bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment of Giant Intracranial Aneurysms with Saphenous Vein Extracranial-to-Intracranial Bypass Grafting: Indications, Operative Technique, and Results in 29 Patients
Authors: Jafar Jafar J. , Russell Stephen M. , Woo Henry H. 
Published: July 2004

Abstract

OBJECTIVE
The treatment of giant intracranial aneurysms is a challenge because of the limitations and difficulty of direct surgical clipping and endovascular coiling. We describe the indications, surgical technique, and complications of saphenous vein extracranial-to-intracranial bypass grafting followed by acute parent vessel occlusion in the management of these difficult lesions.

METHODS
Between January 1990 and December 1999, 29 patients with giant intracranial aneurysms underwent 30 saphenous vein bypass grafts followed by immediate parent vessel occlusion. There were 11 men and 18 women with a mean follow-up period of 62 months. Twenty-five patients harbored aneurysms involving the internal carotid artery, 2 had middle cerebral artery aneurysms, and 2 had aneurysms in the basilar artery. Serial cerebral or magnetic resonance angiograms were obtained to assess graft patency and aneurysm obliteration.

RESULTS
All 30 aneurysms were excluded from the cerebral circulation, with 28 vein grafts remaining patent. Two patients had graft occlusions: one because of poor runoff and the other because of misplacement of a cranial pin during a bypass procedure on the contralateral side. Other surgical complications included one death from a large cerebral infarction, homonymous hemianopsia from thrombosis of an anterior choroidal artery after internal carotid artery occlusion, and temporary hemiparesis from a presumed perforator thrombosis adjacent to a basilar aneurysm.

CONCLUSION
With appropriate attention to surgical technique, a saphenous vein extracranial-to-intracranial bypass followed by acute parent vessel occlusion is a safe and effective method of treating giant intracranial aneurysms. A high rate of graft patency and adequate cerebral blood flow can be achieved. Thrombosis of perforating arteries caused by altered blood flow hemodynamics after parent vessel occlusion may be a continuing source of complications.
Partial Labyrinthectomy Petrous Apicectomy Approach to the Petroclival Region: An Anatomic and Technical Study
Authors: Chanda Amitabha , Nanda Anil 
Published: July 2004

Abstract

OBJECTIVE
The petroclival region generally is thought to be an inaccessible area in the intracranial compartment. A number of ways of reaching this area during surgery have been described, including the presigmoid petrosal approach. The partial labyrinthectomy petrous apicectomy approach is a relatively new approach to this region and is a variant of the presigmoid petrosal approach. This study aims to demonstrate the technique and the microsurgical anatomy of the partial labyrinthectomy petrous apicectomy approach and to provide a quantitative study of its exposure to compare it with other common approaches to this region, particularly the presigmoid petrosal approach.

METHODS
Bilateral stepwise dissections were performed on 15 formalin-fixed and dye-injected cadaveric heads (30 sides) under ×3 to ×40 magnification. A temporal craniotomy was performed after a complete mastoidectomy. A partial labyrinthectomy and petrous apicectomy were performed next. The amount of dura exposed was measured before and after the partial labyrinthectomy and the petrous apicectomy. By measuring the angles of exposure, the approach was examined to analyze how much increased access was gained.

RESULTS
This approach provided wide exposure to the petroclival region, the cerebellopontine angle, Meckel's cave, the cavernous sinus, and the prepontine region. On average, there was an increase of 10.8 mm in horizontal exposure as compared with the retrolabyrinthine approach. The average angle of vision achieved with the clival pit as the target was 58.9 degrees. In most of the specimens, an area from the IIIrd to the IXth cranial nerves was easily visible without any significant brain retraction. A high jugular bulb did not reduce the exposure.

CONCLUSION
The partial labyrinthectomy petrous apicectomy approach converts two narrow tunnels into a wide corridor. It increases the angle of exposure markedly, providing easy and excellent exposure of the otherwise difficult-to-access petroclival region, and it may also preserve hearing.
Familial Medulloblastoma: Case Report of One Family and Review of the Literature
Authors: von Koch Cornelia S. , Gulati Mittul , Aldape Kenneth , Berger Mitchel S. 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE
Medulloblastoma is the most common malignant brain tumor and the most common malignant solid tumor in children. Most medulloblastomas are sporadic, but rare familial forms have been described. To the best of our knowledge, only 10 case reports of familial medulloblastoma have been published. A variety of candidate genes have been suggested to be involved in familial medulloblastomas. However, the exact pathogenesis and genetics involved in familial medulloblastoma remain unknown.

