bluuebunny/crossref_metadata_2025_split huggingface dataset:
Relationship between Severity of Lumbar Disc Disease and Disability Scores in Sciatica Patients
Authors: Porchet François , Wietlisbach Vincent , Burnand Bernard , Daeppen Karine , Villemure Jean-Guy , Vader John-Paul 
Published: July 2004

AbstractOBJECTIVETo study the association between the clinical examination and the radiological assessment of lumbar disc disease in patients with sciatica.METHODSThe study included 394 consecutive sciatica patients. The patients’ disabilities were evaluated by a visual analog pain scale, the Prolo functional-economic rating scale, the modified Roland-Morris disability questionnaire, and the health-related quality of life short form (SF-36) questionnaire. Radiological imaging findings were independently classified according to the Modic criteria into five groups of increasing severity of disc disease. Stepwise multivariate logistic regression was used to determine which scores were significant independent predictors of a severe disc disease (extrusion or sequestration).RESULTSOf these patients, 9.6% had no disc disease, 3.3% had a bulging, 11.4% had a protrusion, 68.5% had an extrusion, and 7.1% had a disc sequestration. Statistically significant positive linear associations with the severity of disc disease were found for the leg pain scale, the Roland-Morris and Prolo disability scales, and the SF-36 scores related to physical functioning, physical role, and bodily pain (all P &lt; 0.005). A poor (&lt;5) Prolo score (odds ratio, 2.91; 95% confidence interval, 1.74–4.87), a higher leg pain score (odds ratio, 1.16 per centimeter increase; 95% confidence interval, 1.07–1.27), and a lower low back pain score (odds ratio, 0.90 per centimeter decrease; 95% confidence interval, 0.82–0.98) were retained in the multivariate logistic model as independent predictors of severe disc disease.CONCLUSIONThe positive correlation between disability status and imaging findings validates both assessment methods. Routine use of disability scores brings a useful contribution to the assessment of sciatica patients.
Cerebellar Hemorrhage after Spinal Surgery: Report of Two Cases and Literature Review
Authors: Friedman Jonathan A. , Ecker Robert D. , Piepgras David G. , Duke Derek A. 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE
Cerebellar hemorrhage remote from the site of surgery may complicate neurosurgical procedures. We describe our experience with two cases of cerebellar hemorrhage after spinal surgery and review the three cases previously reported in the literature to determine whether these cases provide insight regarding the pathogenesis of remote cerebellar hemorrhage.

CLINICAL PRESENTATION
One of our patients developed cerebellar hemorrhage in the vermis and right hemisphere after transpedicular removal of a partially intradural T9–T10 herniated disc with the patient in the prone position. The other patient developed cerebellar hemorrhage in the vermis and bilateral hemispheres after L3–S1 decompression and instrumentation with the patient in the prone position, during which the dura was inadvertently opened.

INTERVENTION
The first patient was treated conservatively and had mild residual dysarthria and gait ataxia 2 months after surgery. The second patient underwent exploration and revision of the lumbar wound with primary dural repair. The cerebellar hemorrhage was treated conservatively, and the patient had mild dysarthria and ataxia 1 month after surgery.

CONCLUSION
Cerebellar hemorrhage must be considered in patients with unexplained neurological deterioration after spinal surgery. Dural opening with loss of cerebrospinal fluid has occurred in every reported case of cerebellar hemorrhage complicating a spinal procedure, supporting the hypothesis that loss of cerebrospinal fluid is central to the pathogenesis of this condition. Because remote cerebellar hemorrhage can occur after procedures with the patient in the supine, sitting, and prone positions, patient positioning seems unlikely to play a causative role in its occurrence.
Bilateral Multiple Cervical Root Avulsions without Skeletal or Ligamentous Damage Resulting from Blast Injury: Case Report
Authors: Morenski John David , Avellino Anthony M. , Elliott J. Paul , Winn H. Richard 
Published: July 2004

