bluuebunny/crossref_metadata_2025_split huggingface dataset:
Integrated positron emission tomography and magnetic resonance imaging–guided resection of brain tumors: a report of 103 consecutive procedures
Authors: Pirotte Benoît , Goldman Serge , Dewitte Olivier , Massager Nicolas , Wikler David , Lefranc Florence , Ben Taib Nordeyn Oulad , Rorive Sandrine , David Philippe , Brotchi Jacques , Levivier Marc 
Published: January 2008

Object
The aim of this study was to evaluate the integration of positron emission tomography (PET) scanning data into the image-guided resection of brain tumors.

Methods
Positron emission tomography scans obtained using fluorine-18 fluorodeoxyglucose (FDG) and l-[methyl-11C]methionine (MET) were combined with magnetic resonance (MR) images in the navigational planning of 103 resections of brain tumors (63 low-grade gliomas [LGGs] and 40 high-grade gliomas [HGGs]). These procedures were performed in 91 patients (57 males and 34 females) in whom tumor boundaries could not be accurately identified on MR images for navigation-based resection. The level and distribution of PET tracer uptake in the tumor were analyzed to define the lesion contours, which in turn yielded a PET volume. The PET scanning–demonstrated lesion volume was subsequently projected onto MR images and compared with MR imaging data (MR volume) to define a final target volume for navigation-based resection—the tumor contours were displayed in the microscope’s eyepiece. Maximal tumor resection was accomplished in each case, with the intention of removing the entire area of abnormal metabolic activity visualized during surgical planning. Early postoperative MR imaging and PET scanning studies were performed to assess the quality of tumor resection. Both pre- and postoperative analyses of MR and PET images revealed whether integrating PET data into the navigational planning contributed to improved tumor volume definition and tumor resection.
Metabolic information on tumor heterogeneity or extent was useful in planning the surgery. In 83 (80%) of 103 procedures, PET studies contributed to defining a final target volume different from that obtained with MR imaging alone. Furthermore, FDG-PET scanning, which was performed in a majority of HGG cases, showed that PET volume was less extended than the MR volume in 16 of 21 cases and contributed to targeting the resection to the hypermetabolic (anaplastic) area in 11 (69%) of 16 cases. Performed in 59 LGG cases and 23 HGG cases, MET-PET demonstrated that the PET volume did not match the MR volume and improved the tumor volume definition in 52 (88%) of 59 and 18 (78%) of 23, respectively. Total resection of the area of increased PET tracer uptake was achieved in 54 (52%) of 103 procedures.

Conclusions
Imaging guidance with PET scanning provided independent and complementary information that helped to assess tumor extent and plan tumor resection better than with MR imaging guidance alone. The PET scanning guidance could help increase the amount of tumor removed and target image-guided resection to tumor portions that represent the highest evolving potential.
Long-term effects of experimental intracerebral hemorrhage: the role of iron
Authors: Hua Ya , Nakamura Takehiro , Keep Richard F. , Wu Jimin , Schallert Timothy , Hoff Julian T. , Xi Guohua 
Published: January 2008

Object
Intracerebral hemorrhage (ICH) causes brain atrophy and neurological deficits. The mechanisms of brain atrophy after ICH are poorly understood, although recent evidence suggests that some ICH-induced brain injury results from the products of hemoglobin degradation, including iron. In this study the authors examine the role of iron in brain atrophy and neurological deficits following ICH.

Methods
Male Sprague–Dawley rats received an infusion of either 100 μl autologous whole blood or saline into the right caudate. Hematoxylin and eosin staining was used for histological examination, and iron levels and ferritin immunoreactivities were also examined. Deferoxamine was used as an iron chelator. Over the duration of the experiment, the rats underwent behavioral testing (forelimb placing, forelimb use asymmetry, and corner turn tests).
Brain atrophy in the caudate with prolonged neurological deficits occurred after ICH. Although partial functional recovery occurred with time, residual neurological deficits were still detectable at 3 months postprocedure. Iron accumulation and ferritin upregulation were present in the ipsilateral caudate. Deferoxamine reduced brain atrophy and improved behavioral outcomes, and it also reduced brain ferritin immunoreactivity.

