bluuebunny/crossref_metadata_2025_split huggingface dataset:
Zones of Approach for Craniofacial Resection: Minimizing Facial Incisions for Resection of Anterior Cranial Base and Paranasal Sinus Tumors
Authors: Liu James K. , Decker David , Schaefer Steven D. , Moscatello Augustine L. , Orlandi Richard R. , Weiss Martin H. , Couldwell William T. 
Published: August 2004

AbstractOBJECTIVEAnterior cranial base tumors are surgically resected with combined craniofacial approaches that frequently involve disfiguring facial incisions and facial osteotomies. The authors outline three operative zones of the anterior cranial base and paranasal sinuses in which tumors can be resected with three standard surgical approaches that minimize transfacial incisions and extensive facial osteotomies.METHODSThe zones were defined by performing dissections on 10 cadaveric heads and by evaluating radiographic images of patients with anterior cranial base tumors. The three approaches performed on each cadaver were transbasal, transmaxillary, and extended transsphenoidal.RESULTSThree zones of approach were defined for accessing tumors of the anterior cranial base, nasal cavity, and paranasal sinuses. Zone 1 is exposed by the transbasal approach, which is limited anteriorly by the supraorbital rim, posteriorly by the optic chiasm and clivus, inferiorly by the palate, and laterally by the medial orbital walls. This approach allows access to the entire anterior cranial base, nasal cavity, and the majority of maxillary sinuses. The limitation imposed by the orbits results in a blind spot in the superolateral extent of the maxillary sinus. Zone 2 is exposed by a sublabial maxillotomy approach and accesses the entire maxillary sinus, including the superolateral blind spot and the ipsilateral anterior cavernous sinus. However, access to the anterior cranial base is limited. Zone 3 is exposed by the transsphenoidal approach. This approach accesses the midline structures but is limited by the lateral nasal walls and intracavernous carotid arteries. An extended transsphenoidal approach allows further exposure to the anterior cranial base, clivus, or cavernous sinuses. The use of the endoscope facilitates tumor resection in the nasal cavity and paranasal sinuses.CONCLUSIONThe operative zones outlined offer minimally invasive craniofacial approaches to accessing lesions of the anterior cranial base and paranasal sinuses, obviating facial incisions and facial osteotomies. Case illustrations demonstrating the approach selection paradigm are presented.
Surgery of the Subthalamic Nucleus: Use of Movement-related Neuronal Activity for Surgical Navigation
Authors: Starr Philip A. , Theodosopoulos Philip V. , Turner Robert 
Published: August 2004

Abstract
THE BASAL GANGLIA have important roles in somatic motor, oculomotor, limbic, and associative functions. These functions are represented in anatomically distinct territories in each basal ganglion nucleus. During surgery of the subthalamic nucleus for Parkinson's disease, the primary goal is to influence the physiology of the motor territory without affecting nonmotor areas. This article describes the use of movement-related cellular activity during single-unit microelectrode mapping to identify and to navigate within the motor territory of the subthalamic nucleus.
Dosimetric Comparison of CyberKnife with Other Radiosurgical Modalities for an Ellipsoidal Target
Authors: Yu Cheng , Jozsef Gabor , Apuzzo Michael L.J. , Petrovich Zbigniew 
Published: August 2004

Abstract

OBJECTIVE
To compare treatment plans obtained with the CyberKnife (CK) (Accuray, Inc., Sunnyvale, CA) with those of other commonly used radiosurgical modalities, such as the gamma knife (GK), linear accelerator multiple arcs, conformally shaped static fields, and intensity-modulated radiotherapy (IMRT).

METHODS
An ellipsoidal simulated target was chosen centrally located in a three-dimensional model of a patient's head acquired with magnetic resonance or computed tomographic imaging. It was 25 mm in diameter and 35 mm long. The aims of treatment plans were 100% target volume coverage with an appropriate isodose line, minimum radiation dose to normal tissue, and clinically acceptable delivery. These plans were evaluated by use of a dose-volume histogram and other commonly used radiosurgical parameters such as target coverage, homogeneity index, and conformity index.

