bluuebunny/crossref_metadata_2025_split huggingface dataset:
Timing of Aneurysm Surgery in Subarachnoid Hemorrhage: A Systematic Review of the Literature
Authors: de Gans Koen , Nieuwkamp Dennis J. , Rinkel Gabriël J.E. , Algra Ale 
Published: July 2004

ABSTRACT

OBJECTIVE
Many practitioners favor early operation after aneurysmal rupture, but sound data supporting this practice are lacking. A systematic review was conducted to compare early aneurysm surgery (Days 0–3), intermediate surgery (Days 4–7), and late surgery (more than 7 d after subarachnoid hemorrhage).

METHODS
We performed a MEDLINE search of the literature published between January 1974 and December 1998 and an additional manual search of selected journal titles from January 1998 to December 1998. Main outcome measures were death and poor outcome (defined as death or dependency) at the end of the follow-up period. Risk ratios (RRs) and corresponding 95% confidence intervals (CIs) were calculated; patients planned for late surgery were used as the reference.

RESULTS
Identified were 1 randomized clinical trial and 268 observational studies, of which only 10 studies (assessing a total of 1814 patients) fulfilled a set of minimum requirements for methodological quality. In the trial, the RR of poor outcome was 0.42 (95% CI, 0.17–1.04) for patients planned for early surgery and 1.07 (95% CI, 0.56–2.05) for intermediate surgery. In analyses with data from the 11 included studies, the RR of poor outcome for patients in good clinical condition at admission was 0.41 (95% CI, 0.34–0.51) for early surgery and 0.47 (95% CI, 0.32–0.69) for intermediate surgery. For patients in poor clinical condition at admission, the RR of poor outcome was 0.84 (95% CI, 0.67–1.05) for early surgery and 0.54 (95% CI, 0.24–1.22) for intermediate surgery. Adjustment of the RRs for year of publication, study design, and aneurysm location yielded essentially the same results, as did a sensitivity analysis after exclusion of the data from the randomized trial.

CONCLUSION
This meta-analysis suggests that both early and intermediate surgical treatment improve outcome after aneurysmal subarachnoid hemorrhage—in particular for patients in good clinical condition at admission. However, this impression is derived only from an indirect comparison between different cohorts of patients. Sound evidence on the best timing of surgery is still lacking. Observational studies with better methods—and ideally a new randomized trial—are needed.
Histological Findings in Coil-packed Experimental Aneurysms 3 Months after Embolization
Authors: Böcher-Schwarz Hans G. , Ringel Kurt , Bohl Jürgen , Filippi Ronald , Kempski Oliver , Perneczky Axel 
Published: July 2004

ABSTRACT

OBJECTIVE
Knowledge regarding tissue reactions within coil-packed aneurysms is poor. The purpose of this study was to analyze histological changes in a chronic experimental bifurcation aneurysm model that might explain the protective effect of Guglielmi detachable coils.

METHODS
The aneurysms were produced by means of a venous graft pouch at a surgically created bifurcation of the carotid artery in the neck of rabbits. After 3 weeks, embolization with Guglielmi detachable coils was performed in the treatment group but not in the control group (seven rabbits each). At the time of embolization, six of seven treated aneurysms were completely occluded according to radiological criteria. Twelve weeks later, all aneurysms were explanted after final angiography. Histological examinations were performed with coils in situ.

RESULTS
Six of seven embolized aneurysms demonstrated complete occlusion in final angiography. But gross pathology revealed that all specimens had differently sized open cavities between the coils. In only two cases, these spaces were very small and the aneurysmal sacs were filled with coils and tissue by more than 90%. Light microscopy demonstrated intraluminal granulation tissue and strong chronic inflammatory wall thickening with numerous foreign body cells at the interface between coils and tissue. Coils were partially incorporated into the aneurysmal wall, sometimes close to the surface and occasionally even outside the wall within the surrounding tissue.

CONCLUSION
The protective effect of Guglielmi detachable coil treatment in our chronic experimental bifurcation aneurysms results from formation of intraluminal granulation tissue and wall thickening attributable to chronic inflammation.
Castleman's Disease and Spinal Cord Compression: Case Report
Authors: Kachur Edward , Ang Lee-Cyn , Megyesi Joseph F. 
Published: July 2004

ABSTRACT

OBJECTIVE AND IMPORTANCE
Castleman's disease is a rare lymphoproliferative disorder most often found in the mediastinum. Localized forms are usually benign, whereas multicentric forms may be aggressive . We report a patient with Castleman's disease who presented with spinal cord compression, and we review previously published cases of Castleman's disease involving the central nervous system. To our knowledge, this is only the second case of Castleman's disease presenting as a spinal epidural mass with cord compression.

