bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ectopic Recurrence of Craniopharyngioma after an Interhemispheric Transcallosal Approach: Case Report
Authors: Liu Jeannette M. , Garonzik Ira M. , Eberhart Charles G. , Sampath Prakash , Brem Henry 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE:
Ectopic recurrence of a craniopharyngioma is a rare postoperative complication. We present a case of a craniopharyngioma that ectopically recurred along the tract of a previous surgical route.

CLINICAL PRESENTATION:
A 73-year-old female patient presented 8 years earlier with a suprasellar craniopharyngioma. She underwent a right frontal craniotomy, with an interhemispheric transcallosal approach, for total microsurgical resection of the tumor. No postoperative radiotherapy was administered. Four years after surgery, magnetic resonance imaging studies revealed a well-circumscribed, heterogeneously enhancing, parasagittal mass with significant vasogenic edema in the right frontal lobe. Enlargement of the lesion was noted in subsequent radiological evaluations until 8 years after surgery, when the patient experienced a significant decline in neurocognitive status and the mass was surgically resected.

INTERVENTION:
Gross total resection of a histologically confirmed craniopharyngioma was achieved.

CONCLUSION:
To our knowledge, only eight previous case reports described the ectopic recurrence of a craniopharyngioma. Transplantation of tumor cells along the tract of a previous surgical route in six cases and dissemination in cerebrospinal fluid in two cases are presumed to be the primary mechanisms by which these ectopic recurrences occurred. The results of our literature review led us to conclude that total surgical resection, combined with careful inspection and irrigation of the surgical field, is the optimal treatment for preventing ectopic recurrences. Furthermore, it is recommended that, after primary craniopharyngioma resection, patients undergo long-term clinical and radiological follow-up monitoring for the rare development of an ectopically recurring tumor.
Treatment of an Iatrogenic Petrous Carotid Artery Pseudoaneurysm with a Symbiot Covered Stent: Technical Case Report
Authors: Alexander Michael J. , Smith Tony P. , Tucci Debara L. 
Published: July 2004

AbstractOBJECTIVE AND IMPORTANCE:Surgery involving the middle ear or the temporal bone may cause an injury to the petrous carotid artery resulting in a pseudoaneurysm. Conventional treatment of such pseudoaneurysms has ranged from carotid occlusion to conservative management. The use of a balloon-expandable stent and/or Guglielmi detachable coils may be effective in a partially healed pseudoaneurysm. This report details the case of an acute petrous carotid pseudoaneurysm after a myringotomy procedure that was effectively treated with an expanded polytetrafluoroethylene-covered stent.CLINICAL PRESENTATION:During a right myringotomy procedure, pulsatile blood was encountered in a 42-year-old woman with a history of repeated ear infections and bilateral middle ear ventilation tube placement. The blood was adequately tamponaded with gauze packing. Computed tomography of the temporal bone demonstrated a dehiscent carotid artery, and cerebral angiography revealed a 6-mm right petrous carotid pseudoaneurysm.INTERVENTION/TECHNIQUE:An 8-French guide catheter was positioned via a transfemoral approach into the cervical right internal carotid artery, and the patient was systemically heparinized. A 4- × 31-mm Symbiot covered stent (Boston Scientific/Scimed, Maple Grove, MN) was passed over a Choice PT exchange wire (Boston Scientific/Scimed) to cover the neck of the pseudoaneurysm, obliterating the pseudoaneurysm. The patient was given aspirin and clopidogrel after stenting, and ear exploration was possible later the same day. Follow-up computed tomographic angiography performed 6 weeks later verified patency of the stent.CONCLUSION:The use of an expanded polytetrafluoroethylene-covered stent may effectively treat intracranial internal carotid artery pseudoaneurysms in an acute setting. This treatment allows preservation of the parent artery and immediate treatment by reconstruction of the incompetent arterial wall to prevent potentially life-threatening hemorrhagic complications.
Extracranial-Intracranial Vein Graft Bypass for Giant Intracranial Aneurysm Surgery for Pediatric Patients: Two Technical Case Reports
Authors: Zhang Y. Jonathan , Barrow Daniel L. , Day Arthur L. 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE:
Herein we describe two cases of extracranial-intracranial vein graft bypasses for the treatment of giant intracranial aneurysms in prepubertal pediatric patients. One patient is, we think, the youngest patient reported in the literature to have been successfully treated in such a manner, with a good long-term outcome. Such grafts seem to enlarge longitudinally during the growth spurt, making such techniques reasonable long-term therapeutic options for the management of complex intracranial aneurysms in pediatric patients.

