bluuebunny/crossref_metadata_2025_split huggingface dataset:
Far Lateral Disc Excision at L5–S1 Complicated by Iliolumbar Artery Incursion: Case Report
Authors: Harrington J. Frederick 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE
Paramedial approaches to far lateral discs at the L5–S1 space joint have advantages but may also bring the surgical space closer to large branch arteries of the internal iliac artery. I report incursion into an iliolumbar artery that required laparotomy to control hemorrhage. Surgeons performing extraforaminal disc explorations at L5–S1 need to evaluate preoperative magnetic resonance imaging scans for an enlarged iliolumbar artery near the disc space.

CLINICAL PRESENTATION
The patient presented with a right L5 radiculopathy and a far lateral disc at L5–S1, as indicated by analysis of her magnetic resonance imaging scan.

INTERVENTION
A midline incision and an extraforaminal exposure were performed. Arterial bleeding occurred when an anular disc fragment was removed with a pituitary rongeur under direct vision with microscopic magnification. Emergency laparotomy demonstrated hemorrhage from a branch of the internal iliac artery 2 cm from its origin.

CONCLUSION
Iliolumbar artery variants may be at the margins of extraforaminal disc exposure at L5–S1. Preoperative magnetic resonance imaging scans should be evaluated for this vasculature structure.
Posterior Fossa Decompression and Clot Evacuation for Fourth Ventricle Hemorrhage after Aneurysmal Rupture: Case Report
Authors: Lagares Alfonso , Putman Christopher M. , Ogilvy Christopher S. 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE
Massive intraventricular hemorrhage due to aneurysmal rupture is associated with a dismal prognosis. An intraventricular clot causing fourth ventricle dilation can cause compression to the brainstem similar to other posterior fossa masses such as cerebellar hemorrhage or infarction. The presence of fourth ventricle dilation carries a very high risk of death within 48 hours. Neither ventricular drainage nor fibrinolytic infusion has been successful in eliminating clots of the fourth ventricle. Posterior fossa decompression and direct evacuation of the clot could have good results in relieving brainstem compression caused by the clot.

CLINICAL PRESENTATION
A 45-year-old woman was admitted to our intensive care unit after experiencing an aneurysmal subarachnoid hemorrhage. The neurological examination at admission revealed that she was in Grade V according to the World Federation of Neurological Surgeons grading system, but brainstem reflexes were present. Computed tomographic scanning revealed a massive intraventricular hemorrhage, with fourth ventricle dilation caused by an intraventricular clot. Bilateral external ventricular drains were placed to relieve elevated intracranial pressure. Cerebral angiography revealed a 1-cm basilar tip aneurysm, which was embolized with Guglielmi detachable coils (Boston Scientific, Boston, MA) during the same procedure.

INTERVENTION
Given the patient's poor neurological condition, it was decided that brainstem compression should be relieved. A posterior fossa decompressive craniectomy was performed immediately after coil therapy, with direct evacuation of the intraventricular clot. The patient experienced a clear improvement in the level of consciousness and has achieved a good neurological result at early follow-up.

CONCLUSION
Dilation of the fourth ventricle by an intraventricular clot is a sign of brainstem compression that can be relieved by posterior fossa decompression and direct clot evacuation.
Microsurgical Removal of a Petrous Apex Meningioma after Stereotactic Radiation: Technical Case Report
Authors: Samii Madjid , Rosahl Steffen K. , Tatagiba Marcos S. 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE
Stereotactic radiation is increasingly advocated as a primary treatment option for benign cranial base lesions. The clinical course of the patient reported herein raises questions regarding the rationale for initiation of radiotherapy to a petrous apex meningioma before microsurgery.

CLINICAL PRESENTATION
We report a 50-year-old woman who experienced medically refractory trigeminal pain. She was diagnosed with a meningioma around the petrous apex and treated by fractionated stereotactic radiation. After a short period of alleviation accompanied by hypesthesia, the pain returned in a previously unknown and violent fashion.

INTERVENTION
Complete tumor removal through a retrosigmoid intradural suprameatal approach resulted in immediate and permanent pain cessation.