Conclusions
An ICH results in an accumulation of iron in the brain that is not cleared within 3 months and that contributes to brain tissue loss and neurological deficits posthemorrhage. Iron chelation may be a useful therapy for patients with ICH.
Treatment of ruptured intracranial aneurysms since the International Subarachnoid Aneurysm Trial: practice utilizing clip ligation and coil embolization as individual or complementary therapies
Authors: Lanzino Giuseppe , Fraser Kenneth , Kanaan Yassine , Wagenbach Anne 
Published: January 2008

Object
The aim of this study was to analyze the therapeutic decision-making process and outcome in 100 consecutive patients with aneurysmal subarachnoid hemorrhage (SAH) treated since the completion of the International Subarachnoid Aneurysm Trial (ISAT). All patients were evaluated and treated by a neurosurgeon with subspecialty training in both cerebrovascular and neuroendovascular surgery.

Methods
One hundred consecutive patients with aneurysmal SAH who had been admitted within 1 week posthemorrhage and who had been treated using either surgical clip application or endovascular coil embolization were included in this analysis. All patients underwent a uniform perioperative protocol. All surviving patients were given a questionnaire to assess their modified Rankin Scale score (mRS) and to grade themselves at 6 months and 1 year postintervention. The cohort consisted of 73 women and 27 men with a mean age of 57.27 years (range 27–87 years). Twenty-nine percent of the patients had a World Federation of Neurosurgical Societies (WFNS) Grade IV or V SAH. Forty-seven patients underwent direct surgical clip application, 41 endovascular embolization, and 12 a combination of the two procedures. Good functional outcome—indicated by mRS scores of 0 to 2 after at least 6 months—was achieved in 71% of patients.

Conclusions
Data from the ISAT demonstrated a better functional outcome following endovascular embolization in a selected group of patients with aneurysmal SAH. In routine clinical practice, however, a significant number of patients still benefit from direct surgical clip ligation. Excellent functional results can be realized in a complementary clip ligation and coil occlusion practice in which each patient and aneurysm is evaluated and the two treatment modalities are used individually or, when needed, in combination.
Effectiveness of neuronavigation in resecting solitary intracerebral contrast-enhancing tumors: a randomized controlled trial
Authors: Willems Peter W. A. , Taphoorn Martin J. B. , Burger Huib , van der Sprenkel Jan Willem Berkelbach , Tulleken Cees A. F. 
Published: January 2008

Object
The goal of this study was to assess the impact of neuronavigation on the cytoreductive treatment of solitary contrast-enhancing intracerebral tumors and outcomes of this treatment in cases in which neuronavigation was preoperatively judged to be redundant.

Methods
The authors conducted a prospective randomized study in which 45 patients, each harboring a solitary contrast-enhancing intracerebral tumor, were randomized for surgery with or without neuronavigation. Peri- and postoperative parameters under investigation included the following: duration of the procedure; surgeon’s estimate of the usefulness of neuronavigation; quantification of the extent of resection, determined using magnetic resonance imaging; and the postoperative course, as evaluated by neurological examinations, the patient’s quality-of-life self-assessment, application of the Barthel index and the Karnofsky Performance Scale score, and the patient’s time of death.
The mean amount of residual tumor tissue was 28.9% for standard surgery (SS) and 13.8% for surgery involving neuronavigation (SN). The corresponding mean amounts of residual contrast-enhancing tumor tissue were 29.2 and 24.4%, respectively. These differences were not significant. Gross-total removal (GTR) was achieved in five patients who underwent SS and in three who underwent SN. Median survival was significantly shorter in the SN group (5.6 months compared with 9 months, unadjusted hazard ratio = 1.6); however, this difference may be attributable to the coincidental early death of three patients in the SN group. No discernible important effect on the patients’ 3-month postoperative course was identified.

