bluuebunny/crossref_metadata_2025_split huggingface dataset:
Natural course of incidentally found nonfunctioning pituitary adenoma, with special reference to pituitary apoplexy during follow-up examination
Authors: Arita Kazunori , Tominaga Atsushi , Sugiyama Kazuhiko , Eguchi Kuniki , Iida Koji , Sumida Masayuki , Migita Keisuke , Kurisu Kaoru 
Published: January 2008

Object
The increase in the incidental detection of asymptomatic pituitary adenomas, known as “pituitary inciden-talomas,” led the authors to conduct a survey of the natural course of these lesions.

Methods
Forty-two patients with clinically nonfunctioning pituitary adenomas who had manifested no neurological or endocrinological disorders were monitored with magnetic resonance imaging studies. The follow-up period ranged from 10.8 to 168.2 months (mean ± standard deviation, 61.9 ± 38.2 months). The mean initial tumor size was 18.3 ± 7 mm.
In 21 patients, the tumor increased by at least 10% of its measured size on detection. This increase was first detected between 8.4 and 58.8 months (mean 31.8 ± 17.6 months) after diagnosis. There was no correlation between the original tumor size, patient age, or the presence of intratumoral cysts and tumor growth. Symptoms were noted in 10 patients during follow up; in four, extensive tumor necrosis accompanied hemorrhage, leading to severe headache, acute ophthalmological symptoms, and panhypopituitarism, which was indicative of pituitary apoplexy. Transsphenoidal surgery was performed in 12 patients with enlarged tumors, including three with apoplexy. With the exception of one apoplectic patient, visual function was recovered in all who underwent surgery. All apoplectic patients continue to manifest hypopituitarism.

Conclusions
In the course of 4 years, the size of the incidentalomas increased in 40% of 42 patients and became symptomatic in 20%. During the 5-year follow up, pituitary apoplexy developed in 9.5%. These findings may justify early intervention, especially in young individuals with incidentally found macroadenoma.
Endovascular operating suite: future directions for treating neurovascular disease
Authors: Murayama Yuichi , Saguchi Takayuki , Ishibashi Toshihiro , Ebara Masaki , Takao Hiroyuki , Irie Koreaki , Ikeuchi Satoshi , Onoue Hisashi , Ogawa Takeki , Abe Toshiaki 
Published: January 2008

Object
The purpose of this study was to evaluate initial experiences in a surgical operating room (OR) with a multi-purpose angiography unit, which offers integrated neurosurgical and radiological capabilities.

Methods
A specially designed biplane digital subtraction (DS) angiography system was installed in the neurosurgery OR. The new suite, which allows three-dimensional DS angiography with C-arm for computerized tomography and microsurgery capabilities, allows the neurosurgeon to perform a wide range of neurosurgical and endovascular procedures. Three hundred thirty-two procedures were performed in the endovascular OR between November 2003 and March 2005. Patients arriving in the emergency department were transferred to the endovascular OR without delay. The neurovascular team performed diagnostic angiography followed by endovascular interventional procedures or surgery.

Conclusions
The newly designed endovascular OR facilitates safe and systemic treatment of neurovascular disease.
Sequential and spatial profiles of apoptosis in ischemic penumbra after two-vein occlusion in rats
Authors: Nishioka Toshikazu , Nakase Hiroyuki , Nakamura Mitsutoshi , Konishi Noboru , Sakaki Toshisuke 
Published: January 2008

Object
The two-vein occlusion model is known to be useful for ischemic penumbra studies in vivo. It was applied here to examine sequential changes in the expression of Bax and Bcl-2 proteins and in apoptotic cells to assess the relationship between penumbra and apoptosis.

Methods
Two cortical veins were occluded photochemically by using rose bengal dye in 27 Wistar rats. The animals were killed with perfusion fixation at the following intervals: 4, 12, 24, 48, 96, and 168 hours after vein occlusion (four at each interval; three additional rats were sham-treated). Immunohistochemical analysis for the Bcl-2 family of proteins was performed along with the terminal deoxynucleotidyl transferase–mediated deoxyuridine triphosphate nick-end labeling (TUNEL) assay to examine the relationship to single-cell death.
Cells positive for antiapoptotic proteins began to appear in the TUNEL assay for animals killed 24 hours after vein occlusion, with a peak at 48 hours. These cells were localized in the core of infarction. Immunohistochemical staining for Bax protein showed an increased presence around ischemic lesions at 4 hours after vein occlusion, and the amounts continued to rise until 24 hours, when the localization was diffuse around the core of infarction. Negative findings on immunohistochemical studies for Bcl-2 protein were seen at the early phase after two-vein occlusion.

