bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endoscope-assisted Microsurgery for Intracranial Aneurysms
Authors: Kalavakonda Chandrasekar , Sekhar Laligam N. , Ramachandran Pranatartiharan , Hechl Peter 
Published: July 2004

Abstract

OBJECTIVE
We discuss the role of the endoscope in the microsurgical treatment of intracranial aneurysms, analyzing its benefits, risks, and disadvantages.

METHODS
This was a prospective study of 55 patients with 79 aneurysms, treated between July 1998 and June 2001, for whom the endoscope was used as an adjunct in the microsurgical treatment of their lesions. Seventy-one aneurysms were located in the anterior circulation, and eight were located in the posterior circulation. Thirty-seven patients presented with subarachnoid hemorrhage. Eighteen patients had unruptured aneurysms, of whom 5 presented with mass effect, 2 presented with transient ischemic attacks, and 11 were without symptoms. In all cases, the endoscope was used in addition to microsurgical dissection and clipping (sometimes before clipping, sometimes during clipping, and always after clipping), for observation of the neck anatomic features and perforators and verification of the optimal clip position. Intraoperative angiography was performed for all patients after aneurysm clipping.

RESULTS
In the majority of cases, the endoscope was very useful for the assessment of regional anatomic features. It allowed better observation of anatomic features, compared with the microscope, for 26 aneurysms; in 15 cases, pertinent anatomic information could be obtained only with the endoscope. The duration of temporary clipping of the parent artery was significantly reduced for two patients. The clip was repositioned because of a residual neck or inclusion of the parent vessel during aneurysm clipping in six cases, and the clip position was readjusted because of compression of the optic nerve in one case. One patient experienced a small aneurysm rupture that was directly related to use of the endoscope, but this was easily controlled, with no sequelae. For many patients, the combination of the neuro-endoscope and the micro-Doppler probe made intraoperative angiography redundant.

CONCLUSION
“Endoscope-assisted microsurgery” is a major advance in the microsurgical treatment of intracranial aneurysms; the endoscope allows better observation of regional anatomic features because of its magnification, illumination, and ability to “look around corners.”
Nonconvulsive Status Epilepticus after Subarachnoid Hemorrhage
Authors: Dennis Lyle J. , Claassen Jan , Hirsch Lawrence J. , Emerson Ronald G. , Connolly E. Sander , Mayer Stephan A. 
Published: July 2004

Abstract

OBJECTIVE
Although in-hospital seizures have been reported for 3 to 24% of patients with aneurysmal subarachnoid hemorrhage (SAH), nonconvulsive status epilepticus (NCSE) has not been previously described. We sought to determine the frequency and clinical features of NCSE among comatose patients with SAH.

METHODS
Between November 1997 and February 2000, we performed continuous electroencephalographic (cEEG) monitoring for at least 24 hours for all patients with aneurysmal SAH who were treated in our neurological intensive care unit and exhibited unexplained coma or neurological deterioration. NCSE was diagnosed when cEEG monitoring demonstrated continuous or repetitive electrographic seizures exceeding 1 hour in duration. Refractory NCSE was treated aggressively with intravenous anticonvulsant administration and continuous-infusion midazolam therapy.

RESULTS
Of 233 patients with SAH who survived the first 48 hours of hospitalization, 101 were stuporous or comatose at some point during their hospitalization. Twenty-six of those patients underwent cEEG monitoring, and eight were diagnosed as having NCSE, an average of 18 days (range, 5–38 d) after SAH. All eight patients were receiving prophylactic anticonvulsant therapy. Four patients were persistently comatose and four demonstrated deterioration to stupor or coma; only one exhibited overt tonicoclonic activity. A worst Hunt and Hess grade of IV or V, older age, ventricular drainage, and cerebral edema on computed tomographic scans were identified as risk factors for NCSE (all P &lt; 0.01). NCSE was successfully terminated for five patients (63%), but only one experienced clinical improvement, which was transient; all eight patients eventually died after a period of prolonged coma.

