bluuebunny/crossref_metadata_2025_split huggingface dataset:
Percutaneous Transpedicular Polymethylmethacrylate Vertebroplasty for the Treatment of Spinal Compression Fractures
Authors: Amar Arun Paul , Larsen Donald W. , Esnaashari Nasrin , Albuquerque Felipe C. , Lavine Sean D. , Teitelbaum George P. 
Published: July 2004

ABSTRACT

OBJECTIVE
To assess the safety, feasibility, and clinical outcome of percutaneous transpedicular polymethylmethacrylate vertebroplasty (PTPV) for the treatment of spinal compression fractures causing refractory pain.

METHODS
We retrospectively reviewed a consecutive group of patients undergoing PTPV at our institution between April 1998 and January 2001. Outcome measures included analgesic requirements, ambulatory status, sleep comfort, and overall quality of life 2 weeks after the procedure.

RESULTS
A total of 97 patients (73 women and 24 men) underwent 258 PTPV procedures during 133 treatment sessions. The mean age was 76 years (range, 42–99 yr). The mean duration of follow-up was 14.7 months (range, 2–35 mo). Most of the patients had osteoporotic compression fractures, although some had osteolytic malignancies. Complete follow-up was obtained in 81 patients (84%). Narcotic and analgesic usage decreased in 63% of patients, increased in 7%, and remained the same in 30%. Ambulation and mobility were improved in 51%, worse in 1% and the same in 48%. One-half of the patients were able to sleep more comfortably after the procedure, whereas the other half remained the same. Most patients who reported no change in sleep or ambulation had experienced no impairment of these activities before PTPV. Overall, 74% of patients believed that PTPV significantly enhanced their quality of life and 26% reported no change. No patient was worse after PTPV. One patient with preexisting pneumonia died of respiratory failure after the procedure; another died of an acute stroke weeks later. One patient developed symptomatic pulmonary embolism of cement, and another developed transient quadriceps weakness from radiculopathy. Other complications were minor and infrequent. There were no infections.

CONCLUSION
PTPV provided significant relief in a high percentage of patients with refractory pain. PTPV is a safe and feasible treatment for patients with spinal compression fractures.
Intraoperative Magnetic Resonance Imaging to Determine the Extent of Resection of Pituitary Macroadenomas during Transsphenoidal Microsurgery
Authors: Bohinski Robert J. , Warnick Ronald E. , Gaskill-Shipley Mary F. , Zuccarello Mario , van Loveren Harry R. , Kormos Donald W. , Tew John M. 
Published: July 2004

ABSTRACT

OBJECTIVE
Well-established surgical goals for pituitary macroadenomas include gross total resection for noninvasive tumors and debulking with optic chiasm decompression for invasive tumors. In this report, we examine the safety, reliability, and outcome of intraoperative magnetic resonance imaging (iMRI) used to assess the extent of resection, and thus the achievement of preoperative surgical goals, during transsphenoidal microneurosurgery.

METHODS
Our magnetic resonance operating room contains a Hitachi AIRIS II 0.3-T, vertical-field open magnet (Hitachi Medical Systems America, Inc., Twinsburg, OH). A motorized scanner tabletop moves the patient between the imaging and operative positions. For transsphenoidal surgery, the patient is positioned directly on the scanner tabletop so that the surgical field is located between 1.2 and 1.6 m from the magnet isocenter. At this location, the magnetic field strength is low (&lt;20 G), thus permitting the use of many conventional surgical instruments. Thirty consecutive patients with pituitary macroadenomas underwent tumor resection in our magnetic resonance operating room by use of a standard transsphenoidal approach. After initial resection, the patient was advanced into the scanner for imaging. If residual tumor was demonstrated and deemed surgically accessible, the patient underwent immediate re-exploration.

RESULTS
iMRI was performed successfully in all 30 patients. In one patient, iMRI was used to clarify the significance of hemorrhage from the sellar region and resulted in immediate conversion of the procedure to a craniotomy. In the remaining 29 patients, initial iMRI demonstrated that the endpoint for extent of resection had been achieved in only 10 patients (34%) after an initial resection attempt, whereas 19 patients (66%) still had unacceptable residual tumor. All 19 of these latter patients underwent re-exploration. Ultimately, re-exploration resulted in the achievement of the planned endpoint for extent of resection in all of the 29 completed transsphenoidal explorations. Operative time was extended in all cases by at least 20 minutes.

