bluuebunny/crossref_metadata_2025_split huggingface dataset:
Combined Encephaloduroarteriosynangiosis and Bifrontal Encephalogaleo(periosteal)synangiosis in Pediatric Moyamoya Disease
Authors: Kim Seung-Ki , Wang Kyu-Chang , Kim In-One , Lee Dong Soo , Cho Byung-Kyu 
Published: July 2004

ABSTRACT

OBJECTIVE
We compared the surgical results of simple encephaloduroarteriosynangiosis (EDAS) and EDAS with bifrontal encephalogaleo(periosteal)synangiosis for the treatment of pediatric moyamoya disease.

METHODS
Data for 159 children (up to 15 yr of age, 76 boys and 83 girls) who underwent indirect revascularization procedures for the treatment of moyamoya disease between 1987 and 1998 were retrospectively reviewed. Group A patients underwent simple EDAS (n = 67). Group B patients underwent EDAS with bifrontal encephalogaleo(periosteal)synangiosis (n = 92). The surgical results for each group were compared, in terms of clinical outcomes, neuroimaging changes, extent of revascularization evident on angiograms, and hemodynamic changes evident on single-photon emission computed tomographic scans. The average follow-up periods were 45 months for Group A and 22 months for Group B.

RESULTS
The overall clinical outcomes and neuroimaging changes tended to be better for Group B. In terms of single-photon emission computed tomographic changes of the whole brain after surgery, Group B patients exhibited more favorable outcomes than did Group A patients (62 versus 36%, P = 0.003). The surgical results for the anterior cerebral artery territory were significantly better for Group B than for Group A, with respect to outcomes of anterior cerebral artery symptoms (81 versus 40%, P = 0.015), revascularization on angiograms (79 versus 16%, P &lt; 0.001), and hemodynamic changes on single-photon emission computed tomographic scans (70 versus 52%, P = 0.002). The incidences of postoperative infarctions were not significantly different between the two groups.

CONCLUSION
EDAS with bifrontal encephalogaleo(periosteal)synangiosis is a more effective surgical modality for the treatment of pediatric moyamoya disease, compared with simple EDAS, because it covers both the middle cerebral artery and anterior cerebral artery territories of the brain.
Dandy-Walker Complex and Syringomyelia in an Adult: Case Report and Discussion
Authors: Hammond Christopher J. , Chitnavis Bhupal , Penny Christopher C. , Strong Anthony J. 
Published: July 2004

ABSTRACT

OBJECTIVE AND IMPORTANCE
Syringomyelia in association with the Dandy-Walker complex is rare and only 17 cases have been reported, mostly as autopsy findings or incidental reports in series for other conditions. We present a further case report and discuss the possible pathogenetic mechanisms of syrinx formation in the presence of the Dandy-Walker complex. We emphasize the role of foramen magnum obstruction and alteration in cerebrospinal fluid flow dynamics in syrinx formation. The therapeutic importance of disimpaction of the foramen magnum is stressed.

CLINICAL PRESENTATION
A 39-year-old man presented with headache. As a child, he had had cystoperitoneal and ventriculoperitoneal shunts inserted for hydrocephalus in association with the Dandy-Walker complex. On examination, the patient had limited upgaze but was otherwise normal. Magnetic resonance imaging revealed a large cervicothoracic syrinx and a Dandy-Walker cyst obstructing the foramen magnum.

INTERVENTION
The cystoperitoneal shunt was revised. The patient's headaches resolved, and follow-up imaging demonstrated resolution of the syrinx and disimpaction of the foramen magnum.

CONCLUSION
Disimpaction of the foramen magnum can resolve syringomyelia in patients with the Dandy-Walker complex. This can be achieved by a shunt procedure or by formal foramen magnum decompression. The rarity of the association between the Dandy-Walker complex and syringomyelia prevents firm conclusions from being made regarding the best management strategy for this condition.
Internal Carotid-Inferior Petrosal Sinus Fistula Complicating Foramen Ovale Telemetry: Successful Treatment with Detachable Coils: Case Report and Review
Authors: Marshman Laurence A.G. , Connor Steven , Polkey Charles E. 
Published: July 2004

ABSTRACT

OBJECTIVE AND IMPORTANCE
Iatrogenic internal carotid artery-cavernous sinus fistula complicating percutaneous foramen ovale (FO) instrumentation (e.g., retrogasserian rhizotomy for trigeminal neuralgia) has been reported in only four patients to date. To our knowledge, no case of fistula has previously been reported either to complicate FO telemetry or to involve the inferior petrosal sinus (IPS); moreover, most patients have presented within 48 hours. We present a case of internal carotid artery-IPS fistula that complicated FO telemetry in which the clinical syndrome was delayed by 4 weeks.

