bluuebunny/crossref_metadata_2025_split huggingface dataset:
Microvascular Decompression for Glossopharyngeal Neuralgia: Long-term Effectiveness and Complication Avoidance
Authors: Sampson John H. , Grossi Peter M. , Asaoka Katsuyuki , Fukushima Takanori 
Published: August 2004

Abstract

OBJECTIVE
To establish the long-term safety, efficacy, and durability of microvascular decompression (MVD) for the treatment of glossopharyngeal neuralgia, this study presents the immediate (&lt;6 mo) postoperative and long-term results of a large series of 47 patients with treated with MVD.

METHODS
Operative reports and hospital charts were analyzed to collect demographic information, clinical presentation, and surgical findings. Surgical results and complications were ascertained by direct patient contact or by contact with the patient's family or physician if the patient was dead. Long-term (&gt;10 yr) personal follow-up was available for 29 of 47 patients.

RESULTS
Forty-six (98%) of 47 patients experienced complete relief of pain immediately after MVD. Long-term follow-up was available for 29 of these 47 patients (range, 125–211 mo; median, 152 mo, or 12.7 yr), and 28 of these 29 patients continued to be pain-free. Permanent neurological deficits (&gt;6 mo) attributed to the surgery were observed in 5 (11%) of 47 patients. Of these patients, 4 of 5 had mild hoarseness or dysphagia or both, and one had a Grade II/VI facial nerve paresis.

CONCLUSION
This study demonstrates that MVD is a safe, effective, and durable surgical procedure for producing prolonged pain relief in patients with medically intractable glossopharyngeal neuralgia.
Management of Cystic Craniopharyngiomas with Phosphorus-32 Intracavitary Irradiation
Authors: Hasegawa Toshinori , Kondziolka Douglas , Hadjipanayis Costas G. , Lunsford L. Dade 
Published: August 2004

Abstract

OBJECTIVE
The efficacy of stereotactic intracavitary irradiation with phosphorus-32 (32P) for patients with cystic craniopharyngiomas was assessed on the basis of patient survival, tumor control, and visual and endocrinological function before and after treatment. Limited data are available regarding long-term outcomes.

METHODS
Forty-nine patients were treated with stereotactic 32P intracavitary irradiation. Of these, 25 had had no prior treatment as the primary treatment, and 24 were treated for residual or recurrent tumor cysts. At the time of 32P intracavitary irradiation, 34 of the patients were adults, and 15 were children younger than 16 years of age. The mean cyst volume was 13 ml. The radiation dose varied from 189 to 250 Gy to the cyst wall during five half-lives of the isotope (mean, 224 Gy). The mean follow-up periods were 7 years after diagnosis and 4 years after 32P treatment.

RESULTS
The actuarial survival rates were 90% at 5 years after the diagnosis and 80% at 10 years. The actuarial tumor cyst control rates were 76% at 5 years and 70% at 10 years after the diagnosis. After treatment, 9 (23%) of 40 patients who underwent preoperative and postoperative visual testing were found to have delayed worsening in visual function, 6 as a result of tumor progression and 3 attributed to irradiation. Nineteen patients (48%) had improved visual function. Of 17 patients who had normal preoperative pituitary function or stalk effect, 12 (71%) had preserved and 5 (29%) had worsened visual function. No complications other than visual or endocrinological deterioration occurred in these patients.

CONCLUSION
For patients with cystic craniopharyngiomas, 32P intracavitary irradiation proved effective, with a low risk of complications, for the control of tumor cysts but not of solid tumor components.
Surgical Risks Associated with the Management of Grade I and II Brain Arteriovenous Malformations
Authors: Morgan Michael Kerin , Rochford Andrew Michael , Tsahtsarlis Antonio , Little Nicholas , Faulder Kenneth Charles 
Published: August 2004

Abstract

OBJECTIVE
Grade I and II arteriovenous malformations (AVMs) have been considered safe to resect. However, unoperated low-grade AVMs have not been considered in previously reported series. The aim of this study was to examine all cases, both operated and unoperated, to identify any characteristics of low-grade AVMs that comprise a subgroup that might pose a relatively higher risk.

METHODS
A prospectively enrolled AVM database included 237 patients in Spetzler-Martin Grade I or II. These patients were analyzed on the basis of demographic characteristics, angiographic and magnetic resonance imaging features, clinical presentation, method of treatment, and outcome.

