bluuebunny/crossref_metadata_2025_split huggingface dataset:
Significance of the tentorial alignment in approaching the trigeminal nerve and the ventral petrous region through the suboccipital retrosigmoid technique
Authors: Sade Burak , Lee Joung H. 
Published: December 2007

Object
In this study, the authors aimed to identify the factors that would predict the operative distance between the trigeminal nerve (fifth cranial nerve) and the acousticofacial nerve complex (seventh–eighth cranial nerves) preoperatively when approaching the cerebellopontine angle (CPA) through the suboccipital retrosigmoid approach.

Methods
In 40 consecutive patients who underwent microvascular decompression of the trigeminal nerve via a sub-occipital retrosigmoid approach for trigeminal neuralgia, the following three parameters were assessed on preoperative magnetic resonance images: 1) the angle between the tentorium and the line drawn from the hard palate (tentorial angle); 2) the angle between the lines drawn along the petrous bones ventral to the internal auditory canals (petrous angle); and 3) the angle between the tentorium and the line connecting the opisthion to the inion (occipital angle). The distance between the trigeminal nerve and the acousticofacial nerve complex (referred to as “distance”) was measured intraoperatively. Statistical analysis was performed using the Pearson correlation test.

Results
The mean values were 50.9 ± 11.5° for the tentorial angle, 102.5 ± 13.1° for the petrous angle, 83.4 ± 9.7° for the occipital angle, and 3.1 ± 1.5 mm for distance. There was a strong inverse correlation between the tentorial angle and distance (r = −0.228, p = 0.08). The mean distance was 3.5 ± 1.9 mm for a tentorial angle less than 51° and 2.7 ± 1.1 mm for a tentorial angle of at least 51°. No correlation existed between either the petrous or occipital angles and distance.

Conclusions
The distance between the trigeminal nerve and acousticofacial nerve complex decreases in the presence of a steep tentorial angle. This limits the operating field between these cranial nerves when reaching the petroclival or the superior CPA regions through the retrosigmoid approach. Awareness of such anatomical features at the time of pre-operative planning is of paramount importance in selecting the optimum surgical approach and minimizing operative complications.
Long-term follow-up of meningiomas of the cavernous sinus after surgical treatment alone
Authors: Sindou Marc , Wydh Ernesto , Jouanneau Emmanuel , Nebbal Mustapha , Lieutaud Thomas 
Published: December 2007

Object
The authors report on the long-term outcome in 100 consecutive patients with meningiomas arising from the cavernous sinus (CS) with compressive extension outside the CS. The treatment in all cases was surgery alone without adjuvant radiosurgery or radiotherapy. The aim of this study was to evaluate the percentage of patients in whom surgery alone was able to produce long-term tumor control.

Methods
All 100 patients harbored meningiomas with supra- and/or laterocavernous extension, and 27 had petro-clival extension. Surgery was performed via frontopterionotemporal craniotomy associated with orbital and/or zygomatic osteotomy in 97 patients. Proximal control of the internal carotid artery at the foramen lacerum was undertaken in 65 patients; the paraclinoid carotid segment was exposed extradurally at the space made by the anterior clinoidectomy in 81 patients. For the petroclival tumor extension, a second-stage surgery was performed via a presigmoid–retro-labyrinthine or retrosigmoid approach in 13 and 14 patients, respectively.

Results
The mortality rate was 5% and two patients had severe hemiplegic or aphasic sequelae. The creation or aggravation of disorders in vision, ocular motility, or trigeminal function occurred in 19, 29, and 24% of patients respectively, with a significantly higher rate of complications when resection was performed inside the CS (p < 0.05).
Gross-total removal of both the extra- and intracavernous portions was achieved in 12 patients (Group 1), removal of the extracavernous portions with only a partial resection of the intracavernous portion in 28 patients (Group 2), and removal only of the extracavernous portions was performed in 60 patients (Group 3). The follow-up period ranged from 3 to 20 years (mean 8.3 years). There was no tumor recurrence in Group 1. In the 83 surviving patients in Groups 2 and 3 combined, the tumor remnant did not regrow in 72 patients (86.7%); regrowth was noted in 11 (13.3%).

