bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mycotic Aneurysm of the Carotid Bifurcation in the Neck: Case Report and Review of the Literature
Authors: Nader Remi , Mohr Gérard , Sheiner Nathan M. , Tampieri Donatella , Mendelson Jack , Albrecht Steffen 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE
Mycotic aneurysms of the extracranial carotid artery are rare and difficult to diagnose. A search of the world literature published since 1966 reveals at least six cases of mycotic carotid aneurysms due to a Salmonella septicemia. We present an exceptional case of mycotic pseudoaneurysm of the bifurcation of the carotid artery due to Salmonella septicemia and discuss the pathogenesis as well as various aspects of the diagnosis and surgical management.

CLINICAL PRESENTATION
A 68-year-old man presented in Poland with Salmonella sepsis; 1 month later, he was admitted to the emergency department of the Sir Mortimer B. Davis-Jewish General Hospital in Montreal with a bulky and pulsatile right cervical mass. An angiogram and a computed tomographic scan revealed a voluminous and partially thrombosed aneurysm the size of a tangerine originating from the posterior aspect of the carotid junction.

INTERVENTION
Balloon trapping was attempted at the Montreal Neurological Hospital. Subsequently, the patient developed a significant neurological deficit, which was quickly reversed by the administration of hypertensive, hypervolemic, and hemodilution therapy. Thereafter, the pseudoaneurysm was resected surgically, and the internal and external carotid arteries were sacrificed. Pathological examination of the excised specimen of the carotid junction revealed a pseudoaneurysm. Bacterial culture of the lesion showed growth of Salmonella.

CONCLUSION
The postoperative course was satisfactory except for laryngeal paralysis due to involvement of the vagus nerve. Four months later, a computed tomographic scan showed only small lacunae in both centra semiovale.
Carotid Endarterectomy with External Shunt: A New Device and Indication for Use: Technical Note
Authors: Uno Masaaki , Nishi Kyoko , Shinno Kiyohito , Nagahiro Shinji 
Published: July 2004

Abstract

OBJECTIVE
We designed a new external shunt system and evaluated its indications and efficacy in patients undergoing carotid endarterectomy (CEA).

METHODS
In 8 of 332 CEA procedures, external shunts were placed between the common carotid artery and the internal carotid artery (ICA). This procedure was implemented for one of two indications: 1) a change in electroencephalographic and/or somatosensory evoked potential readings immediately after ICA occlusion, or 2) elongation of the ICA made safe insertion of an internal shunt impossible. In addition, a shunt was placed between the common carotid artery and the external carotid artery to establish collateral circulation from the external carotid artery to the intracranial circulation, which is essential during ICA occlusion.

RESULTS
All external shunts were functional, and electroencephalography and somatosensory evoked potentials demonstrated no significant abnormalities during the CEAs. All patients awoke from surgery without manifestation of new neurological deficits.

CONCLUSION
Our new external shunt device proved safe and efficacious in cases that did not permit the placement of an internal shunt.
Venous Congestion Is a Major Cause of Neurological Deterioration in Spinal Arteriovenous Malformations
Authors: Kataoka Hiroharu , Miyamoto Susumu , Nagata Izumi , Ueba Tetsuya , Hashimoto Nobuo 
Published: July 2004

Abstract

OBJECTIVE
Although venous congestion is considered to be a major cause of progressive myelopathy in patients with spinal dural arteriovenous fistulae (DAVFs), the neurological deterioration in patients with spinal intradural arteriovenous malformations (AVMs) has been attributed to hemorrhage or to vascular steal. To reexamine this theory, we analyzed our own cases of spinal vascular diseases.

METHODS
In 24 patients with spinal vascular diseases, those who demonstrated progressive myelopathy with T2 hyperintensity in the spinal cord on magnetic resonance imaging (MRI) were diagnosed as patients with congestive myelopathy. We further examined the clinical courses, MRI findings, and reversibility of these cases.

RESULTS
Venous congestion was judged to be a cause of neurological deterioration in 13 patients (7 DAVFs, 6 intradural AVMs). The T2 signals on these patients' MRI scans were located in the center and extended over several levels not corresponding to distribution of ischemia due to arterial steal. Of the patients who were diagnosed with congestive myelopathy, no differences between those with DAVFs and those with intradural AVMs were apparent in terms of clinical manifestations and reversibility. Eight (four DAVFs, four intradural AVMs) of 13 patients experienced neurological improvement after treatment. All patients with poor outcomes had intervals from onset of more than 3 years and showed contrast enhancement of the spinal cord on MRI studies.

