bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlation of Neurosurgical Subspecialization with Outcomes in Children with Malignant Brain Tumors
Authors: Albright A. Leland , Sposto Richard , Holmes Emi , Zeltzer Paul M. , Finlay Jonathan L. , Wisoff Jeffrey H. , Berger Mitchel S. , Packer Roger J. , Pollack Ian F. 
Published: September 2004

Abstract

OBJECTIVE
This study was performed to evaluate the association between the type of neurosurgeon (general or pediatric) and either the extent of tumor removal or the frequency of complications in children undergoing malignant brain tumor resections.

METHODS
Data were analyzed from three recent Children's Cancer Group studies: two on medulloblastomas/primitive neuroectodermal tumors and one on malignant gliomas. Neurosurgeons were classified as general neurosurgeons, as designated pediatric neurosurgeons in their institutions, or as members of the American Society of Pediatric Neurosurgeons (ASPN), which requires pediatric neurosurgical experience and practice standards.

RESULTS
Data forms from 732 children were analyzed; 485 were from children with medulloblastomas/primitive neuroectodermal tumors, and 247 were from children with malignant gliomas. Operations were performed by 269 neurosurgeons, including 213 general neurosurgeons, 29 designated pediatric neurosurgeons, and 27 ASPN members. The mean number of operations per surgeon was 1.8, 4.9, and 7.6 for general neurosurgeons, designated pediatric neurosurgeons, and ASPN members, respectively. There was a significant relationship between the extent of tumor resection or the amount of residual tumor and the type of neurosurgeon. Designated pediatric neurosurgeons and ASPN members were more likely to remove more than 90% of the tumor and to leave less than 1.5 cc of residual tumor than were general neurosurgeons (P &lt; 0.05). In these studies, the probability of extensive tumor removal correlated with the number of operations the neurosurgeon performed (P &lt; 0.01). Neurological complications occurred in the following proportion of cases: general neurosurgeons, 23%; designated pediatric neurosurgeons, 32%; and ASPN members, 18%.

CONCLUSION
Pediatric neurosurgeons are more likely than general neurosurgeons to extensively remove malignant pediatric brain tumors. In these tumors, extent of removal has been demonstrated to influence survival.
Molecular Insight into Medulloblastoma and Central Nervous System Primitive Neuroectodermal Tumor Biology from Hereditary Syndromes: A Review
Authors: Taylor Michael D. , Mainprize Todd G. , Rutka James T. 
Published: September 2004

AbstractTHROUGH THE STUDY of uncommon familial syndromes, physicians and scientists have been able to illuminate the underlying mechanisms of some of the more common sporadic diseases; this is illustrated best by studies of familial retinoblastoma. A number of rare familial syndromes have been described in which affected individuals are at increased risk of developing medulloblastoma and/or supratentorial primitive neuroectodermal tumors. The descriptions of many of these syndromes are based on patients observed by clinicians in their clinical practice. Determination of the underlying genetic defects in these patients with uncommon syndromes has led to identification of a number of genes subsequently found to be mutated in sporadic medulloblastomas (tumor suppressor genes). Associated genes in the same signaling pathways have also been found to be abnormal in sporadic medulloblastoma. Identification of patients with these rare syndromes is important, as they are often at increased risk for additional neoplasms, as are family members and future children. We review the published literature describing hereditary syndromes that have been associated with an increased incidence of medulloblastoma and/or central nervous system primitive neuroectodermal tumor. Review of the underlying molecular abnormalities in comparison to changes found in sporadic neoplasms suggests pathways important for tumorigenesis.
Tuberculosis of the Axis in a Patient with Systemic Sarcoidosis: Technique of Posterior Open Biopsy of the Dens: Case Report
Authors: Belanger Eric , Levi Allan D. O. 
Published: September 2004

Abstract

OBJECTIVE AND IMPORTANCE
This case report illustrates the importance of obtaining tissue from a destructive lesion of the dens in a patient with systemic sarcoidosis. Although sarcoidosis can involve the axial skeleton, tissue obtained at the time of C1–C2 fusion demonstrated unsuspected pathological features, which dramatically altered the subsequent medical treatment. The technique of open posterior biopsy of the dens is illustrated, and the advantages of the approach are discussed.

CLINICAL PRESENTATION
A 40-year-old woman with systemic sarcoidosis developed neck pain and atlantoaxial instability. Imaging revealed multiple thoracic and cervical vertebral abnormalities, including a destructive enhancing lesion involving the base of the dens.