AbstractOBJECTIVE AND IMPORTANCEWe describe a unique case of multiple bilateral cervical root injuries without ligamentous or bony injury secondary to a sandblast accident.CLINICAL PRESENTATIONA 19-year-old man sustained a sandblast injury to his face, neck, chest, and upper extremities, with immediate loss of motor and sensory function occurring in both of his upper extremities. Cervical spine x-rays, computed tomography, and magnetic resonance imaging demonstrated no fracture, soft tissue abnormality, or malalignment. The restriction of deficits to the patient's upper extremities suggested a central cervical spinal cord injury, bilateral brachial injuries, or a conversion disorder.INTERVENTIONCervical computed tomographic myelography revealed multiple bilateral nerve root injuries.CONCLUSIONThis case report is unique in the literature in that it describes a patient with multiple cervical nerve root injuries secondary to sandblast injury without ligamentous or bony injury. Although magnetic resonance imaging remains the diagnostic modality of choice in patients with acute spinal cord injury, it is deficient in demonstrating cervical root injury in the acute setting. In this setting, computed tomographic myelography is superior.
Dissecting Aneurysms of the Bilateral Vertebral Arteries with Subarachnoid Hemorrhage: Report of Three Cases
Authors: Otawara Yasunari , Ogasawara Kuniaki , Ogawa Akira , Kogure Tetsuo 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE
Treatment of one side in cases of dissecting aneurysms of the bilateral vertebral arteries (VAs) with subarachnoid hemorrhage may result in dissection or rupture on the contralateral side.

CLINICAL PRESENTATION
Three patients presented with dissecting aneurysms of the bilateral VAs with subarachnoid hemorrhage.

INTERVENTION
Two patients underwent trapping of the ruptured VA, with side-to-side anastomosis between the bilateral posteroinferior cerebellar arteries. One patient underwent resection of the ruptured VA, with interposition of a saphenous vein graft. Two patients died as a result of rupture of the contralateral VA dissecting aneurysm after surgery. One patient demonstrated development of an unruptured dissecting aneurysm in the contralateral VA 1 month after surgery.

CONCLUSION
Surgical intervention to treat dissecting aneurysms of the bilateral VAs on one side carries the risk of rupture of the contralateral lesion. Increased hemodynamic stress may be important in the development and rupture of dissections in the contralateral VA.
Transsphenoidal Surgery for Cushing's Disease: Endocrinological Follow-up Monitoring of 82 Patients
Authors: Shimon Ilan , Ram Zvi , Cohen Zvi R. , Hadani Moshe 
Published: July 2004

Abstract

OBJECTIVE
Transsphenoidal surgery is the preferred treatment modality for adrenocorticotropic hormone-secreting pituitary adenomas. In the past 2 decades, several institutions in the United States and Europe have reported remission rates of 70 to 85% after transsphenoidal surgery for treatment of Cushing's disease. We analyzed our postoperative results for a large cohort of patients with Cushing's disease.

METHODS
Eighty-two patients with adrenocorticotropic hormone-secreting adenomas (79 microadenomas and 3 macroadenomas) underwent transsphenoidal surgery between 1990 and 2000. Seventy-seven patients were surgically treated for the first time, and 13 patients underwent reoperations (5 had undergone the first operation elsewhere) because of previous surgical failure (10 patients) or recurrence (3 patients). The mean postoperative follow-up period was 4.2 ± 2.8 years. Biochemical remission was defined as postoperative normalization of elevated 24-hour urinary free cortisol secretion and suppression of morning cortisol levels with 1 mg of dexamethasone.

RESULTS
Remission was achieved for 78% of all patients after one operation and for 62% of patients who underwent a second operation. The recurrence rate was 5%. Ten patients did not exhibit a visible tumor on magnetic resonance imaging scans, and the other patients were divided according to adenoma size (2–5 or 6–10 mm). Remission rates were similar for the three groups of patients (78–80%). Pituitary tumor stained for adrenocorticotropic hormone was detected in 78% of resected pituitary tissue specimens obtained from patients who achieved remission, compared with 53% from patients who experienced surgical failure (P = 0.06).

CONCLUSION
Our series demonstrates the efficacy of transsphenoidal surgery for Cushing's disease resulting from pituitary microadenomas. Microadenoma size had no effect on the remission rate. Reoperations are indicated after initial surgical failures.
Long-term Control of Hydrocephalus via Endoscopic Third Ventriculostomy in Children with Tectal Plate Gliomas
Authors: Wellons John C. , Tubbs R. Shane , Banks Jason T. , Grabb Brenda , Blount Jeffrey P. , Oakes W. Jerry , Grabb Paul A. 
Published: July 2004

Abstract

OBJECTIVE
We report the control of hydrocephalus in children with presumed tectal plate gliomas by the use of endoscopic third ventriculostomy (ETV).