CLINICAL PRESENTATION
Four weeks after undergoing bilateral FO telemetry during Phase 2 investigations for surgery for epilepsy, a 37-year-old man suddenly developed a painful bilateral pupil-sparing oculomotor palsy, poor visual acuity, proptosis, conjunctival suffusion, and an audible bruit over the right frontotemporal region.

INTERVENTION
Cerebral angiography demonstrated a high-flow arteriovenous fistula between the junction of the petrous and laceral portions of the right internal carotid artery and right IPS, with rapid filling of both cavernous sinuses. Successful obliteration was obtained with Guglielmi detachable coils, followed by complete resolution of the bilateral ocular abnormality.

CONCLUSION
This is the first reported case of iatrogenic fistula formation to either involve the IPS or to complicate FO telemetry. In addition, symptomatology was anomalously delayed. This case highlights the importance of noting FO anatomic asymmetries before FO instrumentation and of routinely inquiring for “swooshing” noises after electrode withdrawal.
Intravascular Graft Stent Treatment of a Ruptured Fusiform Dissecting Aneurysm of the Intracranial Vertebral Artery: Technical Case Report
Authors: Chiaradio Juan Carlos , Guzman Luis , Padilla Lucio , Chiaradio Maria Paula 
Published: July 2004

ABSTRACT

OBJECTIVE AND IMPORTANCE
An innovative stenting technique to treat a difficult case of a fusiform aneurysm of the intracranial vertebral artery (VA), with restoration of the vessel lumen, is described.

CLINICAL PRESENTATION
A 58-year-old patient experienced sudden pain in the upper cervical spine, followed by a severe headache. He underwent computed tomographic evaluation, which demonstrated subarachnoid hemorrhage in the prepontine cistern. A fusiform aneurysm of the distal right VA and critical stenosis of the left VA were detected in digital subtraction angiograms. The patient experienced a new subarachnoid hemorrhaging episode, and urgent endovascular treatment was planned.

INTERVENTION
The patient underwent angioplastic and stenting procedures in the left VA, with good results. Forty-eight hours later, an endovascular procedure was performed to treat the right VA aneurysm. We decided to use a graft stent (Jostent graft stent; Jomed, Conroe, TX) instead of a balloon to preserve the arterial lumen. The complete procedure was well tolerated by the patient, and he was discharged, without symptoms, 48 hours later.

CONCLUSION
The patient was discharged, without neurological deficits, 48 hours after completion of the endovascular procedure, with clopidogrel (75 mg/d) and aspirin (325 mg/d) therapy. This treatment was discontinued after 4 weeks. According to our search of the medical literature, this is the first clinical case in which an intracranial fusiform aneurysm was permanently sealed with a graft stent.
Repair of a Tear at the Base of a Blister-like Aneurysm with Suturing and an Encircling Clip: Technical Note
Authors: Yanaka Kiyoyuki , Meguro Kotoo , Nose Tadao 
Published: July 2004

ABSTRACT

OBJECTIVE
An aneurysm can produce large defects in the parent vessel if the aneurysm tears at the neck of the vessel. The authors present a technique to repair a tear at the base of a blister-like aneurysm encountered during microsurgical clipping of an anterior wall aneurysm of the internal carotid artery.

METHODS
The repair technique involved suturing and covering the aneurysm with an encircling aneurysm clip. A large tear had destroyed the vessel's tubular structure, and repair was not sufficient using an encircling clip alone. Two microsuture stitches were placed on the tear, so that a split artery re-formed a tubular structure. The lesion was then covered with Surgicel (Ethicon, Inc., Somerville, NJ) and fibrin glue. When the Surgicel and fibrin glue were applied, the temporary clip on the distal internal carotid artery was removed for a moment, allowing retrograde blood flow to provide the counterforce necessary to maintain the vessel's tubular structure. An encircling clip was then applied to cover the entire circumference of the lesion.

RESULTS
This method required only a short occlusion time for arterial repair, thus helping avoid ischemic complications. The patient awoke with transient hemiparesis, but recovery was prompt.