CLINICAL PRESENTATION
We describe the presentation of medulloblastoma in two siblings (one of each sex) and their great-uncle. The three cases differ with regard to age at onset and pathological subtype of medulloblastoma.

INTERVENTION OR TECHNIQUE
Immunostaining of tissue blocks for gene products involved in medulloblastoma differed in the two siblings for β-catenin and was similar with staining for gli.

CONCLUSION
This article is only the second report in the literature to address the genetics of familial medulloblastoma in the absence of characterized conditions such as Li-Fraumeni's cancer syndrome and basal cell nevus, Rubinstein-Taybi's, and Turcot's syndromes. The discrepancy in β-catenin staining in the two siblings suggests that the two tumors differentiated through divergent pathways. We briefly summarize all published cases of familial medulloblastoma and review the literature on the genes involved in medulloblastoma formation.
Endovascularly Treated Cerebral Aneurysm Using Guglielmi Detachable Coils Acting as a Nidus for Brain Abscess Formation Secondary to Salmonella Bacteremia: Case Report
Authors: Kirollos Ramez W. , Bosma Jark J.D. , Radhakrishnan Jayakumar , Pigott Timothy D.J. 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE
Intracranial infections related to the various foreign materials used to secure intracranial aneurysms are extremely rare. The lack of neoendothelium formation across the necks of aneurysms, which is particularly prone to occur when the sac is incompletely packed by Guglielmi detachable coils (GDC), results in the absence of isolation of the coils from the circulation. Colonization of GDCs, which act as a foreign-body nidus after hematogenous spread from infections with bacteremia, may result in localized intracranial infection.

CLINICAL PRESENTATION
A 55-year-old woman developed meningitis and a brain abscess surrounding a giant aneurysm that was treated endovascularly with GDC 31/2 years earlier. Four weeks before she sought care, she experienced an infective illness with proven Salmonella bacteremia. Salmonella group D was isolated from cerebrospinal fluid.

INTERVENTION
The patient was treated successfully with long-term cephalosporin therapy. Follow-up imaging studies revealed regression of the abscess.

CONCLUSION
This case suggests that the GDC acted as a colonized foreign body, resulting in the surrounding abscess formation after infection with Salmonella bacteremia. Alternatively, the reaction of the surrounding tissue to the GDC was the predisposing factor and acted as the nidus for the abscess formation.
Cervical Spinal Cord Compression Attributable to a Calcified Intervertebral Disc in a Patient with X-linked Hypophosphatemic Rickets: Case Report and Review of the Literature
Authors: Soehle Martin , Casey Adrian T.H. 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE
X-linked hypophosphatemic rickets is a common inherited phosphate-wasting disorder, but it is a rare cause of spinal cord compression. We present the first reported case of a calcified intervertebral disc causing spinal canal stenosis in X-linked hypophosphatemic rickets.

CLINICAL PRESENTATION
A 44-year-old woman presented with paresthesia of her left arm and a loss of grip in both hands. Magnetic resonance imaging revealed a calcified intervertebral disc, as well as a posterior osteophytic bar causing marked cervical cord compression at C6/C7.

INTERVENTION
An anterior cervical discectomy at C6/C7 and fusion with autologous bone graft were performed. The patient then exhibited significant improvement.

CONCLUSION
A review of the 16 published cases demonstrates that thickening of the vertebral laminae, facet joint hypertrophy, and ossification of the intervertebral discs, posterior longitudinal ligament, and/or ligamentum flavum contribute to spinal canal stenosis in X-linked hypophosphatemic rickets. Those changes are caused by the disease itself and are unlikely to be related to long-term vitamin D treatment. Eleven of 16 patients were reported to have experienced favorable outcomes after surgery.
Covered Stent-graft Repair of the Brachiocephalic Arteries: Technical Note
Authors: Amar Arun Paul , Teitelbaum George P. , Giannotta Steven L. , Larsen Donald W. 
Published: July 2004

Abstract

OBJECTIVE
The use of a covered stent-graft to repair disruptions of the cervical carotid and vertebral arteries is described. This device maintains vessel patency while effectively excluding pseudoaneurysms, arteriovenous fistulae, and other breaches in the integrity of the arterial wall.

