bluuebunny/crossref_metadata_2025_split huggingface dataset:
Congenital Reactive Myofibroblastic Tumor of the Petrous Bone: Case Report
Authors: Pollack Ian F. , Hamilton Ronald L. , Fitz Charles , Kassam Amin , Snyderman Carl H. 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE
Myofibroblastic tumors are members of a diverse spectrum of neoplastic and quasineoplastic lesions that occur most commonly during childhood and typically involve soft tissues. We present a case of a congenital reactive myofibroblastic tumor of the petrous bone (i.e., cranial fasciitis) that was successfully treated with surgical excision.

CLINICAL PRESENTATION
A newborn girl with congenital right facial palsy and deafness was noted during imaging evaluation to have a large enhancing mass that was destroying the right petrous bone and extending into the posterior and middle cranial fossae.

INTERVENTION
After embolization, an open biopsy was performed, which revealed a moderately cellular, spindle cell neoplasm without mitosis or necrosis, with scattered lymphocytes, eosinophils, and multinucleated giant cells. The spindle cells demonstrated strong immunoreactivity for vimentin, muscle-specific actin, and α-smooth muscle actin, with prominent reticulin staining between individual cells. Staining for CD68, a histiocyte marker, was positive within the multinucleated giant cells and many of the spindle cells; CD34, S-100, and desmin staining was absent. On the basis of these findings, the lesion was classified as a reactive myofibroblastic tumor, consistent with a cranial variant of nodular fasciitis. Because of the large size and significant mass effect of the tumor, a resection was performed several days later, using a combined supra- and infratentorial approach. Dense adherence of the mass to the walls of the sigmoid sinus and the carotid artery precluded complete resection without sacrifice of these vessels, which was not performed because of the known potential of these tumors to remain stable or regress after extensive subtotal resection. The presumed residual tumor subsequently regressed, and the patient has exhibited no detectable residual disease in 2 years of follow-up monitoring.

CONCLUSION
Reactive myofibroblastic tumors of the calvarium are uncommon lesions that superficially resemble sarcomas. Recognition of this diagnostic entity is important, to avoid unnecessary treatment with intensive adjuvant therapy. Although the management of these tumors relies predominantly on surgical resection, surgical decision-making should take into account the fact that small areas of residual disease can regress spontaneously.
Intraoperative Reduction of Locked Facets in the Cervical Spine by Use of a Modified Interlaminar Spreader: Technical Note
Authors: Fazl Mahmood , Pirouzmand Farhad 
Published: July 2004

Abstract

OBJECTIVE
Facet dislocations commonly require intraoperative reduction after closed reduction with traction has failed. Reduction should be performed in a gradual, controlled fashion to prevent additional inadvertent spinal cord compromise.

METHODS
We describe a new technique for safe and simple dorsal reduction of facet dislocations by use of a modified interlaminar spreader. This technique requires only minimal controlled manipulation of the spine.

RESULTS
We have used this technique in 52 consecutive patients with no complications or failures related to its use in open reduction. This technique increases the stability of the cervical spine after reduction because it limits bone removal from the facet joints.

CONCLUSION
This technique provides a feasible and reliable approach to open reduction of cervical facet dislocations via the posterior approach.
Cerebral Hemodynamic Parameters for Patients with Neurological Improvements after Extracranial-Intracranial Arterial Bypass Surgery: Evaluation Using Positron Emission Tomography
Authors: Iwama Toru , Hashimoto Nobuo , Hayashida Kohei 
Published: July 2004

Abstract

OBJECTIVE
The purpose of this study was to clarify the hemodynamic features of patients who experienced improved neurological function after extracranial-intracranial arterial bypass surgery. With this aim, we retrospectively analyzed the results of their pre- and postoperative positron emission tomographic studies.

METHODS
This study included 16 patients who exhibited stable neurological dysfunction just before extracranial-intracranial bypass surgery. All underwent pre- and postoperative positron emission tomographic studies. They were divided into groups, i.e., patients who did (Group 1, n = 6) or did not (Group 2, n = 10) manifest postoperative improvements in neurological functions. Positron emission tomographic parameters obtained in the middle cerebral artery territories were compared between the two groups.

