bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endoscopic Transsphenoidal Surgery
Authors: de Divitiis Enrico 
Published: September 2006

Abstract
THE TRANSSPHENOIDAL MIDLINE route represents the standard approach to the pituitary and sellar area and is used for more than 95% of surgical indications in this region. It is the least traumatic route to the sella turcica, it avoids brain retraction, and it provides excellent visualization of the pituitary gland and lesions related to that structure. The technique has essentially replaced craniotomy and has been used by every pituitary neurosurgeon, representing the “gold standard” of the transsphenoidal approach to the sellar region for more than 30 years. The introduction of endoscopic techniques has produced a “stone-in-the-pond” effect, influencing the relatively peaceful neurosurgical environment. The brilliant increased vision of the surgical target offered by the endoscope can allow more effective removal of the lesion, followed by superior clinical results and a reduction in the incidence of complications. Endoscopy contributes to better and more contemporary knowledge of the possibilities of the transsphenoidal approach, thus increasing the extended approaches, not only for the pituitary area. Whether or not the transsphenoidal approach should be performed with the use of the microscope or the endoscope is finally discussed.
Are Primary Supratentorial Intracerebral Hemorrhages Surrounded by a Biochemical Penumbra? A Microdialysis Study
Authors: Nilsson Ola G. , Polito Angelo , Säveland Hans , Ungerstedt Urban , Nordström Carl-Henrik 
Published: September 2006

Abstract

OBJECTIVE:
Opinions vary regarding the indications for surgical evacuation of spontaneous intracerebral hemorrhages (ICH) and whether or not penumbra zones surround them.

METHODS:
We performed intracerebral microdialysis (mean duration, 3.5 d) after surgical evacuation of ICH in 22 patients. Probes were placed in the parenchyma within 1 to 2 cm of the evacuated hematoma; a postoperative computed tomographic scanning verified their positions. The catheters were perfused with an artificial cerebrospinal fluid solution at 0.3 μl/min. Biochemical variables (glucose, pyruvate, lactate, glutamate, and glycerol) were analyzed and displayed at the bedside. The levels obtained were compared with previous data from normal human brains and the pericontusional penumbra zones of patients with severe traumatic brain lesions.

RESULTS:
During 1 to 12 hours after surgery, interstitial levels of glucose (median level, 1.3 mmol/L; interquartile range, 0.6–2.2 mmol/L) were within normal variations, whereas the levels of lactate (median level, 6.4 mmol/L; interquartile range, 3.9–9.0 mmol/L), glutamate (median level, 14 μmol/L; interquartile range, 5–370 μmol/L), and glycerol (median level, 190 μmol/L; interquartile range, 74–380 μmol/L), as well as the lactate/pyruvate ratio (median ratio, 35; interquartile range, 23–50) were increased. A gradual normalization of the lactate/pyruvate ratio and glycerol level was observed within 48 hours.

CONCLUSION:
The area close to an evacuated ICH exhibits a biochemical pattern similar to that of the biochemical penumbra zone surrounding focal traumatic brain contusions. The presence of a penumbra zone around large ICH may be of importance for making surgical decisions.
Preoperative Prediction of Long-term Outcome in Poor-grade Aneurysmal Subarachnoid Hemorrhage
Authors: Mocco J , Ransom Evan R. , Komotar Ricardo J. , Schmidt J Michael , Sciacca Robert R. , Mayer Stephan A. , Connolly E. Sander 
Published: September 2006

Abstract

OBJECTIVE:
To evaluate which presentation indices, demographics, and clinical information predict 12-month outcome in poor-grade aneurysmal subarachnoid hemorrhage (SAH), and to provide a preoperative index of prognosis.

METHODS:
Data were obtained on all patients with poor-grade (Hunt and Hess Grades IV and V) aneurysmal SAH from a prospectively maintained SAH database and health outcomes project. Demographics, medical history, presenting clinical condition, and health outcomes were analyzed. Survival analysis was performed and Kaplan-Meier curves were generated. Multivariable logistic regression analysis was used to identify significant predictors of poor outcome at 12 months after hemorrhage, as measured by the modified Rankin disability scale.