METHODS
The hospital records, office charts, and imaging studies from children who underwent ETV at the Children's Hospital of Alabama were reviewed. Thirteen children with the diagnosis of tectal plate glioma and hydrocephalus were identified. ETV was the primary therapy instituted for all but one of these children. Successful treatment outcome was defined as shunt freedom, improvement in symptoms, and reduced ventricular size.

RESULTS
Thirteen children underwent a total of 15 ETVs, and all children were shunt-free at their most recent follow-up examinations. One child underwent successful secondary ETV, one child underwent shunt removal concomitant with the initial ETV, and one child underwent shunt removal concomitant with secondary ETV. Symptoms and signs resolved in all patients. All postoperative cranial imaging studies revealed normal or reduced ventricular size as compared with preoperative cranial imaging scans. The median follow-up period was 31 months.

CONCLUSION
In our surgical experience, ETV has been uniformly successful in the management of hydrocephalus caused by tectal plate gliomas in children. ETV should be considered the treatment of choice for hydrocephalus in pediatric patients with tectal plate gliomas.
Transsphenoidal Microsurgery
Authors: Ciric Ivan , Rosenblatt Sami , Zhao Jin-Chen 
Published: July 2004

Abstract
TRANSSPHENOIDAL MICROSURGERY IS a well-established neurosurgical procedure that has become the standard of care in the management of the majority of pituitary tumors and a select group of other sellar lesions. The safety of the procedure depends on the surgeon's adherence to certain anatomic concepts. Foremost among these concepts is the necessity of preserving the integrity of the arachnoid membrane covering the tumor dome and avoiding vascular injuries in the cavernous sinus. The objective of this article is to demonstrate the sequential steps of a transsphenoidal microsurgical procedure for the removal of a pituitary tumor in light of the anatomic concepts discussed, with the goal of preventing complications and achieving the best possible outcome.
Ventriculostomy-related Infections: A Critical Review of the Literature
Authors: Lozier Alan P. , Sciacca Robert R. , Romagnoli Mario F. , Connolly E. Sander 
Published: July 2004

Abstract

OBJECTIVE
To provide a critical evaluation of the published literature describing risk factors for ventriculostomy-related infections (VRIs) and the efficacy of prophylactic catheter exchange.

METHODS
A MEDLINE literature search was performed, and data were extracted from studies published from 1941 through 2001.

RESULTS
Published criteria for diagnosing VRIs are highly variable. Intraventricular hemorrhage, subarachnoid hemorrhage, cranial fracture with cerebrospinal fluid leak, craniotomy, systemic infections, and catheter irrigation all predispose patients to the development of VRIs. Extended duration of catheterization is correlated with an increasing risk of cerebrospinal fluid infections during the first 10 days of catheterization. Prophylactic catheter exchange does not modify the risk of developing later VRIs in retrospective studies.

CONCLUSION
Categorizing suspected cerebrospinal fluid infections as contaminants, colonization, suspected or confirmed VRIs, or ventriculitis more accurately describes the patient's clinical condition and may indicate different management strategies. A prospective, randomized clinical trial is required to further evaluate the efficacy of prophylactic catheter exchange in limiting the incidence of VRIs during prolonged catheterization. Although prophylactic catheter exchange remains a practice option, the available data suggest that this procedure is not currently justified.
The Role of Radiosurgery for the Treatment of Pineal Parenchymal Tumors
Authors: Hasegawa Toshinori , Kondziolka Douglas , Hadjipanayis Constantinos G. , Flickinger John C. , Lunsford L. Dade 
Published: July 2004

Abstract

OBJECTIVE
Radiosurgery is an appealing alternative management strategy for selected patients with biopsy-proved pineal parenchymal tumors. The purpose of this report was to clarify its role in conjunction with other surgical, radiation, and medical approaches.

METHODS
We retrospectively evaluated 16 patients who had undergone radiosurgery as the primary or adjuvant treatment for pineal parenchymal tumors. Ten patients (62.5%) had pineocytomas, two (12.5%) had mixed pineocytoma and pineoblastoma, and four (25%) had pineoblastomas. The mean marginal dose was 15 Gy, and the mean tumor volume was 5.0 cm3. The mean follow-up periods from the time of diagnosis or the time of radiosurgery were 61 and 52 months, respectively.

