bluuebunny/crossref_metadata_2025_split huggingface dataset:
Combined medical and surgical treatment after acute spinal cord injury: results of a prospective pilot study to assess the merits of aggressive medical resuscitation and blood pressure management
Authors: Vale Fernando L. , Burns Jennifer , Jackson Amie B. , Hadley Mark N. 
Published: January 2008

The optimal management of acute spinal cord injuries remains to be defined. The authors prospectively applied resuscitation principles of volume expansion and blood pressure maintenance to 77 patients who presented with acute neurological deficits as a result of spinal cord injuries occurring from C-1 through T-12 in an effort to maintain spinal cord blood flow and prevent secondary injury. According to the Intensive Care Unit protocol, all patients were managed by Swan-Ganz and arterial blood pressure catheters and were treated with immobilization and fracture reduction as indicated. Intravenous fluids, colloid, and vasopressors were administered as necessary to maintain mean arterial blood pressure above 85 mm Hg. Surgery was performed for decompression and stabilization, and fusion in selected cases. Sixty-four patients have been followed at least 12 months postinjury by means of detailed neurological assessments and functional ability evaluations.
Sixty percent of patients with complete cervical spinal cord injuries improved at least one Frankel or American Spinal Injury Association (ASIA) grade at the last follow-up review. Thirty percent regained the ability to walk and 20% had return of bladder function 1 year postinjury.
Thirty-three percent of the patients with complete thoracic spinal cord injuries improved at least one Frankel or ASIA grade. Approximately 10% of the patients regained the ability to walk and had return of bladder function.
As of the 12-month follow-up review, 92% of patients demonstrated clinical improvement after sustaining incomplete cervical spinal cord injuries compared to their initial neurological status. Ninety-two percent regained the ability to walk and 88% regained bladder function.
Eighty-eight percent of patients with incomplete thoracic spinal cord injuries demonstrated significant improvements in neurological function 1 year postinjury. Eighty-eight percent were able to walk and 63% had return of bladder function.
The authors conclude that the enhanced neurological outcome that was observed in patients after spinal cord injury in this study was in addition to, and/or distinct from, any potential benefit provided by surgery. Early and aggressive medical management (volume resuscitation and blood pressure augmentation) of patients with acute spinal cord injuries optimizes the potential for neurological recovery after sustaining trauma.
Epilepsy in children with shunted hydrocephalus
Authors: Bourgeois Marie , Sainte-Rose Christian , Cinalli Giuseppe , Maixner Wirginia , Malucci Conor , Zerah Michel , Pierre-Kahn Alain , Renier Dominique , Hoppe-Hirsch Elisabeth , Aicardi Jean 
Published: January 2008

The incidence of epilepsy among children with hydrocephalus and its relation to shunts and their complications, raised intracranial pressure (ICP), and developmental outcome are explored in a retrospective study.
The authors studied a series of 802 children with hydrocephalus due to varying causes, who were treated by ventriculoperitoneal shunt placement between 1980 and 1990, with a mean follow-up period of 8 years. Patients who had tumoral hydrocephalus and those whose files lacked significant data were excluded. Data extracted from medical records, including history of the hydrocephalus and history of seizures, if any, were analyzed.
Thirty-two percent of the children had epilepsy, the onset of which frequently occurred at approximately the same time that the diagnosis of hydrocephalus was made. The majority of the affected children had severe uncontrolled epilepsy. The incidence of epilepsy was significantly affected by the original cause of the hydrocephalus. The presence of radiological abnormalities was also found to be a significant predictor of epilepsy. Similarly, shunt complications predisposed to epilepsy. Episodes of raised ICP related to hydrocephalus or in association with shunt malfunction may also predispose to epileptic seizures. Furthermore, the presence of a shunt by itself seems able to promote an epileptogenic focus. Finally, epilepsy appears to be an important predictor of poor intellectual outcome in hydrocephalic children with shunts.
A prospective study is needed to identify clearly and confirm avoidable factors predisposing to seizures in these children so that we can strive to reduce the incidence of these seizures and, subsequently, improve quality of life.
Acute postoperative seizures following anterior temporal lobectomy for intractable partial epilepsy
Authors: Malla Bhaskara Rao , O'Brien Terence J. , Cascino Gregory D. , So Elson L. , Radhakrishnan Kurupath , Silbert Peter , Marsh W. Richard 
Published: January 2008

