bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trochlear Nerve Neuroma Manifested with Intractable Atypical Facial Pain: Case Report
Authors: Veshchev Igor , Spektor Sergey 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE:
Trochlear nerve neuromas are extremely rare. Seventeen surgical cases of this pathological condition have been reported in the English literature. The presented case is distinct from previous reports.

CLINICAL PRESENTATION:
A 26-year-old woman presented with atypical facial pain. The neurological examination results were normal. Magnetic resonance imaging revealed a left parasellar mass.

INTERVENTION:
A left pterional craniotomy was performed, providing access to the left parasellar area. After incision of the tentorial edge, the tumor was observed to originate from the short segment of the trochlear nerve that runs between the tentorial leaves. The neuroma was totally removed.

CONCLUSION:
The facial pain resolved immediately after surgery. Although facial dysesthesias have been noted among patients with trochlear nerve neuromas, here the atypical facial pain was the only clinical manifestation. In all previously reported cases, neuromas originated from the cisternal segment of the trochlear nerve (always before the site of nerve entrance into the tentorial leaves) and expanded mainly into the prepontine and interpeduncular cisterns. Subtemporal and suboccipital approaches were used. In this case, the tumor arose from the short segment of the nerve running between the tentorial leaves. The tumor did not extend either into the ambient cistern or into the cavernous sinus but did involve the parasellar area. A pterional approach was appropriate for tumor removal. A trochlear nerve neuroma should be considered as a potential cause of atypical facial pain.
Intraoperative Assessment of Aneurysm Clipping Using Magnetic Resonance Angiography and Diffusion-weighted Imaging: Technical Case Report
Authors: Sutherland Garnette R. , Kaibara Taro , Wallace Carla , Tomanek Boguslaw , Richter Marlene 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE:
To use intraoperative magnetic resonance imaging, including magnetic resonance angiography and diffusion-weighted imaging, to monitor the surgical treatment of a patient with an intracranial aneurysm.

TECHNIQUE:
Intraoperative imaging was performed with a ceiling-mounted, mobile, 1.5-T magnet (developed in collaboration with Innovative Magnetic Resonance Imaging Systems, Inc., Winnipeg, MB, Canada) that included high-performance 20-mT/m gradients. Pre- and postclipping, intraoperative, T1-weighted, angiographic and diffusion-weighted magnetic resonance images were obtained from a patient with an incidental, 8-mm, anterior communicating artery aneurysm.

RESULTS:
T1-weighted images demonstrated brain anatomic features, with visible shifts induced by surgery. Magnetic resonance angiography demonstrated the aneurysm and indicated that, after clipping, the A1 and A2 anterior cerebral artery branches were patent. Diffusion-weighted studies demonstrated no evidence of brain ischemia.

CONCLUSION:
For the first time, intraoperative magnetic resonance imaging has been used to monitor the surgical treatment of a patient with an intracranial aneurysm.
Management of Intraprocedural Arterial Thrombus in Cerebral Aneurysm Embolization with Abciximab: Technical Case Report
Authors: Alexander Michael J. , Duckwiler Gary R. , Gobin Y. Pierre , Viñuela Fernando 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE:
Thromboembolic complications after cerebral aneurysm treatment with Guglielmi detachable coils (Boston Scientific/Target, Fremont, CA) are not infrequent; in a University of California, Los Angeles institutional review of 720 treated aneurysms, thromboembolic complications occurred in 2.5% of cases. The development of intraluminal thrombus during the embolization procedure, however, may be diagnosed promptly and treated effectively with appropriate therapy. This report describes the use of intravenously administered abciximab for the treatment of intraprocedural arterial thrombus encountered during the coil embolization of a recently ruptured anterior communicating artery aneurysm.

CLINICAL PRESENTATION:
A 45-year-old man presented with severe headache 12 days before transfer to our institution. He had no neurological deficits at admission. Previous computed tomography of the brain demonstrated subarachnoid hemorrhage, and magnetic resonance angiography from the other institution demonstrated a 4-mm anterior communicating artery aneurysm.