Conclusions
After vein occlusion, apoptosis appeared sequentially and widely in cortical lesions considered to be the penumbra. Therefore, control of apoptosis would be expected to offer a therapeutic window for treatment of venous infarction.
Anatomical and quantitative description of the transcavernous approach to interpeduncular and prepontine cisterns
Authors: Figueiredo Eberval Gadelha , Zabramski Joseph M. , Deshmukh Pushpa , Crawford Neil R. , Preul Mark C. , Spetzler Robert F. 
Published: January 2008

Object
The management of wide-necked, giant, or unsuccessfully coil-treated basilar apex aneurysms requires a wide exposure, for both working area and linear visualization of the basilar artery (BA). Cranial-based approaches, such as the transcavernous approach, have been proposed to deal with such aneurysms; whether abbreviated forms of this approach might provide similar exposure remains controversial. The authors examine this issue quantitatively.

Methods
Four alcohol-preserved cadaveric heads injected with pigmented silicone were prepared for bilateral dissection. After completing an orbitozygomatic craniotomy, the surgeons worked in a reverse direction, performing the transcavernous approach in five steps: 1) posterior clinoidectomy; 2) cavernous sinus opening; 3) anterior clinoidectomy; 4) cutting of the distal dural ring; and 5) cutting of the proximal dural ring.
Performing the complete transcavernous approach significantly increased the working area and linear exposure of the BA compared with abbreviated forms of the approach (p < 0.05). Opening the roof of the cavernous sinus significantly increased the working area compared with posterior clinoidectomy alone (p = 0.014); however, additional gains in exposure required completing the transcavernous approach. Resection of the anterior clinoid process combined with opening of only the distal dural ring did not significantly increase the working area or linear exposure of the BA.

Conclusions
The complete transcavernous approach significantly increases the working area and linear exposure of the BA compared with the more conservative forms of approach.
Accurate placement of the distal end of a ventriculoatrial shunt with the aid of real-time transesophageal echocardiography
Authors: Machinis Theofilos G. , Fountas Kostas N. , Hudson John , Robinson Joe Sam , Troup E. Christopher 
Published: January 2008

Objective
Ventriculoatrial (VA) shunts remain a valid option for the treatment of hydrocephalus, especially in patients in whom ventriculoperitoneal (VP) shunts fail. Correct positioning of the distal end of the catheter in the right atrium is of paramount importance for maintaining shunt patency and reducing the incidence of VA shunt-associated morbidity. The authors present their experience with real-time transesophageal echocardiography (TEE) monitoring for the accurate placement of the distal catheter of a VA shunt.

Methods
Four patients underwent conversion of a VP shunt to a VA shunt under the guidance of intraoperative fluoroscopy and TEE between May 2003 and December 2004. After induction of general anesthesia, the TEE transducer was advanced into the esophagus. A cervical incision was made and the external jugular vein was visualized. An introducer was passed through an opening in the jugular vein and a guidewire was placed through the introducer. Under continuous TEE guidance, the guidewire was carefully advanced into the superior vena cava. A distal shunt catheter overlying a J-wire was then passed to the superior vena cava, again under TEE guidance. The catheter was advanced to the right atrium after removing the guidewire.
Final visualization with TEE and fluoroscopy revealed a good position of the catheter in the right atrium in all four cases. The mean duration of the operation was 91 minutes (range 65–120 minutes) and the mean operative blood loss was 23 ml (range 10–50 ml). No procedure-related complication was noted.

Conclusions
Real-time TEE is a safe and simple technique for the accurate placement of the distal catheter of a VA shunt.
Use of surface electromyography to assess and select patients with idiopathic dystonia for bilateral pallidal stimulation
Authors: Wang Shouyan , Liu Xuguang , Yianni John , Green Alex L. , Joint Carole , Stein John F. , Bain Peter G. , Gregory Ralph , Aziz Tipu Z. 
Published: January 2008

Object
The object of this study was to identify a preoperative physiological index by using surface electromyography (EMG) signals that would correlate with clinical outcome in dystonic patients following bilateral pallidal stimulation.