RESULTS
All selected treatment modalities were equivalent in providing full target coverage. For dose homogeneity, all modalities except for multiple isocenter plans for GK (homogeneity index, 2.0) were similar (homogeneity index, ≅1.25). Dose conformity was essentially equivalent for all treatment plans except for IMRT, which had a slightly higher value (conformity index, ≅1.27). There was a substantial variation in the radiation dose to normal tissue between the studied modalities, particularly at the lower dose levels.

CONCLUSION
CK plans seemed to be more flexible for a given target size and shape. For a target of limited volume and essentially of any shape, one could obtain similarly good conformal dosimetry with CK and GK. For a regular-shaped but other than spherical target, homogeneous dose distribution could be obtained with all selected modalities except for multiple isocenters, linear accelerator multiple arcs, or GK. Both IMRT and conformally shaped static fields offered good alternative treatment modalities to CK, GK, or linear accelerator multiple arc radiosurgery, with slightly inferior dosimetry in conformity (IMRT).
Multiple Intracranial Arterial Stenoses around the Circle of Willis in Association with Graves' Disease: Report of Two Cases
Authors: Nakamura Kazuhiro , Yanaka Kiyoyuki , Ihara Satoshi , Nose Tadao 
Published: August 2004

Abstract

OBJECTIVE AND IMPORTANCE
The association of Graves' disease with multiple intracranial arterial stenoses is rare.

CLINICAL PRESENTATION
We report on two Japanese women who experienced the concurrence of Graves' disease and cerebral ischemia attributable to multiple intracranial arterial stenoses around the circle of Willis. Clinically, these patients demonstrated hyperthyroidism, goiter, ophthalmopathy, and ensuing ischemic strokes. Cerebral angiography demonstrated multiple intracranial arterial stenoses around the circle of Willis in both cases. These cases did not meet the full diagnostic criteria for moyamoya disease, in that there were no abnormal, net-like, collateral vessels, but the other clinical and angiographic findings were consistent with this condition.

INTERVENTION
After normalization of their hormonal conditions, the patients underwent cerebral revascularization procedures. Both patients achieved excellent recoveries and returned to normal daily life after treatment.

CONCLUSION
Multiple intracranial arterial stenoses and Graves' disease may occur simultaneously. Such cases may offer new insights into the pathogenesis of these two conditions. It is important to study more patients with this dual condition, to obtain more evidence of the relationship between genetic and immunogenic backgrounds.
Endoscopic Third Ventriculostomy with Cystoventricular Stent Placement in the Management of Dandy-Walker Malformation: Technical Case Report of Three Patients
Authors: Mohanty Aaron 
Published: August 2004

Abstract

OBJECTIVE AND IMPORTANCE
Dandy-Walker malformation has conventionally been managed with placement of cystoperitoneal or ventriculoperitoneal shunts. However, associated aqueductal obstruction requires simultaneous drainage of both the supratentorial and infratentorial compartments.

CLINICAL PRESENTATION
Three children with Dandy-Walker malformation and aqueductal obstruction were managed with endoscopic third ventriculostomy and placement of a stent from the third ventricle to the posterior fossa cyst.

INTERVENTION
After an endoscopic third ventriculostomy was performed, the stent was placed from the third ventricle to the posterior fossa cyst through the thinnest part of the posteroinferior wall of the aqueduct. There was no operative morbidity. In one patient, the stent was malpositioned, requiring a repositioning. The endoscopic third ventriculostomy was successful in two patients, whereas it failed in one, requiring a ventriculoperitoneal shunt placement.

CONCLUSION
Cystoventricular stent placement with endoscopic third ventriculostomy is a promising alternative in patients with Dandy-Walker malformation with aqueductal obstruction.
Surgical Management and Results of 135 Tibial Nerve Lesions at the Louisiana State University Health Sciences Center
Authors: Kim Daniel H. , Cho Yong-Jun , Ryu Stephen , Tiel Robert L. , Kline David G. 
Published: August 2004