METHODS
Patient 1 bled from a large rent in the proximal common carotid artery as a result of tumor invasion. Patient 2 developed a vertebral arteriovenous fistula after a stab injury to the neck. Patient 3 developed cerebral infarction and an enlarging pseudoaneurysm of the internal carotid artery, also after a stab wound to the neck.

RESULTS
All three patients were treated with the Wallgraft endoprosthesis (Boston Scientific, Watertown, MA). In each case, the vessel wall defect was repaired while antegrade flow through the artery was preserved or restored. No neurological complications occurred as a result of stent-graft deployment.

CONCLUSION
Covered stent-grafts offer an alternative to endovascular occlusion of the parent vessel, thereby expanding the therapeutic options for patients with extracranial cerebrovascular disease. These three cases highlight the usefulness and versatility of these devices for endoluminal reconstruction of the brachiocephalic vasculature.
Clinical and Hemodynamic Responses to Balloon Test Occlusion of the Straight Sinus: Technical Case Report
Authors: Houdart Emmanuel , Saint-Maurice Jean-Pierre , Boissonnet Hervé , Bonnin Philippe 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE
Surgical sacrifice of the straight sinus may be performed during intracranial tumor resection. Sacrifice of the straight sinus is associated with an unpredictable risk of venous infarction. We describe a patient with a falcine meningioma who underwent endovascular balloon test occlusion of the straight sinus before surgical resection.

CLINICAL PRESENTATION
A 48-year-old woman presented with symptoms resulting from a 4-cm-diameter meningioma in the left occipital region. Along its inferior margin, the tumor abutted the straight sinus. Cerebral angiography demonstrated occlusion of the posterior one-third of the superior sagittal sinus but patency of the straight sinus.

TECHNIQUE
A 4-mm angioplasty balloon was directed into the straight sinus via the right jugular vein. In addition to clinical assessments, the pressure within the proximal straight sinus, upstream from the balloon, was measured before and during inflation. Severe headaches followed balloon inflation, and the pressure in the proximal straight sinus increased 18 mm Hg. With balloon deflation, the clinical and hemodynamic findings immediately returned to normal. On the basis of these findings, the straight sinus was preserved during surgery.

CONCLUSION
This technique is straightforward and allows some assessment of the physiological responses and individual tolerance to sinus occlusion before surgery.
Trapping and Revascularization for a Dissecting Aneurysm of the Proximal Posteroinferior Cerebellar Artery: Technical Case Report and Review of the Literature
Authors: Ali Mir Jafer , Bendok Bernard R. , Tawk Rabih G. , Getch Christopher C. , Batjer H. Hunt 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE
Subarachnoid hemorrhage caused by an isolated dissection of the proximal portion of the posteroinferior cerebellar artery (PICA) is a rare problem. The optimal treatment to use for patients presenting with this clinical scenario varies and therefore is controversial in the literature. We report a patient in whom this problem was treated effectively with trapping of the diseased segment and revascularization of the PICA. We report this case to review this rare topic and to present our perspective on the indications for and the effectiveness of trapping and revascularization for proximal PICA dissections that cause hemorrhage.

CLINICAL PRESENTATION
A 55-year-old man was transferred to our institution and admitted for Hunt and Hess Grade IV subarachnoid hemorrhage, which improved to Hunt and Hess Grade III after ventricular drainage. Imaging revealed the source of the hemorrhage to be a pseudoaneurysm related to the dissection of the proximal portion of the PICA.

INTERVENTION
Three days after the initial bleeding episode, we operated on the patient. After the occipital artery was prepared for bypass, the diseased segment was trapped. The occipital artery-to-PICA anastomosis was then immediately performed distal to the trapped segment.

CONCLUSION
On the basis of our experience, the literature regarding this topic, and the anatomy of the perforators of the PICA, we think that the best treatment for a pseudoaneurysm located within the first three segments of the PICA is trapping of the diseased segment followed by revascularization distal to the trapped segment. This approach should prevent rehemorrhage and should avoid iatrogenic ischemic complications of the brainstem.
Radiosurgery for Treatment of Recurrent Intracranial Hemangiopericytomas
Authors: Sheehan Jason , Kondziolka Douglas , Flickinger John , Lunsford L. Dade 
Published: July 2004

Abstract

OBJECTIVE
Hemangiopericytomas are highly aggressive meningeal tumors with tendencies for recurrence and metastasis. The purpose of this retrospective, single-institution review was to evaluate the efficacy and role of stereotactic radiosurgery in the management of recurrent hemangiopericytomas.