CLINICAL PRESENTATION
A 44-year-old otherwise healthy woman presented acutely with difficulty walking. Examination revealed mild myelopathy in her legs. Magnetic resonance imaging revealed a posterior epidural mass compressing the thoracic spinal cord at T3–T5.

INTERVENTION
Thoracic laminectomy and gross total resection of the lesion were performed. Pathological examination of the lesion identified the hyaline-vascular type of Castleman's disease. The patient's symptoms resolved postoperatively.

CONCLUSION
Castleman's disease presenting as a spinal epidural mass lesion with cord compression is rare. Surgical treatment can result in an excellent outcome.
Postoperative Edema after Vascular Access Causing Nerve Compression Secondary to the Presence of a Perineuronal Lipoma: Case Report
Authors: Goldstein Lawrence J. , Helfend Lisa K. , Kordestani Rouzbeh K. 
Published: July 2004

ABSTRACT

OBJECTIVE AND IMPORTANCE
Median nerve neuropathy can be clinically devastating to a patient. It can be caused by compression of the median nerve anywhere along its course. We present the case of delayed median nerve neuropathy after the placement of a vascular graft in the arm.

CLINICAL PRESENTATION
An arm shunt was placed in the nondominant upper extremity in a 60-year-old man with end-stage renal disease. Twelve hours postoperatively, the patient developed neurapraxia in the median nerve distribution in the hand.

INTERVENTION
Exploration of the arm revealed a lipoma coursing along and deep to the median nerve. Resection of the lipoma decompressed the nerve.

CONCLUSION
In this patient, median nerve neuropathy was caused by a lipoma and postoperative swelling from placement of the vascular graft. The swelling that occurred after the shunt placement unmasked subclinical compression of the nerve by a lipoma deep to the median nerve. To our knowledge, this report is unique in documenting damage to the median nerve after vascular graft placement as a result of an occult mass.
Use of Intraventricular Tissue Plasminogen Activator and Guglielmi Detachable Coiling for the Acute Treatment of Casted Ventricles from Cerebral Aneurysm Hemorrhage: Two Technical Case Reports
Authors: Azmi-Ghadimi Hooman , Heary Robert F. , Farkas Jeffrey E. , Hunt C. David 
Published: July 2004

ABSTRACT

OBJECTIVE AND IMPORTANCE
We report two cases of massive intraventricular hemorrhage resulting from subarachnoid hemorrhage. Both patients had experienced a ruptured cerebral aneurysm and were initially moribund. The patients were treated with Guglielmi detachable coiling and then administration of intraventricular tissue plasminogen activator (tPA). Rapid clot resolution was demonstrated radiographically in both. Both patients survived and had a meaningful functional neurological recovery. These are the first reported cases of the acute use of intraventricular tPA after Guglielmi detachable coiling treatment for ruptured cerebral aneurysm.

CLINICAL PRESENTATION
A 59-year-old woman and a 44-year-old man presented with high-grade subarachnoid hemorrhage. Both had had extensive casting of their ventricular systems with blood.

INTERVENTION
The patients were treated with Guglielmi detachable coiling thrombosis of the aneurysm and then intraventricular administration of tPA for dissolution of blood clots. Both patients survived; one is able to carry out activities of daily living with moderate assistance, and the other is able to communicate with his family.

CONCLUSION
This is a novel method to manage patients with high-grade aneurysms with massive intraventricular blood clots. The tPA reduced the mass effect of the blood clot, possibly helping to improve the neurological grade; in addition, the administration of tPA helped keep the external ventricular drains functional, enabling treatment of the acute hydrocephalus. The safety of administering tPA after endovascular thrombosis was demonstrated in these two patients. Further investigation is required to determine the applicability of this approach on a broader scale.
Reoperation for Acute Hemispheric Stroke after Carotid Endarterectomy: Is There Any Value?
Authors: Findlay J. Max , Marchak B. Elaine 
Published: July 2004

Abstract

OBJECTIVE:
Because the clinical benefit of urgent investigation and carotid rerepair for acute stroke complicating carotid endarterectomy (CEA) is uncertain, the results of this approach were examined in a large series of patients.