Conclusions
There is no rationale for the routine use of neuronavigation to improve the extent of tumor resection and prognosis in patients harboring a solitary enhancing intracerebral lesion when neuronavigation is not already deemed advantageous because of the size or location of the lesion.
Correlation between the efferent venous drainage of the tumor and peritumoral edema in intracranial meningiomas: superselective angiographic analysis of 25 cases
Authors: Tanaka Michihiro , Imhof Hans G. , Schucknecht Bernhard , Kollias Spyros , Yonekawa Yasuhiro , Valavanis Anton 
Published: January 2008

Object
The extent of peritumoral brain edema (PTBE) associated with meningiomas can be highly variable. The authors studied the correlation between the development of efferent venous drainage from the tumor and the degree of PTBE that occurs in intracranial meningiomas.

Methods
Twenty-five patients with 27 intracranial supratentorial meningiomas were investigated to identify the correlation between the efferent venous drainage system of the tumor and peritumoral edema. The overall mean age of the patients was 54 years. Seventeen patients (68%) were female and eight (32%) were male. All patients underwent magnetic resonance imaging and digital subtraction angiography. In each meningioma, superselective angiography of the dominant feeding artery was performed, including the late venous phase to evaluate the development of the tumor’s draining vein. An edema index (EI) was introduced to serve as an objective means by which to judge the extent of PTBE. Eleven meningiomas (41%), in which the mean EI was 0.14 ± 0.10, clearly showed dominant draining veins originating from the tumor itself. In the other 16 meningiomas (59%), superselective angiography demonstrated no efferent venous drainage from the tumor, which could account for this group’s mean EI value of 1.49 ± 1.05 (p < 0.001)

Conclusions
The current results suggest that hypoplasia of the efferent draining vein from the meningioma itself contributes to PTBE formation. The development of an efferent venous system mitigates against the formation of PTBE. Intratumoral venous congestion can be considered the main cause of PTBE in meningiomas.
Motor neuronal and glial apoptosis in the adult facial nucleus after intracranial nerve transection
Authors: Mattsson Per , Delfani Kioumars , Janson Ann Marie , Svensson Mikael 
Published: January 2008

Object
Intracranial lesions affecting the facial nerve are usually associated with significant morbidity and poor functional restitution, despite the fact that a peripheral nerve injury normally recovers well. Mechanistic explanations are needed to direct future therapies. Although neonatal motor neurons are known to die as a result of apoptosis after axotomy, this cell death mechanism has not been explicitly demonstrated after peripheral cranial nerve transection in adult mammals.

Methods
The authors induced substantial retrograde neuronal death in the adult rodent by transecting the facial nerve during its intracranial course. Neuronal apoptosis was demonstrated as shrunken facial motor neurons, retrogradely labeled with fluorogold and with nuclei positively labeled by terminal deoxynucleotidyl transferase–mediated deoxyuridine triphosphate nick–end labeling (TUNEL). Glial apoptosis was demonstrated by double labeling with respect to cell type.
On postinjury Days 7 and 14, the intracranial axotomy led to neuronal apoptosis, corresponding to a neuronal loss that was observed quantitatively in cresyl violet–stained tissue sections obtained using a stereological method. In contrast, no neuronal apoptosis was observed after creating a distal lesion of the facial nerve, which causes less neuronal loss. In addition, glial apoptosis was seen in the facial nucleus after both distal and proximal axotomy. Whereas the proximal intracranial axotomy led to TUNEL-positive nuclei in cells showing markers for oligodendrocytes and microglia, only the latter glial cell population was double labeled with TUNEL-positive nuclei after distal lesioning.