INTERVENTION
At the time of posterior C1–C2 fusion, we elected to perform an open biopsy of the base of the dens. A 16-gauge biopsy needle was introduced along the medial portion of the left C2 pars, aiming medially toward the base of the odontoid process. This procedure was performed under direct observation, with fluoroscopic guidance. The biopsy specimen contained caseating granulomas, and cultures were positive for Mycobacterium tuberculosis.

CONCLUSION
The unusual presentation, the technique, and the importance of obtaining tissue to confirm the diagnosis of tuberculous involvement of the dens are emphasized. The relationship between sarcoidosis and tuberculosis reported in the literature is reviewed. In the current case, cell wall-positive tuberculous bacteria were cultured, confirming the presence of two separate diseases in the same patient.
Molecular Biology of Degenerative Disc Disease
Authors: Guiot Bernard H. , Fessler Richard G. 
Published: September 2004

AbstractTHE INTERVERTEBRAL DISC is a complex anatomic and biochemical structure. It is composed primarily of fibrocytes and chondrocytes that are anatomically segregated in an elaborate avascular macromolecular matrix of collagen and proteoglycans. Degenerative processes associated with aging and trauma result in morphological and molecular changes to the disc. Morphological changes are observed as dehydration, fissuring, and tearing of the nucleus, annulus, and endplates. On the molecular level, degenerative changes include decreased diffusion, decreased cell viability, decreased proteoglycan synthesis, and alteration in collagen distribution. The role of inflammatory mediators in these processes, and the potential use of growth factors to delay or reverse the degenerative cascade, is poorly understood. However, these areas are under active investigation, the results of which may soon contribute significantly to our understanding of degenerative disc disease.
Transcranial Brainstem Stab Injuries: A Retrospective Analysis of 17 Patients
Authors: Nathoo Narendra , Boodhoo Hemraz , Nadvi Syed Sameer , Naidoo Steven R. , Gouws Eleanor 
Published: September 2004

Abstract

OBJECTIVE
Transcranial stab injuries remain a frequent cause of emergent neurosurgical admissions to neurosurgical units in South Africa. Brainstem stabs are an uncommon, yet often fatal, form of brain injury.

METHODS
A retrospective audit of 597 patients with transcranial stab injuries admitted to our unit over a 12-year period (January 1987 to December 1998) identified 17 patients (2.85%) with brainstem stab injuries. The computed tomographic scans of all patients were analyzed, and a detailed autopsy examination of the skull and its contents was performed in all patients who died. Stepwise linear regression analysis was used to formulate a predictive model of outcome for the entire series of 597 patients.

RESULTS
The majority of the patients were males (16 patients), and the study group had a mean age of 28.65 ± 9.59 years and a mean Glasgow Coma Scale score of 8.59 ± 2.76. Knives (82%) were the most common instruments of penetration. Cerebral angiography identified 3 patients with vascular abnormalities, and autopsy revealed an additional 4 patients with vascular injury. Emergency ventriculostomy was performed in 10 patients for obstructive hydrocephalus. Four of the 17 patients survived (76.5% mortality). Factors significantly predictive of outcome in patients with transcranial stab injuries were the Glasgow Coma Scale score (F = 43.7), the occurrence of intraventricular hemorrhage (F = 22.8), the type of associated lesion (intracranial bleed, vascular abnormality, or brain abscess) (F = 5.9), and the number of operations (F = 3.2).

CONCLUSION
The Glasgow Coma Scale score is the most significant predictor of outcome in low-velocity transcranial stab injuries. Brainstem stab injuries have a great propensity for vascular damage. Survivors are incapacitated by severe, fixed neurological deficits.
The Efficacy and Cost of Prophylactic and Periprocedural Antibiotics in Patients with External Ventricular Drains
Authors: Alleyne Cargill H. , Hassan Mahmood , Zabramski Joseph M. 
Published: September 2004

Abstract

OBJECTIVE
Prophylactic antibiotics are routinely administered to patients with external ventricular drains (EVDs); however, no conclusive evidence supports this practice. This study compared the efficacy and cost of prophylactic and periprocedural antibiotics in patients with EVDs.