CONCLUSION
This technique is useful for repairing an aneurysmal tear at its base, especially if the tear is large.
Surgical Simulation Software for Insertion of Pedicle Screws
Authors: Eftekhar Behzad , Ghodsi Mohammad , Ketabchi Ebrahim , Rasaee Saman 
Published: July 2004

ABSTRACT

OBJECTIVE
As the first step toward finding noninvasive alternatives to the traditional methods of surgical training, we have developed a small, stand-alone computer program that simulates insertion of pedicle screws in different spinal vertebrae (T10–L5).

METHODS
We used Delphi 5.0 and DirectX 7.0 extension for Microsoft Windows. This is a stand-alone and portable program.

RESULTS
The program can run on most personal computers. It provides the trainee with visual feedback during practice of the technique. At present, it uses predefined three-dimensional images of the vertebrae, but we are attempting to adapt the program to three-dimensional objects based on real computed tomographic scans of the patients. The program can be downloaded at no cost from the web site: www.tums.ac.ir/downloads

CONCLUSION
As a preliminary work, it requires further development, particularly toward better visual, auditory, and even proprioceptive feedback and use of the individual patient's data.
Anterior Cervical Plating Enhances Arthrodesis after Discectomy and Fusion with Cortical Allograft
Authors: Kaiser Michael G. , Haid Regis W. , Subach Brian R. , Barnes Bryan , Rodts Gerald E. 
Published: July 2004

ABSTRACT

OBJECTIVE
Anterior plate fixation has gained widespread acceptance for the treatment of cervical spondylosis, theoretically enhancing the rate of arthrodesis. There are few studies comparing fusion rates after anterior cervical discectomy and fusion (ACDF) with and without a plate. The purpose of this study was to evaluate the efficacy of anterior cervical plating for fusion enhancement after one- and two-level ACDF with cortical allograft.

METHODS
A retrospective review was performed with 251 patients who underwent one- or two-level ACDF with cortical allograft and plate stabilization between 1993 and 1999. An independent surgeon reviewer determined fusion status and complications. A successful fusion was defined by the absence of lucency around the graft, evidence of bridging bone between the endplate and the graft, and the absence of movement on dynamic imaging scans. Follow-up data, ranging from 9 months to 3.6 years, were available for 233 patients. A control group of 289 patients who underwent ACDF without plating was described in a previously published report by the senior author (RWH). Therefore, a total of 540 patients were evaluated for determination of the efficacy of anterior cervical plating with cortical allograft bone. Statistical significance was determined by χ2 test.

RESULTS
The fusion rates for one- and two-level ACDF with anterior fixation were 96 and 91%, respectively, compared with 90 and 72% for one- and two-level ACDF without anterior fixation. The observed increases in fusion rates for both one- and two-level procedures proved to be statistically significant (P &lt; 0.05). There were no recorded infectious, neurological, or graft-related complications among the cohort treated with anterior cervical plating. Compared with the results for the cohort treated without anterior cervical plates, there was a statistically significant decrease in the graft-related complication rate with the application of plates (P &lt; 0.001). Two patients who received plates were noted to have adjacent-segment degenerative changes that required surgical intervention. No hardware fractures were noted; however, one patient was noted to have a single displaced screw, without clinical consequences.

CONCLUSION
The use of anterior cervical plating after one- and two-level ACDF with allograft cortical bone significantly enhanced arthrodesis. The improved fusion rate and negligible complication rate associated with anterior cervical plating are compelling factors justifying its use in the treatment of cervical spondylosis.
Follow-up Angiography of Intracranial Aneurysms Treated with Endovascular Placement of Guglielmi Detachable Coils
Authors: Thornton John , Debrun Gerard M. , Aletich Victor A. , Bashir Qasim , Charbel Fady T. , Ausman James 
Published: July 2004

ABSTRACT

OBJECTIVE
The success of endovascular treatment of intracranial aneurysms with Guglielmi detachable coils (GDCs) is dependent on the long-term exclusion of the aneurysm from the circulation. We reviewed our experience with the long-term angiographic follow-up monitoring of aneurysms that had been treated with GDCs.

METHODS
All patients whose aneurysms had been treated with GDCs between January 1995 and August 1999 and who subsequently underwent follow-up angiography at 6 months or more were included in this study. We reviewed all of the angiographic findings, to determine the percentage of aneurysm occlusion on the initial angiograms and on the last available follow-up angiograms. The categories of aneurysm occlusion used were 100%, ≥95%, and less than 95% occlusion.