AbstractOBJECTIVEThis retrospective study presents 33 years of clinical and surgical experience with 135 tibial nerve lesions to review operative techniques and their results and to provide management guidelines for the proper selection of surgical candidates.METHODSBetween 1967 and 1999, 135 patients with tibial nerve lesions at the knee level or below were managed surgically at the Louisiana State University Health Sciences Center. We reviewed these cases.RESULTSOf the 135 cases, traumatic injury accounted for 71, tarsal tunnel syndrome for 46, and nerve sheath tumor for 18. Of 22 lesions not in continuity, functional recovery of Grade 3 or better was achieved in 4 (67%) of 6 patients who required end-to-end suture repair and 11 (69%) of 16 patients who required graft repair. One hundred thirteen tibial nerve lesions in continuity underwent primarily external or internal neurolysis or resection of the lesions. A few received end-to-end suture or graft repair. Direct intraoperative recording of nerve action potentials guided case management decisions. Among the 113 patients with lesions in continuity, 76 (81%) of 94 patients receiving neurolysis, 5 (83%) of 6 receiving suture repair, and 11 (85%) of 13 receiving graft repair recovered function to Grade 3 or better. Repair results were best in patients with recordable nerve action potentials treated by external neurolysis. Results were poor in a few patients with very lengthy lesions in continuity and in reoperated patients with tarsal tunnel syndrome.CONCLUSIONSurgical exploration and repair of tibial nerve lesions, including nerve sheath tumors and tarsal tunnel syndromes, achieved excellent outcomes.
Removal of an Anterior Spinal Dermoid Cyst with Fenestra Corpectomy in Klippel-Feil Syndrome: Technical Case Report
Authors: Kaya R. Alper , Türkmenoğlu Osman , Dalkılıç Türker , Aydın Yunus 
Published: August 2004

Abstract

OBJECTIVE AND IMPORTANCE
A spinal cord tumor occurring in association with Klippel-Feil syndrome is quite rare. The removal of an anteriorly located spinal cord tumor at the level of block vertebrae creates a surgical challenge.

CLINICAL PRESENTATION
A case of an intradural extramedullary dermoid cyst located anterior to the spinal cord and a syringomyelic cavity at the level of block vertebrae in a 43-year-old woman with Klippel-Feil syndrome is presented. She experienced pain and numbness in both shoulders and in her neck, and she had a slight weakness in both arms before the operation. Her weakness and the clinical symptoms completely disappeared after the operation, and the resolution of the syringomyelic cavity was observed at control magnetic resonance imaging.

INTERVENTION
An anterior approach creating a fenestra corpectomy to the block vertebrae was performed, and the tumor was removed totally. No fusion or fixation was performed.

CONCLUSION
To our knowledge, this is the first report of an anteriorly located intradural extramedullary cervical spine tumor in association with Klippel-Feil syndrome treated with this surgical technique. A three-dimensional computed tomographic control scan obtained 1 year after the operation did not show any instability.
Emergency Craniotomy for Intraparenchymal Massive Hematoma after Embolization of Supratentorial Arteriovenous Malformations
Authors: Iwama Toru , Yoshimura Kunikazu , Keller Emanuela , Imhof Hans-Georg , Khan Nadia , Leblebicioglu-Könu Dilek , Tanaka Michihiro , Valavanis Anton , Yonekawa Yasuhiro 
Published: August 2004

Abstract

OBJECTIVE
We sought to evaluate the efficacy of emergency craniotomy for patients with massive hematoma secondary to endovascular embolization of supratentorial arteriovenous malformations (AVMs) and to investigate relevant factors affecting outcome.

METHODS
Within the past 15 years, 605 patients with intracranial AVMs have undergone 1066 endovascular embolizations at our institution. Of these, 24 patients experienced intracranial hemorrhage during or after the procedure. Fourteen patients were demonstrated to have massive intraparenchymal hematomas and deteriorated to a comatose state (Glasgow Come Scale score ≤6). Twelve patients underwent craniotomy within 170 minutes of being diagnosed with intraparenchymal hemorrhage. The surgical procedures performed were hematoma evacuation with total (6 patients) or partial (2 patients) resection of the AVM or hematoma evacuation only (4 patients). The clinical records of these 12 patients were analyzed retrospectively.

RESULTS
Nine patients recovered to a favorable condition (good recovery, four patients; moderately disabled, five patients), one patient remained in a persistent vegetative state, and two patients died. The interval between hemorrhage and emergency craniotomy was significantly shorter in patients with favorable outcomes than in those with poor clinical outcomes. Advanced age and a larger volume of intraoperative blood loss were the factors relevant to poor outcome. Temporal lobe location of the AVM and incomplete embolization tended to correlate to poor clinical outcome, but this correlation was not statistically significant. The sizes of the AVM and the hematoma did not correlate to patient outcome. There was no difference in outcomes with regard to the surgical procedure performed.