METHODS
We reviewed data for patients who underwent stereotactic radiosurgery at the University of Pittsburgh between 1987 and 2001. Fourteen patients underwent radiosurgery for 15 discrete tumors. Prior treatments included transsphenoidal resection (n = 1), craniotomy and resection (n = 27), embolization (n = 1), and conventional radiotherapy (n = 7). Clinical and radiological responses were evaluated. Follow-up periods varied from 5 to 76 months (mean, 31.3 mo; median, 21 mo). The mean radiation dose to the tumor margin was 15 Gy.

RESULTS
Seventy-nine percent of patients (11 of 14 patients) with recurrent hemangiopericytomas demonstrated local tumor control after radiosurgery. Twelve of 15 tumors (i.e., 80%) dramatically decreased in size on follow-up imaging scans. Regional intracranial recurrences were retreated with radiosurgery for two patients (i.e., 15%); neither of those two patients experienced long-term tumor control. Local recurrences occurred 12 to 75 months (median, 21 mo) after radiosurgery. Local tumor control and survival rates at 5 years after radiosurgery were 76 and 100%, respectively (Kaplan-Meier method). We could not correlate prior irradiation or tumor size with tumor control. Twenty-nine percent of the patients (4 of 14 patients) developed remote metastases. Radiosurgery did not seem to offer protection against the development of intra- or extracranial metastases.

CONCLUSION
Gamma knife radiosurgery provided local tumor control for 80% of recurrent hemangiopericytomas. When residual tumor is identified after resection or radiotherapy, early radiosurgery should be considered as a feasible treatment modality. Despite local tumor control, patients are still at risk for distant metastasis. Diligent clinical and radiological follow-up monitoring is necessary.
Role of Venous Drainage in Cerebral Arteriovenous Malformation Surgery, as Related to the Development of Postoperative Hyperperfusion Injury
Authors: Schaller Carlo , Urbach Horst , Schramm Johannes , Meyer Bernhard 
Published: July 2004

AbstractOBJECTIVETo elucidate the role of venous drainage in cerebral arteriovenous malformation (AVM) surgery, with respect to the development of postoperative hyperperfusion injury.METHODSFor 52 patients with supratentorial AVMs, cortical capillary oxygenation (SaO2) was assessed intraoperatively, before and after resection, in the vicinity of the AVMs, by using a microspectrophotometric method. Assessed areas were defined as being related to feeding arteries or draining veins or as distant areas. Patients were divided into three groups on the basis of postoperative angiographic findings, as follows: Group 1, all former draining veins preserved (8 patients); Group 2, ≥1 former draining vein visible (12 patients); Group 3, no former draining veins visible (32 patients). Patients and SaO2 values were pooled and compared by using paired and unpaired t tests (P &lt; 0.05). Venous circulation times were calculated from digital subtraction angiography films.RESULTSThe postresectional relative increases in SaO2 values were highest in draining vein areas (+40.8%, compared with +25% in feeder areas and +25.5% in distant areas). Five postoperative hyperemic complications occurred (9.6%), none in Group 1 (with all draining veins preserved), two (16.7%) in Group 2, and three (9.4%) in Group 3 (with all draining veins occluded). The lowest preresectional SaO2 values (31.7 ± 6.2%) were measured in the drainer areas of the five patients who subsequently developed hyperperfusion injuries. Among those patients, postresectional increases in SaO2 values were significantly greater in drainer areas (+167.8%) than in feeder areas (+28.3%) or distant areas (+25.8%). Postoperative venous circulation times in former draining veins in Group 2 were significantly greater than those in Group 1 (8.9 ± 1.5 s versus 6.3 ± 0.6 s). Circulation times in normal veins in the five patients with hyperperfusion injury increased from 5.6 ± 1.0 seconds (preoperatively) to 8.4 ± 1.9 seconds (postoperatively).CONCLUSIONPostoperative hyperperfusion injury after resection of cerebral AVMs can be explained on the basis of unconstrained arterial inflow into cortical areas, which are rendered hypoxic/ischemic by longstanding preoperative venous hypertension. The risk for postoperative breakthrough complications seems higher in the presence of multiple draining veins, which also participate in the physiological venous drainage system of the ipsilateral hemisphere.
Preoperative Evaluation of Neurovascular Compression in Patients with Trigeminal Neuralgia by Use of Three-dimensional Reconstruction from Two Types of High-resolution Magnetic Resonance Imaging
Authors: Akimoto Hideaki , Nagaoka Tsukasa , Nariai Tadashi , Takada Yoshiaki , Ohno Kikuo , Yoshino Norio 
Published: July 2004

Abstract

OBJECTIVE
To assess the value of three-dimensional (3-D) images reconstructed from 3-D constructive interference in steady state (3-D-CISS) and 3-D fast inflow with steady-state precession (3-D-FISP) images for the visualization of neurovascular compression in patients with trigeminal neuralgia.