Methods
In 14 patients with spasmodic torticollis, generalized dystonia, and myoclonic dystonia, surface EMG signals were recorded from the most affected muscle groups. Although the dystonia affected different body segments, the EMG signals in all patients could be decomposed into bursting and sustained components. Subsequently, a ratio of the EMG amplitude was calculated between the two components and then correlated with clinical outcome.
Patients who experienced rapid improvement following bilateral pallidal stimulation had a significantly higher EMG ratio compared with those who did not. Furthermore, a significant correlation was found between the EMG ratio and clinical improvement during the 12-month period following pallidal stimulation.

Conclusions
The authors concluded that surface EMG studies could be used to predict the clinical outcome of and to select patients for pallidal stimulation for dystonia.
Evaluation, management, and long-term follow up of vein of Galen malformations
Authors: Gupta Arun Kumar , Rao Vedula Rajani Kanth , Varma Dandu Ravi , Kapilamoorthy Tirur R. , Kesavadas Chandrasekharan , Krishnamoorthy Thamburaj , Thomas Bejoy , Bodhey Narendra K. , Purkayastha Sukalyan 
Published: January 2008

Object
Vein of Galen malformations (VGMs) are extremely rare intracranial lesions. Clinical presentation and management strategies vary significantly in different areas of the world. The authors report their experience in evaluation, management, and long-term follow up of these lesions in India.

Methods
Between October 1983 and June 2003, 25 patients with VGMs were referred to the authors’ institution for evaluation and management. Ten children younger than 2 years of age presented with rapidly increasing head size as the chief complaint. Among 11 children 2 years of age or older, the most common presenting symptom was chronic headache. Four patients who presented during adulthood had chronic headache for many years before presentation. Angiographic evaluation of the lesion was performed in 21 patients. Fifteen patients were treated using endovascular techniques. Injection of the embolic material was performed after induction of systemic hypotension when the flow in the fistula was high.
Complete occlusion of the arteriovenous shunt could be achieved in two patients with vein of Galen aneurysmal dilation (100% of patients with this type of malformation) and in five of the six patients with the mural type of malformation (83%). Among patients with the choroidal type of malformation, complete obliteration of the shunt could be achieved in three patients. In three patients with high-flow choroidal malformations, embolization carried out in a single sitting resulted in shunt reduction of nearly 90%. These patients received clinical follow up.

Conclusions
The authors’ experience in evaluation and management of VGMs reveals that in areas of the world where access to dedicated specialist care is limited, the clinical presentation of VGMs can differ appreciably from the classic descriptions in the literature. Endovascular management of these lesions results in excellent angiographic and clinical results.
Volumetric extent of resection and residual contrast enhancement on initial surgery as predictors of outcome in adult patients with hemispheric anaplastic astrocytoma
Authors: Keles G. Evren , Chang Edward F. , Lamborn Kathleen R. , Tihan Tarik , Chang Chih-Ju , Chang Susan M. , Berger Mitchel S. 
Published: January 2008

Object
To investigate the prognostic significance of the volumetrically assessed extent of resection on time to tumor progression (TTP), overall survival (OS), and tumor recurrence patterns, the authors retrospectively analyzed preoperative and postoperative tumor volumes in 102 adult patients from the time of the initial resection of a hemispheric anaplastic astrocytoma (AA).

Methods
The quantification of tumor volumes was based on a previously described method involving computerized analysis of magnetic resonance (MR) images. Analysis of contrast-enhancing tumor volumes on T1-weighted MR images was conducted for 67 patients who had contrast-enhancing tumors. Measurements of T2 hyperintensity were obtained for all 102 patients in the study.
The presence or absence of preresection enhancement, actual volume of this enhancement, and the percentage of preoperative enhancement as it relates to the total T2 tumor volume did not have a statistically significant relationship to TTP or OS. In addition to age, the volume of residual disease measured on T2-weighted MR images was the most significant predictor of TTP (p < 0.001), and residual contrast-enhancing tumor volume was the most significant predictor of OS (p = 0.003) on multivariate analysis. In contrast to low-grade gliomas, there was no statistically significant relationship between the extent of resection and histological characteristics at the time of recurrence, that is, tumor Grade III compared with Grade IV.