CONCLUSION
In patients with massive postembolization hematomas, emergency craniotomy should be performed as soon as possible to achieve a favorable outcome. Cooperation among interventional neuroradiologists, intensive care physicians, and neurosurgeons is essential to manage AVM patients with critical postembolization hemorrhage. There is no need to persist in performing simultaneous total resection of the AVM at the emergency craniotomy.
Poor-grade Aneurysmal Subarachnoid Hemorrhage: Outcome after Treatment with Urgent Surgery
Authors: Laidlaw John D. , Siu Kevin H. 
Published: August 2004

Abstract

OBJECTIVE
We sought to determine whether the rebleeding rate in poor-grade patients justified a period of supportive observation before selective treatment and whether unselected ultraearly surgery would lead to acceptable results.

METHODS
A prospectively audited, nonselected series of 177 consecutive poor-grade (i.e., World Federation of Neurological Surgeons Grades IV and V) patients with aneurysmal subarachnoid hemorrhage managed during a 9-year period was analyzed. A management policy of aggressive ultraearly surgery (not selected by age or by grade) was followed. Coiling was not available. Outcomes were assessed at 3 months.

RESULTS
Despite the aggressive management policy, surgery could be performed in only 132 poor-grade patients (75%). Twenty percent of all patients were 70 years of age or older (15% of the surgical cases). All surgery was performed within 12 hours of subarachnoid hemorrhage (majority &lt;6 h). Preoperative rebleeding occurred within the first 12 hours (&gt;85% within 6 h) in 20% of the patients, which is four times the rate found in good-grade patients managed according to the same policy. Outcome assessment performed at 3 months in the 132 poor-grade surgical patients revealed that 40% were independent, 15% were dependent, and 45% had died. There was no significant difference in outcomes for young and old (70+ yr) poor-grade surgical patients (P &gt; 0.05).

CONCLUSION
The high ultraearly rebleeding rate indicates a need to urgently secure the ruptured aneurysm by performing surgery or coiling, and this indication is more pronounced for poor-grade patients than for good-grade patients. The outcome results of ultraearly surgery indicate that a nonselective policy does not lead to a large number of dependent survivors, even among elderly poor-grade patients.
Cortical Areas Involved in Virtual Movement of Phantom Limbs: Comparison with Normal Subjects
Authors: Roux Franck-Emmanuel , Lotterie Jean-Albert , Cassol Emmanuelle , Lazorthes Yves , Sol Jean-Christophe , Berry Isabelle 
Published: August 2004

Abstract

OBJECTIVE
To demonstrate that amputees performing “virtual” movements of their amputated limb activate cortical areas previously devoted to their missing limb, we studied amputees with functional magnetic resonance imaging (fMRI) and positron emission tomographic (PET) scans and compared the results with those of normal volunteers performing imaginary movements during fMRI acquisitions.

METHODS
Ten amputees (age range, 33–92 yr; average age, 49 yr; six men and four women; eight upper-limb and two lower-limb amputations) able to move their phantom limb at will were studied by fMRI (all patients) and PET scan (seven patients). The time between amputation and fMRI and PET studies ranged from 1 to 27 years (average, 13 yr). Patients were asked to perform virtual movements of the amputated limb and normal movements of the contralateral normal limb according to the functional images acquisition procedure. Movements of the stump were also used to differentiate stump cortical areas from virtual movement-activated areas. Ten right-handed volunteers, age- and sex-matched to the amputees, were also studied by fMRI. All volunteers were asked to perform four tasks during their fMRI study: imaginary movements of their right arm (1 task) and foot (1 task) and real movements of their left arm (1 task) and foot (1 task).

RESULTS
In amputees, virtual movements of the missing limbs produced contralateral primary sensorimotor cortex activation on both fMRI and PET scans. These activation areas, different from the stump activation areas, were similar in location to contralateral normal limb-activated areas. Quantitatively, in two amputees who claimed to be able to perform both slow and fast virtual movements, regional cerebral blood flow measured by PET scan in the precentral gyrus increased significantly during fast movements in comparison with slow virtual movements. In normal subjects, significant differences between real versus imaginary fMRI activations were found (for both foot and hand movements); imaginary right hand and foot tasks activated primarily the contralateral supplementary motor areas, with no significant activation detected in the contralateral precentral or postcentral gyri.