CONCLUSION
Spinal intradural AVMs as well as spinal DAVFs can be a cause of venous congestive myelopathy. Regardless of its etiology, congestive myelopathy is potentially reversible if properly diagnosed and treated.
Radiosurgery for the Treatment of Recurrent Central Neurocytomas
Authors: Anderson Richard C. , Elder James B. , Parsa Andrew T. , Issacson Steven R. , Sisti Michael B. 
Published: July 2004

Abstract

OBJECTIVE
Central neurocytomas are benign neoplasms with neuronal differentiation typically located in the lateral ventricles of young adults. Although the treatment of choice is complete surgical excision, patients may experience local recurrence. Adjuvant therapy for patients with residual or recurrent tumor has included reoperation, radiotherapy, or chemotherapy. To avoid the side effects of conventional radiotherapy in young patients, we present a series of patients with clear evidence of tumor progression who were treated with gamma knife radiosurgery.

METHODS
Four patients (ages 20–49 yr; mean, 28 yr) who presented with an intraventricular mass on magnetic resonance imaging scans and underwent craniotomy for tumor resection were reviewed retrospectively. Histopathological analysis confirmed central neurocytoma in all cases. Each patient was followed up clinically and radiographically with serial magnetic resonance imaging. When radiographic signs of tumor progression were evident, patients were treated with radiosurgery.

RESULTS
Complete radiographic tumor resection was achieved in all patients. There were no major postoperative complications. Local tumor progression was detected on magnetic resonance imaging scans 9 to 25 months after surgery (median, 17.5 mo). All patients achieved complete response to radiosurgery with reduction in tumor size. There have been no complications from radiosurgery. Follow-up ranged from 12 to 28 months (mean, 16.5 mo) after radiosurgery, and from 24 to 84 months (mean, 54.5 mo) after initial presentation.

CONCLUSION
Radiosurgery with the gamma knife unit provides safe and effective adjuvant therapy after surgical resection of central neurocytomas. Radiosurgery may eliminate the need for reoperation and avoid the possible long-term side effects from conventional radiotherapy in young patients.
Treatment of Idiopathic Trigeminal Neuralgia: Comparison of Long-term Outcome after Radiofrequency Rhizotomy and Microvascular Decompression
Authors: Tronnier Volker M. , Rasche Dirk , Hamer Jürgen , Kienle Anna-Lena , Kunze Stefan 
Published: July 2004

Abstract

OBJECTIVE
To evaluate the long-term outcome of patients after either percutaneous trigeminal rhizotomy or microvascular decompression (MVD) for idiopathic trigeminal neuralgia at a single institution.

METHODS
From 1977 to 1997, 316 radiofrequency lesion procedures and 378 MVDs were performed. Questionnaires were sent to all patients who were alive in 1981, 1982, 1992, and 1998. For all other patients, interviews were conducted with their relatives and general practitioners. A retrospective comparative analysis was performed with Kaplan-Meier probability curves as of the latest follow-up date. In addition, 80 patients who underwent MVD were examined postoperatively with quantitative sensory measurements by use of von Frey hairs.

RESULTS
Two hundred twenty-five patients who underwent MVD and 206 patients who underwent radiofrequency could be analyzed retrospectively in detail. Overall, there was a 50% risk for recurrence of pain 2 years after percutaneous radiofrequency rhizotomy. Conversely, 64% of patients who underwent MVD remained completely pain free 20 years postoperatively. Patients without sensory impairment after MVD were pain free significantly longer than patients who experienced postoperative hypesthesia or partial rhizotomy.