CONCLUSION
iMRI can be used to safely, reliably, and objectively assess the extent of resection of pituitary macroadenomas during the transsphenoidal approach. The surgeon is frequently surprised by the extent of residual tumor after an initial resection attempt and finds the intraoperative images useful for guiding further resection.
Solitary Fibrous Tumor of the Orbit with Extraorbital Extension: Case Report
Authors: Hayashi Satoru , Kurihara Hideyuki , Hirato Junko , Sasaki Tomio 
Published: July 2004

ABSTRACTOBJECTIVE AND IMPORTANCESolitary fibrous tumors (SFTs) are rare tumors of mesenchymal origin that typically arise in the pleura. Only 24 cases of SFTs in the orbit have been reported, all located within the orbit and generally with a benign course. We report the first case of an orbital SFT with extraorbital extension and short-term regrowth.CLINICAL PRESENTATIONA 54-year-old man presented with proptosis and double vision that had persisted for 7 months. The tumor extended from the right extraconal inferolateral orbit to the extradural middle cranial fossa and cavernous sinus, via the superior orbital fissure, on magnetic resonance imaging scans. Positron emission tomography with [18F]fluorodeoxyglucose demonstrated faint uptake in the orbital portion.INTERVENTIONResection of the tumor was performed twice, because of short-term regrowth of the residual tumor in the orbit. The histological diagnosis was a SFT. The MIB-1 labeling index was 7% and the mitotic count was 5 mitotic figures/10 high-power fields at the time of the second operation. These findings indicate the malignant nature of the tumor.CONCLUSIONThe natural history of SFTs of the orbit remains unclear, and the importance of careful and continued follow-up monitoring of the tumor should be emphasized.
Age and Radiation Response in Glioblastoma Multiforme
Authors: Barker Fred G. , Chang Susan M. , Larson David A. , Sneed Penny K. , Wara William M. , Wilson Charles B. , Prados Michael D. 
Published: July 2004

ABSTRACTOBJECTIVEAdvanced age is a strong predictor of shorter survival in patients with glioblastoma multiforme (GM), especially for those who receive multimodality treatment. Radiographically assessed tumor response to external beam radiation therapy is an important prognostic factor in GM. We hypothesized that older GM patients might have more radioresistant tumors.METHODSWe studied radiographically assessed response to external beam radiation treatment (five-level scale) in relation to age and other prognostic factors in a cohort of 301 GM patients treated on two prospective clinical protocols. A total of 223 patients (74%) were assessable for radiographically assessed radiation response. A proportional odds ordinal regression model was used for univariate and multivariate analysis.RESULTSYounger age (P = 0.006), higher Karnofsky Performance Scale score before radiotherapy (P = 0.027), and more extensive surgical resection (P = 0.028) predicted better radiation response in univariate analyses. Results were similar when clinical criteria were used to classify an additional 61 patients without radiographically assessed radiation response (stable versus progressive disease). In multivariate analyses, age and extent of resection were significant independent predictors of radiation response (P &lt; 0.05); Karnofsky Performance Scale score was of borderline significance (P = 0.07).CONCLUSIONOlder GM patients are less likely to have good responses to postoperative external beam radiation therapy. Karnofsky Performance Scale score before radiation treatment and extent of surgical resection are additional predictors of radiographically assessed radiation response in GM.
Functional Activity within Brain Tumors: A Magnetic Source Imaging Study
Authors: Schiffbauer Hagen , Ferrari Paul , Rowley Howard A. , Berger Mitchel S. , Roberts Timothy P.L. 
Published: July 2004

ABSTRACT

OBJECTIVE
To determine whether low-grade gliomas contain functional cortical activity more often than high-grade gliomas within radiologically defined abnormal tissue.

METHODS
Patients with intra-axial cerebral lesions located in the vicinity of eloquent brain cortex preoperatively underwent magnetic source imaging. A dual 37-channel biomagnetometer was used to perform the imaging. Evoked magnetic fields were analyzed using the single-equivalent dipole representation to ascertain the neuronal source. Stimuli included painless tactile somatosensory stimulation of fingers, toes, and lips and auditory presentation of pure sinusoidal tones.