RESULTS
One hundred thirty patients with 141 aneurysms underwent 143 endovascular coiling procedures and subsequently underwent angiographic follow-up monitoring of 6 months or more. There were 102 female and 28 male patients. The mean angiographic follow-up period was 16.7 months (range, 6–62 mo). The initial rates of occlusion were 100% for 56 aneurysms (39%), ≥95% for 65 aneurysms (46%), and less than 95% for 22 aneurysms (15%). Recurrence of one aneurysm (1.8%) was observed. Of the 87 aneurysms that were incompletely occluded initially, there was progressive thrombosis in 40 (46%), stable neck remnants in 23 (26%), and enlargement of the residual neck in 24 (28%). The final occlusion rates, determined on the last available angiograms, were 100% for 88 aneurysms (61%), ≥95% for 31 aneurysms (22%), and less than 95% for 24 aneurysms (17%). No patient experienced repeat or new subarachnoid hemorrhage more than 6 months after the initial treatment.

CONCLUSION
Late angiographic follow-up monitoring of aneurysms that have been treated with GDCs demonstrates the durability of the treatment. Aneurysms with large residual neck remnants were subjected to further treatment, whereas aneurysms with small residual neck remnants remain under observation.
Traumatic Subarachnoid Hemorrhage: Demographic and Clinical Study of 750 Patients from the European Brain Injury Consortium Survey of Head Injuries
Authors: Servadei Franco , Murray Gordon D. , Teasdale Graham M. , Dearden Mark , Iannotti Fausto , Lapierre Françoise , Maas Andrew J.R. , Karimi Abbi , Ohman Juha , Persson Lennart , Stocchetti Nino , Trojanowski Tomasz , Unterberg Andy 
Published: July 2004

ABSTRACT

OBJECTIVE
Previous reports identified the presence of traumatic subarachnoid hemorrhage (tSAH) on admission computed tomographic (CT) scans as an independent prognostic factor in worsening outcomes. The mechanism underlying the link between tSAH and prognosis has not been clarified. The aim of this study was to investigate the association between CT evidence of tSAH and outcomes after moderate or severe head injuries.

METHODS
In a survey organized by the European Brain Injury Consortium, data on initial severity, treatment, and subsequent outcomes were prospectively collected for 1005 patients with moderate or severe head injuries who were admitted to one of the 67 European neurosurgical units during a 3-month period in 1995. The CT findings were classified according to the Traumatic Coma Data Bank classification system, and the presence or absence of tSAH was recorded separately in the initial CT scan forms.

RESULTS
Complete data on early clinical features, CT findings, and outcomes at 6 months were available for 750 patients, of whom 41% exhibited evidence of tSAH on admission CT scans. There was a strong, highly statistically significant association between the presence of tSAH and poor outcomes. In fact, 41% of patients without tSAH achieved the level of good recovery, whereas only 15% of patients with tSAH achieved this outcome. Patients with tSAH were significantly older (median age, 43 yr; standard deviation, 21.1 yr) than those without tSAH (median age, 32 yr; standard deviation, 19.5 yr), and there was a significant tendency for patients with tSAH to exhibit lower Glasgow Coma Scale scores at the time of admission. A logistic regression analysis of favorable/unfavorable outcomes demonstrated that there was still a very strong association between tSAH and outcomes after simultaneous adjustment for age, Glasgow Coma Scale Motor Scores, and admission CT findings (odds ratio, 2.49; 95% confidence interval, 1.74–3.55;P &lt; 0.001). Comparison of the time courses for 164 patients with early (within 14 d after injury) deaths demonstrated very similar patterns, with an early peak and a subsequent decline; there was no evidence of a delayed increase in mortality rates for either group of patients (with or without tSAH).

CONCLUSION
These findings for an unselected series of patients confirm previous reports of the adverse prognostic significance of tSAH. The data support the view that death among patients with tSAH is related to the severity of the initial mechanical damage, rather than to the effects of delayed vasospasm and secondary ischemic brain damage.
Cerebral Revascularization for Aneurysms and Tumors
Authors: Sekhar Laligam N. , Kalavakonda Chandrasekar 
Published: July 2004

ABSTRACT

OBJECTIVE
To discuss the indications, techniques, pitfalls, complication avoidance, and management of cerebral revascularization techniques for the treatment of aneurysms and cranial base tumors.