Recurrence of seizures immediately following epilepsy surgery can be emotionally devastating, and raises concerns about the chances of successfully attaining long-term seizure control. The goals of this study were to investigate the frequency of acute postoperative seizure (APOS) occurring in the 1st postoperative week following anterior temporal lobectomy (ATL) to identify potential risk factors and to determine their prognostic significance.
One hundred sixty consecutive patients who underwent an ATL for intractable nonlesional temporal lobe epilepsy were retrospectively studied. Acute postoperative seizures occurred in 32 patients (20%). None of the following factors were shown to be significantly associated with the occurrence of APOS: age at surgery, duration of epilepsy, side of surgery, extent of neocortical resection, electrocorticography findings, presence of mesial temporal sclerosis, and hippocampal volume measurements (p > 0.05). Patients who suffered from APOS overall had a lower rate of favorable outcome with respect to seizure control at the last follow-up examination than patients without APOS (62.5% compared with 83.6%, p < 0.05). The type of APOS was of prognostic importance, with patients whose APOS were similar to their preoperative habitual seizures having a significantly worse outcome than those whose APOS were auras or were focal motor and/or generalized tonic-clonic seizures (excellent outcome: 14.3%, 77.8%, and 75%, respectively, p < 0.05). Only patients who had APOS similar to preoperative habitual seizures were less likely to have an excellent outcome than patients without APOS (14.3% compared with 75%, p < 0.05). Timing of the APOS and identification of a precipitating factor were of no prognostic importance.
The findings of this study may be useful in counseling patients who suffer from APOS following ATL for temporal lobe epilepsy.
Postimaging brain distortion: magnitude, correlates, and impact on neuronavigation
Authors: Dorward Neil L. , Alberti Olaf , Velani Binti , Gerritsen Frans A. , Harkness William F. J. , Kitchen Neil D. , Thomas David G. T. 
Published: January 2008

This prospective study was conducted to quantify brain shifts during open cranial surgery, to determine correlations between these shifts and image characteristics, and to assess the impact of postimaging brain distortion on neuronavigation.
During 48 operations, movements of the cortex on opening, the deep tumor margin, and the cortex at completion were measured relative to the preoperative image position with the aid of an image-guidance system. Bone surface offset was used to assess system accuracy and correct for registration errors. Preoperative images were examined for the presence of edema and to determine tumor volume, midline shift, and depth of the lesion below the skin surface. Results were analyzed for all cases together and separately for four tumor groups: 13 meningiomas, 18 gliomas, 11 nonglial intraaxial lesions, and six skull base lesions.
For all 48 cases the mean shift of the cortex after dural opening was 4.6 mm, shift of the deep tumor margin was 5.1 mm, and shift of the cortex at completion was 6.7 mm. Each tumor group displayed unique patterns of shift, with significantly greater shift at depth in meningiomas than gliomas (p = 0.007) and significantly less shift in skull base cases than other groups (p < 0.003). Whereas the preoperative image characteristics correlating with shift of the cortex on opening were the presence of edema and depth of the tumor below skin surface, predictors of shift at depth were the presence of edema, the lesion volume, midline shift, and magnitude of shift of the cortex on opening.
This study quantified intraoperative brain distortion, determined the different behavior of tumors in four pathological groups, and identified preoperative predictors of shift with which the reliability of neuronavigation may be estimated.
Complete endoscopic removal of colloid cysts: issues of safety and efficacy
Authors: Teo Charles 
Published: January 2008