INTERVENTION:
The patient underwent Guglielmi detachable coil embolization of the aneurysm under systemic heparinization. During the embolization, however, a thrombus developed in the proximal left A2 segment. The patient was given an intravenous infusion (20 mg) of abciximab for 10 minutes, and within 15 minutes dissolution of the thrombus was observed with no angiographic evidence of distal emboli. After reversal of general anesthesia, the patient exhibited minimal right leg weakness, which resolved within 1 hour.

CONCLUSION:
Abciximab may be a useful adjunct for endovascular treatment of patients with cerebral aneurysms in whom intraprocedural arterial thrombus is encountered.
Transvascular Coil Hooking Procedure to Retrieve an Unraveled Guglielmi Detachable Coil: Technical Note
Authors: Raftopoulos Christian , Goffette Pierre , Billa Rudolf F. , Mathurin Pierre 
Published: July 2004

Abstract

OBJECTIVE:
A patient with an anterior communicating artery aneurysm was treated by use of endovascular coiling, and a Guglielmi detachable coil (Boston Scientific/Target, Fremont, CA) fractured distal to its connection to the delivering catheter. The unraveled coil floated out from the aneurysm to extend into the bifurcation of the left middle cerebral artery. We describe the microsurgical procedure used to retrieve the coil after an endovascular approach failed.

METHODS:
The left anterior cerebral artery was punctured just below the aneurysm neck, and a titanium microhook was introduced to anchor the coil and pull it out. Slight traction was exerted before sectioning the coil to avoid protrusion of the stump into the parent vessel.

RESULTS:
The unraveled coil was removed in totality without permanent morbidity.

CONCLUSION:
This report describes the case of a rare complication of coil embolization treated with a minimal transarterial coil hooking procedure.
Optic Nerve Sheath Meningiomas: Visual Improvement after Stereotactic Radiotherapy
Authors: Liu James K. , Forman Scott , Hershewe Gerard L. , Moorthy Chitti R. , Benzil Deborah L. 
Published: July 2004

Abstract

OBJECTIVE:
The management of primary optic nerve sheath meningioma (ONSM) is controversial. Surgery often results in postoperative blindness in the affected eye and thus has been abandoned as a treatment option for most patients. When these tumors are left untreated, however, progressive visual impairment ensues, which also leads to blindness. Recently, radiation therapy has gained wider acceptance in the treatment of these lesions. Experience with stereotactic radiotherapy (SRT) in the treatment of ONSMs is limited because of the rare incidence of this tumor. We present a series of patients with ONSM who were treated with SRT.

METHODS:
Five patients (three women, two men), ranging in age from 40 to 73 years, presented with progressive visual loss with decreased visual field, visual acuity, and color vision affecting six eyes (one patient had tumor involving both optic nerves). One patient also presented with proptosis and diplopia. Five eyes had functional residual vision (range, 20/20 to 20/40), and one eye was completely blind. All five patients were diagnosed clinically and radiographically to have an ONSM. Three were intraorbital, one was intracanalicular as well as intraorbital, and one was a left ONSM extending through the optic foramen into the intracranial space and involving the right optic nerve. The five functional eyes were treated with SRT by use of 1.8-Gy fractions to a cumulative dose of 45 to 54 Gy.

RESULTS:
Follow-up ranged from 1 to 7 years, and serial magnetic resonance imaging revealed no changes in the size of the tumor in all five patients. Four patients experienced dramatic improvement in visual acuity, visual field, and color vision within 3 months after SRT. One patient remained stable without evidence of visual deterioration or disease progression. None had radiation-induced optic neuropathy.

CONCLUSION:
SRT may be a viable option for treatment of primary ONSM in patients with documented progressive visual deterioration, and it may be effective in improving or stabilizing remaining functional vision.
Volumetric Stereotaxy and the Supratentorial Occipitosubtemporal Approach in the Resection of Posterior Hippocampus and Parahippocampal Gyrus Lesions
Authors: Russell Stephen M. , Kelly Patrick J. 
Published: July 2004

Abstract

OBJECTIVE:
Resection of intracranial tumors in the posterior hippocampus and the parahippocampal gyrus can be associated with significant morbidity because of the parenchymal resection and the cortical retraction often required in gaining access to this infrequently explored region. With the use of image guidance, the occipitosubtemporal (OST) approach requires neither lateral cortical resection nor the placement of brain retractors to gain surgical access to the posterior hippocampus and the parahippocampal gyrus, and this approach is associated with a high rate of gross total tumor resection.