CONCLUSION
cEEG monitoring detected NCSE for 8% of patients with SAH and otherwise unexplained coma or neurological deterioration. The seizures were highly refractory to therapy, and the prognosis for these patients was extremely poor. Routine postoperative cEEG monitoring of patients with SAH who are at high risk for NCSE, allowing earlier diagnosis and treatment, offers the best chance of improving the outcomes for patients with this disorder.
Spinal Cord Mapping as an Adjunct for Resection of Intramedullary Tumors: Surgical Technique with Case Illustrations
Authors: Quinones-Hinojosa Alfredo , Gulati Mittul , Lyon Russell , Gupta Nalin , Yingling Charles 
Published: July 2004

AbstractOBJECTIVEResection of intramedullary spinal cord tumors may result in transient or permanent neurological deficits. Intraoperative somatosensory evoked potentials (SSEPs) and motor evoked potentials are commonly used to limit complications. We used both antidromically elicited SSEPs for planning the myelotomy site and direct mapping of spinal cord tracts during tumor resection to reduce the risk of neurological deficits and increase the extent of tumor resection.METHODSIn two patients, 3 and 12 years of age, with tumors of the thoracic and cervical spinal cord, respectively, antidromically elicited SSEPs were evoked by stimulation of the dorsal columns and were recorded with subdermal electrodes placed at the medial malleoli bilaterally. Intramedullary spinal cord mapping was performed by stimulating the resection cavity with a handheld Ojemann stimulator (Radionics, Burlington, MA). In addition to visual observation, subdermal needle electrodes inserted into the abductor pollicis brevis-flexor digiti minimi manus, tibialis anterior-gastrocnemius, and abductor halluces-abductor digiti minimi pedis muscles bilaterally recorded responses that identified motor pathways.RESULTSThe midline of the spinal cord was anatomically identified by visualizing branches of the dorsal medullary vein penetrating the median sulcus. Antidromic responses were obtained by stimulation at 1-mm intervals on either side of the midline, and the region where no response was elicited was selected for the myelotomy. The anatomic and electrical midlines did not precisely overlap. Stimulation of abnormal tissue within the tumor did not elicit electromyographic activity. Approaching the periphery of the tumor, stimulation at 1 mA elicited an electromyographic response before normal spinal cord was visualized. Restimulation at lower currents by use of 0.25-mA increments identified the descending motor tracts adjacent to the tumor. After tumor resection, the tracts were restimulated to confirm functional integrity. Both patients were discharged within 2 weeks of surgery with minimal neurological deficits.CONCLUSIONAntidromically elicited SSEPs were important in determining the midline of a distorted cord for placement of the myelotomy incision. Mapping spinal cord motor tracts with direct spinal cord stimulation and electromyographic recording facilitated the extent of surgical resection.
Cerebral Venous Steal: Blood Flow Diversion with Increased Tissue Pressure
Authors: Pranevicius Mindaugas , Pranevicius Osvaldas 
Published: July 2004

Abstract

PURPOSE
Flow in areas with increased tissue pressure is described by a Starling resistor and is determined by the inflow pressure (Pi), the external pressure (Pe), and the outflow or venous pressure (Pv). Flow is in Zone 1 at Pe &gt; Pi &gt; Pv, Zone 2 at Pi &gt; Pe &gt; Pv, and Zone 3 at Pi &gt; Pv &gt; Pe. A focal tissue pressure increase after stroke or trauma may lead to a transition from Zone 1 or 2 in the center to Zone 3 in the periphery. We hypothesize that the coexistence of different zones may lead to steal-like blood flow diversion in the perifocal area.

CONCEPT
We used a lumped-parameter model of two parallel Starling resistors with a common inflow. The first resistor, with higher Pe, represented the area with increased tissue pressure. The second resistor, with Pe′ = 0, represented the surrounding area. We evaluated the effects of venous pressure on the flow distribution between the two Starling resistors.

RATIONALE
The model demonstrated blood flow diversion toward the second Starling resistor with low external pressure. High inflow resistance facilitates this “steal.” Flow diversion is caused by effective outflow pressure differences for the Starling resistors (Pe for the first and Pv for the second). The venous pressure increase equilibrates the effective backpressure and decreases flow diversion. When the venous pressure equals the external tissue pressure, blood flow diversion (cerebral venous steal) is abolished. Although increased venous pressure causes global flow reduction, it may restore flow to more than 50% of baseline values in areas of increased tissue pressure.