The ideal management of colloid cysts is controversial. Treatment options include shunting procedures, stereotactic cyst aspiration, open craniotomy for microsurgical removal, and endoscopic removal. Although recent literature would suggest endoscopic removal is a reasonable approach, issues of safety and efficacy have dampened the universal acceptance of this surgical modality. The author performed a retrospective anaylsis to address these controversial issues.
The charts of all patients in whom endoscopic removal of colloid cysts was performed by the primary author at the University of Arkansas for Medical Sciences were reviewed. Eighteen patients underwent this procedure over the last 5 years. The mean patient age was 32 years, and the mean follow-up period was 32 months. In all patients complete tumor removal was macroscopically and radiologically confirmed, and there were no permanent deficits. Two patients suffered aseptic meningitis without long-term sequelae. There were no deaths and no incidence of tumor recurrence.
The results of this series support those previously published that underscore the advantages of endoscopic removal of colloid cysts. The procedure is safe and effective. Longer follow-up review is required to address the issue of duration of tumor-free survival.
Intracranial endoscopy
Authors: Schroeder Henry W. S. , Gaab Michael R. 
Published: January 2008

The authors' intention is to reduce the invasiveness of intracranial procedures while avoiding traumatization of brain tissue, to decrease the risk of neurological and mental deficits. Intracranial endoscopy is a minimally invasive technique that provides rapid access to the target via small burr holes without the need for brain retraction. Craniotomy as well as microsurgical brain splitting and dissection can often be avoided. Furthermore, because obstructed cerebrospinal fluid pathways can be physiologically restored, the need for shunt placement is eliminated. The ventricular system and subarachnoid spaces provide ideal conditions for the use of an endoscope. Therefore, a variety of disorders, such as hydrocephalus, small intraventricular lesions, and arachnoid and parenchymal cysts can be effectively treated using endoscopic techniques. With the aid of special instruments, laser fibers, and bipolar diathermy, even highly vascularized lesions such as cavernomas may be treated. Moreover, during standard microsurgical procedures, the endoscopic view may provide valuable additional information ("looking around a corner") about the individual anatomy that is not visible with the microscope. In transsphenoidal pituitary surgery, transseptal dissection can be avoided if an endonasal approach is taken. In the depth of the intrasellar space, the extent of tumor removal can be more accurately controlled, especially in larger tumors with para- and suprasellar growth.
The combined use of endoscopes and computerized neuronavigation systems increases the accuracy of the approach and provides real-time control of the endoscope tip position and approach trajectory. In the future, the indications for neuroendoscopy will certainly expand with improved technical equipment.
Reoperation for herniated thoracic discs
Authors: Dickman Curtis A. , Rosenthal Daniel , Regan John J. 
Published: January 2008

In this review the authors address the surgical strategies required to resect residual thoracic disc herniations. Fifteen patients who had undergone prior thoracic discectomy and who harbored residual or incompletely excised symptomatic thoracic discs were reviewed retrospectively. The surgical procedures that had failed to excise the herniated discs completely included 11 posterolateral approaches, one thoracotomy, and three thoracoscopic procedures. Of the incompletely resected or residual disks 13 were central calcified, two were soft, 12 were extradural, and three were intradural discs. Indications for reoperation were often multiple in each patient and included misidentification of the level of disc disease at the initial operation (five cases), abandoning the procedure because of intraoperative spinal cord injury (three cases), inadequate visualization of the pathology (eight cases), migration of a soft disc fragment within the spinal canal (one case), and intradural disc extension (three cases). The symptoms at the time of reoperation included myelopathy in 13 patients and radicular pain in two. The mean interval before reoperation was 150 days (range 1 day-4 years). The reoperation procedures included one thoracotomy and 14 video-assisted thoracoscopic procedures performed ipsilateral (11 cases) or contralateral (four cases) to the site of the initial surgery.
The herniated disc material was excised completely in all 15 cases without causing new neurological deficits. Reoperation complications included atelectasis in three patients, intercostal neuralgia in two, a loosened screw that required removal in one, and a cerebrospinal fluid leak in one patient. Of the 13 patients who experienced myelopathy preoperatively, 10 recovered neurological function and three stabilized. All patients with radicular pain improved.
Calcified, large, broad-based, centrally located, or transdural thoracic disc herniations can be difficult to resect. These lesions require a ventral operative approach to visualize the dura adequately for a safe and complete resection.
Gliomas in rodent whisker barrel cortex: a new tumor model
Authors: Sherburn Eric W. , Wanebo John E. , Kim Paul , Song Sheng-Kwei , Chicoine Michael R. , Woolsey Thomas A. 
Published: January 2008

