bluuebunny/crossref_metadata_2025_split huggingface dataset:
Screening for brain aneurysm in the Familial Intracranial Aneurysm study: frequency and predictors of lesion detection
Authors: Brown Robert D. , Huston John , Hornung Richard , DR.P.H.  , Foroud Tatiana , Kallmes David F. , Kleindorfer Dawn , Meissner Irene , Woo Daniel , Sauerbeck Laura , Broderick Joseph , _ _ 
Published: June 2008

Object
Approximately 20% of patients with an intracranial saccular aneurysm report a family history of intracranial aneurysm (IA) or subarachnoid hemorrhage. A better understanding of predictors of aneurysm detection in familial IA may allow more targeted aneurysm screening strategies.

Methods
The Familial Intracranial Aneurysm (FIA) study is a multicenter study, in which the primary objective is to define the susceptibility genes related to the formation of IA. First-degree relatives (FDRs) of those affected with IA are offered screening with magnetic resonance (MR) angiography if they were previously unaffected, are ≥ 30 years of age, and have a history of smoking and/or hypertension. Independent predictors of aneurysm detection on MR angiography were determined using the generalized estimating equation version of logistic regression.

Results
Among the first 303 patients screened with MR angiography, 58 (19.1%) had at least 1 IA, including 24% of women and 11.7% of men. Ten (17.2%) of 58 affected patients had multiple aneurysms. Independent predictors of aneurysm detection included female sex (odds ratio [OR] 2.46, p = 0.001), pack-years of cigarette smoking (OR 3.24 for 20 pack-years of cigarette smoking compared with never having smoked, p < 0.001), and duration of hypertension (OR 1.26 comparing those with 10 years of hypertension to those with no hypertension, p = 0.006).

Conclusions
In the FIA study, among the affected patients' FDRs who are > 30 years of age, those who are women or who have a history of smoking or hypertension are at increased risk of suffering an IA and should be strongly considered for screening.
Venous-predominant parenchymal arteriovenous malformation: a rare subtype with a venous drainage pattern mimicking developmental venous anomaly
Authors: Im So-Hyang , Han Moon Hee , Kwon Bae Ju , Ahn Jung Yong , Jung Cheolkyu , Park Sung-Hye , Oh Chang Wan , Han Dae Hee 
Published: June 2008

Object
Considerable confusion exists in the literature regarding the classification of cerebrovascular malformations and their clinical significance. One example is provided by the atypical developmental venous anomaly (DVA) with arteriovenous shunt, because it remains controversial whether these lesions should be classified as DVAs or as atypical cases of other subtypes of cerebrovascular malformations. The purpose of this study was to clarify the classification of these challenging vascular lesions in an effort to suggest an appropriate diagnosis and management strategy.

Methods
The authors present a series of 15 patients with intracranial vascular malformations that were angiographically classified as atypical DVAs with arteriovenous shunts. This type of vascular malformation shows a fine arterial blush without a distinct nidus and early filling of dilated medullary veins that drain these arterial components during the arterial phase on angiography. Those prominent medullary veins converge toward an enlarged main draining vein, which together form the caput medusae appearance of a typical DVA.

Results
Based on clinical, angiographic, surgical, and histological findings, the authors propose classifying these vascular malformations as a subtype of an arteriovenous malformation (AVM), rather than as a variant of DVA or as a combined vascular malformation.

Conclusions
Correct recognition of this AVM subtype is required for its proper management, and its clinical behavior appears to follow that of a typical AVM. Gamma Knife radiosurgery appears to be a good alternative to resection, although long-term follow-up results require verification.
Multimodality treatment of posterior fossa arteriovenous malformations
Authors: Kelly Michael E. , Guzman Raphael , Sinclair John , Bell-Stephens Teresa E. , Bower Regina , Hamilton Scott , Marks Michael P. , Do Huy M. , Chang Steven D. , Adler John R. , Levy Richard P. , Steinberg Gary K. 
Published: June 2008

Object
Posterior fossa arteriovenous malformations (AVMs) are relatively uncommon and often difficult to treat. The authors present their experience with multimodality treatment of 76 posterior fossa AVMs, with an emphasis on Spetzler–Martin Grades III–V AVMs.