CONCLUSION
Radiotherapy should be withheld for benign and accessible tumors of the cranial base until the option of radical microsurgical treatment has been explored.
Clinical Manifestations and Survival Rates among Patients with Saccular Intracranial Aneurysms: Population-based Study in Olmsted County, Minnesota, 1965 to 1995
Authors: Menghini Vanessa V. , Brown Robert D. , Sicks JoRean D. , O'Fallon W. Michael , Wiebers David O. 
Published: July 2004

Abstract

OBJECTIVE
To report presenting clinical symptoms, previous medical history, and survival rates for people with saccular intracranial aneurysms (IAs), in a defined population.

METHODS
The medical records of all residents of Olmsted County, Minnesota, with possible IAs were reviewed. Clinical manifestations at the time of diagnosis, previous medical history, demographic factors, and survival rates after diagnosis were determined.

RESULTS
Of 270 people with IAs detected between 1965 and 1995, 188 exhibited symptoms at the time of diagnosis, including 74% of women and 63% of men (P = 0.054). Intracranial hemorrhage (ICH) was the most common presenting symptom (60% of all patients and 86% of patients who exhibited symptoms), followed by cranial nerve palsy, transient ischemic attacks, and seizures. Survival rates after detection (with the exclusion of cases that were first detected during autopsies) were dependent on the occurrence of ICH; 23% of patients who presented with ICH died by 1 day after diagnosis, compared with 5% of those who did not exhibit symptoms or exhibited symptoms but without ICH at presentation. At 5 years, 44.7% of patients with hemorrhage had died, compared with 29.4% of patients with symptoms other than hemorrhage. After the first 24 hours after detection, survival rates did not differ significantly for those presenting with or without hemorrhage. Predictors of better survival rates also included lower age and later calendar year of presentation.

CONCLUSION
This study provides the first data on aneurysm characteristics, clinical symptoms, and survival rates among people with IAs in a defined population. During the study period, most aneurysms were detected in the context of an aneurysm-related symptom (particularly among women), with a large proportion of patients presenting with ICH. After the acute phase of hemorrhage, long-term survival rates among people with IAs were similar for those presenting with or without ICH.
Early Proactive Management of Vestibular Schwannomas in Neurofibromatosis Type 2
Authors: Brackmann Derald E. , Fayad Jose N. , Slattery William H. , Friedman Rick A. , Day John Diaz , Hitselberger William E. , Owens Robert M. 
Published: July 2004

Abstract

OBJECTIVE
The treatment of patients with neurofibromatosis Type 2 has always been challenging for neurosurgeons and neurotologists. Guidelines for appropriate management of this devastating disease are controversial.

METHODS
A retrospective study of 28 patients with neurofibromatosis Type 2 who underwent 40 middle fossa craniotomies for excision of their acoustic tumors is reported. Eleven patients underwent bilateral procedures. The study focused on hearing preservation and facial nerve results for this group of patients. The 16 male patients and 12 female patients ranged in age (at the time of surgery) from 10 to 70 years, with a mean age of 22.6 years. The mean tumor size was 1.1 cm (range, 0.5–3.2 cm), and the majority of tumors were less than 1.5 cm.

RESULTS
Measurable hearing was preserved in 28 ears (70%), with 42.5% being within 15 dB pure-tone average and 15% speech discrimination score of preoperative levels. In 55% of cases there was no change in the hearing class, as defined by the American Academy of Otolaryngology-Head and Neck Surgery. Of the 11 patients who underwent bilateral operations, 9 (82%) retained some hearing bilaterally. After 1-year follow-up periods (mean, 12.8 mo), 87.5% of patients exhibited normal facial nerve function (House-Brackmann Grade I).

CONCLUSION
Early surgical intervention to treat acoustic tumors among patients with neurofibromatosis Type 2 is a feasible treatment strategy, with high rates of hearing and facial nerve function preservation.
Long-term Outcome of 104 Patients after Lumbar Sequestrectomy According to Williams
Authors: Wenger Markus , Mariani Luigi , Kalbarczyk Andreas , Gröger Uli 
Published: July 2004