METHODS
The indications for cerebral revascularization procedures included microsurgical occlusion of a parent vessel during the treatment of aneurysms and occlusion of a major vessel during the treatment of basal tumors. The techniques discussed include arterial patch grafting, end-to-end anastomosis, side-to-side anastomosis, arterial interposition grafting, and extracranial-to-intracranial bypass grafting, using radial artery grafts or saphenous vein grafts.

RESULTS
During the 15-year period between 1985 and 2000, the senior author performed 24 radial artery grafts, 105 saphenous vein grafts, and 8 other revascularization procedures, among 50 patients with aneurysms and 83 patients with cranial base tumors. The overall patency rate was 95.6%. Twenty-three patients experienced a cerebral infarction; among those patients, 17 (12.5%) exhibited symptoms but the majority demonstrated considerable recovery during the follow-up period. One hundred one patients recovered to an excellent (Glasgow Outcome Scale score of 5) or good (Glasgow Outcome Scale score of 4) condition. Fifteen patients died as a result of recurrence or progression of tumors during the follow-up period. There were five perioperative deaths. For the last 35 patients, the surgical mortality rate was 0%, with all patients returning to an excellent or good condition.

CONCLUSION
Although highly specialized, these sophisticated cerebral revascularization techniques should be learned and practiced by all neurosurgeons who wish to microsurgically treat intracranial aneurysms or cranial base tumors.
Hemihypoglossal Nerve Transfer in Brachial Plexus Repair: Technique and Results
Authors: Ferraresi Stefano , Garozzo Debora , Ravenni Roberta , Dainese Rinaldo , De Grandis Domenico , Buffatti Paolo 
Published: July 2004

ABSTRACT

OBJECTIVE
In multiple avulsions of the brachial plexus, the search for extraplexal donor nerves in the hope of achieving motor neurotization is a major goal. We explored the possibility of using the hypoglossal nerve as a transfer point to reanimate muscles in the upper limb.

METHODS
The hypoglossal nerve was used as a donor nerve for neurotization in seven patients with avulsive injuries of the brachial plexus. The surgical technique—an end-to-side microsuture using approximately half of the nerve fascicles—is basically the same as that used in the hypoglossal nerve-facial nerve jump graft, which is a well-known technique in facial nerve reanimation. The recipient nerves were the suprascapular (two patients), the musculocutaneous (one patient), the posterior division of the upper trunk (two patients), and the medial contribution to the median nerve (two patients).

RESULTS
In spite of a connection documented by electromyography and selective activation in three of seven patients, the functional results in our patients were extremely disappointing: no patient had an outcome better than M1 in the reinnervated muscles.

CONCLUSION
This technique was of no help to the patients and thus has been abandoned at our institution.
Fluorodeoxyglucose and Methionine Uptake in Lhermitte-Duclos Disease: Case Report
Authors: Pirotte Benoit , Goldman Serge , Baleriaux Danielle , Brotchi Jacques 
Published: July 2004

ABSTRACT

OBJECTIVE AND IMPORTANCE
Lhermitte-Duclos disease (LDD) represents a focally indolent dysplastic growth of the cerebellar cortex. The 106 cases reported previously in the literature show an extremely slow evolution, and the operative indications and techniques for this disease entity are still controversial. The authors present the first case of LDD studied with positron emission tomography using the labeled tracers [18F]2-fluoro-2-deoxy-d-glucose ([18F]FDG) and 11C-labeled methionine ([11C]Met) to study the glucose and protein metabolism of the lesion.

CLINICAL PRESENTATION
A 40-year-old woman suddenly became unconscious then completely recovered 5 minutes later. Magnetic resonance imaging of her brain showed a well-delineated 10 × 5-cm abnormal area with enlarged cerebellar folia, which led to the diagnosis of LDD.

TECHNIQUE
On positron emission tomographic scans, [18F]FDG and [11C]Met uptake in the normal cerebral and cerebellar cortex appeared higher than normal, reaching levels found in patients with primary malignant brain tumors. Moreover, the uptake of both tracers was heterogeneous, in contrast to the homogeneous uptake visualized on magnetic resonance imaging scans. The areas of greatest [11C]Met and [18F]FDG uptake were discordant. Some areas of greater than normal [18F]FDG uptake corresponded to areas of moderate or low [11C]Met uptake. Because of the important mass effect in the posterior fossa, total surgical resection was performed. A histological examination confirmed the diagnosis of LDD.

CONCLUSION
This first reported metabolic study of LDD supports the view that LDD is an active and evolving disease. These data should prompt reevaluation of the indications for surgery in patients with this disease as well as the timing of surgery.