RESULTS
Comparison of the preoperative hemodynamic values on the affected side and the contralateral side demonstrated that the mean regional cerebral blood flow values were significantly lower on the affected side in both groups (Group 1, P &lt; 0.005; Group 2, P &lt; 0.05). For Group 1 patients, the mean regional oxygen extraction fraction (rOEF) and regional cerebral blood volume values were significantly higher on the affected side than on the contralateral side (P &lt; 0.01 and P &lt; 0.05, respectively). For Group 2 patients, the mean regional cerebral metabolic rate of oxygen (rCMRO2) value was significantly lower on the affected side than on the contralateral side (P &lt; 0.05). The mean rOEF and rCMRO2 values on the affected side were significantly higher for Group 1 patients, compared with Group 2 patients, before surgery (P &lt; 0.05 and P &lt; 0.05, respectively). The preoperative regional cerebral blood flow and regional cerebral blood volume values on the affected side were similar for the two groups. Postoperative changes in mean regional cerebral blood flow and mean rOEF on the affected side were statistically significant for both groups. The mean rCMRO2 on the affected side for Group 2 was significantly lower than that for Group 1, even after bypass surgery (P &lt; 0.05).

CONCLUSION
Bypass surgery may improve neurological function for patients with significantly elevated rOEF values and rCMRO2 values near the normal level. These hemodynamic parameters may be useful for the identification of candidates for extracranial-intracranial bypass surgery.
Management of Malignant Pineal Germ Cell Tumors with Residual Mature Teratoma
Authors: Friedman Jonathan A. , Lynch James J. , Buckner Jan C. , Scheithauer Bernd W. , Raffel Corey 
Published: July 2004

Abstract

OBJECTIVE
The treatment of intracranial mixed germ cell tumors presents a unique challenge, since eradication of malignant tumor by radiation and/or chemotherapy may spare the benign tumor component. We reviewed our surgical experience with residual malignant pineal germ cell tumors after neoadjuvant therapy.

METHODS
Between 1987 and 1997, 16 patients with malignant intracranial germ cell tumors were treated at the Mayo Clinic with a protocol of neoadjuvant chemotherapy and radiation therapy. After the diagnosis was confirmed by histopathological examination, all patients were treated with four cycles of etoposide and cisplatin as well as external beam radiation therapy (range, 3030–5940 cGy). Six patients had an incomplete response to therapy, as demonstrated by observation of residual tumor on magnetic resonance imaging scans. Initial pathology in these six patients was germinoma in four and combinations of yolk sac tumor, embryonal carcinoma, malignant teratoma, and germinoma in two. Two patients had synchronous pineal and suprasellar tumors, with leptomeningeal dissemination. Tumor markers were elevated in four of the six patients at presentation.

RESULTS
All patients with residual pineal tumors underwent surgical resection via an infratentorial, supracerebellar approach. Pathological examination revealed mature teratoma in five patients and amorphous debris in one patient. No patient had recurrent malignancy. Significant neurological morbidity occurred in one patient, with no mortality. At a mean follow-up of 23 months, no recurrence on magnetic resonance imaging has been documented.

CONCLUSION
Residual pineal tumor occurring after treatment of malignant intracranial germ cell tumor with neoadjuvant therapy is likely to be mature teratoma. Operative resection of these benign recurrences is safe and effective.
Percutaneous Controlled Radiofrequency Trigeminal Rhizotomy for the Treatment of Idiopathic Trigeminal Neuralgia: 25-year Experience with 1600 Patients
Authors: Kanpolat Yücel , Savas Ali , Bekar Ahmet , Berk Caglar 
Published: July 2004

Abstract

OBJECTIVE
The objective of this study was to evaluate the effectiveness of percutaneous, controlled radiofrequency trigeminal rhizotomy (RF-TR). The outcome of 1600 patients with idiopathic trigeminal neuralgia after RF-TR was analyzed after a follow-up period of 1 to 25 years.

METHODS
A total of 1600 patients with idiopathic trigeminal neuralgia underwent 2138 percutaneous radiofrequency rhizotomy procedures between 1974 and 1999. Sixty-seven patients had bilateral idiopathic trigeminal neuralgia, and 36 of them were treated with bilateral RF-TR; 1216 patients (76%) were successfully managed with a single procedure, and the remainder were treated with multiple procedures. Benzodiazepines and narcotic analgesics were used for anesthesia because patient cooperation during the procedures was essential so that the physician could create selective, controlled lesions.