RESULTS
A retrospective analysis of 106 nonconsecutively treated patients, who had undergone preoperative magnetic source imaging between February 1996 and December 1999, revealed that 24.5% of the patients had been at risk for neurological deficits, because functionally active tissue was located within or at the border of the tumor. Functional activity was found within the radiologically defined lesion in 18% of Grade 2 tumors, in 17% of Grade 3 tumors, and in 8% of Grade 4 tumors.

CONCLUSION
The results confirm that, regardless of tumor grade, intra-axial brain tumors may involve or directly border on functional cortex. The degree of involvement of functionally viable cortex appeared greater for low-grade tumors than for high-grade lesions. On the other hand, high-grade lesions were more likely to be associated with functional cortex at their margins or within peritumoral edema. To safely maximize tumor resection, preoperative functional imaging and intraoperative electrophysiological mapping of the cerebral cortex and the white matter tracts are deemed necessary.
A Review of Size and Location of Ruptured Intracranial Aneurysms
Authors: Forget Thomas R. , Benitez Ronald , Veznedaroglu Erol , Sharan Ashwini , Mitchell William , Silva Marco , Rosenwasser Robert H. 
Published: July 2004

ABSTRACT

OBJECTIVE
To review our experience and examine the size at which aneurysms ruptured in our patient population.

METHODS
Patient charts and angiograms for all patients admitted with a diagnosis of subarachnoid hemorrhage to the Thomas Jefferson/Wills Eye Hospital between April 1996 and March 2000 were reviewed.

RESULTS
Of the 362 cases reviewed, definite measurements of the ruptured aneurysm were obtained in 245. The data clearly showed that most ruptured aneurysms presenting to our institution were less than 10 mm in diameter. We found that, regardless of location on the circle of Willis, 85.6% of all aneurysms presenting with rupture were less than 10 mm. Review by location shows that aneurysms of the anterior communicating artery most often presented with rupture at sizes less than 10 mm (94.4%). A large number of ruptured posterior communicating artery aneurysms also presented at sizes less than 10 mm (87.5%). This trend continued for all aneurysm sites in our review. The incidence of subarachnoid hemorrhage in Western countries is estimated at 10 per 100,000 people per year. Recent reports have indicated that aneurysms less than 10 mm in size are unlikely to rupture.

CONCLUSION
We argue that the risk of small aneurysms rupturing is not insignificant, especially those of the anterior communicating artery. Our findings indicate that surgery on unruptured aneurysms should not be predicated on aneurysm size alone.
Remote Cerebellar Hemorrhage after Supratentorial Surgery
Authors: Friedman Jonathan A. , Piepgras David G. , Duke Derek A. , McClelland Robyn L. , Bechtle Perry S. , Maher Cormac O. , Morita Akio , Perkins William J. , Parisi Joseph E. , Brown Robert D. 
Published: July 2004

ABSTRACT

OBJECTIVE
Remote cerebellar hemorrhage (RCH) is an infrequent and poorly understood complication of supratentorial neurosurgical procedures. We retrospectively compared 42 patients who experienced RCH with a case-matched control cohort, to delineate risk factors associated with the occurrence of this complication.

METHODS
Between 1988 and 2000, 42 patients experienced RCH after supratentorial neurosurgical procedures at our institution. Diagnoses were made on the basis of postoperative computed tomographic or magnetic resonance imaging findings in all cases. The medical records for these patients were reviewed and compared with those for a control cohort of 43 patients, matched for age, sex, surgical lesion, and type of craniotomy, who were treated during the same period.

RESULTS
RCH most commonly occurred after frontotemporal craniotomies for unruptured aneurysm repair or temporal lobectomy and was frequently an incidental finding on postoperative computed tomographic scans. However, some cases of RCH were associated with significant morbidity, and two patients died. Preoperative aspirin use and elevated intraoperative systolic blood pressure were significantly associated with RCH (P = 0.026 and P = 0.036, respectively). Pathological findings for two cases demonstrated hemorrhagic infarctions in both.