RESULTS
Surgery was performed in 220 patients in Spetzler-Martin Grade I or II. Seventeen patients did not undergo treatment because of poor neurological condition (six patients), patient refusal (nine patients), and perceived surgical difficulty (AVM size approaching 3 cm adjacent to Broca's area) (two patients). The overall surgical morbidity rate was 0.9%, and the mortality rate was 0.5%. Adverse outcomes occurred in 1 (0.6%) of 180 patients with AVMs located away from eloquent cortex and in 2 (5%) of 40 patients with AVMs adjacent to eloquent cortex. None of 28 surgical patients with deep venous drainage had an adverse outcome. All 219 patients who survived surgery underwent postoperative angiography that confirmed cure. No postoperative hemorrhage has occurred in 1143 patient-years of follow-up (mean follow-up, 5.3 yr).

CONCLUSION
When considering adverse outcome in the surgical series of Grade I and II AVMs alone, no statistical difference between non-eloquently located AVMs (0.6%) and eloquently located AVMs (5% adverse outcome) can be detected. However, consideration of all Grade I and II AVMs, both surgical and nonsurgical, may prove that a difference in outcome exists between these two groups masked by case selection. Generalization of the chances of adverse outcomes to all Grade I and II AVMs (both operated and unoperated) suggests that the risk of performing surgery on noneloquent brain in our series was 0.6% and that in eloquent brain could have been as high as 9.5%, had all such patients undergone surgery.
Preoperative Blood Oxygen Level-dependent Functional Magnetic Resonance Imaging in Patients with Primary Brain Tumors: Clinical Application and Outcome
Authors: Håberg Asta , Kvistad Kjell Arne , Unsgård Geirmund , Haraldseth Olav 
Published: August 2004

Abstract

OBJECTIVE
This study sought to evaluate the ability of blood oxygen level-dependent (BOLD) functional magnetic resonance imaging (fMRI) to successfully identify functional cortical areas in patients with primary brain tumors, to evaluate the use of the fMRI results in presurgical planning, and to assess the functional outcome of the patients with respect to the functional maps obtained with fMRI.

METHODS
The study included 25 consecutive preoperative fMRI sessions in patients with primary brain tumors in or near sensorimotor and/or language cortices. All fMRI paradigms were analyzed and rated according to the degree of success. Several distances between tumor and functional cortex as delineated with BOLD fMRI were measured to assess the topographic relationship between these two structures. Pre- and postoperative neurological statuses were obtained from the patients' journals.

RESULTS
Acquisition of BOLD fMRI images was successful in 80% of the cases. The primary cause of unsuccessful fMRI was echo-planar imaging signal voids that were the result of previous craniotomy; the secondary cause was excessive motion. The neurosurgeons used the fMRI results for preoperative planning in 75% of the cases in which fMRI was successful. The risk of postoperative loss of function tested with fMRI was significantly lower when the distance between tumor periphery and BOLD activity was 10 mm or more.

CONCLUSION
The majority of patients with primary brain tumors were capable of satisfactorily performing the fMRI paradigms, and the information obtained was used in the preoperative planning. A distance of 10 mm or more between the functional cortex, as delineated with fMRI, and the tumor significantly reduced the risk of postoperative loss of function.
Transcranial Motor Evoked Potentials during Basilar Artery Aneurysm Surgery: Technique Application for 30 Consecutive Patients
Authors: Quiñones-Hinojosa Alfredo , Alam Mirza , Lyon Russ , Yingling Charles D. , Lawton Michael T. 
Published: August 2004

Abstract

OBJECTIVE
Microsurgical clipping of basilar artery aneurysms carries a risk of neurological compromise resulting from midbrain or thalamic ischemia. Somatosensory evoked potential (SSEP) monitoring and electroencephalography are the standard techniques for assessing the level of cerebroprotective anesthesia and monitoring ischemia during temporary occlusion or after permanent clipping. Transcranial motor evoked potential (TcMEP) monitoring was added to determine whether this modality improved intraoperative monitoring.

METHODS
Combined SSEP/electroencephalographic/TcMEP monitoring was used for 30 consecutive patients with basilar artery apex aneurysms in the past 1.5 years. Voltage thresholds were recorded before, during, and after aneurysm treatment for the last 10 patients.