CLINICAL PRESENTATION:
Patient 1, a 13-year-old boy, presented with headaches and rapidly progressive right cavernous sinus syndrome. Computed tomography and cerebral angiography revealed a giant, fusiform, right intracavernous internal carotid artery aneurysm. Patient 2, a 23-month-old girl, was discovered to harbor an asymptomatic, recurrent, giant, fusiform, left M1 middle cerebral artery aneurysm 1 year after presenting with seizures related to subarachnoid hemorrhage from the aneurysm, for which she had been treated with clipping and an M2-M2 anastomosis.

INTERVENTION:
Both patients underwent craniotomies, with sacrifice of the proximal parent vessel (the distal cervical internal carotid artery and the proximal middle cerebral artery, respectively), combined with cerebral revascularization through extracranial-intracranial saphenous vein bypass grafts. Both patients experienced excellent long-term clinical outcomes, have undergone significant growth, and exhibit excellent long-term graft patency and aneurysm obliteration.

CONCLUSION:
These two cases highlight the safety and efficacy of extracranial-intracranial vein graft bypasses among prepubertal pediatric patients. The indications for bypass procedures to treat giant intracranial aneurysms are discussed, and the technical aspects of maximizing vein bypass graft patency are reviewed.
Microvascular Decompression to Treat Hemifacial Spasm: Long-term Results for a Consecutive Series of 143 Patients
Authors: Samii Madjid , Günther Thomas , Iaconetta Giorgio , Muehling Michael , Vorkapic Peter , Samii Amir 
Published: July 2004

Abstract

OBJECTIVE:
The concept of neurovascular decompression for the treatment of hemifacial spasm is now widely accepted. In this study, we report our long-term results for 145 cases treated with this procedure.

METHODS:
The results of 145 microvascular decompressions to treat hemifacial spasm (performed between 1980 and 1998) among 143 patients (62.2% female patients and 37.8% male patients; mean age, 54.5 yr) are presented. The onset of symptoms was typical in 95.9% of cases and atypical in 4.1%. Platysma muscle involvement was observed for 24.5% of patients, with a higher incidence among female patients (74.3%). Patients were monitored with annual questionnaires. Twenty-six patients were lost to follow-up monitoring, and 117 are still undergoing follow-up monitoring, with an average period of 9.6 years (range, 1–17.6 yr).

RESULTS:
At discharge, 69 patients (59%) were spasm-free and 48 patients (41%) experienced further spasm. At 6 months, the number of spasm-free patients had increased to 108 (92.3%), whereas only 9 patients (7.7%) complained of hemifacial spasm; 44 patients were spasm-free at an average time of 15 weeks. In follow-up examinations (average period, 9.4 yr), 106 patients were spasm-free. Seven patients experienced only temporary relief, with recurrence after 4.5 years. Two patients were spasm-free after 4 or 6 weeks, and the recurrence of spasm was observed 1 year later. Two patients were never completely spasm-free. Among the patients who did not undergo previous surgery elsewhere, only two experienced recurrence.

CONCLUSION:
Deafness was the main postoperative complication (8.3%); most of those cases (66%) occurred before the routine use of intraoperative evoked potential monitoring. Analysis of our series demonstrates that this surgical procedure involves very low risk, is well tolerated by elderly patients, is associated with very low recurrence rates, and is a definitive treatment for more than 90% of cases.
Role of Postoperative Magnetic Resonance Imaging after Microvascular Decompression of the Facial Nerve for the Treatment of Hemifacial Spasm
Authors: Chang Jin Woo , Chang Jong Hee , Choi Jae Young , Kim Dong Ik , Park Yong Gou , Chung Sang Sup 
Published: July 2004

Abstract

OBJECTIVE:
This study was performed to investigate the role of postoperative three-dimensional short-range magnetic resonance angiography in the prediction of clinical outcomes after microvascular decompression (MVD) for the treatment of hemifacial spasm.