Conclusions
The results suggest that there is no significant oncological benefit in performing surgery within the CS. Because entering the CS entails a significantly higher risk of complications, radiosurgical treatment should be reserved for remnants with secondary growth and clinical manifestations.
Persistent perioperative hyperglycemia as an independent predictor of poor outcome after aneurysmal subarachnoid hemorrhage
Authors: McGirt Matthew J. , Woodworth Graeme F. , Ali Mohammed , Than Khoi D. , Tamargo Rafael J. , Clatterbuck Richard E. 
Published: December 2007

Object
The authors of previous studies have shown that admission hyperglycemia or perioperative hyperglycemic events may predispose a patient to poor outcome after aneurysmal subarachnoid hemorrhage (SAH). The results of experimental evidence have suggested that hyperglycemia may exacerbate ischemic central nervous system injury. It remains to be clarified whether a single hyperglycemic event or persistent hyperglycemia is predictive of poor outcome after aneurysmal SAH.

Methods
Ninety-seven patients undergoing treatment for aneurysmal SAH were observed, and all perioperative variables were entered into a database of prospectively recorded data. Daily serum glucose values were retrospectively added. Patients were examined at hospital discharge (14–21 days after SAH onset), and Glasgow Outcome Scale (GOS) scores were prospectively documented. The GOS score at last follow-up was retrospectively determined. Serum glucose greater than 200 mg/dl for 2 or more consecutive days was defined as persistent hyperglycemia. Outcome was categorized as “poor” (dependent function [GOS Score 1–3]) or “good” (independent function [GOS Score 4 or 5]) at discharge. The independent association of 2-week and final follow-up outcome (GOS score) with the daily serum glucose levels was assessed using a multivariate analysis.

Results
In the univariate analysis, increasing age, increasing Hunt and Hess grade, hypertension, ventriculomegaly on admission computed tomography scan, Caucasian race, and higher mean daily glucose levels were associated with poor (dependent) 2-week outcome after aneurysmal SAH. In the multivariate analysis, older age, the occurrence of symptomatic cerebral vasospasm, increasing admission Hunt and Hess grade, and persistent hyperglycemia were independent predictors of poor (dependent) outcome 2 weeks after aneurysmal SAH. Admission Hunt and Hess grade and persistent hyperglycemia were independent predictors of poor outcome at last follow-up examination a mean 10 ± 3 months after aneurysmal SAH. Isolated hyperglycemic events did not predict poor outcome. Patients with persistent hyperglycemia were 10-fold more likely to have a poor (dependent) 2-week outcome and sevenfold more likely to have a poor outcome a mean 10 months after aneurysmal SAH independent of admission Hunt and Hess grade, occurrence of cerebral vasospasm, or all comorbidities.

Conclusions
Patients with persistent hyperglycemia were seven times more likely to have a poor outcome at a mean of 10 months after aneurysmal SAH. Isolated hyperglycemic events were not predictive of poor outcome. Serum glucose levels in the acute setting of aneurysmal SAH may help predict outcomes months after surgery.
Neurovascular compression of the abducent nerve causing abducent palsy treated by microvascular decompression
Authors: De Ridder Dirk , Menovsky Tomas 
Published: December 2007

✓Isolated abducent palsy is a symptom that can be caused by many different intracranial pathological conditions. In this report the authors describe the case of a patient who suffered isolated abducent palsy resulting from vascular compression of the sixth cranial nerve; surgical treatment consisted of microvascular decompression (MVD).
This 56-year-old man presented with short-lasting episodes of a pulling sensation at the lateral side of his right eye associated with intermittent diplopia, followed by a progressive palsy of the abducent nerve and constant diplopia. Magnetic resonance imaging revealed a neurovascular contact of a dolichoectatic basilar artery with the abducent nerve. The patient underwent surgery consisting of a combined supra- and infratentorial presigmoid approach and subsequent MVD of the abducent nerve. Postoperatively, the abducent nerve palsy resolved within days, and the patient remains free of symptoms with a follow-up time of 4 years.
This is the first report of a neurovascular compression of the abducent nerve treated successfully by MVD.
Nonenhancing tumors of the spinal cord
Authors: White J. Bradley , Miller Gary M. , Layton Kennith F. , Krauss William E. 
Published: December 2007