METHODS:
In a consecutive series of 700 CEAs, 24 patients (3.4%) had a postoperative stroke. Thirteen of these 24 patients experienced major hemispheric deficits (hemiplegia with or without aphasia, forced eye deviation, and decreased consciousness) that prompted either immediate surgical reexploration or cerebral angiography with reoperation on the basis of angiogram results; these 13 patients are the subject of this report. Neurological improvement was attributed to carotid reopening when affected muscle strength increased to antigravity power within 6 hours of reoperation.

RESULTS:
Of the 13 patients with severe postoperative deficits, 5 (38%) had the deficits when they awakened, 7 deficits occurred within 12 hours of surgery, and the only intracerebral hemorrhage in this series occurred 8 days after surgery. Five patients underwent urgent reoperation without angiography, and carotid occlusions were found and repaired in two patients. In another patient, the carotid was patent, and an intra-arterial injection of tissue plasminogen activator (20 mg) was given. In the seven patients who underwent cerebral angiography as the first step, two carotid occlusions and one residual stenosis with thrombus were found and repaired on an urgent basis. Surgical reopening of occluded arteries was followed by improvement in two of four patients, and early improvement was noted in one patient with a stenosis correction as well as in the patient who received intraoperative tissue plasminogen activator. Four patients who underwent urgent reoperation did not demonstrate a benefit soon after surgery. Two patients died, two were left with major deficits and five with moderate deficits, and four patients eventually had good recovery at a minimum of 6 months of follow-up.

CONCLUSION:
In this series, approximately one-half of hemispheric strokes complicating CEA had an underlying correctable lesion (occlusion or stenosis), and these patients typically had delayed-onset strokes. Approximately one-half of these patients improved early as a result of reopening, although computed tomography revealed new infarcts in most of them. Urgent carotid repair may benefit a minority of selected patients who have a major stroke after CEA.
Repeat Radiosurgery for Refractory Trigeminal Neuralgia
Authors: Hasegawa Toshinori , Kondziolka Douglas , Spiro Richard , Flickinger John C. , Lunsford L. Dade 
Published: July 2004

Abstract

OBJECTIVE:
Stereotactic radiosurgery has become an important and minimally invasive alternative for patients with refractory trigeminal neuralgia. When a second procedure is necessary, the outcomes are unknown. The degree of pain relief and morbidity after repeat radiosurgery were studied.

METHODS:
Thirty-one patients underwent a second gamma knife radiosurgery procedure because of unsatisfactory or unsustained relief of pain after the first procedure. Twenty-seven patients were assessable at median follow-up periods of 42.7 and 20.4 months after the first and second procedures, respectively. Most patients had undergone multiple previous operations of other types (microvascular decompression, radiofrequency rhizotomy, glycerol rhizotomy, balloon compression). The median target doses of the first and second radiosurgeries were 75 and 64 Gy, respectively. All patients were evaluated by a physician who did not participate in patient treatment.

RESULTS:
After the first radiosurgical procedure, 13 patients had an excellent response initially (complete relief without any medication), 3 had a good response (complete relief with some medication), 7 had a fair response (&gt;50% relief), and 4 had a poor response (&lt;50% pain relief or treatment failure). Repeat radiosurgery was performed in patients with recurrent or residual pain. After the second radiosurgical procedure, 5 patients had an excellent response, 8 had a good response, 10 had a fair response, and 4 had a poor response. Thirteen patients (48%) achieved complete pain relief (with or without medication). Two patients (7.4%) experienced new sensory symptoms after the first radiosurgical procedure, and three (12.7%, actuarial) experienced new sensory symptoms after the second procedure.

CONCLUSION:
Repeat radiosurgery provided a similar rate of pain relief as the first procedure, despite a modest dose reduction. The risk of new sensory symptoms was increased, but no other morbidity was identified. For patients who experience recurrent pain and choose to undergo a second procedure, our current procedure is to deliver a maximum dose of 50 to 60 Gy to a trigeminal target anterior to the root entry zone near the entrance of the nerve beneath the petrous dura.
Pure Subdural Hematomas: A Postmortem Analysis of Their Form and Bleeding Points
Authors: Maxeiner Helmut , Wolff Michael 
Published: July 2004

Abstract

OBJECTIVE:
Although the literature concerning subdural hematomas (SDHs) is vast, few data are available as to the sources and related clinical differences of SDHs. Pure SDHs of arterial versus venous origin should be compared in terms of cause, size, space-occupying effect, and form.