DISCUSSION
Cerebral venous steal is a potential cause of secondary brain injury in areas of increased tissue pressure. It can be eliminated with increased venous pressure. Increased venous pressure may recruit the collapsed vascular network and correct perifocal perfusion maldistribution. This resembles how positive end expiratory pressure recruits collapsed airways and decreases the ventilation/perfusion mismatch.
Extradural Thoracic Arteriovenous Malformation in a Patient with Klippel-Trenaunay-Weber Syndrome: Case Report
Authors: Alexander Michael J. , Grossi Peter M. , Spetzler Robert F. , McDougall Cameron G. 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE
Spinal cord involvement in Klippel-Trenaunay-Weber (KTW) syndrome is rare. Cases of intradural spinal cord arteriovenous malformations (AVMs) have been associated with this syndrome. Likewise, cases of epidural hemangioma and angiomyolipoma have been reported to occur at the same segmental level as cutaneous hemangioma in KTW syndrome. This report details a rare case of an extradural thoracic AVM in a patient with KTW syndrome.

CLINICAL PRESENTATION
A 30-year-old man presented with a 10-month history of progressive myelopathy, bilateral lower-extremity weakness, and numbness, with the right side affected more than the left. His symptoms had progressed to the point that he was unable to walk. The patient had the characteristic manifestations of KTW syndrome, including numerous cutaneous angiomas and cavernomas, limb hypertrophy and syndactyly, and limb venous malformations. A magnetic resonance imaging scan and subsequent angiogram demonstrated a large extradural AVM causing cord compression at the T3–T4 levels.

INTERVENTION
The patient underwent two separate endovascular procedures, including embolization of upper thoracic and thyrocervical trunk feeders. Subsequently, he underwent T1–T4 laminectomy and microsurgical excision of the AVM. Clinically, the patient improved such that he could walk without assistance.

CONCLUSION
KTW syndrome represents a spectrum of clinical presentations. Although involvement of the spinal cord is uncommon, the manifestations of this syndrome may include both intradural and extradural AVMs in addition to various tumors.
Brainstem Infarction after Delayed Thrombosis of a Stented Vertebral Artery Fusiform Aneurysm: Case Report
Authors: Levy Elad I. , Boulos Alan S. , Bendok Bernard R. , Kim Stanley H. , Qureshi Adnan I. , Guterman Lee R. , Hopkins L. Nelson 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE
Recent technological advances have provided clinicians with stents that can be navigated throughout the tortuous proximal vessels of the posterior intracranial circulation. There have been few reports of fusiform and wide-necked aneurysms treated with stents. Of the known risks involved in stent placement in the intracranial circulation, delayed stent thrombosis has not been well described.

CLINICAL PRESENTATION
A 34-year-old man who experienced the sudden onset of a severe headache with increasing lethargy was found on computed tomographic imaging to have a subarachnoid hemorrhage. Angiography revealed a left vertebral artery fusiform aneurysm that incorporated the posteroinferior cerebellar artery origin.

INTERVENTION
A low-porosity Magic Wallstent (Boston Scientific, Natick, MA) was placed in the left vertebral artery across the aneurysm and the origin of the posteroinferior cerebellar artery. Angiography performed 9 days later revealed significant reduction in filling of the aneurysm. The patient returned 3 months after stent placement with severe neurological deterioration from a brainstem infarction caused by complete thrombotic occlusion of the left vertebral artery at the stented segment of the vessel.

CONCLUSION
Stenting of fusiform aneurysms has provided an alternative to surgical clipping or parent vessel reconstruction. With the increasing frequency of intracranial stent placement for various cerebrovascular disease entities, we must become aware of potential complications associated with these procedures. Such awareness may influence decision-making processes regarding treatment and follow-up care.
Necrotizing Neurosarcoidosis of the Cranial Base Resembling an en Plaque Sphenoid Wing Meningioma: Case Report
Authors: Tobias Samuel , Prayson Richard A. , Lee Joung H. 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE
Necrotizing sarcoid granuloma (NSG) has been recognized as a histological variant of sarcoidosis. Two cases of neurosarcoidosis (NS) with NSG with concomitant systemic disease have been described previously. We present an unusual case of primary NS-NSG that resembled an en plaque cranial base meningioma.