AbstractOBJECTIVEThe authors report the late outcome of 104 consecutive patients after Williams' sequestrectomy for virgin lumbar disc herniation.METHODSThe clinical records and the mailed questionnaires of 38 women and 66 men operated consecutively between March 1991 and November 1993 were analyzed retrospectively. In these 104 patients, 105 Williams' sequestrectomies were performed.RESULTSThe mean age at operation was 50.5 years (range, 23.2–86.7 yr), and follow-up ranged from 4.1 to 6.9 years (mean, 5.3 yr). Success rates, including excellent, good, and fair results, were 92.5%, 94.7%, and 93.3% for lumbalgia, radicular pain, and neurological dysfunction, respectively. Only a few patients did not improve or presented with worsened symptoms. Three of four patients with cauda equina syndrome recovered immediately after the intervention. There were eight (7.7%) minor postoperative complications, which were treated conservatively. Three women and three men (5.8%) underwent a revision procedure for a recurrent lumbar disc herniation at the same level after 0.4 to 3.1 years (mean, 1.8 yr). Two (1.9%) of these patients underwent further operations because of reherniation, and they required internal instrumentation eventually because of failed back surgery syndrome.CONCLUSIONWilliams' conservative approach with sequestrectomy alone is a safe operative modality. It should be used whenever possible. As demonstrated in our series with a long follow-up time, the results are as favorable as or better than results after standard microsurgical lumbar discectomy with curettement of the interspace. Whether the incidence of failed back surgery syndrome can be reduced by this approach remains to be proved.
Middle Meningeal Origin of the Ophthalmic Artery
Authors: Liu Qingliang , Rhoton Albert L. 
Published: July 2004

Abstract

OBJECTIVE
To examine the microsurgical anatomy and clinical significance of an anomalous origin of the ophthalmic artery from the middle meningeal artery.

METHODS
In the course of an anatomic study of the cavernous sinus, an anomalous ophthalmic artery arising from the middle meningeal artery was found. To further define the anatomy of the region, five additional skulls, in which the arteries and veins were injected with colored latex, were dissected using 3× to 40× magnification.

RESULTS
The anomalous ophthalmic artery arose from the frontal branch of the middle meningeal artery, passed through the superior orbital fissure, and supplied the entire contents of the orbit, as well as giving rise to the central retinal artery. This study provides the first display of this anomaly in an anatomic dissection.

CONCLUSION
The ophthalmic artery may infrequently arise from the middle meningeal artery. This anomaly places the ophthalmic artery at risk during procedures in which the dura is elevated from the greater and lesser wings of the sphenoid or when the sphenoid ridge is removed and during embolization procedures involving the branches of the external carotid artery.
Isolated, Primary Extranodal Hodgkin's Disease of the Spine: Case Report
Authors: Citow Jonathan S. , Rini Brian , Wollmann Robert , Macdonald R. Loch 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE
To describe an unusual case of isolated, primary spinal Hodgkin's disease to draw attention to this disease as a possible diagnosis in patients with mixed inflammatory cell infiltrate lesions located in the spine.

CLINICAL PRESENTATION
A 54-year-old African American woman presented with back pain and progressive lower-extremity weakness as a result of spinal cord compression from Hodgkin's disease of the thoracic vertebrae.

INTERVENTION
The patient underwent decompressive surgery with stabilization, then was incorrectly treated with antituberculosis medication. When the disease progressed, later investigations revealed Hodgkin's disease, which responded to a course of radiation therapy. An extensive examination failed to detect lymphoma elsewhere.

CONCLUSION
Isolated, primary extranodal Hodgkin's disease of the spine is extremely rare. Seven other cases were reported in 1954. Although the Hodgkin's disease in these cases may arise in the bone of the spine, the possibility of origin in the paraspinous soft tissues also cannot be excluded.
Blood Clot Resolution in Human Cerebrospinal Fluid: Evidence of First-order Kinetics
Authors: Naff Neal J. , Williams Michael A. , Rigamonti Daniele , Keyl Penelope M. , Hanley Daniel F. 
Published: July 2004

Abstract

OBJECTIVE
To determine the kinetics of blood clot resolution in human cerebrospinal fluid.

METHODS
Computed tomographic scans of 17 adult patients with intraventricular hemorrhages were analyzed. Intraventricular clot volume was determined and analyzed over time to determine both a standardized percentage rate and an absolute rate of clot resolution. Results were analyzed by use of regression for cross sectional time-series data. To determine the kinetics of intraventricular clot resolution, the effect of the clot volume on the percentage rate of clot resolution, clot half-life, and absolute rate of clot resolution was analyzed. The potential effect of age, sex, type of hemorrhage, and treatment with external ventricular drainage on the percentage rate of clot resolution was assessed.