METHODS:
The computer-assisted volumetric stereotactic OST approach was used to resect 40 posterior hippocampus and parahippocampal gyrus tumors in 34 consecutive patients during an 8-year period. Patient, radiographic, and surgical outcome data were collected retrospectively.

RESULTS:
The series included operations in 25 men and 15 women, and the patients' average age was 40.3 years (range, 15–69 yr). Twenty-five of the 40 procedures were performed to remove lesions in the dominant hemisphere, and previous craniotomies for resection had been performed in 12 of 40 cases. In 38 of 40 cases, histopathological analysis revealed a glial neoplasm, and 50% of these tumors were high-grade lesions. Preoperatively, 23 patients were neurologically intact before 40 procedures, whereas visual field deficits were noted in 7 patients, mild hemiparesis was documented in 4 patients, and other neurological deficits were present in 9 patients. An excellent outcome (Glasgow Outcome Scale Grade 5) was noted after 38 (95%) of the 40 computer-assisted volumetric stereotactic OST procedures. Permanent postoperative hemiparesis (Glasgow Outcome Scale Grade 4) occurred after one procedure, and a second patient, despite being neurologically unchanged postoperatively and despite having had an optimal tumor resection, died on postoperative Day 33 (Glasgow Outcome Scale Grade 1). Complete resection of the preoperatively defined tumor volume was noted on postoperative gadolinium-enhanced magnetic resonance imaging examinations after 39 (97.5%) of the 40 procedures. The average duration of clinical follow-up was 15.9 months (range, 0.5–67 mo).

CONCLUSION:
We think that the OST approach is well suited to the resection of tumors in the posterior hippocampus and the parahippocampal gyrus. By allowing the neurosurgeon to avoid unnecessary brain resection and retraction, this approach reduces the risk of injury to important lateral temporal and occipital lobe cortex and tracts. In addition, the resection of a posterior hippocampus or parahippocampal gyrus mass with the OST approach relieves temporal horn entrapment. Computer-assisted volumetric stereotaxy helps the neurosurgeon to maintain precise spatial and anatomic orientation and accurately delineates the margin between the tumor and the surrounding neural tissue.
Natural History of Tethered Cord in Patients with Meningomyelocele
Authors: Phuong Loi K. , Schoeberl Kimberly A. , Raffel Corey 
Published: July 2004

AbstractOBJECTIVE:The purpose of this study was to describe the natural history of tethered cord in patients who have undergone meningomyelocele repair.METHODS:We performed a retrospective review of 45 patients with a history of neonatal meningomyelocele repair who subsequently developed symptoms of tethered cord. Symptoms of tethered cord in this cohort consisted of the development of bladder spasticity or orthopedic foot deformity. None of these patients were treated with cord untethering; instead, they were treated symptomatically.RESULTS:On follow-up, 40 (88.9%) of these patients subsequently required additional orthopedic or urological procedures because of further symptoms of tethered cord. The incidence of progression of tethered cord syndrome is 27.5, 40, and 60% at 1, 2, and 5 years, respectively.CONCLUSION:Although this study does not address the question whether cord untethering will prevent further symptom development, these results do provide a strong rationale for consideration of an untethering procedure in patients with repaired meningomyelocele at the time of the onset of symptoms of tethered cord.
Clinical Utility of Quantitative Cerebral Blood Flow Measurements during Internal Carotid Artery Test Occlusions
Authors: Marshall Randolph S. , Lazar Ronald M. , Young William L. , Solomon Robert A. , Joshi Shailendra , Duong D. Hoang , Rundek Tanja , Pile-Spellman John 
Published: July 2004

Abstract

OBJECTIVE:
Internal carotid artery (ICA) balloon test occlusions (BTOs) are performed in the angiography suite to predict whether the patient has adequate collateral circulation to prevent stroke when permanent ICA occlusion (PCO) is required for treatment. Although many criteria have been proposed to facilitate predictions of stroke risk after PCO, no BTO techniques have been subjected to predictive validity testing in outcome studies. We describe a prospective case series study that tests the predictive validity of quantitative cerebral blood flow (CBF) measurements during ICA BTO.