Methods
Seventy-six patients with posterior fossa AVMs treated with radiosurgery, surgery, and endovascular techniques were analyzed.

Results
Between 1982 and 2006, 36 patients with cerebellar AVMs, 33 with brainstem AVMs, and 7 with combined cerebellar–brainstem AVMs were treated. Natural history data were calculated for all 76 patients. The risk of hemorrhage from presentation until initial treatment was 8.4% per year, and it was 9.6% per year after treatment and before obliteration. Forty-eight patients had Grades III–V AVMs with a mean follow-up of 4.8 years (range 0.1–18.4 years, median 3.1 years). Fifty-two percent of patients with Grades III–V AVMs had complete obliteration at the last follow-up visit. Three (21.4%) of 14 patients were cured with a single radiosurgery treatment, and 4 (28.6%) of 14 with 1 or 2 radiosurgery treatments. Twenty-one (61.8%) of 34 patients were cured with multimodality treatment. The mean Glasgow Outcome Scale (GOS) score after treatment was 3.8. Multivariate analysis performed in the 48 patients with Grades III–V AVMs showed radiosurgery alone to be a negative predictor of cure (p = 0.0047). Radiosurgery treatment alone was not a positive predictor of excellent clinical outcome (GOS Score 5; p > 0.05). Nine (18.8%) of 48 patients had major neurological complications related to treatment.

Conclusions
Single-treatment radiosurgery has a low cure rate for posterior fossa Spetzler–Martin Grades III–V AVMs. Multimodality therapy nearly tripled this cure rate, with an acceptable risk of complications and excellent or good clinical outcomes in 81% of patients. Radiosurgery alone should be used for intrinsic brainstem AVMs, and multimodality treatment should be considered for all other posterior fossa AVMs.
Recent trends in the treatment of cerebral aneurysms: analysis of a nationwide inpatient database
Authors: Andaluz Norberto , Zuccarello Mario 
Published: June 2008

Object
The most appropriate treatment for cerebral aneurysms, both ruptured and unruptured, is currently under debate, and updated guidelines have yet to be defined. The authors attempted to identify trends in therapy for cerebral aneurysms in the US as well as outcomes.

Methods
The authors retrospectively reviewed data from the Nationwide Inpatient Sample hospital discharge database (Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality) for the period 1993–2003. Multiple variables were categorized and subjected to statistical analysis for International Classification of Diseases, 9th Revision, Clinical Modification codes related to subarachnoid hemorrhage (SAH), unruptured aneurysm, and clipping and endovascular treatment of cerebral aneurysm.

Results
During the study period, the numbers of discharges remained stable for SAH but doubled for unruptured aneurysms. Concomitantly, the number of aneurysms treated with clip placement remained stable, and the number treated by means of endovascular procedures doubled. By the study's end, the mortality rates had decreased 20% for SAH and 50% for unruptured aneurysms. Increasing age was associated with increased mortality rates, mean length of hospital stay (LOS), and mean charges (p < 0.01). Endovascular treatment was used more often in older patients (p < 0.01). Teaching status and larger hospital size were associated with higher charges and longer hospital stays (although the association was not statistically significant) and with better outcomes (p < 0.05) and lower mortality rates (p < 0.05), especially in patients who underwent aneurysm clipping (p < 0.01). Endovascular treatment was associated with significantly higher mortality rates in small hospitals (p < 0.001) and steadily increasing morbidity rates (45%). Morbidity rates, mean LOS, and mean charges were higher for aneurysm clipping (p < 0.01).

Conclusions
From 1993 to 2003, endovascular techniques for aneurysm occlusion have been increasingly used, while the use of surgical clipping procedures has remained stable. Toward the end of the study period, better overall outcomes were observed in the treatment of cerebral aneurysms, both ruptured and unruptured. Large academic centers were associated with better results, particularly for surgical clip placement.
Magnetic resonance imaging in patients with cerebral hyperperfusion and cognitive impairment after carotid endarterectomy
Authors: Hirooka Ryounoshin , Ogasawara Kuniaki , Sasaki Makoto , Yamadate Keiko , Kobayashi Masakazu , Suga Yasunori , Yoshida Kenji , Otawara Yasunari , Inoue Takashi , Ogawa Akira 
Published: June 2008

Object
Cerebral hyperperfusion after carotid endarterectomy (CEA) impairs cognitive function and is often detected on cerebral blood flow (CBF) imaging. The purpose of the present study is to investigate structural brain damage seen on magnetic resonance (MR) images obtained in patients with cerebral hyperperfusion and cognitive impairment after CEA.