Conclusions
These findings may ultimately lead to new therapeutic strategies in patients suffering from facial nerve palsy due to an intracranial lesion.
Comparison between the microscope and endoscope in the direct endonasal extended transsphenoidal approach: anatomical study
Authors: Catapano Domenico , Sloffer Chris A. , Frank Giorgio , Pasquini Ernesto , D’Angelo Vincenzo A. , Lanzino Giuseppe 
Published: January 2008

Object
The authors compare the views afforded by the operating microscope and the endoscope in the direct endonasal extended transsphenoidal approach to the sellar, suprasellar, and parasellar regions.

Methods
Five formalin-fixed, silicone-injected adult cadaveric heads were studied. A direct endonasal transsphenoidal approach was performed via the right nostril, pushing aside the nasal septum. The approach was performed with the microscope first, then with the endoscope. For each step (sellar, suprasellar, and clival), the exposure afforded by direct microscopic view was measured and then compared with that obtained using the endoscope. The direct endonasal approach provides a slightly off-midline view. Although the microscope provides an adequate view of the mid-line structures and part of the contralateral parasellar areas, the addition of the endoscope allows for a more panoramic view and permits widening of the approach in all directions.

Conclusions
An adequate exposure of the sellar, suprasellar, and infrasellar/upper clival regions can be achieved via a simple, direct endonasal approach. From a direct endonasal route, there is a preferential visualization of the structures contralateral to the approach. The endoscope affords a more panoramic view that extends the area covered by the operating microscope.
Medical application of an infrared free-electron laser: selective removal of cholesterol ester in carotid artery atheromatous plaques
Authors: Nakajima Yoshikazu , Iwatsuki Koichi , Ishii Katsunori , Suzuki Sachiko , Fujinaka Toshiyuki , Yoshimine Toshiki , Awazu Kunio 
Published: January 2008

Object
The purpose of this study was to determine the effectiveness of infrared free-electron laser (FEL) irradiation of cholesterol esters in human carotid artery (CA) atheromas.

Methods
The degradation of cholesterol ester was estimated from changes in the infrared absorption spectra acquired using microscopic transmission Fourier transform infrared spectroscopy. An FEL emitting radiation at 5.75-μm wavelengths and a power density of 15.9 W/cm2 was used to treat intimal slices of extirpated human arterial atherosclerotic plaques.
Peak signals derived from an ester bond of cholesterol ester decreased in height as irradiation time increased and disappeared completely after 180 seconds. No other change was observed in the infrared absorption spectrum after 180 seconds of irradiation, and no histological damage was noted.

Conclusions
The authors concluded that FEL irradiation can remove cholesterol ester selectively from human atheromatous CA plaques. This novel technique differs from previous approaches involving conventional lasers.
Efficacy of and morbidity associated with stereoelectroencephalography using computerized tomography– or magnetic resonance imaging–guided electrode implantation
Authors: de Almeida Antonio Nogueira , Olivier André , Quesney Felipe , Dubeau François , Savard Ghislaine , Andermann Frederick 
Published: January 2008

Object
The purpose of this paper was to define the general efficacy of and morbidity associated with stereoelectroencephalography using modern methods of imaging and to particularize the risks related to specific lobes of the brain.

Methods
All patients admitted to the Montreal Neurological Institute who had undergone either computerized tomography – or magnetic resonance imaging–guided electrode implantation by one surgeon (A.O.) were reviewed. The procedure was considered efficient if the obtained information was sufficient to make a decision either in support of or against surgery.
Two hundred seventeen patients underwent 224 implantations with 3022 electrodes. Complications related to each lobe were as follows: temporal lobe, two abscesses (0.54%); frontal lobe, one abscess and three hematomas (1.4%); and occipital lobe, one hypointense lesion found 1 week after electrode explantation (2.6%). Significant risk factors associated with hematomas were implantation in the frontal lobe (p < 0.05) and the use of four or more implanted electrodes (p < 0.025).
General complications included the following: 26 patients, psychiatric symptoms during monitoring; one patient, meningitis; four patients, scalp cellulitis; and two patients, hemiparesis during angiography in the early 1980s. One of these latter patients maintained a mild hemiparesis and represents the only case of permanent neurological sequela in the entire series. Data obtained during recordings supported an indication for surgery in 178 patients (79.5%), excluded a surgical option in 37 patients (16.5%), and were unsatisfactory in nine patients (4%). Thus, the overall efficacy as defined previously was 96%.