METHODS
Twenty-four consecutive patients with trigeminal neuralgia underwent preoperative 3-D-FISP and 3-D-CISS imaging. 3-D reconstruction of nerves and vessels was performed with the use of a volume-rendering method. We compared the 3-D reconstructed images with intraoperative findings.

RESULTS
3-D-CISS and 3-D-FISP images scanned from the same position clearly delineated the trigeminal nerve and vessels. 3-D reconstructed images showed the spatial relationship between the trigeminal nerve and causative vessels. The responsible arteries were identified from the 3-D reconstructed images, which closely simulated the microscopic operative view.

CONCLUSION
3-D reconstructions from two types of high-resolution magnetic resonance images (3-D-CISS and 3-D-FISP) are very useful for creating preoperative simulations and in deciding whether to perform surgery in patients with trigeminal neuralgia.
Anterior Communicating Artery Aneurysms
Authors: Riina Howard A. , Lemole G. Michael , Spetzler Robert F. 
Published: July 2004

Abstract
ANTERIOR COMMUNICATING ARTERY aneurysms are complex lesions for which surgical success requires extensive preoperative and intraoperative planning. Adherence to the tenets of aneurysm surgery, including vascular control and preservation of perforating arteries, is essential for their exclusion from the circulation.
Ruptured Aneurysm of the Ophthalmic Artery Trunk Demonstrated by Three-dimensional Rotational Angiography: Case Report
Authors: Yanaka Kiyoyuki , Matsumaru Yuji , Kamezaki Takao , Nose Tadao 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE
Aneurysms arising from the ophthalmic artery are extremely rare, compared with carotid-ophthalmic aneurysms arising from the wall of the internal carotid artery. We present a very unusual type of aneurysm arising from the ophthalmic artery itself.

CLINICAL PRESENTATION
A 54-year-old man presented with a sudden onset of headache and was transferred to a local hospital. Computed tomography demonstrated subarachnoid hemorrhage around the left anterior clinoid process, but digital subtraction angiography failed to localize the source of the hemorrhage. The patient was referred to our hospital for further evaluation and treatment. Conventional cerebral angiography did not reveal the source of the hemorrhage, but three-dimensional rotational angiography clearly demonstrated an aneurysm arising from the ophthalmic artery trunk, apart from the internal carotid artery.

INTERVENTION
The patient underwent microsurgical clipping of the aneurysm via a left pterional craniotomy. The aneurysm originated from the bifurcation of the ophthalmic artery and a perforating artery to the optic nerve. The aneurysm was successfully obliterated, and the postoperative course was uneventful.

CONCLUSION
This report is the first to describe a case of a ruptured aneurysm arising from the ophthalmic artery trunk. We discuss the clinical significance of an aneurysm at this site, as well as the role of three-dimensional rotational angiography in determining the source of subarachnoid hemorrhage.
Basilar Trunk Aneurysm Surgically Treated with Anterior Petrosectomy and External Carotid Artery-to-Posterior Cerebral Artery Bypass: Technical Note
Authors: Terasaka Shunsuke , Itamoto Koji , Houkin Kiyohiro 
Published: July 2004

Abstract

OBJECTIVE
We discuss a detailed surgical technique, its indications, and potential pitfalls in its use.

METHODS
A surgical procedure combining Kawase's anterior petrosectomy and external carotid artery-to-posterior cerebral artery high-flow bypass was performed for the treatment of a patient with a fusiform basilar trunk aneurysm.

RESULTS
Follow-up angiography revealed the successful obliteration of the aneurysm and that the graft was functioning well. Late ischemic complications, however, occurred 5 weeks after surgery.

CONCLUSION
Kawase's approach is a versatile option for safe vascular reconstruction of the posterior cerebral artery and exposure of a basilar trunk aneurysm in the upper clival region. Although, theoretically, a high-flow bypass might decrease the risk of hemodynamic ischemia, it does not prevent thromboembolic complications.