RESULTS
The percentage rate of clot resolution was 10.8% per day (95% confidence interval, 9.05–12.61%), and it was independent of initial clot volume, age, sex, type of underlying hemorrhage, and use of external ventricular drainage. The absolute rate of clot resolution varied directly with the maximal clot volume (R2 = 0.88;P &lt; 0.001). The percentage clot resolution data are consistent with events during the first 24 to 48 hours that antagonize clot resolution.

CONCLUSION
These findings demonstrate that intraventricular blood clot resolution in patients with intraventricular hemorrhage follows first-order kinetics. The thrombolytic enzyme system responsible for intraventricular clot resolution seems to be saturated at 24 to 48 hours after the initial hemorrhage.
Successful Surgical Relief of Seizures Associated with Hamartoma of the Floor of the Fourth Ventricle in Children: Report of Two Cases
Authors: Delalande Olivier , Rodriguez Diana , Chiron Catherine , Fohlen Martine 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE
To discuss the physiopathology and surgical handling of seizures due to hamartoma of the floor of the fourth ventricle in two children.

CLINICAL PRESENTATION
Two girls aged 3 years at the time of their operations presented with seizures due to a lesion of the floor of the fourth ventricle. The seizures began within the first days of life and consisted of hemifacial contraction, then head deviation, blinking of the eyelids, and intermittent dysautonomic manifestations. The interictal neurological condition seemed normal in one patient and showed a slight development delay in the other. An ictal electroencephalogram showed slow waves in the posterior areas. A magnetic resonance imaging scan revealed a mass that remained unchanged on serial examinations bordering the fourth ventricle, with an isointense signal on T1-weighted sequences and high-intensity signals on T2-weighted sequences without gadolinium enhancement. An ictal single-photon emission computed tomographic scan showed hyperperfusion in the lesion in both girls.

INTERVENTION
The operation consisted of resection and disconnection of the lesion. An electrical recording was obtained in one patient during the operation while she was anesthetized; the recording, made by means of a depth electrode with five contacts inside the lesion, indicated that repetitive θ rhythmic discharges were present. Neuropathology was consistent with a hamartoma. In both girls, the seizures disappeared after their operations, and antiepileptic drugs were withdrawn (follow-up periods, 8 and 3 yr, respectively).

CONCLUSION
Considering the results of single-photon emission computed tomography, the intralesional electrical record, and the relief of seizures after the operation, we postulate that the seizures arose from inside the lesion. This particular kind of noncortical seizure is similar to gelastic seizure due to hypothalamic hamartoma.
Bilateral Resective Epilepsy Surgery in a Child with Tuberous Sclerosis: Case Report
Authors: Romanelli Pantaleo , Weiner Howard L. , Najjar Souhel , Devinsky Orrin 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE
Surgical intervention can reduce the burden of seizures in selected patients with tuberous sclerosis and medically refractory epilepsy.

CLINICAL PRESENTATION
A child presented with tuberous sclerosis and severe epilepsy beginning in the first month of life and delayed development before 1 year of age. Video-electroencephalographic monitoring at the age of 1 year revealed a left temporal seizure focus. Repeat video-electroencephalography at 2 years of age revealed a right posterior quadrant seizure focus. Bilateral subdural electrodes were placed, confirming independent seizure onsets from the right parietal area (overlying a tuber) and prominent interictal activity over the left superior temporal region.

INTERVENTION
The right parietal focus was resected, and electrodes were maintained over the left temporal focus. After right parietal resection, ictal discharges were recorded over the left temporal region; a corticectomy was performed 2 days later. No tonicoclonic or complex partial seizures have occurred during a follow-up period of more than 24 months. Simple partial motor seizures involving the right foot have been reduced by more than 80%, and other simple partial seizures have been eliminated. Postoperatively, there has been marked improvement in the patient's cognitive and motor developmental status.