METHODS:
We examined pre- and postoperative magnetic resonance imaging scans obtained between March 1999 and May 2000 for 122 patients with hemifacial spasm, to evaluate the degree of detachment of the vascular contact and changes in the positions of offending vessels. The degree of vascular decompression of the facial nerve root was classified into three groups, i.e., contact, partial decompression, or complete decompression. Contact was defined as unresolved compression, as indicated by postoperative three-dimensional short-range magnetic resonance angiography. Partial decompression was defined as incompletely resolved compression; vascular indentation of the facial nerve was improved, but contact with the facial nerve remained. Complete decompression was defined as completely resolved compression. These findings were compared with the surgical findings and clinical outcomes.

RESULTS:
Of 122 patients with MVD, complete decompression of offending vessels at the root entry zone of the facial nerve was observed for 106 patients (86.9%), partial decompression was observed for 10 patients (8.2%), and contact with offending vessels was observed for 6 patients (4.9%) by using postoperative three-dimensional short-range magnetic resonance angiography. Our study demonstrated that the types of offending vessels affected neither the degree of decompression of the root entry zone of the facial nerve nor surgical outcomes (P &gt; 0.05). Also, there was no significant relationship between the degree of decompression and improvement of symptoms (P &gt; 0.05). Furthermore, there was no significant relationship between the degree of decompression and the timing of symptomatic improvement (P &gt; 0.05).

CONCLUSION:
Our data suggest that MVD of the facial nerve alone may not be sufficient to resolve symptoms for all patients with hemifacial spasm. Therefore, unknown factors in addition to vascular compression may cause symptoms in certain cases, and it may be necessary to remove those factors, simultaneously with MVD, to obtain symptom resolution.
Diffusion-weighted Magnetic Resonance Imaging in Patients with Subarachnoid Hemorrhage
Authors: Hadeishi Hiromu , Suzuki Akifumi , Yasui Nobuyuki , Hatazawa Jun , Shimosegawa Eku 
Published: July 2004

Abstract

OBJECTIVE:
To evaluate the occurrence and distribution of direct brain injury caused by acute subarachnoid hemorrhage (SAH) by the use of magnetic resonance imaging.

METHODS:
Computed tomography and magnetic resonance imaging, including diffusion-weighted imaging (DWI), were performed in 32 patients with SAH by use of a 1.5-T whole-body superconductive scanner equipped with an echo planar imaging system. In all cases, computed tomographic and magnetic resonance imaging scans were obtained at the time of admission, before angiography and surgical intervention.

RESULTS:
No abnormalities were revealed by DWI in any of the low-grade SAH patients. However, five (71%) of seven patients diagnosed as having poor-grade SAH (World Federation of Neurosurgical Societies Grades 4 and 5) displayed multiple, patchy focal abnormalities on DWI. Computed tomographic scans obtained at admission failed to clearly demonstrate all of the damaged areas of the brain that were visualized by DWI. These lesions were located in supratentorial cerebral parenchyma, but not in the thalamus, basal ganglia, or cerebellar hemisphere. These multiple widespread lesions exhibiting laminar involvement of the cerebral cortex were not associated with the site of the ruptured aneurysm.

CONCLUSION:
DWI revealed widespread multifocal lesions in the cerebral cortex of acute poor-grade SAH patients. DWI provides accurate images of all areas of brain damage directly attributable to SAH.
Aneurysm Originating from the Fenestration of the Posterior Cerebral Artery: Case Report
Authors: Iwashita Tomomi , Tanaka Yuichiro , Hongo Kazuhiro , Koyama Jun-ichi , Koyama Toru , Nitta Junpei 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE:
A rare case of an aneurysm arising at the fenestration of the P2 segment of the posterior cerebral artery is reported.

CLINICAL PRESENTATION:
A 37-year-old man presented with severe headache and disturbance of consciousness. Computed tomographic scanning showed diffuse subarachnoid hemorrhage. Cerebral angiography revealed an aneurysm at the fenestration of the P2 segment of the right posterior cerebral artery. The aneurysm was located at the middle portion of the lower trunk of the fenestration. An unruptured arteriovenous malformation was incidentally found in the right thalamus.

INTERVENTION:
A right frontotemporal craniotomy with orbitozygomatic osteotomy was made, and the aneurysm was successfully clipped. One year after the operation, gamma knife surgery was performed for the right thalamic arteriovenous malformation.