Object
Surgical treatment of gliomas is difficult because they are invasive. Invasion of essential cortex often limits or precludes surgical resection. A tumor model was developed in which the rodent whisker barrel cortex was used to examine how gliomas affect cortical function and structure.

Methods
Both DBT (mouse) and C6 (rat) glioma cell lines were grown in culture and labeled with the fluorescent marker Dil in vitro. Labeled tumor cells were then injected into the whisker barrel cortex of adult mice and rats. Neurological assessments were made daily and magnetic resonance (MR) images were obtained. Animals were killed by perfusion 6 to 14 days after injection, and histological sections were prepared and studied.
Tumors were found in all 20 rats and 10 mice that had been injected with the C6 and DBT cell lines, respectively. The animal cells had been labeled with Dil in vitro, and all in vivo tumors proved to be Dil positive. The MR images revealed the tumor locations and serial MR images demonstrated tumor growth. Histological evaluation confirmed the location of the tumor and the disruption of barrel cortex architecture.

Conclusions
Both DBT and C6 glioma cell lines can be used to generate malignant glial tumors reproducibly in the whisker barrel cortex. Fluorescent labeling and cytochrome oxidase staining permit visualization of tumor growth patterns, which disrupt the barrel cortex by microscopic invasion and by gross tissue deformation. Magnetic resonance imaging demonstrates the anatomical extension of these tumors in live rodents. Using this model for further studies on the effects of malignant glioma growth on functional cerebral cortex should advance our understanding of the neurological issues and management of patients with these tumors.
A neural transplantation cannula and microinjector system: experimental and clinical experience
Authors: Mendez Ivar , Hong Murray , Smith Stephen , Dagher Alain , Desrosiers Jacques 
Published: January 2008

The authors present a simple, reliable, and safe system for performing neural transplantation in the human brain. The device consists of a transplantation cannula and microinjector system that has been specifically designed to reduce implantation-related trauma and to maximize the number of graft deposits for each injection. The system was evaluated first in an experimental rat model of Parkinson's disease (PD). Animal transplantation with this system showed excellent graft survival with minimal trauma to the brain. Following this experimental stage, the cannula and microinjector system was used in eight patients with PD enrolled in the Halifax Neural Transplantation Program who received bilateral putaminal transplants of fetal ventral mesencephalic tissue. A total of 16 transplantation operations and 64 trajectories were performed in the eight patients, and there were no intra- or perioperative complications. Magnetic resonance imaging studies obtained 24 hours after surgery revealed no evidence of tissue damage or hemorrhage. Transplant survival was confirmed on fluorodopa positron emission tomography scans 6 and 12 months after surgery.
As neural transplantation procedures for the treatment of neurological conditions evolve, the ability to deliver viable grafts safely will become of critical importance. The device presented here has been proven to be of value in maximizing the number of graft deposits while minimizing implantation-related trauma to the host brain.
Multilevel anterior thoracic discectomies and anterior interbody fusion by using a microsurgical thoracoscopic approach
Authors: Dickman Curtis A. , Mican Camilla A. 
Published: January 2008