Object
Enhancement of pathological entities in the central nervous system is a common finding when the blood–brain barrier has been compromised. In the brain, the presence or absence of gadolinium enhancement is often an indicator of tumor invasiveness and/or grade. In the spinal cord, however, contrast enhancement has been shown in all tumor types, regardless of grade. In this study the authors explore the incidence of nonenhancing tumors of the spinal cord and the clinical course of patients with these lesions.

Methods
A retrospective analysis was conducted in which investigators examined the patterns of enhancement of histologically proven intramedullary spinal cord tumors that had been evaluated at the Mayo Clinic between 1998 and 2002. The tumors that did not enhance were the subject of this report.

Results
A total of 130 patients with intramedullary tumors were evaluated. Of those, 11 patients (9%) had tumors that did not enhance. Histologically, a majority of tumors were astrocytomas (eight low-grade and two high-grade lesions); one tumor was a subependymoma. Morphologically, most of the tumors were diffuse and none had associated cysts. Tumors spanned from two to seven levels and were located throughout the spinal cord (four cervical, three cervicothoracic, one thoracic, and three thoracolumbar). Biopsy procedures were performed in eight patients, subtotal resection was performed in two, and gross-total resection in one. After a mean follow-up period of 19 months, tumors remained stable in eight patients but progressed in three, two of whom died.

Conclusions
A number of intramedullary spinal cord tumors will not enhance after addition of contrast agents. The absence of enhancement does not imply the absence of tumor.
Intraoperative facet joint injury during anterior cervical discectomy and fusion: an experimental study
Authors: Tsitsopoulos Parmenion Ph. , Tsonidis Christos , Papaioannou Nikolaos , Venizelos Ioannis , Psalla Dimitra , Dessiris Angelos , Tsitsopoulos Philippos 
Published: December 2007

Object
Disorders of the cervical spine can be successfully addressed by surgical intervention when the choice of such intervention takes into account the possible complications in the treated and adjacent structures. The aim of this study was to investigate the potential for intraoperative trauma in cervical zygapophysial joints and to describe possible pathological changes that may occur during cervical spine surgery.

Methods
Fifteen sheep underwent surgical intervention via an anterior cervical approach; discectomy at the C5–6 level was performed. In 10 animals, the discectomy was accompanied by titanium cage fusion. The sheep were killed immediately after completion of the operation. Radiological examination of the isolated cervical spines followed. Furthermore, the cervical spines were submitted to decalcification and incised using a microtome, and tissue sections were then studied using light microscopy.

Results
Radiological examination was used to assess vertebral alignment, vertebral body (VB) morphology, implant position, and endplate and facet joint gross morphology. Histological examination of the endplate and VB demonstrated degenerative lesions as well as cellular necrosis. The study of the facet joints at the treated as well as at adjacent segments (both above and below) revealed in some cases edema between the collagen fibers of the joint capsules, congestion, and microhemorrhages. Injuries were evident in animals in which the Caspar device was used.

Conclusions
Histopathologically confirmed lesions occurred in facet joints while anterior cervical spine surgery was being performed in sheep. The findings were indicative of trauma and, in the case of human spine surgery, could possibly account for several postoperative complications and patient complaints.
Comparison of cervical spine kinematics using a fluoroscopic model for adjacent segment degeneration
Authors: Cheng Joseph S. , Liu Fei , Komistek Richard D. , Mahfouz Mohamed R. , Sharma Adrija , Glaser Diana 
Published: December 2007

Object
In this cervical spine kinematics study the authors evaluate the motions and forces in the normal, degenerative, and fused states to assess how alteration in the cervical motion segment affects adjacent segment degeneration and spondylosis.