METHODS
We reviewed the charts of 308 patients who had an EVD in place for 3 or more days between January 1996 and June 1997. Patients with EVDs placed for shunt infections or meningitis were excluded. A standard protocol was used to insert and monitor EVDs. Catheters were left in place as long as clinically indicated and changed only if they malfunctioned. Cerebrospinal fluid cultures were obtained twice weekly. Prophylactic antibiotics were used at the discretion of the attending neurosurgeon. Patients were divided into two groups: Group A comprised 209 patients who received prophylactic antibiotics for the duration of the EVD (intravenously administered cefuroxime, 1.5 g every 8 h); Group B comprised 99 patients who received only periprocedural antibiotics (intravenously administered cefuroxime, 1.5 g every 8 h, three or less doses).

RESULTS
Although there were significantly more males in Group A than in Group B, the two groups were otherwise well matched, with no significant differences in age, indications, or duration of EVD placement. The overall rate of ventriculitis was 3.9%. The infection rates for Group A (3.8%) and Group B (4.0%) were almost identical.

CONCLUSION
Prophylactic antibiotics did not significantly reduce the rate of ventriculitis in patients with EVDs, and they may select for resistant organisms. Discontinuing the use of prophylactic antibiotics for EVDs at the authors' institution would save approximately $80,000 per year in direct drug costs.
Surgical Anatomic Evaluation of the Cervical Pedicle and Adjacent Neural Structures
Authors: Uğur Hasan Çağlar , Attar Ayhan , Uz Aysun , Tekdemir İbrahim , Egemen Nihat , Çağlar Sukru , Genç Yasemin 
Published: September 2004

Abstract

OBJECTIVE
Although several clinical applications of transpedicular screw fixation in the cervical spine have been documented recently, few anatomic studies concerning the cervical pedicle are available. This study was designed to evaluate the anatomy and adjacent neural relationships of the middle and lower cervical pedicle (C3–C7). The main objective is to provide accurate information for transpedicular screw fixation in the cervical region and to minimize complications by providing a three-dimensional orientation.

METHODS
Twenty cadavers were used to observe the cervical pedicle and its relationships. After removal of the posterior bony elements, including spinous processes, laminae, lateral masses, and inferior and superior facets, the isthmus of the pedicle was exposed. Pedicle width, pedicle height, interpedicular distance, pedicle-inferior nerve root distance, pedicle-superior nerve root distance, pedicle-dural sac distance, medial pedicle-dural sac distance, mean angle of the pedicle, root exit angle, and nerve root diameter were measured.

RESULTS
The results indicate that there was no distance between the pedicle and the superior nerve root and between the pedicle and the dural sac in 16 specimens, whereas there was a slight distance in the lower cervical region in the 4 other specimens. The mean distance between the pedicle and the inferior nerve root for all specimens ranged from 1.0 to 2.5 mm. The mean distance between the medial pedicle and the dural sac increased consistently from 2.4 to 3.1 mm. At C3–C7, the mean pedicle height ranged from 5.2 to 8.5 mm, and the mean pedicle width ranged from 3.7 to 6.5 mm. Interpedicular distance ranged from 21.2 to 23.2 mm. The mean root exit angle ranged from 69 to 104 degrees, with the largest angle at C3 and the smallest at C6. The mean angle of the pedicle ranged from 38 to 48 degrees. The nerve root diameter increased consistently from 2.7 mm at C3 to 3.8 mm at C6 and then decreased to 3.7 mm at the C7 level. Differences in measurements were considered statistically significant at levels ranging from P &lt; 0.05 to P &lt; 0.01.

CONCLUSION
This study indicates that improper placement of the pedicle screw medially and superiorly in the middle and lower cervical spine should be avoided and that the anatomic variations between individuals should be established by measurement.
αvβ3 and αvβ5 Integrin Expression in Meningiomas
Authors: Bello Lorenzo , Zhang Jianping , Nikas Demetrios C. , Strasser Jon F. , Villani Roberto M. , Cheresh David A. , Carroll Rona S. , Black Peter McL. 
Published: September 2004