RESULTS
The average follow-up time was 68.1 ± 66.4 months (range, 12–300 mo). Acute pain relief was accomplished in 97.6% of patients. Complete pain relief was achieved at 5 years in 57.7% of the patients who underwent a single procedure. Pain relief was reported in 92% of patients with a single procedure or with multiple procedures 5 years after the first rhizotomy was performed. At 10-year follow-up, 52.3% of the patients who underwent a single procedure and 94.2% of the patients who underwent multiple procedures had experienced pain relief; at 20-year follow-up, 41 and 100% of these patients, respectively, had experienced pain relief. No mortalities occurred. After the first procedure was performed, early pain recurrence (&lt;6 mo) was observed in 123 patients (7.7%) and late pain recurrence was observed in 278 patients (17.4%). Complications included diminished corneal reflex in 91 patients (5.7%), masseter weakness and paralysis in 66 (4.1%), dysesthesia in 16 (1%), anesthesia dolorosa in 12 (0.8%), keratitis in 10 (0.6%), and transient paralysis of Cranial Nerves III and VI in 12 (0.8%). Permanent Cranial Nerve VI palsy was observed in two patients, cerebrospinal fluid leakage in two, carotid-cavernous fistula in one, and aseptic meningitis in one.

CONCLUSION
Percutaneous, controlled RF-TR represents a minimally invasive, low-risk technique with a high rate of efficacy. The procedure may safely be repeated if pain recurs.
Retrosigmoid Approach to Acoustic Neuroma (Vestibular Schwannoma)
Authors: Ojemann Robert G. 
Published: July 2004

Abstract

THE RETROSIGMOID APPROACH for the microsurgical removal of an acoustic neuroma (vestibular schwannoma) is described, and perioperative medical management of the patient is discussed. The techniques for monitoring facial and cochlear nerve function are presented. The supine-oblique position, skin incision, bone removal, dural opening, and initial exposure are outlined. Important points in the technique for removing acoustic neuromas and preserving hearing, when possible, are described and illustrated.
Image-guided Transorbital Roof Craniotomy via a Suprabrow Approach: A Surgical Series of 72 Patients
Authors: Shanno George , Maus Marlon , Bilyk Jurij , Schwartz Steven , Savino Peter , Simeone Frederick , Goldman H. Warren 
Published: July 2004

Abstract

OBJECTIVE
Many subfrontal and orbitofrontal craniotomy techniques have been developed. We present our results with the transorbital roof craniotomy, a frontal craniotomy that incorporates the orbital roof and is performed via a suprabrow incision. This technique was used in 72 patients, primarily for tumor resection.

METHODS
Charts were retrospectively reviewed for all patients undergoing transorbital procedures. A total of 72 patients underwent 82 transorbital craniotomies from September 1995 to July 1999. The primary indication for the transorbital approach was mass lesion of the orbit, anterior fossa, or parasellar region.

RESULTS
A total of 47 women and 25 men with a mean age of 53 years underwent 82 procedures. The primary pathological finding was meningioma, which occurred in 40 patients (55.6%), followed by craniopharyngioma (6.9%), pituitary macroadenoma (6.9%), schwannoma (5.5%), and hemangioma (5.5%). Simpson Grade I or II resection was achieved in 54% of patients, with Simpson Grade III to V resection achieved in the remaining 46%. Forty-one patients presented with visual loss in 43 cases, with 44.2% experiencing postoperative visual improvement, 46.5% remaining unchanged, and 9.3% worsening. Overall morbidity was 18.4%, with cerebrospinal fluid leak being the most common complication (6.6%). No patients died.

CONCLUSION
The transorbital roof craniotomy is an evolutionary approach that provides excellent exposure to the orbit, anterior fossa, and parasellar region with little significant morbidity and, in our series, no mortality. Although we have used this approach primarily for resection of mass lesions, future directions for this procedure will likely lie in treating vascular lesions and lesions of the interpeduncular fossa.
Meningeal Hemangiopericytoma: A Retrospective Study of 21 Patients with Special Review of Postoperative External Radiotherapy
Authors: Dufour Henry , Métellus Philippe , Fuentes Stéphane , Murracciole Xavier , Régis Jean , Figarella-Branger Dominique , Grisoli François 
Published: July 2004

Abstract

OBJECTIVE
To specify that postoperative radiotherapy is useful for preventing local recurrence and neuraxis recurrence of surgically treated meningeal hemangiopericytomas.