RESULTS
All 30 patients underwent an orbitozygomatic craniotomy for clipping (28 patients), wrapping (1 patient), or superficial temporal artery-superior cerebellar artery bypass (1 patient). Electrophysiological changes occurred for 10 patients (33%), elicited by temporary clipping (6 patients), permanent clipping (3 patients), or retraction (1 patient). Isolated SSEP changes were observed for one patient, isolated TcMEP changes for five patients, and changes in both TcMEPs and SSEPs for four patients. Among patients with simultaneous changes, TcMEP abnormalities were more robust and occurred earlier than SSEP abnormalities. Impaired motor conduction was detected first with an increase in the voltage threshold (from 206 ± 22 to 410 ± 49 V, P &lt; 0.05, n = 3) and then with loss of TcMEP responses. SSEP and TcMEP signals returned to baseline values for all patients after corrective measures were taken.

CONCLUSION
TcMEP monitoring can be safely and easily added to traditional neurophysiological monitoring during basilar artery aneurysm surgery. These results suggest that TcMEPs may be more sensitive than SSEPs to basilar artery and perforating artery ischemia. This additional intraoperative information might minimize the incidence of ischemic complications attributable to prolonged temporary occlusion or inadvertent perforator occlusion.
Systematic Review of Ablative Neurosurgical Techniques for the Treatment of Trigeminal Neuralgia
Authors: Lopez Benjamin C. , Hamlyn Peter J. , Zakrzewska Joanna M. 
Published: August 2004

Abstract

OBJECTIVE
There are no randomized controlled trials comparing retrogasserian percutaneous radiofrequency thermocoagulation, glycerol rhizolysis, balloon compression of the gasserian ganglion, and stereotactic radiosurgery, nor are there systematic reviews using predefined quality criteria. The objective of this study was to systematically identify all of the studies reporting outcomes and complications of ablative techniques for treatment of trigeminal neuralgia, from the development of electronic databases, and to evaluate them with predefined quality criteria.

METHODS
Inclusion criteria for the outcome analysis included thorough demographic documentation, defined diagnostic and outcome criteria, a minimum of 30 patients treated and median/mean follow-up times of 12 months, not more than 20% of patients lost to follow-up monitoring, Kaplan-Meier actuarial analysis of individual procedures, less than 10% of patients retreated because of failure or early recurrence, and a minimal dose of 70 Gy for stereotactic radiosurgery. High-quality studies with no actuarial analysis were used for the evaluation of complications.

RESULTS
Of 175 studies identified, 9 could be used to evaluate rates of complete pain relief on a yearly basis and 22 could be used to evaluate complications. In mixed series, radiofrequency thermocoagulation offered higher rates of complete pain relief, compared with glycerol rhizolysis and stereotactic radiosurgery, although it demonstrated the greatest number of complications.

CONCLUSION
Radiofrequency thermocoagulation offers the highest rates of complete pain relief, although further data on balloon microcompression are required. It is essential that uniform outcome measures and actuarial methods be universally adopted for the reporting of surgical results. Randomized controlled trials are required to reliably evaluate new surgical techniques.
Microsurgical Excision of a Retro-odontoid Disc Hernia via a Far-lateral Approach: Successful Treatment of a Rare Cause of Myelopathy: Case Report
Authors: Matsuno Akira , Nakashima Michi , Murakami Mineko , Nagashima Tadashi 
Published: August 2004

AbstractOBJECTIVE AND IMPORTANCEAmong mass lesions causing myelopathy at the craniovertebral junction, retro-odontoid intervertebral disc hernias are very rare, with only four such cases reported in the literature.CLINICAL PRESENTATIONA 77-year-old woman with this rare condition complained of motor and sensory disturbances in her extremities. Magnetic resonance imaging scans demonstrated an extradural mass lesion at the craniovertebral junction, compressing the lower medulla oblongata and the upper cervical cord posteriorly.INTERVENTIONThe lesion, which was partly mucinous cartilaginous and partly fatty and fibrous, was meticulously removed via a left far-lateral approach. The lesion was not neoplastic but was determined to be composed of fibrocartilaginous tissue, consistent with disc material. Postoperatively, the patient's sensory disturbances and motor weakness improved, and magnetic resonance imaging scans demonstrated marked shrinkage of the lesion.CONCLUSIONSagittal, T1-weighted, magnetic resonance imaging scans demonstrated a low-intensity band between the odontoid process and the body of the axis, which suggested a persistent cartilaginous band. Although upward migration of a herniated disc from the lower cervical spine and degeneration of retro-odontoid ligaments might be possible causes, a persistent cartilaginous band extending between the odontoid process and the body of the axis was considered to be the more likely origin of the retro-odontoid intervertebral disc hernia. Because the far-lateral surgical approach does not require retraction of the cervical cord and provides safe access to the lesion at the craniovertebral junction, it is a suitable surgical method for this condition.
Endoscope-assisted Microsurgery for Microvascular Compression Syndromes
Authors: Rak Ramin , Sekhar Laligam N. , Stimac Dinko , Hechl Peter 
Published: August 2004

Abstract

OBJECTIVE
To discuss the results of endoscope-assisted surgery in microvascular decompression (MVD) of Cranial Nerves (CNs) V, VII, and VIII.