CONCLUSION:
This is the first reported case of an aneurysm originating from the middle portion of a fenestrated posterior cerebral artery.
Interactive Use of Cerebral Angiography and Magnetoencephalography in Arteriovenous Malformations: Technical Note
Authors: Kamiryo Toshifumi , Cappell Joshua , Kronberg Eugene , Woo Henry H. , Jafar Jafar J. , Llinás Rodolfo R. , Nelson Peter K. 
Published: July 2004

Abstract

OBJECTIVE:
To minimize the risks associated with treating cortical cerebral arteriovenous malformations (AVMs), we developed a technique combining functional imaging and cerebral angiography. The functional loci obtained by performing magnetoencephalography (MEG) are projected onto stereoscopic pairs of a stereotactically derived digital subtraction angiogram. The result is a simultaneous three-dimensional perspective of the angioarchitecture of an AVM and its relationship to the sensorimotor cortex.

METHODS:
Eight patients underwent multimodality brain imaging, including magnetic resonance imaging, functional mapping via MEG, and stereotactic angiography using a modified Compass fiducial system (Compass International, Rochester, MN). The coordinates derived by performing MEG were superimposed onto stereotactic, stereoscopic, angiographic pairs using custom-made distortion correction and coordinate transfer software.

RESULTS:
The magnetoencephalographic angiogram allowed simultaneous viewing of the angioarchitecture of the AVM nidus, the feeding vessels, and the draining veins and their relationship to the normal cerebral vasculature and functional cortex. This imaging technique was particularly valuable in identifying en passant vessels that supplied functional cortex and was used during the treatment of these lesions.

CONCLUSION:
The techniques of MEG and cerebral angiography were combined to provide simultaneous viewing of both modalities in a three-dimensional perspective. This technique can aid in risk stratification in the management of patients with cerebral AVMs. In addition, this technique can facilitate the selective targeting of vessels, thus potentially reducing the risks associated with embolization of these formidable lesions.
Intrinsic Spinal Cord Tumor Resection
Authors: Brotchi Jacques 
Published: July 2004

Abstract
SPINAL CORD TUMORS are more frequently detected than in the past, because of progress in neuroradiology. Many neurosurgeons must now decide how to treat such lesions. The recent neurosurgical literature contains many case reports, few series, and different strategies. This article describes the surgical method I have developed in a period of 15 years, with Georges Fischer in Lyon, on the basis of experience with more than 260 patients and 300 operations. The standard treatment is complete resection whenever possible, but we must learn when and where to stop to preserve the quality of life. I have several useful strategies, which are explained in this report. For gliomas (ependymomas and astrocytomas), I favor a midline approach; for most vascular tumors (such as hemangioblastomas and cavernomas), however, I prefer to proceed from the point at which the lesion is observed through the microscope and to dissect the lesion in one piece. Meticulous nonbleeding surgery and experience are the keys to success.
Surgical Indications and Microsurgical Anatomy of the Transchoroidal Fissure Approach for Lesions in and around the Ambient Cistern
Authors: Ikeda Kiyonobu , Shoin Katsuo , Mohri Masanao , Kijima Tamotsu , Someya Shigeru , Yamashita Junkoh 
Published: July 2004

Abstract

OBJECTIVE:
Opening the temporal part of the choroidal fissure (CF) makes it possible to expose the crural cistern, the ambient cistern, and the medial temporal lobe. We examined the microsurgical anatomy and the surgical indications for use of the trans-CF approach.

METHODS:
The microsurgical anatomy encountered in the trans-CF approach for lesions in and around the ambient cistern was studied in three cadavers. On the basis of these cadaveric studies, the trans-CF approach was used during surgery in three live patients with such lesions.

RESULTS:
The angiographic “plexal point,” which indicates the entrance of the anterior choroidal artery as it enters the temporal horn of the lateral ventricle, was thought to be a key anatomic landmark of the trans-CF approach. A cortical incision for entry into the temporal horn should be made in the inferior temporal gyrus to minimize the potential damage to the optic radiations and to the speech centers. After the CF is opened posteriorly to the plexal point between the tenia fimbria and the choroid plexus, the posterior cerebral artery (PCA) in the ambient cistern can be observed with minimal caudal retraction of the hippocampus. In this study, surgical procedures using the trans-CF approach were successfully performed on patients with high-positioned P2 aneurysms whose PCA ran close to the plexal point or higher, whose medial temporal arteriovenous malformations were fed mainly by the PCA, and whose tentorial hiatus meningiomas protruded into the temporal horn through the CF, with no resulting postoperative visual or memory disturbances.