CLINICAL PRESENTATION
A 51-year-old man presented with a 3-month history of progressive left visual deterioration and proptosis. Brain magnetic resonance imaging demonstrated a large cranial base lesion occupying the left anterior clinoid process and sphenoid wing, extending to the left frontotemporal convexity. A second dura-based lesion was observed in the right parietal convexity. Both lesions enhanced homogeneously after administration of intravenous contrast medium. Magnetic resonance imaging characteristics were consistent with a typical clinoidal meningioma with an en plaque extension laterally.

INTERVENTION
A left frontotemporal craniotomy with extradural removal of the anterior clinoid process was performed. When the dura was opened, a red fibrous mass was identified. Intraoperative histological analysis revealed the presence of necrotizing and noncaseating granulomas. Postoperatively, cerebrospinal fluid, erythrocyte sedimentation rate, C-reactive protein, and serum and cerebrospinal fluid angiotensin-converting enzyme values were normal. The search for acid-fast bacilli or fungi was negative. A diagnosis of primary NS-NSG was made. The patient began long-term high-dose corticosteroid therapy. One and a half years after surgery, his vision had improved significantly and the lesions were stable as revealed by magnetic resonance imaging.

CONCLUSION
The first case of primary NS-NSG in the absence of systemic sarcoidosis is reported. NS should be included in the differential diagnosis of dura-based lesions resembling meningioma.
Vertebroplasty for Osteoporotic Compression Fractures: Current Practice and Evolving Techniques
Authors: Peters Keith R. , Guiot Bernard H. , Martin Pamela A. , Fessler Richard G. 
Published: July 2004

Abstract
PERCUTANEOUS VERTEBROPLASTY WAS developed in France by Deramond et al., who provided initial reports of the procedure in 1987. This minimally invasive procedure uses a large-bore bone-cutting needle to percutaneously access a vertebral body, inject bone cement, and thereby stabilize and reinforce the remaining bone structure. The procedure was used initially to treat aggressive hemangiomas, but it then was extended to the treatment of osteolytic metastases and myeloma and currently osteoporotic compression fractures refractory to medical therapy. In this article, we review the current technique and its indications along with emerging devices and areas of current research.
Extracoelomic Mini Approach for Anterior Reconstructive Surgery of the Thoracolumbar Area
Authors: ElSaghir Hesham 
Published: July 2004

Abstract

OBJECTIVE
An extracoelomic mini approach is introduced as a less invasive technique for surgery of the thoracolumbar area performed via the anterior approach.

METHODS
Twenty-one patients with spinal pathological findings at the thoracolumbar junction were assessed. The reasons for surgery were as follows: burst fracture of the first lumbar vertebra (n = 5), degenerative disc at L1–L2 (n = 4), spondylodiscitis at L1–L2 (n = 8) and at T11–L1 (n = 1), pathological fracture of the first lumbar vertebra (n = 2), and pseudarthrosis at T11–L1 after failed reconstruction (n = 1). The anterior surgical procedure was performed via an extracoelomic mini approach. Intersomatic fusion was performed in 13 patients, corpectomy and bone grafting in 4, corpectomy and vertebral replacement with titanium cage packed with bone cement in 3, and removal of a cage in a failed fusion and bridging the defect with a strut bone graft in 1. Posterior instrumentation of the affected segment was performed in the same sitting.

RESULTS
The mean ± standard deviation of operative time of the anterior procedure was 101.2 ± 36.5 minutes. The mean blood loss during the anterior procedure was 724 ± 483.5 ml. The procedure was safe. No pseudarthrosis was encountered, and the reconstructed bone was stable in the three patients in whom bone cement was used.