RESULTS:
Survival curves for open surgery and endovascular treatment did not differ significantly. Overall, 40% of the 98 definitively treated patients had a favorable outcome at 12 months. Multivariable analysis identified patient age older than 65 years (P &lt; 0.001), hyperglycemia (P &lt; 0.03), worst preoperative Hunt and Hess Grade V (P &lt; 0.0001), and aneurysm size of at least 13 mm (P &lt; 0.002) as significant predictors of poor outcome. These variables were weighted and used to compute a poor-grade aneurysmal SAH Prognosis Score (hereafter, Prognosis Score) for each patient. A Prognosis Score of 0 was associated with a 90% favorable outcome; Prognosis Score of 1 with 83%; Prognosis Score of 2 with 43%; Prognosis Score of 3 with 8%; Prognosis Score of 4 with 7%; and a Prognosis Score of 5 with 0%.

CONCLUSION:
Outcome in poor-grade aneurysmal SAH is strongly predicted by patient age, worst preoperative Hunt and Hess clinical grade, and aneurysm size. Hyperglycemia on admission after poor-grade aneurysmal SAH increases the likelihood of poor outcome, and is a potentially modifiable risk factor. The Prognosis Score is a useful tool for preoperatively assessing the likelihood of a favorable outcome for poor-grade aneurysmal SAH patients.
Endoscopic Third Ventriculostomy for Occlusive Hydrocephalus Caused by Cerebellar Infarction
Authors: Baldauf Jörg , Oertel Joachim , Gaab Michael R. , Schroeder Henry W.S. 
Published: September 2006

Abstract

OBJECTIVE:
The surgical management of occlusive hydrocephalus caused by massive cerebellar infarction remains controversial. The procedures that are more commonly used to avoid progressive neurological deterioration are based on transient external ventricular drainage or the placement of permanent shunt systems. To our knowledge, this is the first report regarding using endoscopic third ventriculostomy (ETV) in patients with an occlusive hydrocephalus caused by cerebellar ischemic stroke. We report our experience of 10 reviewed cases.

METHODS:
Between 1997 and 2004, 10 patients with a resulting hydrocephalus caused by a space-occupying cerebellar infarction were managed with ETV. Glasgow Coma Scale score on admission, cause of stroke, and computed tomographic signs, including the ischemic vascular territory involved and brain edema, were noted. Clinical outcome was evaluated using the Glasgow Outcome Scale.

RESULTS:
In all patients, there was a mean interval of 4 days from the onset of deterioration of consciousness to operation. Mean Glasgow Coma Scale score on admission was 11.2. In nine patients, ETV was the initial procedure of ventricular drainage. One patient was primarily treated with an external ventricular drainage, but the device dislocated and ETV was performed. In one patient, an external ventricular drainage became necessary 7 days after the initial ETV because of a malfunction of the stoma. One patient showed a progressive brain edema 2 days after ETV, and suboccipital decompression was performed. Eight successfully treated patients demonstrated an improvement in the level of consciousness after ETV. Mean Glasgow Outcome Scale score on discharge of all patients was 3.4.

CONCLUSION:
Occlusive hydrocephalus caused by cerebellar infarction is infrequent. When occlusive hydrocephalus is observed, ETV can be used successfully with minimal risks, especially with avoidance of a higher rate of infectious complications caused by external drainage systems.
Glomus Jugulare Tumors
Authors: Gerosa Massimo , Visca Anna , Rizzo Paolo , Foroni Roberto , Nicolato Antonio , Bricolo Albino 
Published: September 2006

Abstract

OBJECTIVE:
Glomus jugulare tumors are generally considered slow-growing, benign lesions. However, their pronounced local aggressiveness frequently results in severe neurological deficits. Surgical removal is rarely radical and is usually associated with morbidity. There is increasing evidence that stereotactic radiosurgery, particularly gamma knife radiosurgery (GKR), may play a relevant role as a therapeutic option in these tumors.

METHODS:
Between 1996 and 2005, we used GKR to treat 20 patients bearing growing glomus jugulare tumors, mostly classified as Glasscock-Jackson Grade IV or Fisch Stage D1. Follow-up (mean, 50.85 mo) data was available for 20 patients (four men, 16 women; mean age, 56 yr): eight out of 20 tumors were surgical recurrences, three out of 20 patients had GKR as the primary treatment, and 11 out of 20 patients previously underwent endovascular embolization. Regarding the radiosurgical dose planning, the average tumor volume was 7.03 cm3 (range, 1.5–13.4 cm3) and the mean marginal dose was 17.3 Gy (range, 13–24 Gy).

RESULTS:
Neurological signs and symptoms were unchanged in 13 out of 20 patients. An improvement of cranial nerve function was observed in five patients and hearing deterioration was observed in two patients. Tumor volume was unchanged in 11 out of 20 patients and was slightly (≤ 20%) decreased in eight out of 20 patients. In one unusual case of a bulky cavernous sinus recurrence, neoplastic regression was particularly pronounced.