Methods
One hundred and fifty-eight patients with ipsilateral internal carotid artery stenosis (≥ 70%) underwent CEA. Neuropsychological testing was performed preoperatively and at the 1st postoperative month. Cerebral blood flow was measured using single-photon emission computed tomography before, immediately after, and 3 days after surgery. Magnetic resonance imaging was performed before and 1 day after surgery. In patients with post-CEA hyperper-fusion (defined as a CBF increase ≥ 100% compared with preoperative values) on CBF imaging, MR images were also obtained on the 3rd postoperative day, the day on which hyperperfusion syndrome developed, and 1 month after the operation.

Results
The incidence of postoperative cognitive impairment was significantly higher in patients with post-CEA hyperperfusion on CBF imaging (12 [75%] of 16 patients) than in those without (6 [4%] of 142 patients; p < 0.0001). Only 1 of 5 patients with cerebral hyperperfusion syndrome developed reversible brain edema in the cerebral hemisphere ipsilateral to the CEA on MR images obtained on the day hyperperfusion syndrome occurred. However, postoperative cognitive impairment developed in all 5 patients with cerebral hyperperfusion syndrome regardless of the presence or absence of new lesions on MR images. In addition, postoperative cognitive impairment developed in 5 (45%) of 11 patients with asymptomatic cerebral hyperperfusion on CBF imaging despite the absence of new lesions on any postoperative MR images.

Conclusions
Although cerebral hyperperfusion syndrome after CEA sometimes results in reversible brain edema visible on MR imaging, postoperative cerebral hyperperfusion—even when asymptomatic—often results in impaired cognitive function without structural brain damage on MR imaging.
Sixteen-row multislice computed tomography angiography in the diagnosis and characterization of intracranial aneurysms: comparison with conventional angiography and intraoperative findings
Authors: Chen Wenhua , Yang Yilin , Xing Wei , Qiu Jianguo , Peng Ya 
Published: June 2008

Object
The goal of this study was to prospectively compare the effectiveness of 16-slice computed tomography (CT) angiography with that of conventional digital subtraction (DS) angiography and the surgical findings used to detect and characterize intracranial aneurysms.

Methods
Two hundred forty-four consecutive patients underwent both CT angiography and DS angiography no more than 3 days apart. Computed tomography angiography was performed with a 16-row multislice CT scanner in which a collimation of 0.75 mm was used. Two observers independently reviewed the CT images, and 1 of the 3 attending neuroradiologists reviewed the DS angiograms. They determined the presence, location, quantitation, and characterization of the intracranial aneurysms. Statistical results were calculated independently for the image interpretation performed by the 2 CT scan readers and the DS angiogram reader by using the combination of DS angiography or intraoperative findings or both as a reference standard.

Results
One hundred thirty-six patients harboring 153 intracranial aneurysms were included in this series. There was no statistically significant difference in sensitivity between 16-slice CT angiography and conventional DS angiography (p > 0.05). The sensitivities of 16-slice CT angiography for aneurysms < 5 mm, 5–10 mm, and > 10 mm were 94.8, 100, and 100%, respectively, on a per-aneurysm basis. The overall sensitivity and specificity of CT angiography for aneurysms were 98.0 and 99.1%, respectively. Sixteen-slice CT angiograms were clearer and more accurate in depicting the relationship of aneurysms to bone structures and adjacent branch vessels.

Conclusions
Computed tomography angiography using a 16-slice scanner is an accurate tool for detecting and characterizing intracranial aneurysms, including small aneurysms. Noninvasive 16-slice CT angiography will become a viable replacement for conventional DS angiography in the diagnosis and characterization of aneurysms.
Comparison of the surgical and follow-up costs associated with microsurgical resection and stereotactic radiosurgery for vestibular schwannoma
Authors: Banerjee Ritesh , Moriarty James P. , Foote Robert L. , Pollock Bruce E. 
Published: June 2008

Object
The best approach to the management of vestibular schwannoma (VS) remains controversial. The aim of this study is to analyze the initial and follow-up costs of resection and stereotactic radiosurgery for patients with VS.