Conclusions
Stereoelectroencephalography is an efficient procedure with low associated morbidity. Bilateral exploration of the temporal lobes has a morbidity rate of approximately 1%. A higher risk of hematomas occurs with the implantation of four or more electrodes in the frontal lobes.
Microelectrode-guided implantation of deep brain stimulators into the globus pallidus internus for dystonia: techniques, electrode locations, and outcomes
Authors: Starr Philip A. , Turner Robert S. , Rau Geoff , Lindsey Nadja , Heath Susan , Volz Monica , Ostrem Jill L. , Marks William J. 
Published: January 2008

Object
Deep brain stimulation (DBS) of the globus pallidus internus (GPI) is a promising new procedure for the treatment of dystonia. The authors describe their technical approach for placing electrodes into the GPI in awake patients with dystonia, including methodology for electrophysiological mapping of the GPI in the dystonic state, clinical outcomes and complications, and the location of electrodes associated with optimal benefit.

Methods
Twenty-three adult and pediatric patients with various forms of dystonia were included in this study. Baseline neurological status and DBS-related improvement in motor function were measured using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS). The implantation of DBS leads was performed using magnetic resonance (MR) imaging–based stereotaxy, single-cell microelectrode recording, and intraoperative test stimulation to determine thresholds for stimulation-induced adverse effects. Electrode locations were measured on computationally reformatted postoperative MR images according to a prospective protocol.

Conclusions
Physiologically guided implantation of DBS electrodes in patients with dystonia was technically feasible in the awake state in most patients, and the morbidity rate was low. Spontaneous discharge rates of GPI neurons in dystonia were similar to those of globus pallidus externus neurons, such that the two nuclei must be distinguished by neuronal discharge patterns rather than rates. Active electrode locations associated with robust improvement (> 70% decrease in BFMDRS score) were located near the intercommissural plane, at a mean distance from the pallidocapsular border of 3.6 mm.
The Physical Performance Test and the evaluation of functional status in patients with cerebral aneurysms
Authors: King Joseph T. , Tsevat Joel , Roberts Mark S. 
Published: January 2008

Object
Cerebral aneurysms can adversely affect the functional status of patients who harbor them through rupture, mass effect, or treatment sequela. The authors compared the Physical Performance Test (PPT)—an observer-administered test requiring the completion of seven tasks—with three functional status measures based on patient self-reports: the Glasgow Outcome Scale (GOS), the modified Rankin Scale (mRS), and the modified Barthel Index (mBI).

Methods
Data were collected from 144 patients with aneurysms who had been recruited from a neurosurgery clinic. The patients completed the PPT and were assigned GOS scores, mRS scores, and mBIs based on their responses during a structured interview. The validity of the PPT was assessed by examining the relationship between the results of the PPT and the values assigned to each patient by using the GOS, mRS, and mBI by applying rank-order methods; the reliability of the PTT was assessed using the Cronbach α coefficient.
The mean age of the patients was 52.8 years; 72% were women and 54% had survived a subarachnoid hemorrhage. The mean ± standard deviation PPT score was 24.0 ± 3.7. The PPT generated a broad distribution of scores, whereas GOS and mRS scores and mBIs displayed significant ceiling effects, that is, 75% of the patients were clustered in the highest categories. The PPT scores were validated by their strong association with GOS scores, mRS scores, and mBIs (for all, p < 0.001), and the reliability of the PPT was demonstrated by a Cronbach α value of 0.77.

Conclusions
The PPT provides an objective measure of functional status in patients with cerebral aneurysms. The results suggest that the PPT may differentiate among patients better than the GOS, mRS, or mBI. The PPT is a valid and reliable instrument for measuring functional status in patients with cerebral aneurysms.