METHODS:
We analyzed data from 46 patients who died as a result of pure SDHs. Twenty-three SDHs resulted from bridging vein ruptures and 23 from torn cortical arteries. We performed a morphometric analysis of the intracranial situation on the horizontal plane at the level of the greatest fronto-occipital diameter. We included in our analysis the clinical one-dimensional parameters (e.g., hematoma thickness, midline shift); the areas of the hemispheres, the SDHs, and their displacement; and the hematoma volume.

RESULTS:
Most of the investigated postmortem characteristics of both types of hematomas were similar, with the exception of the form and the midline shift. SDHs resulting from arterial ruptures (which are generally located in the temporoparietal region) differ in form from those caused by bridging vein ruptures (which typically rupture in the frontoparietal parasagittal region).

CONCLUSION:
The form difference allows the probable rupture site to be estimated; this observation might prove useful for clinical purposes.
Efficacy of the Morphine-Adcon-L Compound in the Management of Postoperative Pain after Lumbar Microdiscectomy
Authors: Mastronardi Luciano , Pappagallo Marco , Puzzilli Fabrizio , Tatta Carlo 
Published: July 2004

Abstract

OBJECTIVE:
Epidural analgesia is a pharmacological technique for operative and postoperative pain control. It has been used with lumbar microdiscectomy to facilitate management of surgical pain, shorten patient recovery time, and increase patient satisfaction with the procedure and the hospital stay. Adcon-L (Gliatech, Inc., Cleveland, OH) (adhesion control in a barrier gel) has been demonstrated to act as a barrier to the development of epidural fibrosis after lumbar procedures, minimizing the formation of fibrotic scar and improving the long-term outcome. In this study, we used Adcon-L as a vehicle to administer 1 mg of morphine epidurally to patients who underwent lumbar microdiscectomy. Our objective was to evaluate the safety and analgesic efficacy of this compound .

METHODS:
A randomized, controlled, double-blind study was conducted in 100 patients. Patients were randomized to two groups: the morphine-Adcon-L (M-ADL) group (n = 51 patients) or the Adcon-L control group (n = 49 patients). Outcome measures included: 1) a visual analog scale to assess the intensity of spontaneous low back and radicular pain, 2) a straight leg-raising maneuver to assess the degree of leg elevation in relation to evoked sciatic pain, 3) postoperative time to comfortable walking, 4) duration of postoperative hospitalization, 5) required amount of postoperative analgesics, and 6) postoperative work time loss.

RESULTS:
No intraoperative or postoperative complications were observed. No clinically relevant adverse events, such as urinary retention, respiratory disturbances, or wound infections were reported in the M-ADL group. At the time of hospital discharge, results were as follows: 1) the M-ADL group had significantly lower pain intensity scores (mean value of postoperative visual analog scale, 12.3 mm ± 0.9 in the M-ADL group versus 24.7 mm ± 11.5 in the control group [P &lt; 0.0001]); 2) the M-ADL group consumed significantly less analgesics: 57.4% of M-ADL patients versus 95.9% of controls received analgesics in the hospital, and 23.5% of M-ADL patients versus 55.1% of controls used analgesics at home (P &lt; 0.0001); 3) the M-ADL group had significantly shorter hospital stays (1.37 ± 0.07 d versus 2.53 ± 0.12 d in the control group [P &lt; 0.0001]); 4) the M-ADL group had a significantly higher degree of symptomatic leg elevation in the straight leg raising (mean postoperative straight leg-raising test, 64.41 degrees ± 1.59 versus 57.77 degrees ± 1.85 in the controls [P = 0.02]); and 5) the M-ADL group lost significantly less postoperative work time (21.67 ± 0.92 d versus 29.47 ± 1.18 d in the control group). In addition, at 1 year of follow-up, there was no clinical evidence of late-onset neurological complications.

CONCLUSION:
The epidural application of the compound M-ADL after lumbar microdiscectomy was found to be safe and effective, and it significantly improved postoperative pain control and return to function.
Bilateral Metachronous Germinoma of the Basal Ganglia Occurring Long after Total Removal of a Mature Pineal Teratoma: Case Report
Authors: Sugimoto Keiji , Nakahara Ichiro , Nishikawa Michio 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE:
We report the extremely rare occurrence of a second germ cell tumor at a different site and with different histological types long after total removal of a mature pineal teratoma.