Methods
Initial and follow-up costs in 53 cases in which patients with unilateral, previously unoperated VSs > 3 cm underwent resection (21 cases) or radiosurgery (32 cases) at the Mayo Clinic from June 2000 until July 2002 were analyzed for 36 months. Follow-up treatment-specific utilization records were gathered prospectively for patients not returning to the Mayo Clinic after treatment. Six-month moving averages of incremental follow-up costs were calculated for the 2 patient groups.

Results
The mean cost of surgery in the microsurgery group was $23,788 (95% confidence interval $22,280–$24,842) compared with $16,143 (95% confidence interval $15,277–$17,545) for the radiosurgical group. Mean incremental follow-up costs per month for patients in the microsurgery group started just > $1000 per month, decreased steadily, and remained < $70 per month by the 10th month of follow-up. Mean incremental follow-up costs per month for patients in the radiosurgery group were <$10 per month for the first few months and thereafter increased to as much as $200 per month.

Conclusions
Although the total cost of microsurgery is higher due to the costs of hospitalization, follow-up costs for radiosurgery are greater in general. From a societal perspective, radiosurgery is less expensive than microsurgical resection provided that the rate of tumor progression after radiosurgery remains low with long-term follow-up.
The long thoracic nerve as a donor for facial nerve reanimation procedures: cadaveric feasibility study
Authors: Tubbs R. Shane , Shaffer William A. , Loukas Marios , Shoja Mohammadali M. , Oakes W. Jerry 
Published: June 2008

Object
Injury of the facial nerve with resultant facial muscle paralysis may result in other significant complications such as corneal ulceration. To the authors' knowledge, neurotization to the facial nerve using the long thoracic nerve (LTN), a nerve used previously for neurotization to other branches of the brachial plexus, has not been explored previously.

Methods
In an attempt to identify an additional nerve donor candidate for facial nerve neurotization, 8 adult human cadavers (16 sides) underwent dissection of the LTN, which was passed deep to the clavicle and axillary neurovascular bundle. The facial nerve was localized from the stylomastoid foramen onto the face, and the distal cut end of the previously dissected LTN was tunneled to this location. Measurements were made of the length and diameter of the LTN. Long thoracic nerve innervation to the first and second digitations of the serratus anterior was maintained on all sides.

Results
All specimens were found to have an LTN with more than enough length to be tunneled superiorly, tension-free to the extracranial facial nerve. Connections remained tensionless with left and right head rotation of up to 45°. The mean length of this part of the LTN was 18 cm with a range of 15–22 cm. The overall mean diameter of this nerve was 2.5 mm. No evidence of injury to the surrounding neurovascular structures was identified on gross examination.

Conclusions
To the authors' knowledge, the LTN has not been previously examined as a donor nerve for facial nerve reanimation procedures. Based on the results of this cadaveric study, the use of the LTN may be considered for such surgical maneuvers.
A 15-year review of pediatric neurosurgical fellowships: implications for the pediatric neurosurgical workforce
Authors: Durham Susan R. , Shipman Scott A. 
Published: June 2008

Object
The Accreditation Council for Pediatric Neurosurgical Fellowships (ACPNF) was established in 1992 to oversee fellowship training in pediatric neurological surgery. The present study is a review of all graduates from 1992 through 2006 to identify predictors of American Board of Pediatric Neurological Surgery (ABPNS) certification.

Methods
Basic demographic information including sex, year of graduation from residency, residency training program, year of fellowship training, and fellowship program was collected on each graduate from each of the 22 ACPNF programs. Individuals who did not meet ACPNF requirements (39 trainees) and those currently practicing in Canada (11 individuals) were excluded. Univariate and multivariate analysis were used to identify predictors of ABPNS certification.