Methods
Fluoroscopic images obtained in 30 individuals (10 in each group with disease at C5–6) undergoing flexion/extension motions were collected. Kinematic data were obtained from the fluoroscopic images and analyzed with an inverse dynamic mathematical model of the cervical spine that was developed for this analysis.

Results
During 20° flexion to 15° extension, average relative angles at the adjacent levels of C6–7 and C4–5 in the fused patients were 13.4° and 8.8° versus 3.7° and 4.8° in the healthy individuals. Differences at C3–4 averaged only about 1°. Maximum transverse forces in the fused spines were two times the skull weight at C6–7 and one times the skull weight at C4–5, compared with 0.2 times the skull weight and 0.3 times the skull weight in the healthy individuals. Vertical forces ranged from 1.6 to 2.6 times the skull weight at C6–7 and from 1.2 to 2.5 times the skull weight at C4–5 in the patients who had undergone fusion, and from 1.4 to 3.1 times the skull weight and from 0.9 to 3.3 times the skull weight, respectively, in the volunteers.

Conclusions
Adjacent-segment degeneration may occur in patients with fusion due to increased motions and forces at both adjacent levels when compared with healthy individuals in a comparable flexion and extension range.
In vitro flexibility of the cervical spine after ventral uncoforaminotomy
Authors: Schmieder Kirsten , Kettner Annette , Brenke Christopher , Harders Albrecht , Pechlivanis Ioannis , Wilke Hans-Joachim 
Published: December 2007

Object
Degenerative spine disorders are, in the majority of cases, treated with ventral discectomy followed by fusion (also known as anterior cervical discectomy and fusion). Currently, nonfusion strategies are gaining broader acceptance. The introduction of cervical disc prosthetic devices was a natural consequence of this development. Jho proposed anterior uncoforaminotomy as an alternative motion-preserving procedure at the cervical spine. The clinical results in the literature are controversial, with one focus of disagreement being the impact of the procedure on stability. The aim of this study was to address the changes in spinal stability after uncoforaminotomy.

Methods
Six spinal motion segments derived from three fresh-frozen human cervical spine specimens (C2–7) were tested. The donors were two men whose ages at death were 59 and 80 years and one woman whose age was 80 years. Bone mineral density in C-3 ranged from 155 to 175 mg/cm3. The lower part of the segment was rigidly fixed in the spine tester, whereas the upper part was fixed in gimbals with integrated stepper motors. Pure moment loads of ± 2.5 Nm were applied in flexion/extension, axial rotation, and lateral bending. For each specimen a load-deformation curve, the range of motion (ROM), and the neutral zone (NZ) for negative and positive directions of motion were calculated. Median, maximum, and minimum values were calculated for the six segments and normalized to the intact segment. Tests were done on the intact segment, after unilateral uncoforaminotomy, and after bilateral uncoforaminotomy.

Results
In lateral bending a strong increase in ROM and NZ was detectable after unilateral uncoforaminotomy on the right side. Overall, the ROM during flexion/extension was less influenced after uncoforaminotomy. The ROM and NZ during axial rotation to the left increased strongly after right unilateral uncoforaminotomy. Changes after bilateral uncoforaminotomy were marked during axial rotation to both sides.

Conclusions
Following unilateral uncoforaminotomy, a significant alteration in mobility of the segment is found, especially during lateral bending and axial rotation. The resulting increase in mobility is less pronounced during flexion and least evident on extension. Further investigations of the natural course of disc degeneration and the impact on mobility after uncoforaminotomy are needed.
Basilar impression and osteogenesis imperfecta: a 21-year retrospective review of outcomes in 20 patients
Authors: Ibrahim Ahmed G. , Crockard H. Alan 
Published: December 2007

Object
Basilar impression (BI) secondary to osteogenesis imperfecta (OI) is a rare but debilitating condition that is often progressive unless it is halted. More recently, ventral decompression surgery has been advocated for this condition. This study is a retrospective review of the 21-year experience of ventral decompression surgery and dorsal occipitocervical fixation in patients with BI secondary to OI and is the largest patient series reported to date.

Methods
Twenty patients treated between 1982 and 2003 by the senior author at the authors' institution were included in this study. All patients underwent ventral decompression surgery followed by dorsal craniocervical stabilization. Patients were followed up for a median of 10 years.