METHODS
Neuroendoscopy was used as an adjunct to the surgical microscope in the MVD of the trigeminal (17 patients), facial (10 patients), and vestibulocochlear (1 patient) nerves in a series of 28 consecutive patients. After a standard microsurgical approach to CNs V, VII, and VIII, the endoscope was used to inspect all aspects of neural anatomy, to assess vascular compression, and to check the results of the decompression. Endoscope use was graded in four categories: Grade I, used but no definite role; Grade II, visualization assisted; Grade III, procedure assisted; and Grade IV, primary role. The usefulness of the endoscope was evaluated in each case.

RESULTS
The endoscope was useful in visualizing the anatomy in all cases. It was especially useful in establishing trigeminal vein compression of CN V in Meckel's cave; observing multiple sources of vascular compression; ensuring adequate decompression after cauterization of vein, insertion of the Teflon felt, or a pexy procedure; and permitting observation of the compression of CN VII at the root exit zone by small arteries and veins. In six patients with trigeminal neuralgia, the trigeminal vein was cauterized and divided by using endoscopic vision only because the venous compression was not completely visualized with the microscope. During a follow-up period of 6 to 52 months (mean, 29 mo; median, 40 mo), all patients were asymptomatic and receiving no medication.

CONCLUSION
The endoscope is a useful adjunct to MVD in the treatment of trigeminal neuralgia, hemifacial spasm, and disabling positional vertigo or tinnitus.
Outcomes of Cubital Tunnel Surgery among Patients with Absent Sensory Nerve Conduction
Authors: Taha Assad , Galarza Marcelo , Zuccarello Mario , Taha Jamal 
Published: August 2004

AbstractOBJECTIVETo report the outcomes of cubital tunnel surgery for patients with absent ulnar sensory nerve conduction.METHODSThe charts of 34 patients who exhibited clinical symptoms of ulnar nerve entrapment at the elbow and who had electromyography-confirmed prolonged motor nerve conduction across the cubital tunnel in association with absent sensory nerve conduction were reviewed. The mean age was 63 years, and the mean symptom duration was 17 months. Four patients had bilateral symptoms. Surgery was performed for 38 limbs, i.e., neurolysis for 21 limbs and subcutaneous transposition for 17 limbs. Fifteen limbs demonstrated associated ulnar nerve-related motor weakness. The mean postoperative follow-up period was 4 years (range, 3 mo to 11 yr).RESULTSSensory symptoms (i.e., pain, paresthesia, and two-point discrimination) improved in 20 limbs (53%), and muscle strength improved in 2 limbs (13%). Improvements in sensory symptoms were not related to patient age, symptom duration, cause, severity of prolonged motor nerve conduction, select psychological factors, associated medical diseases, associated cervical pathological conditions, or type of surgery. Improvements in sensory symptoms were significantly decreased among patients who had experienced cervical disease for more than 1 year and patients with bilateral symptoms.CONCLUSIONPatients with cubital tunnel syndrome who have absent sensory nerve conduction seem to experience less improvement of sensory symptoms after surgery, compared with all patients with cubital tunnel syndrome described in the literature. Bilateral symptoms and delayed surgery secondary to associated cervical spine disease seem to be significant negative factors for postoperative improvement of sensory symptoms. Sensory symptoms improved similarly among patients who underwent neurolysis or subcutaneous transposition
Far-lateral Lumbar Disc Herniation: The Microsurgical Transmuscular Approach
Authors: Tessitore Enrico , de Tribolet Nicolas 
Published: August 2004

Abstract
INTRA- AND EXTRAFORAMINAL disc herniations can be treated via a lateral approach. The far-lateral approach is a muscle-splitting approach that allows surgeons to reach the disc herniation without any facet bone removal. The target of the surgical exposure is the isthmus. Good knowledge of the anatomic features of the intervertebral foramen and intertransverse space is mandatory. The transmuscular approach is discussed. We provide illustrations and a video to emphasize some operative aspects.
Bleeding after Radiosurgery for Cerebral Arteriovenous Malformations
Authors: Nataf François , Ghossoub May , Schlienger Michel , Moussa Ronald , Meder Jean-François , Roux François-Xavier 
Published: August 2004

Abstract

OBJECTIVE:
Obliteration is progressive after radiosurgery (RS) for cerebral arteriovenous malformation (AVM), and until it is complete, there is still a risk of hemorrhage. The aim of our study was to evaluate the severity of hemorrhage after RS, the actuarial risk of hemorrhage, and the parameters associated with hemorrhage.