Conclusions
Data from this retrospective analysis of a histologically uniform group of hemispheric AAs treated in the MR imaging era suggest that residual tumor volumes, as documented on postoperative imaging studies, may be a prognostic factor for TTP and OS for this patient population.
Cellular immunity of patients with malignant glioma: prerequisites for dendritic cell vaccination immunotherapy
Authors: Rapp Marion , Özcan Zakir , Steiger Hans-Jakob , Wernet Peter , Sabel Michael C. , Sorg Rüdiger V. 
Published: January 2008

Object
Vaccination therapy that uses dendritic cells (DCs) is a promising immunotherapeutic approach. However, it relies on intact cellular immunity and efficient generation of mature DCs, both of which can be impaired in patients with glioma. Therefore, the immune status and ex vivo generation of DC in such patients were studied.

Methods
The frequencies of white blood cell subsets and monocyte-derived, mature DCs in patients with high-grade gliomas and healthy control volunteers were analyzed using flow cytometry.
In the patients, frequencies of lymphocytes, T cells, and B cells were reduced in comparison with the volunteers in the control group, whereas frequencies of neutrophils and monocytes were increased. There were no differences between the two groups in terms of white blood cell counts or the frequency of NK cells and the major T-cell subsets. The responsiveness of T cells to lectin stimulation was normal. For monocytes, lower frequencies of CD80+ and CD86+ cells but not of CD40+ and HLA-DR+ cells were observed in patients. Ex vivo DC generation in a two-step culture protocol in autologous plasma–supplemented medium or in serum-free medium showed only minor differences in CD80 and HLA-DR expression between the patient and control groups. Frequencies of CD83+, CD1a+, CD14−, CD40+, and CD86+ cells were comparable. Overall, the serum-free medium was superior to the plasma-supplemented medium and allowed efficient ex vivo generation of CD83+, CD1a+, and CD14− mature DCs.

Conclusions
Only minor defects in the immune status of patients with glioma were observed, which probably would not hamper immunotherapy. Mature DCs can be generated successfully in normal numbers and with typical immunophenotypes from monocytes of patients with glioma, particularly under serum-free conditions.
Subtraction ictal single-photon emission computed tomography coregistered to magnetic resonance imaging in evaluating the need for repeated epilepsy surgery
Authors: Wetjen Nicholas M. , Cascino Gregory D. , Fessler A. James , So Elson L. , Buchhalter Jeffrey R. , Mullan Brian P. , O’Brien Terence J. , Meyer Fredric B. , Marsh W. Richard 
Published: January 2008

Object
The aim of this study was to determine whether ictal single-photon emission computed tomography (SPECT) is useful in localizing the site of seizure onset in patients in whom surgery for intractable epilepsy failed and who are being considered for repeated surgery.

Methods
Subtraction ictal SPECT coregistered to magnetic resonance imaging (SISCOM) studies were retrospectively analyzed in 58 patients who were being evaluated for possible repeated resection for intractable partial epilepsy between January 1, 1996, and October 31, 1999. All patients had persistent seizures subsequent to an initial resection and underwent another excision. The SISCOM-demonstrated abnormalities were classified as concordant, discordant, or indeterminate, compared with the localization of the epileptogenic zone revealed on video electroencephalography monitoring. The ability of SISCOM to predict operative outcome was also determined in patients who had undergone repeated surgical procedures.
The SISCOM studies revealed a localized hyperperfused alteration in 46 (79%) of 58 patients. Forty-one (89%) of these 46 patients had a SISCOM-demonstrated alteration in the hemisphere of the previous epilepsy surgery. Imaging changes in 33 (72%) of the 46 patients were at the site of the previous focal cortical resection. Eight (17%) of the 46 had SISCOM-demonstrated abnormalities remote from the lobe in which surgery had been performed but in the ipsilateral hemisphere. The hyperperfusion focus was in the contralateral hemisphere in the remaining five patients (11%). The site of the epileptogenic zone was concordant with the SISCOM focus in 32 (70%) of 46 patients. Twenty-six patients underwent repeated resection and were followed up for a mean of 44 months thereafter; 11 of these patients (42%) had a significant reduction in seizure tendency. Only five patients (19%) were seizure free. Ten (50%) of 20 patients with a concordant SISCOM focus compared with none (0%) of three patients with a discordant focus had a favorable surgical outcome (p = 0.23).