RESULTS
The overall actuarial 2- and 5-year survival rates after diagnosis were 75.0 and 66.7%, respectively. In 14 patients who were evaluated with imaging, 4 (29%) demonstrated complete remission, 8 (57%) had partial remission, 2 (14%) had no change, and no patient had local progression. The local tumor control rate (complete remission, partial remission, or no change) was 100%. Five patients died during follow-up. One patient with a pineocytoma and three patients with pineoblastomas died secondary to leptomeningeal or extracranial spread tumor. No cause of death was established for one patient. Two patients developed adverse radiation effects after radiosurgery.

CONCLUSION
Our initial experience suggests that stereotactic radiosurgery is a valuable primary management modality for patients with pineocytomas. As adjuvant therapy, radiosurgery may be used to boost local tumor dose during multimodality management of malignant pineal parenchymal tumors.
Management of Intracranial Vertebral Artery Dissections Initially Presenting without Subarachnoid Hemorrhage
Authors: Naito Isao , Iwai Tomoyuki , Sasaki Tomio 
Published: July 2004

Abstract

OBJECTIVE
The clinical and angiographic follow-up results for intracranial vertebral artery (VA) dissections that initially presented without subarachnoid hemorrhage (SAH) were retrospectively investigated, to clarify their management.

METHODS
Twenty-one patients with VA dissections that initially presented without SAH were studied. Initial angiography revealed aneurysmal dilation in 11 cases (typical pearl-and-string sign in 8 cases, aneurysmal dilation only in 2, and aneurysmal dilation with double-lumen sign in 1), occlusion in 7, double-lumen sign in 2, and string-like stenosis in 1. Nine patients (six with pearl-and-string sign, one with occlusion with aneurysmal dilations, and two with double-lumen sign), including three patients who experienced subsequent SAH, underwent endovascular proximal parent artery occlusion. The other 12 patients were treated conservatively. All patients were monitored with magnetic resonance angiography or digital subtraction angiography.

RESULTS
Three patients experienced subsequent SAH, 1 day (two patients) or 51 months after onset. Follow-up angiographic assessments of the 20 patients demonstrated complete resolution in five cases, reduction of aneurysmal dilation in one case, and partial recanalization in one case. However, enlargement or formation of an aneurysmal dilation was recognized in four cases and progression of dissection was observed in one case. Eighteen patients experienced good recoveries, and three patients demonstrated moderate disabilities as a result of the initial ischemic insult.

CONCLUSION
The risk of bleeding from unruptured VA dissections is higher than previously considered. Therefore, endovascular treatment should be considered for patients with VA dissections with relatively large or growing aneurysmal dilations.
Evaluation of Vasospasm after Subarachnoid Hemorrhage by Use of Multislice Computed Tomographic Angiography
Authors: Otawara Yasunari , Ogasawara Kuniaki , Ogawa Akira , Sasaki Makoto , Takahashi Kei 
Published: July 2004

Abstract

OBJECTIVE
Multislice computed tomographic angiography (CTA) can provide clearer vascular images, even of the peripheral arteries, than conventional CTA. Multislice CTA was compared with digital subtraction angiography (DSA) for the detection of cerebral vasospasm in patients with acute aneurysmal subarachnoid hemorrhage (SAH) to analyze whether multislice CTA can replace DSA in the detection of vasospasm after SAH.

METHODS
Within 72 hours after the onset of symptoms, multislice CTA and DSA were performed in 20 patients with SAH. Multislice CTA and DSA were repeated on Day 7 to assess cerebral vasospasm. Regions of interest were established in the proximal and distal segments of the anterior and middle cerebral arteries on both multislice CTA and DSA images, and the agreement between the severity of vasospasm on multislice CTA and DSA images was statistically compared. The multislice Aquilon computed tomography system (Toshiba, Inc., Tokyo, Japan) used the following parameters: 1 mm collimation and 3.5 mm per rotation table increment (pitch, 3.5).

RESULTS
The degree of vasospasm as revealed by multislice CTA correlated significantly with the degree of vasospasm revealed by DSA (P &lt; 0.0001). The agreement between the severity of vasospasm on multislice images obtained via CTA and DSA in the overall, proximal, and distal segments of the cerebral arteries was 91.6, 90.8, and 92.3%, respectively.