METHODS:
Of 756 patients treated by linear accelerator RS for AVM, 51 (6.5%) had one or more hemorrhages after the RS. We studied the clinical, anatomic, and dosimetric parameters and obliteration rate before hemorrhage and then calculated the actuarial risk per patient and per hemorrhage before and after RS. Correlations between parameters and risk were studied by univariate and multivariate analysis using Kaplan-Meier hemorrhage-free survival curves and the Cox model.

RESULTS:
Apart from one exclusively ventricular hemorrhage, which caused the death of the patient, only parenchymal hemorrhages were associated with morbidity and neurological deficits (64.5% of all cases of hemorrhage had neurological deficits, 45% had a permanent deficit). The overall mortality rate per hemorrhage was 7.14%. The overall morbidity rate was 47.6%, 26.2% with a permanent deficit. In all but one patient, the AVM was not cured before hemorrhage; thus, the mean obliteration rate before hemorrhage was 24%. The actuarial hemorrhage rates were 3.08% per year per patient and 3.31% per year per hemorrhage. The actuarial rate per patient increased from 1.66% the 1st year to 3.87% in the 5th year after RS but was not statistically different from the rate before radiosurgery. The parameters found to be correlated with hemorrhage risk after RS using multivariate analysis were intranidal or paranidal aneurysms, complete coverage, and minimum dose.

CONCLUSION:
The risk of hemorrhage after RS would seem to be the sum of hemorrhage risk factors of the AVM and factors predicting a poor level of obliteration. These factors can be predicted in some cases but rarely avoided.
Evidence for a Clinically Distinct New Subtype of Grade II Astrocytomas in Patients with Long-term Epilepsy
Authors: Schramm Johannes , Luyken Cordelia , Urbach Horst , Fimmers Rudolf , Blümcke Ingmar 
Published: August 2004

Abstract

OBJECTIVE:
The authors tested the hypothesis that among Grade II astrocytomas with a particularly long seizure history, a subgroup is hidden with a different prognosis and possibly histological characteristics. To do so, clinical and histological characteristics of two groups of World Health Organization Grade II astrocytoma patients were analyzed: the long-term epilepsy-associated tumor (LEAT) astrocytoma group, with a mean duration of 12.5 years of seizures (n = 19), and the ordinary astrocytomas (n = 87), with a mean length of seizure history of 1.5 years (Non-LEAT).

METHODS:
All astrocytomas operated on between 1988 and 1999 were collected and followed up for 2 to 13 years (median, 7.0 yr). The 19 LEAT astrocytomas belonged to a group of 207 long-term epilepsy-associated tumors from the epilepsy surgery program. The 87 Non-LEAT cases were 60 so-called ordinary or diffuse World Health Organization Grade II astrocytomas and 27 oligoastrocytomas without long-term epilepsy operated on during the same time period. All tumor cases have been reviewed and partly reclassified as a result of the use of modern immunohistochemical techniques. Statistical analyses for possible discriminating factors included χ2 test, Fisher's exact test, Kaplan-Meier curves, and multifactorial analysis.

RESULTS:
Histological subtyping revealed a possible new isomorphic astrocytoma subtype in seven patients. By use of Kaplan-Meier curves, this isomorphic subtype had 50% fewer recurrences at 7.5 years and an estimated long-term survival of 80%. LEAT astrocytomas differed from ordinary Non-LEAT astrocytomas in overall length of history, younger age at first seizure, and higher percentage of 10-year survivors (80%). Temporal location did not influence outcome, and the presence of epilepsy per se was also not a prognostic factor.

CONCLUSION:
Differences between astrocytomas with a very long seizure history and those with a very short seizure history do exist. Significant factors for prognosis were age at surgery and presence of postoperative tumor residue but not the presence of epilepsy per se. A new subtype of astrocytomas, provisionally called isomorphic LEA astrocytoma, has putatively been identified with significantly better survival and lower recurrence rate. The negative prognostic factor of a gemistocytic differentiation pattern in diffuse astrocytomas was confirmed.