Authors: Nandi Dipankar , Parkin Simon , Scott Richard , Winter Jonathan L. , Joint Carole , Gregory Ralph , Stein John , Aziz Tipu Z. 
Published: January 2008

The authors report the neurological, neurophysiological, and neuropsychological effects of using chronic bilateral pallidal high-frequency deep brain stimulation (DBS) in a case of disabling camptocormia.
Deep brain stimulation electrodes were implanted stereotactically to target the globus pallidus internus (GPi) bilaterally. Local field potentials (FPs) were recorded using the DBS electrodes and concurrent abdominal flexor elec-tromyography (EMG) potentials during camptocormic episodes. Videotaped assessments of the movement disorder and neuropsychological evaluation before implantation and at 6 months after initiation of pallidal stimulation were recorded.
There was significant functional improvement following chronic pallidal stimulation, and some improvement was noted in neuropsychological scores. The GPi FPs showed temporal correlation with EMG-recorded rectus abdominis potentials. There were no treatment-related adverse effects.
The authors have found that chronic pallidal stimulation was safe and offered functional benefit in this severely disabling condition. The physiological studies may help further the understanding of the pathophysiology of this rare entity.
Lateral skull base malignancies
Authors: McGrew Benjamin M. , Jackson C. Gary , Redtfeldt Raquel A. 
Published: January 2008

Object
Historically poor outcomes have been characteristic in patients with lateral skull base malignancies. As advances in skull base surgical techniques have been made, complete resection has increasingly been achieved. This has resulted in improved survival rates and local tumor control.

Methods
The authors performed a retrospective review of 95 patients treated for lateral skull base malignancies. The mean age of the patients was 49.4 years. There were 44 females and 51 males. The mean follow-up period was 50 months. Resection was performed in all patients, and postoperative radiotherapy was undertaken in 54% of the cases. Local disease control was maintained in 73% of the patients. Tumor involvement of the facial nerve and intracranial tumor extension did not jeopardize the rate of local control.

Conclusions
Despite the fact that technical advances in skull base surgery have resulted in a higher incidence of complete tumor resection and improved survival rates, a respect for the poor prognosis historically associated with lateral skull base malignancies should be maintained and treatment should be appropriately aggressive.
Spinal cord cysticercosis: neurosurgical aspects
Authors: Colli Benedito Oscar , Valença Marcelo Moraes , Carlotti Carlos Gilberto , Machado Hélio Rubens , Assirati João Alberto 
Published: January 2008

Object
The authors report their experience in the treatment of 12 symptomatic patients with intradural spinal neurocysticercosis.

Methods
The mean age of the 12 patients was 33 years. There were eight female and four male patients. Cysticercosis was present in association with hydrocephalus in nine cases. In nine of 12 patients the spinal lesion was confined to the thoracic or lumbar spinal cord, and in three the cysticerci occupied the cervical region. In all patients with hydrocephalus nerve root symptoms developed seven to 48 months later (mean 27.6 ± 15.5 months). In one patient hydrocephalus was absent, but he presented with cysticercal meningitis 24 months before spinal cord compression developed. Presenting symptoms suggesting spinal cysticercosis included muscular weakness (67%), pain (67%), and sphincter disturbance (25%). Neurological examination demonstrated a motor deficit in nine patients, sensory deficit in four, and radicular pain in three. The prognosis was worse in patients with moderate-to-severe arachnoiditis and spinal cord compression compared with those with isolated nerve roots involvement in whom outcome was favorable. Ten patients underwent laminectomy, after which neurological status improved in 44%, remained unchanged in 33%, or worsened in 22.2%.

Conclusions
The authors discuss their findings in these cases. Additionally they briefly review the literature, patho-physiology, and therapeutic and/or surgical strategies involved in this disease.
Bilateral decompressive surgery in lumbar spinal stenosis associated with spondylolisthesis: unilateral approach and use of a microscope and tubular retractor system
Authors: Palmer Sylvain , Turner Robert , Palmer Rosemary 
Published: January 2008

Object
The objective of this study was to assess the feasibility and efficacy of treating spondylolisthesis-related spinal stenosis via unilateral approach bilateral decompression in which METRx-MD instrumentation is placed.

Methods
Eight consecutive patients with spinal stenosis underwent bilateral decompressions via a unilateral approach in which METRx-MD instrumentation was placed. The procedures were performed on an outpatient basis after induction of general anesthesia. The patients underwent preoperative and 3-month postoperative plain radiography in which flexion–extension x-ray films were obtained. Preoperative and postoperative magnetic resonance imaging was also performed. All radiographs and neuroimages were read by a single radiologist blinded to the clinical results.
Eight vertebral levels in the eight patients were sugically decompressed (in one patient an additional level of non-spondylolisthesis-related stenosis was decompressed). The mean operative time was 92 minutes and the mean blood loss was 33 ml/level. Preoperatively stenosis was severe in five patients, moderate/severe in two, and moderate in one; postoperatively stenosis was absent in five, mild in two, and mild/moderate in one. Motion was detected on flexion–extension radiographs in three patients, but on early (3-month) postoperative radiographs there was no evidence of progression.

Conclusions
By following the authors' procedure, minimally invasive bilateral decompression of acquired spinal stenosis associated with spondylolisthesis can be successfully performed on an outpatient basis, with reasonable operative times, minimal blood loss, and acceptable morbidity.