CONCLUSION:
Despite the constraints of the limited case material, considering the estimated doubling time of these rare tumors (4.2 yr), our preliminary results with GKR at a mid-term follow-up examination suggest an effective tumor growth control with negligible incidence of untoward sequelae.
Visual Outcome of Tuberculum Sellae Meningiomas after Extradural Optic Nerve Decompression
Authors: Mathiesen Tiit , Kihlström Lars 
Published: September 2006

Abstract

OBJECTIVE:
Meningiomas of the tuberculum sellae have a close relationship with the optic apparatus. Even modern series show a 10 to 20% risk of visual deterioration after surgery. We have attempted to improve visual outcome by extradural decompression of the optic canal and anterior clinoid process, followed by intradural release of the optic nerve; this study provides an analysis of visual outcomes with this approach.

METHODS:
Treatment, histopathology, and follow-up data of 29 consecutive patients undergoing surgery for tuberculum sellae meningiomas with initial release of the optic nerve were prospectively collected.

RESULTS:
Radical tumor removal was possible in all 23 patients with primary tumors and in three out of six patients with recurrent tumors. All patients but two of the worst affected with preoperative visual compromise improved from surgery; there were no instances of visual deterioration. Five patients with normal preoperative vision remained intact and visual improvement was 22 (91%) out of 24 patients in the remaining patients. In total, 13 patients (42%) had completely normal vision at follow-up. Mainly patients younger than 60 years experienced complete normalization after surgery. Two patients underwent transsphenoidal surgery for cerebrospinal fluid leaks. Postoperative endocrinological symptoms were temporary diabetes insipidus in one patient and permanent diabetes insipidus in another patient undergoing elective sectioning of the pituitary stalk because of a recurrent tumor with invasive growth into the stalk.

CONCLUSION:
Adding early optic nerve decompression by extradural clinoidectomy and optic canal unroofing to a frontopterional approach seemed to improve visual outcomes because there were no instances of visual deterioration. Simpson Grade 1 to 2 removal was possible in all patients with primary surgery, whereas recurrent cases could only be treated with lower grades of radicality. Radical removal, however, required readiness to reoperate for cerebrospinal fluid leakage at the site of the drilled tumor origin in bone.
Difference in Recovery Potential of Peripheral Nerves after Graft Repairs
Authors: Roganovic Zoran , Pavlicevic Goran 
Published: September 2006

AbstractOBJECTIVE:To our knowledge, few studies have been published regarding differences in nerve recovery potentials. In this study, sensory and motor recovery potentials were compared between different nerves.METHODS:A prospective study of a homogenous group of 393 graft repairs of the median, ulnar, radial, tibial, peroneal, femoral, and musculocutaneous nerves, with the scoring of motor and sensory recoveries. Sensory and motor recovery potentials, defined on the basis of average scores and rates of useful recovery, were compared between the different nerves, and separately for high-, intermediate-, and low-level repairs.RESULTS:Sensory recovery potential was similar for all nerves tested (P &gt; 0.05), but motor recovery potential differed significantly. After high-level repairs, motor recovery potential was significantly better for the radial and tibial nerves (useful recovery in 66.7 and 54.5% of patients, respectively), than for the ulnar and peroneal nerves (useful recovery in 15.4 and 13.8% of patients, respectively; P &lt; 0.05). After intermediate-level repairs, motor recovery potential was better for the musculocutaneous, radial, and femoral nerves (useful recovery in 100, 98.3, and 87.5% of repairs, respectively), than for the tibial, median and ulnar nerves (useful recovery in 63.9, 52, and 43.6% of repairs, respectively; P &lt; 0.05). In addition, motor recovery potential was significantly the worst with peroneal nerve repairs (useful recovery in 15.2% of patients; P &lt; 0.05). After low-level repairs, motor recovery potential was similar for all nerves (useful recovery in the range of 88.9–100% of patients and in 56.3% of peroneal nerve repairs).CONCLUSION:Sensory recovery potential is similar for the median, ulnar, and tibial nerves. The expression of motor recovery potential depends on the repair level. With low- and high-level repairs, it does not stand out in an obvious way, but it is fully expressed with intermediate-level repairs, classifying nerves into three categories with excellent, moderate, and poor recovery potential.
Posttraumatic Peripherally-induced Dystonia and Multifocal Deep Brain Stimulation
Authors: Capelle Hans-Holger , Grips Eva , Weigel Ralf , Blahak Christian , Hansjörg Baezner , Wohrle Johannes C. , Krauss Joachim K. 
Published: September 2006

Abstract

OBJECTIVE:
We report on the effect of multifocal deep brain stimulation for the treatment of posttraumatic peripherally-induced dystonia.