AbstractOBJECTIVEIntegrins are emerging as alternative receptors capable of mediating several biological functions, such as cell-matrix and cell-cell adhesion, cell migration, signal transduction, and angiogenesis. Two αv integrins, i.e., αvβ3 and αvβ5, play critical roles in mediating these activities, particularly in tumors. No data are available on the expression of these integrins in meningiomas.METHODSUsing Western blot and immunohistochemical analyses with LM609 and PG32, two monoclonal antibodies capable of recognizing the functional integrin heterodimer, we evaluated the expression of αvβ3 and αvβ5 integrins in a series of 34 meningiomas of different histological subtypes and grades. We studied their expression in tumor cells and vasculature, as well as the expression of their related angiogenic factors (fibroblast growth factor 2 and vascular endothelial growth factor) and the αvβ3 ligand vitronectin.RESULTSαvβ3 and αvβ5 integrins were expressed by neoplastic vasculature and cells. αvβ3 and αvβ5 expression was associated and correlated with that of their respective growth factors (fibroblast growth factor 2 and vascular endothelial growth factor) and microvessel counts and densities. αvβ3 was more strongly expressed than αvβ5 in two cases of histologically benign meningiomas with aggressive clinical behavior. αvβ3 expression was associated with that of its related ligand vitronectin and was also evident in small vessels of brain tissue closely surrounding meningiomas.CONCLUSIONOur data demonstrate the expression of αvβ3 and αvβ5 integrins in meningioma cells and vasculature. Our findings suggest a role for both of these integrins, and particularly αvβ3, in meningioma angiogenesis.
Primary Spinal Epidural Mantle Cell Lymphoma: Case Report
Authors: Barnard Maja , Perez-Ordoñez Bayardo , Rowed David W. , Ang Lee Cyn 
Published: September 2004

Abstract

OBJECTIVE AND IMPORTANCE
Mantle cell lymphoma is a distinct clinicopathological type of non-Hodgkin's lymphoma that often presents at an advanced stage, with systemic spread. Spinal involvement is uncommon and generally occurs as part of advanced disease or generalized relapses. Primary spinal epidural lymphoma is a rare initial manifestation of non-Hodgkin's lymphoma, and mantle cell lymphoma with initial presentation in the spinal epidural space is extremely rare, having been previously reported in only two cases.

CLINICAL PRESENTATION
We report a case of a 71-year-old man who presented with increasing weakness and numbness of the legs. Magnetic resonance imaging revealed a spinal epidural mass in the lumbosacral region.

INTERVENTION
The patient underwent a partial L4 and L5–S1 laminectomy, with incomplete resection of the mass for spinal decompression and tissue diagnosis. Mantle cell lymphoma was diagnosed in the pathological examination.

CONCLUSION
After radiotherapy, the disease recurred with a soft-tissue mass in the anterior maxillary area of the face. The patient underwent restaging and was treated with chemotherapy, with only a partial response. Mantle cell lymphoma with primary spinal epidural presentation is rare. This diagnosis can be established and other causes of spinal cord compression can be ruled out by obtaining tissue for proper histopathological examinations. Because of its aggressive behavior and poor prognosis, mantle cell lymphoma should be treated using a combined-modality approach.
Nimodipine-induced Acute Hypoxemia: Case Report
Authors: Devlin John W. , Coplin William M. , Murry Kellie R. , Rengachary Setti S. , Wilson Robert F. 
Published: September 2004

Abstract

OBJECTIVE AND IMPORTANCE
Nimodipine is commonly used to improve neurological outcomes after subarachnoid hemorrhage. Although nimodipine reportedly has high specificity for the cerebral vasculature, adverse systemic effects such as hypotension have been described. This case report describes a patient with traumatic subarachnoid hemorrhage who experienced two episodes of previously undescribed, life-threatening hypoxemia that was directly related to nimodipine therapy.

CLINICAL PRESENTATION
The patient experienced acute hypoxemia (partial pressures of oxygen of 32.9 and 58.7 mm Hg), on two separate occasions (3 d apart), that was temporally related to single doses of nimodipine therapy for traumatic subarachnoid hemorrhage. Other disease- and medication-related causes did not explain these episodes.

INTERVENTION
After the inspired oxygen concentration was increased to 100% (both episodes) and the positive end expiratory pressure was increased to 7.5 mm Hg (first episode), the arterial oxygen saturation of the patient returned to baseline levels (&gt;99%) within 40 minutes in each instance. Nimodipine therapy was discontinued after each episode.