METHODS:
Thirty-three patients with clinical indications for PCO underwent ICA BTO and then PCO. During BTO, standard neurological examinations, sustained-attention testing, and quantitative CBF measurements were performed. Two scalp scintillation detectors recorded washout data after ipsilateral intracarotid injection of xenon-133 through a port at the tip of the ICA-occluding balloon. Patients were monitored for the outcome measure of ipsilateral stroke for a mean of 34 months. The variables of quantitative CBF values, neurological examination results, sustained-attention test results, age, sex, and side of occlusion were examined with Kaplan-Meier log-rank tests, predictive validity analyses, and logistic regression analyses.

RESULTS:
CBF of less than 30 ml/100 g/min during BTO was the only variable that predicted stroke after PCO (log rank = 5.87, P = 0.015). The negative and positive predictive values for CBF findings were superior to those for standard neurological examination findings and sustained-attention test results. Age, sex, and side of occlusion did not predict stroke.

CONCLUSION:
Quantitative CBF testing, via the intracarotid injection technique, during BTO seems to be an important predictor of stroke after PCO.
Evaluation of Preoperative Administration of the Cyclooxygenase-2 Inhibitor Rofecoxib for the Treatment of Postoperative Pain after Lumbar Disc Surgery
Authors: Bekker Alex , Cooper Paul R. , Frempong-Boadu Anthony , Babu Ramesh , Errico Thomas , Lebovits Allen 
Published: July 2004

AbstractOBJECTIVE:A combination of analgesics with different mechanisms of action may improve postoperative pain control and reduce the incidence of side effects. This study was designed to assess the efficacy of preoperative administration of rofecoxib (Vioxx; Merck & Co., Inc., Somerset, NJ) in reducing pain and opioid requirements after single-level lumbar microdiscectomy.METHODS:A randomized, double-blind, placebo-controlled clinical trial was performed on 61 consenting patients who were considered American Society of Anesthesiologists Class I or II and who were scheduled for elective single-level lumbar microdiscectomy. Patients received either two doses of rofecoxib 50 mg or a placebo preoperatively. The outcome measures included morphine use in the postanesthesia care unit (PACU), discharge times, and side effect profile. Data were analyzed by use of independent sample t tests for continuous variables or χ2 tests for categorical variables. A P value of &lt;0.05 was considered significant.RESULTS:The two groups were comparable with respect to patient characteristics, intraoperative opioid and hypnotic consumption, and duration of surgery. Patients in the rofecoxib group required significantly less morphine postoperatively. Significantly more patients in the placebo group reported pain scores greater than 7 at admission to the PACU. Time to first request for analgesia was shorter in the placebo group, but the difference did not reach statistical significance. There were no significant differences between groups in the incidence of nausea, time to discharge from the PACU, or hospital stay.CONCLUSION:Preoperative rofecoxib is effective in reducing postoperative narcotic consumption in patients undergoing lumbar laminectomy. The use of rofecoxib does not shorten PACU length of stay or hospital discharge time. These outcome measures depend on multiple administrative factors.
Choristoma of the Optic Nerve: Case Report
Authors: Giannini Caterina , Reynolds Carol , Leavitt Jacqueline A. , Schultz Gregory A. , Garrity James A. , Ebersold Michael J. , Scheithauer Bernd W. , Salomao Diva R. 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE:
Optic nerve choristoma is a rare lesion composed of adipose tissue and smooth muscle involving the optic nerve. Few cases have been reported.

CLINICAL PRESENTATION:
A 20-year-old woman presented with a history of slowly progressive visual loss in the left eye. On T1-weighted magnetic resonance imaging studies, after frequency-selective fat saturation, an optic nerve mass was detected at the level of the optic canal with signal characteristics suggesting the diagnosis of optic nerve lipoma.