CONCLUSION
RCH most commonly follows supratentorial neurosurgical procedures, performed with the patient in the supine position, that involve opening of cerebrospinal fluid cisterns or the ventricular system (such as unruptured aneurysm repair or temporal lobectomy). Preoperative aspirin use and moderately elevated intraoperative systolic blood pressure are potentially modifiable risk factors associated with the development of RCH. Although RCH can cause death or major morbidity, most cases are asymptomatic or exhibit a benign course. Cerebellar “sag” as a result of cerebrospinal fluid hypovolemia, causing transient occlusion of superior bridging veins within the posterior fossa and consequent hemorrhagic venous infarction, is the most likely pathophysiological cause of RCH.
Hemifacial Spasm: Intraoperative Electromyographic Monitoring as a Guide for Microvascular Decompression
Authors: Mooij Jan Jakob A. , Mustafa Mustafa K. , van Weerden Tom W. 
Published: July 2004

ABSTRACT

OBJECTIVE
Microvascular decompression is the logical and well-accepted treatment of choice for hemifacial spasm (HFS). In experienced hands, good to excellent results can be obtained. However, sometimes the exact site of the vascular compression is unclear. The aim of this study was to analyze whether intraoperative monitoring by stimulated electromyography of the facial nerve may help to improve the results of vascular decompression for HFS.

METHODS
In a series of 74 patients operated for HFS, the impact of intraoperative facial nerve monitoring on the surgical procedure was analyzed by use of the clinical and operative patient records. The role of this type of monitoring, with assessment of the so-called abnormal muscle response, was broken down into four categories: a guiding, a confirming, an indirect confirming, or an inconclusive role. The relationship between abnormal muscle response monitoring results and final surgical outcome was analyzed.

RESULTS
The overall cure rate was 87.8%, including patients who had previously undergone unsuccessful operations. Complications were minor, and hearing impairment was found in 2.7% of patients. A guiding role of intraoperative monitoring was apparent in 33.8% of patients, and a confirming role was demonstrated in 52.7% of patients, which resulted in a positive contribution of approximately 87% for intraoperative facial monitoring in microvascular decompression for HFS. In patients defined as guiding cases, the cure rate was 92%.

CONCLUSION
This study demonstrates the applicability and usefulness of intraoperative facial nerve monitoring in microvascular decompression operations for HFS.
Inferior Temporal Sulcus as a Site of Corticotomy: Magnetic Resonance Imaging Analysis of Individual Sulcus Patterns
Authors: Miyagi Yasushi , Shima Fumio , Ishido Katsuya , Araki Takehisa , Kamikaseda Kazufumi 
Published: July 2004

ABSTRACT

OBJECTIVE
Transcortical approaches to the inferior horn often result in quadrant hemianopsia attributable to the injury to the optic radiation. The inferior temporal sulcus (ITS) has received little attention as an entrance point for the transsulcal approach. We used the method of detecting the ITS with magnetic resonance imaging (MRI) scans and investigated the sulcus pattern of ITS, its incidence rate, and the availability of the ITS to the corticotomy for selective amygdalohippocampectomy.

METHODS
The sulcus patterns of the ITS of 100 temporal lobes in 50 healthy individuals were classified according to the number of interruptions by gyral bridges, and the localization of the ITS was characterized in relation to the outer surface by means of the surface anatomy scan of MRI.

RESULTS
Most of the ITS was interrupted by one to three gyral bridges (0 bridges, 8%; one bridge, 27%: two bridges, 37%; three bridges, 20%; more than four bridges or no apparent ITS, 8%). When the ITS was present, it was located 15 mm above the orbitotragus line at a point 20 mm anterior to the tragus. The number of gyral bridges was significantly larger in the left temporal lobes than in the right temporal lobes, regardless of the sex of the subject.

CONCLUSION
The ITS was clearly identified in 72% of the temporal lobes by the oblique sagittal view of MRI scans; thus, in such cases, the ITS was considered to be a candidate for an entrance point of a small temporal corticotomy. The preoperative observation of the ITS in relation to the orbitotragus line by means of MRI may improve the planning of the transsulcal approaches to deeply seated mesial temporal lesions, such as hippocampal sclerosis.
Coadministration of Methylprednisolone with Hypertonic Saline Solution Improves Overall Neurological Function and Survival Rates in a Chronic Model of Spinal Cord Injury
Authors: Legos Jeffrey J. , Gritman Kurt R. , Tuma Ronald F. , Young William F. 
Published: July 2004