CLINICAL PRESENTATION:
A 34-year-old woman presented with an 8-year history of painful tonic dystonia starting in her left leg after injury of the third metatarsal bone. She did not benefit from right-sided pallidal stimulation by an electrode misplaced in the globus pallidus externus in another hospital.

INTERVENTION:
Quadripolar deep brain stimulation electrodes were placed in the globus pallidus internus and the ventrolateral thalamus by computed tomographic-guided stereotactic surgery and microelectrode recording contralateral to the side of dystonia. The Burke-Fahn-Marsden motor score of 34 did not improve with chronic pallidal or thalamic stimulation.

CONCLUSION:
Although deep brain stimulation is received with great enthusiasm, it is important to identify its limitations in certain subtypes of dystonia.
Preservation of Facial Nerve Function after Postoperative Vasoactive Treatment in Vestibular Schwannoma Surgery
Authors: Strauss Christian , Romstöck Johann , Fahlbusch Rudolf , Rampp Stefan , Scheller Christian 
Published: September 2006

Abstract

OBJECTIVE:
Facial nerve paresis and hearing loss are common complications after vestibular schwannoma surgery. Experimental and clinical studies point to a beneficial effect of nimodipine and hydroxyethyl starch for preservation of cochlear nerve function. A retrospective analysis was undertaken to evaluate the effect of vasoactive treatment on facial nerve outcome.

PATIENTS AND METHODS:
Forty-five patients with vestibular schwannoma removal, intraoperative electromyographic monitoring, and postoperative deterioration of facial nerve function were evaluated. Twenty-five patients underwent vasoactive treatment consisting of nimodipine and hydroxyethyl starch for improvement of hearing outcome. Twenty patients did not receive such treatment. Facial nerve function was evaluated before and after surgery, as well as 1 year after the surgical procedure. Patients were comparable regarding age, tumor size, and preoperative facial nerve function.

RESULTS:
Long-term results of facial nerve function were significantly improved in those patients who experienced severe postoperative deterioration of facial nerve function and received vasoactive treatment as compared with patients who did not receive nimodipine and hydroxyethyl starch after surgery. Treated patients showed a significantly higher rate of complete recovery compared with patients without treatment.

CONCLUSION:
The study points to a potential effect of vasoactive treatment for facial nerve function after vestibular schwannoma surgery. In particular, patients with postoperative disfiguring facial nerve palsy clearly benefit from intravenous hydroxyethyl starch and nimodipine with respect to a long-term socially acceptable facial nerve function.
When the Bone Flap Hits the Floor
Authors: Jankowitz Brian T. , Kondziolka Douglas S. 
Published: September 2006

AbstractOBJECTIVE:There is no published data in the neurosurgical literature describing the incidence, treatment, or outcome of contaminating a bone flap. We reviewed our departmental experience to determine methods of prevention and assess our treatment strategies.METHODS:We retrospectively reviewed all incidents of dropped bone flaps during a craniotomy at a single medical center during a 16-year period. In addition, a questionnaire was mailed to neurosurgeons in the United States and abroad asking their own experience and method of management.RESULTS:Fourteen incidents of dropped bone flaps occurred during a 16-year period. Follow-up varied from 2 to 176 months. The bone flap was dropped while elevating the bone (n = 4), when handing the bone off the field (n = 4), and during plating (n = 4). The context was unknown in two cases. Management included soaking the flap in betadine and/or antibiotic solution (n = 8), autoclaving (n = 2), or discarding the bone flap and replacing with a mesh cranioplasty (n = 3). The treatment remains unknown in one case. No instances of infection were noted in follow-up. In response to the survey, 66% (33 out of 50) of the polled neurosurgeons had experienced this complication during their practice, and 83% would replace the bone flap after disinfection.CONCLUSION:Dropping a bone flap during neurosurgery remains an uncommon but preventable complication. Treatment options include discarding the bone followed by cranioplasty versus replacing the bone after treatment with antibiotic irrigation, betadine, and/or autoclaving. Replacement after disinfection is an appropriate option for contaminated bone flaps that avoids the expense and time of cranioplasty.
Construction of Carbon Frameworks through β-Carbon Elimination Mediated by Transition Metals
Authors: Murakami Masahiro , Makino Masaomi , Ashida Shinji , Matsuda Takanori 
Published: September 2006