CONCLUSION
Primary sensorimotor cortical areas can be activated by phantom-limb movements and thus can be considered functional for several years or decades after amputation. In this study, we found that the location of the activation of these areas is comparable to that of activations produced by normal movements in control subjects or in amputees.
Genetic Analysis of a Multifocal Glioblastoma Multiforme: A Suitable Tool to Gain New Aspects in Glioma Development
Authors: Krex Dietmar , Mohr Brigitte , Appelt Hella , Schackert Hans K. , Schackert Gabriele 
Published: August 2004

Abstract

OBJECTIVE
Multifocal glioblastomas constitute an increasingly diagnosed subgroup of glioblastoma multiforme, the most malignant primary brain tumor in adults. The molecular background of these lesions is unknown. However, the ability to study multiple lesions of one patient simultaneously could provide new aspects in glioma development.

METHODS
Short-term cell cultures were derived from three isolated glioblastoma lesions of one patient. Spectral karyotyping and interphase fluorescence in situ hybridization were used for cytogenetic analysis. Loss of heterozygosity was assessed in tumor tissues and cell lines for seven gene loci (p73, p21, p16, PTEN, p27, Rb, p53). In addition, sequence analysis of the PTEN and p53 loci was performed, epidermal growth factor receptor protein expression was assessed, and in vitro proliferation was assayed.

RESULTS
A balanced translocation [t(1;15)(p3?6;q2?5)] that has not been described previously in glioblastomas was identified in all cell lines. Primarily, the cell lines have a homozygous deletion of the p16 locus and inactivation of the PTEN gene by loss of heterozygosity and an identical mutation in common. Furthermore, the cell lines harbor a hemizygous (R175H) or two heterozygous (R175H, R213Q) mutations of the p53 gene or none at all. The occurrence of p53 mutations correlates with the size of the original tumors and in vitro proliferation.

CONCLUSION
The analysis of a multifocal glioma revealed three main aspects: 1) the combined cytogenetic and molecular analysis of this subgroup of glioblastoma multiforme is a suitable tool to gain new perspectives in glioma development, 2) the balanced translocation [t(1;15)(p3?6;q2?5)] might harbor a new genetic marker involved in glioma development, and 3) the pattern of p53 mutation suggests a role of p53 in the progression of malignancy, migration, and growth of this particular primary glioblastoma.
Cerebellar Liponeurocytoma with an Unusually Aggressive Clinical Course: Case Report
Authors: Jenkinson Michael David , Bosma Jark Jan Daniel , Du Plessis Daniel , Ohgaki Hiroko , Kleihues Paul , Warnke Peter , Rainov Nikolai G. 
Published: August 2004

Abstract

OBJECTIVE AND IMPORTANCE
Liponeurocytomas are rare cerebellar neoplasms in adults, with benign histological features and a favorable clinical prognosis. Current clinical opinion is based on a total of less than 20 published cases and suggests that gross total resection and long-term follow-up monitoring, with possible additional surgery and radiotherapy for treatment of recurrent tumors, represent the best treatment approach for this relatively benign tumor type.

CLINICAL PRESENTATION
A 51-year-old Caucasian woman presented with worsening unsteady gait and headaches, suggesting increased intracranial pressure.

INTERVENTION
The patient underwent subtotal resection of a cerebellar liponeurocytoma, followed by fractionated radiotherapy (total dose of 54 Gy). She experienced a local recurrence of the tumor 12 months later and underwent additional surgery for removal of the cerebellar mass. A second recurrent tumor was diagnosed on magnetic resonance imaging scans 3 months later and was surgically resected. The tumor histological findings were consistently devoid of atypical features, apart from leptomeningeal invasion noted in the first surgical specimen.

CONCLUSION
This unusual case demonstrated an atypical clinical course of a highly aggressive and radiation-resistant tumor, despite the consistent absence of aggressive histological features. Cerebellar liponeurocytomas may not be as benign as the current literature and typical low-grade cytological and histological features suggest.