ABSTRACTOBJECTIVEWe previously demonstrated that administration of 7.5% hypertonic saline (HS) significantly improved spinal cord blood flow and neurological outcomes after spinal cord injury. The aim of this study was to determine whether hypertonicity would enhance the effects of methylprednisolone (MP), further improving neurological function.METHODSRat spinal cords were compressed for 10 minutes with 50 g of weight, and neurological function was assessed for 28 days, using the Basso-Beattie-Bresnahan locomotor rating scale. The control group received an intravenous injection of isotonic saline (IS) (5 ml/kg). Group 1 received an intravenous injection of 7.5% HS (5 ml/kg). Group 2 received an intravenous injection of MP (30 mg/kg) and IS (5 ml/kg). Group 3 received an intravenous injection of MP (30 mg/kg) administered with 7.5% HS (5 ml/kg).RESULTSAt 24 hours after spinal cord injury, the combination of MP plus HS provided significant (P &lt; 0.01) neurological improvements, compared with all other treatment groups. At 10 days after injury, the animals that had received MP plus HS exhibited significantly (P &lt; 0.01) higher Basso-Beattie-Bresnahan scores, compared with the MP plus IS and control groups. The median survival time was significantly (P &lt; 0.01) increased for the MP plus HS group (28 d), compared with the MP plus IS group (16 d). Because of the dramatic decrease in survival rates at 28 days after injury, there was a significant (P &lt; 0.01) difference in neurological function only between the MP plus HS group and the control group.CONCLUSIONThe results indicate that the administration of HS may enhance the delivery of MP and prevent immunosuppression, leading to improvements in overall neurological function and survival rates after spinal cord injury.
Cervical Sympathetic Schwannoma: Case Report
Authors: Rosner Michael , Fisher Winfield , Mulligan Lisa 
Published: July 2004

ABSTRACT

OBJECTIVE AND IMPORTANCE
Approximately 20 to 27% of neck masses in the parapharyngeal space may be benign nerve sheath tumors. Cervical sympathetic chain schwannomas or vagal nerve schwannomas are most common. We report a patient with a cervical sympathetic chain schwannoma.

CLINICAL PRESENTATION
The patient was a 47-year-old Caucasian man with a 7-month history of a painless, enlarging right neck mass. No hoarseness or Horner's syndrome was found preoperatively. Formal head and neck examination in the otolaryngology department revealed no vocal cord dysfunction.

INTERVENTION
By use of a standard right carotid incision, a tumor was identified growing from the cervical sympathetic chain posterior to the carotid bifurcation. A gross total resection was performed and a section of the cervical sympathetic chain was sacrificed.

CONCLUSION
Cervical sympathetic chain schwannomas are unusual tumors that require microneurosurgical resection for cure. We discuss the differential diagnosis, evaluation, surgical management, and pathological characteristics of such tumors and review the literature.
Meralgia Paresthetica Occurring 40 Years after Iliac Bone Graft Harvesting: Case Report
Authors: Yamamoto Tetsuji , Nagira Keiko , Kurosaka Masahiro 
Published: July 2004

ABSTRACTOBJECTIVE AND IMPORTANCEMeralgia paresthetica is an entrapment neuropathy involving the lateral femoral cutaneous nerve. We describe an unusual case in which meralgia paresthetica occurred many years after iliac bone graft harvesting.CLINICAL PRESENTATIONAn 81-year-old man presented with a 1-year history of pain, dysesthesia, and hypesthesia in the anterolateral aspect of the right thigh. This patient had undergone iliac bone grafting when he sustained a calcaneal fracture 40 years previously. Radiographs and computed tomographic scans of the pelvis revealed a bony excrescence in the anterosuperior iliac spine.INTERVENTIONThe patient underwent neurolysis of the lateral femoral cutaneous nerve and excision of the bony excrescence. At surgery, the nerve was densely adherent to the bony excrescence.CONCLUSIONThe etiology of meralgia paresthetica in this patient is considered to be heterotopic ossification on the anterosuperior iliac spine and pubic symphysis degeneration. A significant relationship between pubic symphysis degeneration with increasing age and meralgia paresthetica has been reported. One should be aware of meralgia paresthetica as a late complication of iliac bone graft harvesting.