CONCLUSION
Because it is curative and nondestructive, MVD is considered the treatment of choice for trigeminal neuralgia in otherwise healthy people. In our study, it proved to be a more effective and long-lasting procedure for patients with typical trigeminal neuralgia than radiofrequency rhizotomy. Patients without postoperative sensory deficit remained pain free significantly longer, which is a strong argument against the “trauma” hypothesis of this procedure.
Microsurgery for Cerebral Arteriovenous Malformations: A Dissection Technique and Its Theoretical Implications
Authors: Hashimoto Nobuo 
Published: July 2004

Abstract
SURGICAL RESECTION OF cerebral arteriovenous malformations is often complicated by persistent bleeding from the nidus, which is difficult to manage. It has often been mentioned that the difficulty of hemostasis is caused by the fragile and pathological nature of vessels of the nidus. This may be one reason, but I hypothesize that the dissection procedure, which involves coagulation of the surface of the nidus, may cause obstruction of intranidal drainage and that this may cause increased intranidal pressure, especially at the late stage of resection. In operating on patients with cerebral arteriovenous malformations recently, I made an effort not to coagulate the surface of the nidus, and this technique has diminished hemorrhage problems effectively. I illustrate this technique herein with a resected specimen and plastic casts of the lesion.
Fluoroscopic Frameless Stereotaxy for Transsphenoidal Surgery
Authors: Jane John A. , Thapar Kamal , Alden Tord D. , Laws Edward R. 
Published: July 2004

Abstract

OBJECTIVE
To assess the value of frameless fluoroscopy-guided stereotactic transsphenoidal surgery using the FluoroNav Virtual Fluoroscopy System (Medtronic Sofamor Danek, Inc., Memphis, TN).

METHODS
Twenty consecutive patients undergoing transsphenoidal surgery for sellar lesions were assigned to transsphenoidal surgery with or without computer-assisted fluoroscopic image guidance using the FluoroNav system. Prospective data regarding patient age, sex, lesion characteristics, operative time, and treatment cost were obtained.

RESULTS
Although patients in the FluoroNav group were, on average, 17 years younger than the patients in the control group, more patients with recurrent adenomas were treated in the image guidance group. No other significant differences between the groups were found. FluoroNav provided accurate, continuous information regarding the anatomic midline trajectory to the sella turcica as well as anatomic structures (e.g., sella, sphenoid sinus) in the lateral view. No patient required reversion to intraoperative videofluoroscopy. No statistically significant differences were found with regard to preincision setup time, operative time, or cost. FluoroNav allowed procedures to be performed with significantly fewer x-rays being taken.

CONCLUSION
Fluoroscopic computer-assisted frameless stereotaxy furnishes accurate real-time information with regard to midline structures and operative trajectory. Although it is useful in first-time transseptal transsphenoidal surgery, its primary benefit is realized in recurrent surgery.
Combined Oligodendroglioma/Pleomorphic Xanthoastrocytoma: A Probable Collision Tumor: Case Report
Authors: Perry Arie , Scheithauer Bernd W. , Szczesniak David M. , Atkinson John L.D. , Wald John T. , Hammak Julie E. 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE
We report the first case of combined oligodendroglioma and pleomorphic xanthoastrocytoma.

CLINICAL PRESENTATION
A female college student and competitive cross-country runner presented to the Mayo Clinic at age 18 years with complaints of progressive headache and visual disturbances. Neuroimaging revealed a heavily calcified left parieto-occipital mass with focal enhancement and remodeling of the overlying calvarium.

INTERVENTION
A histological examination of the nearly gross total resection specimen disclosed a low-grade oligodendroglioma discretely abutting a superficially situated focus of pleomorphic xanthoastrocytoma. Ten months thereafter, a recurrence was suspected on the basis of the detection of a new focus of nodular enhancement. This lesion stabilized after radiation therapy, and the patient is well, without apparent residual disease 2.8 years after surgery.

CONCLUSION
This unique neoplasm is presumed to represent a collision tumor, its biological behavior being similar to that of oligodendroglioma alone. However, the possibility of an unusual, mixed oligoastrocytoma with pleomorphic xanthoastrocytoma as the astrocytic component cannot be excluded entirely. Potentially, both components have the capacity for recurrence and anaplastic transformation.
Meningeal Solitary Fibrous Tumor as an Unusual Cause of Exophthalmos: Case Report and Review of the Literature
Authors: Ahn Jung Yong , Shim Jeong Yun , Yang Woo Ick , Kim Tai Seung 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE
We report an extremely rare case of a patient with meningeal solitary fibrous tumor with orbital involvement presenting as unilateral exophthalmos. This rare tumor should be considered in the differential diagnosis for aggressive dural-based lesions.