CLINICAL PRESENTATION:
A 10-year-old boy who presented with headache and vomiting was admitted to our hospital. Neuroradiological studies revealed a tumor in the pineal region. The tumor was totally removed. Histologically, the tumor proved to be a mature teratoma. The patient's postoperative course was uneventful. The patient received no adjuvant therapy and was followed in the outpatient clinic. Three years later, he was readmitted with transient left upper limb weakness and vomiting. Neuroradiological studies showed a tumor in the bilateral basal ganglia.

INTERVENTION:
The second tumor, which was located in the right basal ganglion, was partially removed for biopsy. Histologically, the tumor proved to be a germinoma. The patient received three cycles of combination chemotherapy consisting of carboplatin and etoposide with radiotherapy. After the second course of chemotherapy, magnetic resonance imaging studies revealed no evidence of the tumor.

CONCLUSION:
The second tumor was considered to be a de novo metachronous neoplasm rather than a recurrence of the original mature teratoma. We think that if primordial germ cell groups exist along the midline of the brain, more than two primordial germ cell groups could give rise to metachronous neoplasms at different sites and with different histological types.
Suprasellar Adrenocorticotropic Hormone-secreting Ectopic Pituitary Adenoma: Case Report and Literature Review
Authors: Hou Lewis , Harshbarger Todd , Herrick Maie K. , Tse Victor 
Published: July 2004

AbstractOBJECTIVE AND IMPORTANCE:Functional ectopic pituitary adenomas are rare and can be misdiagnosed as extensions of pituitary adenomas when they are located in the vicinity of the normal gland. In this report, we present a case of an ectopic adrenocorticotropic hormone-secreting suprasellar pituitary adenoma that caused Cushing's disease. A literature review of previously reported ectopic pituitary adenomas is included to illustrate the diverse clinical manifestations of this disease entity.CLINICAL PRESENTATION:An 11-year-old boy was noted to have hirsutism, a buffalo hump, and unexplained weight gain consistent with Cushing's syndrome. Laboratory investigations revealed that the boy had elevated adrenocorticotropic hormone and serum cortisol levels unsuppressed by dexamethasone. Magnetic resonance imaging scans were suggestive of a pituitary adenoma with suprasellar extension.INTERVENTION:The initial transsphenoidal approach failed to achieve complete surgical resection. A repeat operation in which the pterional approach was used revealed a suprasellar pituitary adenoma without association with intrasellar contents. The patient's cushingoid symptoms improved significantly 3 months after surgery.CONCLUSION:Ectopic pituitary adenomas should be considered in the differential diagnosis for all patients with Cushing's syndrome. Furthermore, surgical approaches should be chosen carefully once the diagnosis of ectopic pituitary adenoma is made.
Cerebellopontine Angle Lipomas: Report of Four Cases and Review of the Literature
Authors: Tankéré Frédéric , Vitte Elizabeth , Martin-Duverneuil Nadine , Soudant Jacques 
Published: July 2004

AbstractOBJECTIVE:To define the management of internal acoustic meatus and cerebellopontine angle (CPA) lipomas according to their clinical, histological, and surgical characteristics.METHODS:We report four new cases of CPA lipomas diagnosed in the Department of Otorhinolaryngology–Head and Neck Surgery of Hôpital Pitié-Salpêtrière and review 94 cases reported previously in the literature.RESULTS:Lipomas represented 0.14% of CPA and internal acoustic meatus tumors. Localization was on the left side in 59.9%, on the right side in 37%, and bilateral in 3.1% of the patients. The diagnosis was confirmed radiologically in 33 of 98 patients, surgically in 60 patients, and by autopsy in 5 patients. The most frequent associated symptoms were of cochleovestibular origin, such as hearing loss (62.2%), dizziness (43.3%), and unilateral tinnitus (42.2%). Other associated symptoms involved the facial nerve (9%) or the trigeminal nerve (14.4%). Complete resection was performed in only 32.8% of the patients with frequent cranial nerve involvement. Frequent cranial nerve involvement was seen in 95.4% of all patients. After surgery, patient symptomatology was unchanged in 9.2% of the patients, and 50% were improved; however, new postoperative deficits occurred in two-thirds of the patients. Overall, 72.2% of the patients experienced new postoperative deficits such as hearing loss (64.8%). Preservation of hearing was possible in only 26% of the patients. Only 18% of patients were improved after surgery without any new postoperative deficits.CONCLUSION:Preoperative diagnosis of internal acoustic meatus/CPA lipomas is based on magnetic resonance imaging. The aim of surgery in these cases is not tumor removal but cranial nerve decompression or vestibular transection, and surgery is performed only in patients with disabling and uncontrolled symptoms.