CONCLUSION
The extracoelomic mini approach is less invasive; it results in less incisional morbidity, and it avoids opening the pleural and peritoneal cavities.
Current Concepts in Minimally Invasive Discectomy
Authors: Maroon Joseph C. 
Published: July 2004

AbstractOBJECTIVEThe purpose of this study was to evaluate the various minimally invasive procedures available for the treatment of lumbar disc disease.METHODSA review of the literature, as well as my personal experience with minimally invasive approaches to the lumbar discs, was performed. This review included the percutaneous and open surgical approaches currently available and used for the treatment of lumbar disc disease.RESULTSThe primary minimally invasive procedures for the treatment of lumbar disc disease include the following: 1) chemonucleolysis, introduced by Lyman Smith in 1964; 2) percutaneous manual nucleotomy, introduced by Hijikata in 1975; 3) microdiscectomy, first performed by Yaşargil in 1968; 4) automated percutaneous lumbar discectomy, introduced by Onik in 1984; 5) laser discectomy, first performed by Ascher and Choy in 1987; 6) endoscopic discectomy, first used by Schreiber and Suezawa in 1986 and improved by Mayer, Brock, and Mathews; 7) microendoscopic discectomy, introduced by Smith and Foley in 1995; and 8) intradiscal electrothermy, first reported by Saal and Saal in 2000.CONCLUSIONAlthough all percutaneous techniques have been reported to yield high success rates, to date no studies have demonstrated any of these to be superior to microsurgical discectomy, which continues to be regarded as the standard with which all other techniques must be compared.
Itraconazole in the Treatment of Tinea Capitis Caused by Microsporum canis: Experience in a Large Cohort
Authors: Ginter‐Hanselmayer Gabriele , Smolle Josef , Gupta Aditya 
Published: July 2004

Abstract:  Mycotic scalp infection caused by Microsporum canis is one of the more recalcitrant disorders, with increasing incidence during the last decade. We report our experience with administration of itraconazole in 163 children (86 girls, 77 boys) with M. canis tinea capitis. Fifty‐five patients had previous treatment with terbinafine without success. In all children, the dosage of itraconazole was adjusted according to body weight, with 5 mg/kg/day given in a continuous regimen either as a capsule (116 patients) or an oral suspension (47 patients). In all children, there was both clinical and mycologic cure after a mean treatment period of 39 ± 12 days (range 10–77 days). Eleven children (6.7%) had side effects: diarrhea in five children, cutaneous eruption in four, and abdominal pain in two. Itraconazole was effective and safe for the treatment of M. canis tinea capitis.
A simple automatized audit system for following and managing practices of platelet and plasma transfusions in a neonatal intensive care unit
Authors: Petäjä J. , Andersson S. , Syrjälä M. 
Published: July 2004

Summary.  During neonatal intensive care, blood components are often used in clinical situations where both their efficacy and safety lack solid justification. A practical system to continuously analyse actual transfusion practices is a prerequisite for improvements of quality in transfusion therapy. We hypothesized that such a system would reveal inappropriate variations in clinical decission making and offer a means for staff education and quality improvement and assurance.The study consisted of three 120–152‐day periods (P I, P II and P III) between January 2000 and October 2001 and involved 543 new patient admissions (141 patients with birth weight < 1501 g) and 6227 days of patient care at a single tertiary level NICU. P I was a control with no intervention, P II was after technically introducing the computer system and, the last period, P III was after presenting and discussing the results of P I and P II at a staff meeting. Upon an order of platelet or fresh frozen plasma (FFP) unit from the blood bank, a computer‐based audit system compared the last platelet count or prothrombin time [expressed as percentage of normal clotting activity, prothrombin time (PT‐%)] to predefined criteria. In the case of exceeding the preset thresholds, the system required additional information and recorded the pretransfusion laboratory values for later analysis.Thirty‐two per cent of platelet transfusions were given with pretransfusion platelet count >49 × 109 L−1, and 60% of these transfusions (19% of all platelet transfusions) could not be clinically justified in retrospective chart review. There was no significant change in this practice from P II to P III. FFP transfusions were given with significantly different pretransfusion PT‐% values during P II and P III. The proportions of FFP transfusions with pretransfusion PT‐% > 49% were 7·8% and 0·9% during P II and P III, respectively (P < 0·0001). In chart review, none of the FFP transfusions with pretransfusion PT‐% > 49% could be justified by clinical grounds.Inappropriate transfusions of both platelets and plasma remain a significant challenge for quality assurance of neonatal intensive care. Automated recording of pretransfusion platelet count and prothrombin time reliably identified the poorly justified transfusions and thus offered a practical resource‐saving tool for quality assurance of transfusion in the NICU. A significant shift towards more appropriate use of plasma was demonstrated after implementation of the audit system.