CONCLUSION:
The trans-CF approach is especially useful in surgery for lesions in and around the ambient cistern.
Cranial Base Approaches for the Surgical Treatment of Aggressive Posterior Fossa Dural Arteriovenous Fistulae with Leptomeningeal Drainage: Report of Four Technical Cases
Authors: Kattner Keith A. , Roth Toni C. , Giannotta Steven L. 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE:
Dural arteriovenous fistulae (DAVFs) with leptomeningeal drainage have an aggressive natural history. Urgent treatment is necessary to arrest neurological deterioration and to prevent the risk of intracranial hemorrhage. In many patients, a primary endovascular approach is the most appropriate and most successful treatment available. In some circumstances, however, surgical intervention is required for complete obliteration. Posterior fossa DAVFs are generally deep-seated and difficult to gain access to with standard surgical approaches. The advent of cranial base surgery allows 360-degree access to the draining venous complex or sinus via extradural bone removal.

CLINICAL PRESENTATION:
Four patients with posterior fossa DAVFs presented to the neurosurgical service at our institutions. One DAVF was located at the craniocervical junction, and three were tentorial DAVFs of the superior petrosal sinus. All four patients were treated surgically with extradural bone removal.

INTERVENTION:
Postoperative angiography documented complete obliteration of all four DAVFs. All patients had normal recoveries, with the exception of one patient who experienced persistent temporal lobe seizure activity as a result of the presenting hematoma. One patient died of unrelated causes 2 years after surgery. One postoperative temporal lobe hematoma required evacuation.

CONCLUSION:
Recent advances in cranial base techniques have allowed the successful obliteration of aggressive posterior fossa DAVFs with acceptable morbidity. The use of these techniques should be considered in selected patients who cannot be treated with endovascular approaches.
Risk of Hemorrhage from Unsecured, Unruptured Aneurysms during and after Hypertensive Hypervolemic Therapy
Authors: Hoh Brian L. , Carter Bob S. , Ogilvy Christopher S. 
Published: July 2004

Abstract

OBJECTIVE
Hypertensive hypervolemic therapy for vasospasm is widely practiced. It is not clear, however, whether the use of hypertension and hypervolemia as a treatment for vasospasm risks hemorrhage from an unsecured, unruptured aneurysm.

METHODS
From 1991 to 2000, the neurovascular unit at the Massachusetts General Hospital treated 1908 aneurysms, of which 966 were ruptured. Forty patients with ruptured aneurysms had unsecured, unruptured aneurysms and underwent hypertensive hypervolemic therapy for vasospasm. Hypertension was induced by intravenously administered phenylephrine, norepinephrine, and/or dopamine, and hypervolemia was achieved by intravenously administered crystalloid and colloid solutions. The 24-hour mean arterial systolic blood pressure (SBP) and the 24-hour mean central venous pressure were calculated on the basis of hourly measurements during hypertensive hypervolemic treatment.

RESULTS
The 40 study patients harbored 124 aneurysms, of which 51 aneurysms were treated (clipping, 37; coiling, 14) by the time hypertensive hypervolemic therapy began, leaving 73 unsecured aneurysms at risk. The mean size of the unsecured aneurysms was 4.45 mm. Nineteen patients were treated with mild hypertension (SBP, 140–180 mm Hg), 12 patients were treated with moderate hypertension (SBP, 180–200 mm Hg), and 9 patients were treated with severe hypertension (SBP, &gt;200 mm Hg). The 24-hour mean SBP readings were 166.81 ± 8.19, 187.57 ± 5.79, and 204.01 ± 3.75 mm Hg for the mild, moderate, and severe hypertension groups, respectively. The mean central venous pressure was 10.43 ± 3.89 mm Hg. The mean course of hypertensive hypervolemic therapy was 7.25 days, and therapy began on mean post-subarachnoid hemorrhage Day 6.73. Twenty-eight aneurysms were eventually treated in later procedures (clipping, 25; coiling, 3). The mean interval to treatment was 6.93 months. In a treatment and follow-up period of 121.75 aneurysm-years of risk, there was no instance of hemorrhage.

CONCLUSION
Hypertension and hypervolemia do not seem to increase the risk of hemorrhage from unsecured, unruptured aneurysms in the acute setting or in their short-term natural history.