Results
There were no intraoperative or perioperative deaths. Postoperatively, 16 of 20 (80%) patients showed objective improvement or maintained their good preoperative level of function. After surgery, of the 15 patients admitted with Karnofsky Performance Scale (KPS) scores of 70% or less, 11 improved, two remained unchanged, one patient's condition deteriorated, and one patient died of an unrelated cause. Of five patients admitted with a KPS score of 80% or greater, no patient's condition deteriorated in the short- and midterm period, but one patient had recurrence 15 years after surgery. At the end of follow-up, 25% of the patients had recurrence of brainstem compression symptoms or had died, and 15% showed no improvement after surgery. All of the remaining patients (60%) had sustained a long-term benefit from surgery.

Conclusions
Aggressive ventral decompression surgery and dorsal stabilization for patients with BI secondary to OI can not only halt disease progression but can also produce a good and sustainable long-term functional outcome, even in those patients who present as severely symptomatic. Patients who presented early with minor symptoms had good long-term outcomes.
Complex rearrangement of chromosomes 7q21.13‐q22.1 confirms the ectrodactyly‐deafness locus and suggests new candidate genes
Authors: Bernardini Laura , Palka Chiara , Ceccarini Caterina , Capalbo Anna , Bottillo Irene , Mingarelli Rita , Novelli Antonio , Dallapiccola Bruno 
Published: December 2007

AbstractComplex chromosomal rearrangements with more than two breakpoints are rare. We report on a 5‐year‐old girl, evaluated because of psychomotor delay, ectrodactyly of right hand and feet, craniofacial dysmorphic features, cleft palate, deafness, and tetralogy of Fallot. A standard karyotype suggested a small intrachromosomal duplication of chromosome 7q. The chromosomal rearrangement was characterized by mBAND, which disclosed a reciprocal interstitial translocation t(7;8)(q21q22;q23q24). FISH analysis and array‐CGH analysis showed a paracentric inversion of 7q and a microdeletion of 7q21.13. The parents had normal chromosomes. The deletion found in the present patient confirms that candidate region of ectrodactyly‐deafness (OMIM 220600) maps to 7q21 and suggests new candidate genes for that disorder. This patient also had facial features reminiscent of tricho‐rhino‐phalangeal syndrome and one chromosome breakpoint involved band 8q24, a locus for this disorder. In addition, FOG1 gene maps to 8q23 and has been implicated in a subset of subjects with tretralogy of Fallot. We suggest that the aberration of 8q may have contributed to her facial and cardiac findings. © 2007 Wiley‐Liss, Inc.
Priorities for public health research on craniosynostosis: Summary and recommendations from a Centers for Disease Control and Prevention‐sponsored meeting
Authors: Rasmussen Sonja A. , Yazdy Mahsa M. , Frías Jaime L. , Honein Margaret A. 
Published: December 2007

AbstractOn June 8–9, 2006, the National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention held a meeting entitled “Prioritizing a Public Health Research Agenda for Craniosynostosis”. The meeting goals were to review current knowledge in the area, discuss research gaps, and identify future priorities for public health research. Participants with a broad range of expertise (including clinical and molecular genetics, cranial morphology, epidemiology, pediatrics, psychology, public health, and surgery) contributed to the development of the research agenda. Meeting participants were asked to consider public health significance and feasibility when identifying areas of priority for future public health research. Participants identified several priorities, including the need to better delineate the prevalence and phenotype of craniosynostosis (CS); to identify factors important in the causation of CS (including potentially modifiable environmental risk factors as well as genes involved in isolated CS and gene–gene and gene–environment interactions); and to better understand short‐ and long‐term outcomes of CS (e.g., surgical, neurocognitive and neuropsychological outcomes, psychological adjustment, and social relationships) and issues related to clinical care that could affect those outcomes. The need for improved collaboration among clinical treatment centers and standardization of data collection to address these priorities was emphasized. These priorities will be used to guide future public health research on CS. © 2007 Wiley‐Liss, Inc.