CONCLUSION
Multislice CTA can detect angiographic vasospasm after SAH with accuracy equal to that of DSA.
Increased Expression of Phosphorylated c-Jun Amino-terminal Kinase and Phosphorylated c-Jun in Human Cerebral Aneurysms: Role of the c-Jun Amino-terminal Kinase/c-Jun Pathway in Apoptosis of Vascular Walls
Authors: Takagi Yasushi , Ishikawa Masatsune , Nozaki Kazuhiko , Yoshimura Shinichi , Hashimoto Nobuo 
Published: July 2004

Abstract

OBJECTIVE
Vascular remodeling via apoptotic mechanisms is an important factor in vascular diseases. c-Jun amino-terminal kinase (JNK) is a member of the mitogen-activated protein kinase family and initiates apoptosis mainly via phosphorylation of the c-Jun transcription factor. We performed this study to clarify the roles of the JNK/c-Jun pathway and apoptosis in the pathogenesis of cerebral aneurysms.

METHODS
Cerebral aneurysms from 12 patients and control vessels from 5 patients were studied. We analyzed the expression of phosphorylated JNK and phosphorylated c-Jun in cerebral aneurysms by using immunohistochemical methods.

RESULTS
Immunoreactivity for phosphorylated JNK and phosphorylated c-Jun was increased in the vascular walls of the cerebral aneurysms studied. Immunoreactivity for single-stranded deoxyribonucleic acid (a marker of deoxyribonucleic acid damage) was also increased in aneurysmal tissue, compared with control vessels, and was colocalized with that for phosphorylated JNK and phosphorylated c-Jun in smooth muscle cells.

CONCLUSION
These observations may lead to better understanding of the role of the JNK/c-Jun pathway in the development of cerebral aneurysms and to new strategies for treatment.
Optic Nerve Arteriovenous Malformation Causing Optic Apoplexy: Case Report
Authors: Muragaki Yoshihiro , Ujiie Hiroshi , Ohno Masayuki , Kubo Osami , Hori Tomokatsu 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE
Vascular malformations in the optic pathway are rare. Only one case of pathologically confirmed arteriovenous malformation (AVM) of the optic nerve has been reported previously. We document the case of a patient with an optic nerve AVM who presented with optic apoplexy that was diagnosed with the use of magnetic resonance imaging.

CLINICAL PRESENTATION
A 15-year-old girl developed left visual disturbance of sudden onset while playing badminton. A magnetic resonance imaging scan disclosed left optic nerve swelling and intraoptical hemorrhage, although an angiogram did not reveal abnormal vessels.

INTERVENTION
The patient underwent total removal of the hematoma and tangles of the abnormal vessels in the left optic nerve, which was diagnosed pathologically as an AVM. The patient recovered visual acuity, but the left visual field defect remained unchanged.

CONCLUSION
Along with cavernous malformations and optic gliomas, AVMs can be a rare cause of optic nerve apoplexy. T2-weighted magnetic resonance imaging is useful in rendering the diagnosis of an optic nerve AVM, observed as a mass lesion consisting of serpiginous, tangled, low-intensity bands. Early surgical treatment is recommended to obtain a rapid recovery.
Intrasellar Pleomorphic Xanthoastrocytoma: Case Report
Authors: Arita Kazunori , Kurisu Kaoru , Tominaga Atsushi , Sugiyama Kazuhiko , Sumida Masayuki , Hirose Takanori 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE
A patient with a primary intrasellar pleomorphic xanthoastrocytoma is described.

CLINICAL PRESENTATION
A 78-year-old woman experienced slowly progressing bilateral visual disturbance. Analysis of magnetic resonance imaging scans indicated a well-enhanced tumor occupying intra- and suprasellar spaces with displacement of the pituitary gland anteriorly.

INTERVENTION
Partial resection of the tumor via the transsphenoidal route brought about improvement of the patient's visual disturbance. The tumor was conspicuously pleomorphic and composed of plump to spindle-shaped large and bizarre cells with single or multiple nuclei and lipid-laden foamy cytoplasm. The neoplastic cells were positive for glial fibrillary acidic protein, S-100 protein, and vimentin. The MIB-1 antibody labeling index was very low (&lt;1%)

CONCLUSION
Pleomorphic xanthoastrocytoma should be included in the differential diagnosis of tumors arising in the posterior hypophysis.