CLINICAL PRESENTATION
A 54-year-old man presented with a protruded eyeball on the right side and left hemiparesis. Computed tomography and magnetic resonance imaging demonstrated a huge mass, markedly enhanced in and around the right anterior clinoid process, which extended to the orbit and middle cranial fossa. Cerebral angiography revealed a richly vascular tumor fed by branches of both the right external and internal carotid arteries. A presumptive diagnosis of meningioma or hemangiopericytoma was considered.

INTERVENTION
The tumor was exposed through an orbitozygomatic approach. At surgery, the tumor was grossly firm to hard and had destroyed the dura, orbital roof, anterior clinoid process, temporal bone, and muscle. Histological analysis revealed that the tumor was composed of spindle-cell proliferation in a collagen-rich background, but it exhibited regional variations. The vascular network demonstrated irregular vascular lumina with a “hemangiopericytoma-like” pattern. Histological features included high cellularity and a high degree of pleomorphism. Immunohistochemical analysis of the tumor demonstrated diffuse positive staining for CD34 and vimentin. The tumor displayed no positive staining for cytokeratin, epithelial membrane antigen, glial fibrillary antigenic protein, S-100 protein, and factor XIII.

CONCLUSION
Meningeal solitary fibrous tumor is considered a unique pathological entity. Wider use of immunohistochemical screening should enable analysis of the real incidence of these tumors; larger series and longer follow-up duration will allow conclusions to be drawn regarding treatment and prognosis. Differential diagnosis is discussed and the literature is reviewed.
Exclusively Epidural Arteriovenous Fistula in the Cervical Spine with Spinal Cord Symptoms: Case Report
Authors: Asai Jun-cihiro , Hayashi Takaki , Fujimoto Tsukasa , Suzuki Ryuta 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE
We describe the case of an epidural arteriovenous fistula (AVF) in the cervical spine draining only into the epidural and paravertebral plexus. An entirely epidural AVF having such drainage is extremely rare.

CLINICAL PRESENTATION
A 24-year-old man presented with a 4-month history of gradually progressive sensory and motor disturbances of the upper and lower extremities. Magnetic resonance imaging and magnetic resonance angiography revealed a peridural vascular lesion within the canal compressing the spinal cord from C5 to T2. Diagnostic angiography revealed a perimedullary and/or dural high-flow AVF, fed mainly by branches of ascending cervical and deep cervical arteries. The fistula drained into the epidural and paravertebral venous plexus without reflux into intradural venous systems.

INTERVENTION
Multiple feeders of the AVF were embolized with a Liquid coil and n-butylcyanoacrylate via a two-step procedure. One week after embolization, the AVF was surgically removed.

CONCLUSION
Interesting points of this case were the exclusively epidural location of the lesion, the exclusively epidural drainage of the AVF, and the etiology of the symptoms. Venous drainage of the fistula had no relation to any dural or intradural veins. Initially, spinal cord and nerve root compression by extradural veins with varicose dilation seemed to cause the radiculopathy and/or the myelopathy, and subsequent myelopathy caused by spinal venous hypertension was believed to be the main etiology in this case.
Temporal Clustering of Hemorrhages from Untreated Cavernous Malformations of the Central Nervous System
Authors: Barker Fred G. , Amin-Hanjani Sepideh , Butler William E. , Lyons Susan , Ojemann Robert G. , Chapman Paul H. , Ogilvy Christopher S. 
Published: July 2004