A video-assisted thoracoscopic microsurgical approach was performed to treat a myelopathic patient with a severe kyphotic deformity caused by chronic nonunion of compression fractures of T7-9 vertebrae. The kyphotic deformity was treated by combined operative procedures. First, an anterior release was performed using a thoracoscopic technique, sectioning the anterior longitudinal ligament and performing multilevel thoracic discectomies. Next, a posterior reduction and internal fixation of the deformity was achieved using hook-rod instrumentation. Finally, bone graft harvested during the posterior approach was used for interbody fusion via a thoracoscopic approach.
Microsurgical thoracoscopic techniques potentially can be used in a variety of spinal surgeries. Compared to transthoracic and posterolateral approaches, this technique presents distinct advantages to treatment of anterior spinal pathology. The small incisions made into the intercostal spaces without retracting the ribs may reduce postoperative pain, shorten the length of hospitalization, and allow early return to activity.
The operative techniques used in this case are described in detail. This report demonstrates that thoracoscopic discectomies and interbody fusion are technically feasible and can be effectively performed with acceptable results.
Applications of positron emission tomography in neurosurgery: past, present, and future
Authors: Polin Richard S. , Lilien David L. , Menendez Jose , Nanda Anil 
Published: January 2008

Any novel technological innovation is dependent more on the ingenuity of its users than its inherent properties and potential flaws. Positron emission tomography (PET) is unique in this regard because the limitations of this modality are defined by the ability of its users to identify tracers that will aid in the diagnosis of intracerebral processes. The limitations of PET scanning lay in the extent of tissue resolution and in the currently relatively small number centers equipped to perform PET scanning.
In this issue of Neurosurgical Focus, various applications of PET scanning are detailed. The traditional use of this technology in neurosurgery has been to determine the metabolic nature of cerebral neoplastic lesions so as to help differentiate neoplastic from benign or infectious processes. This determination, however, has not been foolproof, and the technique has been further refined to maximize diagnostic yield.
Nonetheless, the utility of PET scanning continues to grow. New applications have allowed for the precise measurements of cerebral blood flow, helping the neuroscientist understand the functional organization of cortex, the pathophysiology of normal-pressure hydrocephalus, and changes in cerebral blood flow following traumatic injury. Other radiotracers such as fluorodopa allow assessment of the metabolic state of cerebral tissue transplants in restorative neurosurgical procedures.
In this introduction, all of these issues will be considered, and a historical perspective and the potential future uses of this technology will be provided. Technology moves so quickly that new instruments are routinely introduced. The authors will try to assess what properties, in the 25-year history of PET scanning, will need to be improved to keep it as a cutting-edge technology and expand its clinical role.
Comparative genomic hybridization indicating two distinct subgroups of pilocytic astrocytomas
Authors: Szymas Janusz , Wolf Gunther , Petersen Simone , Schluens Karsten , Nowak StanislaW , Petersen Iver 
Published: January 2008

Object
The authors investigated the spectrum of chromosomal imbalances of pilocytic astrocytoma by using comparative genomic hybridization (CGH).

Methods
Tumor DNA was extracted from surgically obtained samples of 18 pilocytic astrocytomas that were examined for the presence of neoplastic tissue on frozen sections. Comparative genomic hybridization was performed using standard procedures, and digital image analysis was conducted using out by custom-made software. The chromosomal alterations were determined by a statistical procedure in which Student's t-test (99% confidence interval) was used. Details on CGH analysis and individual ratio profiles are available at http://amba.charite.de/cgh/.

Conclusions
The results suggests the presence of two distinct genetic subgroups of pilocytic astrocytoma, with imbalances of chromosome 19 being the major change for differentiation. In the first group (10 samples), deletions on chromosome 19 were shown as well as multiple gains mainly on chromosomes 5 and 6q but also on chromosomes 4, 7, 8, 10, and 11. The second group (eight samples) was characterized by overrepresentation on chromosomes 19p and 22q, which were associated with deletions on 4q, 5q, 6q, 9p, 13q, and 18q. To understand the diverse biological and clinical behavior exhibited by this tumor type, it is important that pilocytic astrocytomas be classified into distinct subgroups according to their genetic makeup.