Conclusions
The SISCOM method might be useful in the evaluation of, and the surgical planning for, patients with intractable partial epilepsy in whom previous resective treatment has failed and who are being considered for reoperation.
Neurostimulation for chronic noncancer pain: an evaluation of the clinical evidence and recommendations for future trial designs
Authors: Coffey Robert J. , Lozano Andres M. 
Published: January 2008

Object
Neurostimulation to treat chronic pain includes approved and investigational therapies directed at the spinal cord, thalamus, periaqueductal or periventricular gray matter, motor cortex, and peripheral nerves. Persistent pain after surgery and work-related or neural injuries are common indications for such treatments. In light of the risks, efforts, costs, and expectations associated with neurostimulation therapies, a careful reexamination of the methods used to gather evidence for this treatment’s long-term efficacy is in order.

Methods
The authors combed English-language publications to determine the nature of the evidence supporting the efficacy of neurostimulation therapies for chronic noncancer pain. To formulate recommendations for the design of future studies, the results of their analysis were compared with established guidelines for the evaluation of medical evidence.
Evidence supporting the efficacy of neurostimulation has been collected predominantly from retrospective series or from prospective studies whose design or methods of analysis make them subject to limited interpretation. To date, there has been no successful clinical study focused on establishing the efficacy of neurostimulation for pain and incorporating sufficient numbers of participants, matched control groups, sham stimulation, randomization, prospectively defined end points, and methods for controlling experimental bias. Currently available data provide little support for the common practices of psychological or pharmacological screening or trial stimulation to predict and/or improve long-term results.

Conclusions
These findings do not diminish the value of previous investigations or positive patient experiences and do not mean that the treatments are ineffective; rather, they reveal that new data are required to answer the questions raised in and by previous study data. Future analyses of emerging neurostimulation modalities for pain should, whenever feasible, require unambiguous diagnoses as an entry criterion and should involve the use of randomization, parallel control groups that receive sham stimulation, and blinding of patients, investigators, and device programmers. Given the chronicity of patient symptoms and stimulation therapies, efficacy should be studied for 1 year or longer after device implantation. Meticulous study methods are especially important to evaluate new therapies like motor cortex and occipital nerve stimulation.
Vascular complications of vestibular schwannoma surgery: a comparison of the suboccipital retrosigmoid and translabyrinthine approaches
Authors: Sade Burak , Mohr Gérard , Dufour Jean-Jacques 
Published: January 2008

Object
Vascular complications of the surgery for vestibular schwannomas (VSs) can have devastating consequences; however, there is scant literature on the systematic analysis of the different types of complications. In this context, the authors of this study analyzed these complications, with particular interest in the role of surgical approach in their occurrence.

Methods
The charts of 391 patients who had undergone 413 procedures for VS during a 24-year period were reviewed retrospectively. A suboccipital retrosigmoid (RS) approach was used in 338 procedures, and the translabyrinthine (TL) route in 75. Postoperative hemorrhage or infarction was identified and stratified according to the complication type and surgical approach.
Postoperative vascular complications were encountered in 11 procedures (2.7%), and their incidence was the same for both the RS and TL approaches. Of these complications, eight were hemorrhagic (two cerebellopontine angle, one intracerebellar, and five epidural hematomas) and three were ischemic in nature. Five patients (45.4%) had a complete recovery, and four patients (36.4%) a partial recovery; two patients (18.2%) died. The overall procedure-related mortality rate was 0.5% (two of 413 procedures): 0.3% (one of 338 procedures) for the RS approach and 1.3% (one of 75 procedures) for the TL approach (p > 0.05).

Conclusions
In this study, the overall incidences of vascular complications in VS surgery were similar for the RS and TL approaches. Regardless of the preferred surgical route, this group of complications carries a significant risk of morbidity and therefore warrants special consideration in the management of VSs.