CONCLUSION
It is hypothesized that, in the presence of concomitant adult respiratory distress syndrome, nimodipine increased ventilation/perfusion ratio mismatch, through its direct vasodilatory effects on the pulmonary artery, and possibly interfered with the reflex hypoxic pulmonary vasoconstriction necessary to maintain adequate oxygenation for this patient. Clinicians should carefully monitor the oxygenation status of patients when nimodipine therapy is initiated.
Is There a Benefit of Preoperative Meningioma Embolization?
Authors: Bendszus Martin , Rao Gerad , Burger Ralf , Schaller Carlo , Scheinemann Katrin , Warmuth-Metz Monika , Hofmann Erich , Schramm Johannes , Roosen Klaus , Solymosi Laszlo 
Published: September 2004

ABSTRACT

OBJECTIVE
To evaluate the effect of preoperative embolization of meningiomas on surgery and outcomes.

METHODS
In a prospective study, 60 consecutive patients with intracranial meningiomas who were treated in two neurosurgical centers were included. In Center A, embolization was performed for none of the patients (n = 30). In Center B, 30 consecutive patients with embolized meningiomas were treated. Preoperatively, tumor size and location, neurological status, and Barthel scale score were recorded. In Center B, the extent of tumor devascularization was evaluated using angiography and postembolization magnetic resonance imaging. Intraoperatively, blood loss, the numbers of blood units transfused, and the observations of the neurosurgeon concerning hemostasis, tumor consistency, and intratumoral necrosis were recorded. Postoperatively, the neurological status and duration of hospitalization were recorded. Six months after surgery, the outcomes were assessed using the Barthel scale and neurological examinations.

RESULTS
The mean tumor sizes were 22.9 cc in Center A and 29.6 cc in Center B (P &gt; 0.1). The mean blood losses did not differ significantly (646 ml in Center A versus 636 ml in Center B;P &gt; 0.5). However, for a subgroup of patients with subtotal devascularization (&gt;90% of the tumor) on postembolization magnetic resonance imaging scans in Center B, blood loss was less, compared with the entire group in Center A (P &lt; 0.05). The observations of the neurosurgeon regarding hemostasis, tumor consistency, and intratumoral necrosis did not differ significantly. There were no surgery-related deaths in either center. The rates of surgical morbidity, with permanent neurological worsening, were 20% (n = 6) in Center A and 16% (n = 5) in Center B. There was one permanent neurological deficit (3%) caused by embolization.

CONCLUSION
In this preliminary study, only complete embolization had an effect on blood loss. The value of preoperative embolization for all meningiomas must be reconsidered, especially in view of the high costs and risks of embolization.
Effects of Timing of Coil Embolization after Aneurysmal Subarachnoid Hemorrhage on Procedural Morbidity and Outcomes
Authors: Baltsavias Gerasimos S. , Byrne James V. , Halsey Jim , Coley Stuart C. , Sohn Min-Joo , Molyneux Andrew J. 
Published: September 2004

ABSTRACT

OBJECTIVE
To elucidate the effect of treatment timing on procedural clinical outcomes after aneurysmal subarachnoid hemorrhage (SAH) for patients treated by endosaccular coil embolization.

METHODS
A group of 327 patients who were consecutively treated, during a 46-month period, for ruptured intracranial aneurysms by coil embolization within 30 days after SAH were evaluated. Outcomes were assessed by comparing immediate pretreatment World Federation of Neurological Surgeons (WFNS) grades, 72-hour posttreatment WFNS grades, and modified Glasgow Outcome Scale scores at 6 months for patients treated within 48 hours (Group 1), 3 to 10 days (Group 2), or 11 to 30 days (Group 3) after SAH.

RESULTS
The three interval-to-treatment groups included 33, 38, and 29% of the patients, respectively. Before treatment, 70% of the patients in Group 1, 78% of those in Group 2, and 83% of those in Group 3 were in good clinical grades (i.e., WFNS Grade 1 or 2). After coil embolization, the WFNS grades were either unchanged or improved for 93.5% of the patients in Group 1, 89.5% of those in Group 2, and 91.5% of those in Group 3. After 6 months, 81.3% of the patients in Group 1 experienced good outcomes (modified Glasgow Outcome Scale scores of 1 or 2), as did 84% of those in Group 2 and 80% of those in Group 3. No statistical difference was demonstrated between the three groups when they were compared for these two variables.

CONCLUSION
The interval between endovascular treatment and SAH did not affect periprocedural morbidity rates or 6-month outcomes. Coil embolization should therefore be performed as early as possible after aneurysmal SAH, to prevent aneurysmal rerupture.