CONCLUSION
In selected patients with bilateral seizure foci involving separate lobes, aggressive bilateral surgery can be safe and effective.
Dural Reconstruction with Fascia, Titanium Mesh, and Bone Screws: Technical Note
Authors: Sekhar Laligam N. , Sarma Sajjan , Morita Akio 
Published: July 2004

Abstract

OBJECTIVE
After the resection of cranial base tumors, there may not be enough free dural margin left for reconstruction after involved bone and dura have been removed. In such a situation, dural reconstruction becomes a problem. We propose a new technique of dural closure in such cases.

METHODS
A fascial graft is prepared from either fascia lata, abdominal fascia, pericranium, or temporal fascia and is trimmed to a size slightly larger than that of the dural defect. The fascial graft is placed over the dural defect and affixed to the underlying bone with a piece of titanium mesh, titanium screws, or both. The graft is then reinforced with fibrin glue.

RESULTS
This method of dural reconstruction has been used in five patients with basal meningiomas. Three were in the petromastoid area, and two were in the planum-ethmoid area. None of these patients experienced postoperative cerebrospinal fluid leak, and none experienced any complications related to the reconstruction.

CONCLUSION
This technique of dural reconstruction can be used in selected cases of basal tumors without enough free dural margin to sew into a fascial graft.
The Göteborg Cohort of Embolized Cerebral Arteriovenous Malformations: A 6-year Follow-up
Authors: Wikholm Gunnar , Lundqvist Christer , Svendsen Pål 
Published: July 2004

Abstract

OBJECTIVE
To present a follow-up of the results after endovascular treatment of cerebral arteriovenous malformations (AVMs) with acrylic glue. An initial follow-up was published in 1996.

METHODS
A cohort of 150 patients with cerebral AVMs underwent embolization between 1987 and 1993. Fifty-seven patients had supplemental stereotactic irradiation, and 13 had subsequent surgery. The follow-up was carried out clinically and radiologically.

RESULTS
The mean follow-up time was 6.2 years. Only four patients were lost to follow-up. If at least 90% of the AVM had been obliterated, the clinical course was stable and there were no new manifestations from the AVM. No recanalization occurred in any AVM that had been totally obliterated with glue. For patients in whom it was not possible to totally obliterate the AVM either with glue alone or glue supplemented with stereotactic irradiation or surgery, the long-term outcome was discouraging.

CONCLUSION
Obliteration of an AVM with acrylic glue seems to offer stability. If the AVM is totally obliterated, the patient had a stable clinical course. Patients with large AVMs with minor occlusion after embolization may have a worse clinical outcome than expected.
Rupture of Intracranial Aneurysms during Endovascular Coiling: Management and Outcomes
Authors: Levy Elad , Koebbe Christopher J. , Horowitz Michael B. , Jungreis Charles A. , Pride G. Lee , Dutton Kim , Kassam Amin , Purdy Phillip D. 
Published: July 2004

Abstract

OBJECTIVE
In this study, the incidence, etiologies, and management with respect to clinical outcome of patients with iatrogenic aneurysmal rupture during attempted coil embolization of intracranial aneurysms are reviewed.

METHODS
A retrospective analysis was conducted of 274 patients with intracranial aneurysms treated with Guglielmi detachable coils over a 6-year period from 1994 to 2000. Patient medical records were examined for demographic data, aneurysm location, the number of coils deployed preceding and after aneurysmal rupture, the etiology of the rupture, and the clinical status on admission and at the time of discharge.

RESULTS
Of 274 patients with intracranial aneurysms treated with coil embolization, six (2%) had an intraprocedural rupture. Of these six, two were women and four were men. The mean age was 67 years (range, 52–85 yr). Mean follow-up time was 8 months (range, 0–25 mo). Aneurysmal rupture resulted from detachment of the last coil in three patients, detachment of the third coil (of four) in one patient, and insertion of the first coil in another patient. In one patient, the aneurysmal rupture was a result of catheter advancement before detachment of the last coil. The Glasgow Outcome Scale score at last follow-up examination was 1 in two patients, 2 in two patients, and 5 in two patients.

CONCLUSION
The rate of rupture of aneurysms during coil embolization is approximately 2 to 4%. The clinical outcome may be related to the timing of the rupture and the number of coils placed before rupture. If extravasation of contrast agent is seen, which suggests intraprocedural rupture, further coil deposition should be attempted if safely possible.