Results
Of the 193 ACPNF graduates, 143 individuals met the criteria for analysis. Currently, 70 (49%) are ABPNS certified. There is a mean period of 5.1 ± 2.4 years (range 2–13 years) between finishing fellowship and ABPNS certification. If those who are not expected to be sitting for the boards yet (2002–2006 graduates, 57 individuals) are removed, the rate of ABPNS certification is 66.3%. On average, 9.5 ±3.0 (range 4–16) fellows are trained per year. There is no statistically significant relationship between fellowship or residency training program and ABPNS certification.

Conclusions
Although the present training infrastructure has the theoretical capacity to train > 20 pediatric neurosurgeons each year, this analysis suggests that current levels will provide ~ 6 ABPNS-certified pediatric neurosurgeons annually. This raises the question of the sufficiency of the future pediatric neurosurgical workforce.
Ventricular shunt tap as a predictor of proximal shunt malfunction in children: a prospective study
Authors: Rocque Brandon G. , Lapsiwala Samir , Iskandar Bermans J. 
Published: June 2008

Object
The clinical diagnosis of cerebrospinal fluid (CSF) shunt malfunction can be challenging. In this prospective study, the authors evaluated a common method of interrogating shunts: the shunt tap; specifically, its ability to predict proximal malfunction.

Methods
The authors performed standardized shunt taps in a consecutive series of cases involving children with suspected or proven shunt malfunction, assessing flow and, when possible, opening pressure. Data were collected prospectively, and results analyzed in light of surgical findings.

Results
A shunt tap was performed prior to 68 operative explorations in 51 patients. Of the 68 taps, 28 yielded poor or no CSF flow on aspiration. After 26 of these 28 procedures, proximal catheter obstruction was identified. After 28 taps with good CSF return and normal or low opening pressure, 18 shunts were found to have a proximal obstruction, 8 had no obstruction, and 2 had a distal obstruction. Another 12 taps with good CSF flow had high opening pressure; subsequent surgery showed distal obstruction in 11 of the shunts, and proximal obstruction in 1. The positive predictive value of poor flow was 93%, while good flow on shunt tap predicted adequate proximal catheter function in only 55% of cases.

Conclusions
Poor flow of CSF on shunt tap is highly predictive of obstruction of the proximal catheter. Because not all patients with good flow on shunt tap underwent surgical shunt exploration, the specificity of this test cannot be determined. Nonetheless, a shunt tap that reveals good flow with a normal opening pressure can be misleading, and management of such cases should be based on clinical judgment.
Predictive value of preoperative ventricular volume on the need for permanent hydrocephalus treatment immediately after resection of posterior fossa medulloblastomas in children
Authors: Kombogiorgas Dimitris , Natarajan Kal , Sgouros Spyros 
Published: June 2008

Object
In this study, the authors investigated whether preoperative ventricular volume can be used to predict the need for permanent treatment of hydrocephalus in children with posterior fossa medulloblastomas.

Methods
Ventricular volumes were measured on magnetic resonance imaging studies obtained preoperatively and immediately postoperatively in 20 children who had undergone resection for medulloblastomas between 1999 and 2007. Comparison of mean values was performed using the one-way analysis of variance test. The association between ventricular and tumor volume was also investigated.

Results
All patients had obstructive hydrocephalus preoperatively, and 4 patients required postoperative shunt placement. The mean preoperative ventricular volume was 252 ml for those who required shunt placement, and 106 ml for those who did not (p = 0.000). The postoperative ventricular volume was 157 and 78 ml, respectively (p = 0.039), larger than normal in both groups. The mean postoperative and preoperative ratios were 0.69 and 0.70, respectively (p = 0.932). There was no correlation of ventricular volumes with age at operation (older or younger than 3 years), presence of metastasis, or amount of residual tumor. There was a statistical correlation between the preoperative ventricular volume and the tumor volume, related to the need for permanent shunt placement.

Conclusions
Preoperative ventricular volume has predictive value for the later need for shunt placement, but in clinical practice this may be difficult to appreciate because all patients have significant hydrocephalus at presentation. The rate of ventricular size reduction in response to tumor excision does not have predictive value because ventricular volume is related to tumor volume. It appears that the removal of cerebellar medulloblastoma converts hydrocephalus from obstructive to communicating, which requires surgical treatment if it exceeds a certain level of cerebrospinal fluid volume.