AbstractOBJECTIVEHemorrhages from cerebral cavernous malformations (CMs) sometimes seem to occur in closely spaced “clusters” interspersed with long hemorrhage-free intervals. Clustering of hemorrhages could affect retrospective assessments of radiosurgery efficacy in prevention of CM rehemorrhage. However, this empirical observation had not been tested quantitatively. To test whether CM hemorrhages tend to cluster, we reviewed pretreatment rebleeding rates after a first symptomatic hemorrhage in CM patients who later underwent surgery or radiosurgery.METHODSWe performed a retrospective review of 141 patients with CMs who presented with clinically overt hemorrhage, and who subsequently underwent surgery or proton beam radiosurgery during an 18-year period. Statistical models were used to analyze all events per person and identify potential variation in rebleeding risk with time after a previous hemorrhage.RESULTSSixty-three of 141 patients experienced a second hemorrhage before treatment; 16 had additional hemorrhages. Five hundred thirty-eight patient years elapsed between first hemorrhages and treatment. The cumulative incidence of a second hemorrhage after the first CM hemorrhage was 14% after 1 year and 56% after 5 years. During the first 2.5 years after a hemorrhage, the monthly rehemorrhage hazard was 2%. The risk then decreased spontaneously to less than 1% per month, which represents a 2.4-fold decline (P &lt; 0.001). Rehemorrhage rates were higher in younger patients (P &lt; 0.01), but not in females or in patients with deep lesions. Shorter intervals between successive hemorrhages did not predict higher subsequent rehemorrhage risk.CONCLUSIONThe rehemorrhage rate from untreated CMs is high initially, and it decreases 2 to 3 years after a previous hemorrhage. This hazard pattern generates the observed temporal clustering of hemorrhages from untreated CMs.
Measurement of Nitric Oxide and Brain Tissue Oxygen Tension in Patients after Severe Subarachnoid Hemorrhage
Authors: Khaldi Ahmad , Zauner Alois , Reinert Michael , Woodward John J. , Bullock M. Ross 
Published: July 2004

Abstract

OBJECTIVE
Nitric oxide (NO), one of the most powerful endogenous vasodilators, is thought to play a major role in the development of delayed vasospasm in patients with subarachnoid hemorrhage (SAH). However, the role of the production of cerebral NO in patients with SAH is not known. In other SAH studies, NO metabolites such as nitrite and nitrate have been demonstrated to be decreased in cerebrospinal fluid and in plasma.

METHODS
In this study, a microdialysis probe was used, along with a multiparameter sensor, to measure NO metabolites, brain tissue oxygen tension, brain tissue carbon dioxide tension, and pH in the cortex of patients with severe SAH who were at risk for developing secondary brain damage and vasospasm. NO metabolites, glucose, and lactate were analyzed in the dialysates to determine the time course of NO metabolite changes and to test the interrelationship between the analytes and clinical variables.

RESULTS
Brain tissue oxygen tension was strongly correlated to dialysate nitrate and nitrite (r2 = 0.326;P &lt; 0.001); however, no correlation was noted between brain tissue oxygen tension and NO metabolites in cerebrospinal fluid (r2 = 0.018;P = 0.734). No significant correlation between NO production, brain tissue carbon dioxide tension, and dialysate glucose and lactate was observed.

CONCLUSION
Cerebral ischemia and compromised substrate delivery are often responsible for high morbidity rates and poor outcomes after SAH. The relationship between brain tissue oxygen and cerebral NO metabolites that we demonstrate suggests that substrate delivery and NO are linked in the pathophysiology of vasospasm after SAH.
Complications of Epilepsy Surgery after 654 Procedures in Sweden, September 1990–1995: A Multicenter Study Based on the Swedish National Epilepsy Surgery Register
Authors: Rydenhag Bertil , Silander Hans C:son 
Published: July 2004

Abstract

OBJECTIVE
To present the first national multicenter study on complications after epilepsy surgery procedures to include all epilepsy surgery centers in Sweden: Göteborg, Linköping, Lund, Stockholm, Umeå, and Uppsala.

METHODS
Every epilepsy surgery procedure in Sweden is reported to the Swedish National Epilepsy Surgery Register. The report includes relevant social and medical items and complications. A complication is defined as minor if it resolves within 3 months and major if it affects activities of daily living and lasts longer than 3 months. Follow-up data are recorded for 2 years after the operation. Intrinsic checkpoints and external revision validate the register data.

RESULTS
During the inclusion period (September 1990–December 1995), 654 surgical procedures were performed (age range, 6 mo–67 yr). Of these, 205 were invasive electrode procedures (182 first investigations and 23 reinvestigations), and 449 were therapeutic procedures (375 first operations and 74 reoperations). After invasive electrode procedures, only minor complications were reported (6.3%). For all 449 therapeutic procedures (including reoperations), minor complications were reported in 8.9% and major complications in 3.1%. Only one major complication was reported in a patient under the age of 35 years.

CONCLUSION
This is the first national multicenter study on complications after epilepsy surgery. It demonstrates that these procedures as performed at six different centers in Sweden are safe, but also that risk is related to age. In patients younger than age 35 years, the risk for a major complication after invasive subdural strip electrode investigation and epilepsy surgery is low.