Abstract
New catalytic reactions in which transition-metal cyclobutanolates undergo β-carbon elimination have been developed in our laboratory. Rhodium(I) cyclobutanolate generated by the addition of an arylrhodium(I) species to a cyclobutanone undergoes β-carbon elimination to cause ring opening of the four-membered carbocyclic framework. The synthetic potential of the ring-opening process through β-carbon elimination has been demonstrated by its application to a ring-expansion reaction forming a seven-membered ring. Furthermore, a formal alkyne insertion into the cyclobutanone framework is achieved by combining oxidative cyclization of a cyclobutanone and an alkyne on nickel(0) and β-carbon elimination from the resulting nickel(II) cyclobutanolate.
X-ray Analysis of Excited-State Molecular Structure of [AuCl(PPh3)2]
Authors: Hoshino Manabu , Uekusa Hidehiro , Ohashi Yuji 
Published: September 2006

Abstract
When a chloroform solvate crystal of the three-coordinated Au(I) complex [AuCl(PPh3)2]·CHCl3 was irradiated with a mercury lamp at low temperatures, the crystal showed bright green emission from the excited molecules. From X-ray analysis, the unit-cell volume significantly decreased under photoirradiation. The three-dimensional intensity data were collected in the dark (light-off) and under photoirradiation (light-on) at 175, 156, 136, and 84 K. As the temperature decreased, the difference in unit-cell volume between the light-off and -on experiments increased. The molecular structures in the light-off and -on experiments revealed that the Au–P and Au–Cl bonds are significantly contracted by photoirradiation at every temperature. The changes in the other bond lengths were within the experimental errors. The shortening becomes greater as the temperature is lowered. The bond shortening, which causes the decrease in unit-cell volume, is in good agreement with the theoretical assumption that excitation from an anti-bonding orbital to a bonding orbital occurs in the Au(I) complex by photoirradiation.
A Study on Zinc Isotope Fractionation in a Benzo Crown Resin/Acetone System
Authors: Ding Xingcheng , Suzuki Tatsuya , Nomura Masao , Sugiyama Yuichi , Kaneshiki Toshitaka , Fujii Yasuhiko 
Published: September 2006

Abstract
Zinc isotope fractionation has been studied in different cavities of crown ether resins that were synthesized in porous silica beads. Displacement chromatography was performed, as a breakthrough manner, in glass columns by feeding in a zinc chloride solution. From the mass analysis of effluents, the heavier isotopes of zinc were enriched at the beginning of the zinc adsorption band. The front maximum enrichment (1.0168), separation coefficient (8.1 × 10−4), and smaller HETP (0.205 cm) for the isotopic pair 68Zn/64Zn were obtained with the use of the benzo-15-crown-5 resin. Zinc isotope fractionation was obviously affected by the cavity size of the crown ethers.
Synthesis and Structures of Vanadium–Cerium Trinuclear Complexes with Schiff-Base Ligands
Authors: Tsuchimoto Masanobu , Ishii Toshio , Imaoka Takane , Yamamoto Kimihisa , Yoshioka Naoki , Sunatsuki Yukinari 
Published: September 2006

Abstract
A vanadium(V)–cerium(IV) trinuclear complex, [{VVO2(L1)}2CeIV] (1) (H3L1: N,N′-bis-3-ethoxysalicylidene-2-hydroxy-1,3-propanediamine), was prepared by the reaction of [VIVO(acac)2] and [CeIII(acac)3]·3H2O with H3L1 in CH3CN, followed by oxidation of the product in air. The structure of complex 1 was determined by X-ray crystal structure analysis. The complex has a VV–CeIV–VV trinuclear structure with two dioxovanadium(V) moieties on each side of the cerium(IV) moiety. Complex 1 has two L1 ligands to form a trinuclear structure. The basal oxo atoms of the dioxovanadium(V) moieties are coordinated to the cerium atom with Ce–O distances of 2.322(3) and 2.343(3) Å. The apical two non-coordinating oxo atoms are oriented to the same direction to form an endo structure. IR data of complex 1 show V=O stretching bands at 975 cm−1 for the apical non-coordinated oxo atoms and 802 cm−1 for the basal coordinated oxo atoms. The cyclic voltammogram of complex 1 in CH3CN shows a quasi-reversible two-electron redox couple with E1/2 = −0.60 V vs Fc/Fc+.