INTERVENTION:
At left frontotemporal craniotomy, the intracranial optic nerve appeared thin and atrophic proximally and was covered by abundant adipose tissue distally. Because no cleavage plane could be identified between the fatty lesion and the optic nerve, which appeared splayed within the adipose tissue, the nerve was resected after an intraoperative biopsy. The presence of two heterotopic mesodermal elements, a rim of adipose tissue admixed with bundles of mature smooth muscle, extending into the nerve septa, warranted a diagnosis of optic nerve choristoma.

CONCLUSION:
Optic nerve choristoma is an uncommon optic nerve lesion. Even if imaging studies are highly suggestive of the diagnosis, pathological confirmation is required because of the high adipose tissue content in the majority of cases. The lesion, most likely malformative and nonneoplastic in nature, can be the cause of progressive visual loss.
Visual Field Deficit Caused by Vascular Compression from a Suprasellar Meningioma: Case Report
Authors: Bejjani Ghassan K. , Cockerham Kimberly P. , Kennerdell John S. , Maroon Joseph C. 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE:
Suprasellar meningiomas typically cause bitemporal hemianopsia by direct compression of the chiasm, its blood supply, or both. We report another mechanism for visual loss in suprasellar meningiomas, whereby compression by the suprajacent vascular complex is the offending agent.

CLINICAL PRESENTATION:
A 78-year-old woman with a suprasellar meningioma was diagnosed incidentally. During the follow-up period, she developed an inferior homonymous wedge defect consistent with superior compression, without any detectable radiological progression. It was decided to resect her tumor.

INTERVENTION:
The patient underwent a fronto-orbital approach for tumoral excision. Intraoperatively, a groove by the anterior cerebral artery complex was found along the superior surface of the chiasm. Postoperatively, the patient's visual deficit resolved.

CONCLUSION:
This case illustrates an unusual visual field deficit associated with a suprasellar meningioma. It also emphasizes the importance of frequent and careful visual field monitoring, which can precede radiological and symptomatic progression.
Ganglioglioma Presenting as a Meningioma: Case Report and Review of the Literature
Authors: Siddique Khawar , Zagardo Michael , Gujrati Meena , Olivero William 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE:
Gangliogliomas are intra-axial, avascular masses located predominately in the temporal lobe. A ganglioglioma that mimics a meningioma in that it is extra-axial and has a significant extracranial vascular supply has not been reported previously.

CLINICAL PRESENTATION:
A 12-year-old girl presented with a right temporoparietal mass. A neurological examination revealed nothing abnormal, and the girl's symptoms were limited to headaches.

INTERVENTION:
Magnetic resonance imaging revealed an extra-axial mass, and cerebral catheter angiography revealed a blood supply mainly from the posterior division of the right middle meningeal artery. Intraoperative findings confirmed the extra-axial location of the tumor, and histological analysis revealed that the tumor was a ganglioglioma.

CONCLUSION:
This report confirms that gangliogliomas can present as extra-axial, vascular masses that are similar to meningiomas.
De Novo Cerebral Arteriovenous Malformation: Case Report
Authors: Bulsara Ketan R. , Alexander Michael J. , Villavicencio Alan T. , Graffagnino Carmelo 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE:
Arteriovenous malformations (AVMs) are generally thought to have a congenital cause. This is the first report of an angiographically proven de novo cerebral AVM in an adult patient without previous vascular abnormality.

CLINICAL PRESENTATION:
A 26-year-old African-American woman developed multiple cranial nerve deficits and ataxia over the course of a few days after a streptococcal throat infection. T2-weighted magnetic resonance imaging scans revealed a hyperintense signal in the midbrain with extension into the diencephalon. A cerebral angiogram performed at that time to exclude vasculitis revealed normal cerebral vasculature. The patient was treated with corticosteroids, and symptoms resolved. Subsequently, at the age of 32, this patient presented with a severe headache and emesis, but with no focal neurological deficit.

INTERVENTION:
The patient's cranial computed tomographic and magnetic resonance imaging scans revealed a right posterior temporal intraparenchymal hemorrhage, and cerebral angiography revealed a new 3- by 2-cm AVM. The patient underwent microsurgical resection of the AVM and associated hematoma. Postoperative angiography revealed no evidence of residual AVM.

CONCLUSION:
This study details the case of a woman who developed a de novo cerebral AVM during a 6-year period. This report challenges the conventional belief that all AVMs have a congenital cause.