METHODS
We retrospectively studied 21 patients with meningeal hemangiopericytoma who were followed in our department during a 34-year period. In 17 patients, the meningeal hemangiopericytoma was intracranial, and in 4 there was an intradural extramedullary localization. These groups were studied separately.

RESULTS
Of the 17 patients with intracranial hemangiopericytoma, all underwent surgery; 8 also underwent radiotherapy (5000–6400 rads) (Group I), and 9 did not (Group II). The mortality rate was zero for Group I patients and 55% for Group II. The mean local recurrence rate was 52% (12.5% in Group I and 88% in Group II; P &lt; 0.05). Neuraxis recurrences occurred in two patients in Group II, and none occurred in Group I (P = 0.4). Peripheral metastasis took place in two patients (22%) in Group II and in one patient (12.5%) in Group I (P = 0.5). Of the four patients with intradural extramedullary hemangiopericytoma, all underwent surgery. Two patients received 4000 rads of radiotherapy after intervention. No patient in this group had a recurrence.

CONCLUSION
For patients with intracranial meningeal hemangiopericytoma, surgical removal followed by external radiotherapy reduced the risk of local recurrence. It was not demonstrated that postoperative radiotherapy protected against neuraxis metastasis. Radiotherapy did not protect against peripheral metastasis, which can occur up to several years after the first operation. It appears that radiotherapy after surgery for local or neuraxis recurrence did not avoid further recurrence. Radiosurgery is indicated for recurrent tumors measuring less than 25 mm in greatest diameter. For intradural extramedullary localizations, the value of postoperative radiotherapy is more questionable.
Comparison of Thalamotomy and Pallidotomy for the Treatment of Dystonia
Authors: Yoshor Daniel , Hamilton Winifred J. , Ondo William , Jankovic Joseph , Grossman Robert G. 
Published: July 2004

Abstract

OBJECTIVE
Thalamotomy and, more recently, pallidotomy have been used to treat selected patients with intractable dystonia, although few studies have compared the effectiveness of these two surgical procedures. In this study, we compare our results using thalamotomy and pallidotomy to treat patients with different forms of dystonia, and we discuss our results in the context of other published series.

METHODS
Thirty-two patients with intractable dystonia underwent thalamotomy (n = 18) or pallidotomy (n = 14). Dystonia was classified according to cause and distribution, and each patient was evaluated postoperatively at two or more time points, using a global outcome scale.

RESULTS
Although comparisons are limited by differences between the two surgical groups, including longer follow-up periods for the thalamotomy group, differences in symptom distribution, and more bilateral procedures for the pallidotomy group, patients with primary dystonia who underwent pallidotomies demonstrated significantly better long-term outcomes than did patients who underwent thalamotomies (P = 0.0467). Patients with secondary dystonia experienced more modest improvements after either procedure, with little or no difference in outcomes between the two procedures.

CONCLUSION
For patients with primary dystonia, pallidotomy seems to result in better outcomes than does thalamotomy.
Primary Myxoma of the Temporal Bone in a 17-Year-Old Boy: Case Report
Authors: Osterdock Renatta J. , Greene Sandea , Mascott Christopher R. , Amedee Ronald , Crawford Byron E. 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE
Only two cases of primary intracranial myxomas have been described previously in the literature: one patient had a primary intracranial myxoma in the pituitary fossa, and the other patient's myxoma was located in the posterior fossa.

CLINICAL PRESENTATION
A rare case of primary myxoma of the temporal bone in a 17-year-old boy is described. The patient presented with a history of progressive left-sided hearing loss and increasing headaches of a few months' duration.

INTERVENTION
An initial draining procedure in the left ear revealed extant mucous material, and further investigation showed a large calcified lesion involving the petrous and temporal bones and filling the middle fossa. At surgery, a large mucoid-appearing tumor was removed. The tumor pathology revealed a primary myxoma with bone and meningeal involvement. No clinical or histopathological evidence that it was a metastatic lesion was found.

CONCLUSION
The features of myxomas on computed tomographic and magnetic resonance imaging, the histopathology, and surgical considerations are discussed.
Surgical Management of Clinoidal Meningiomas
Authors: Lee Joung H. , Jeun Sin-Soo , Evans James , Kosmorsky Gregory 
Published: July 2004

Abstract

OBJECTIVE
Surgical outcome has been less than desirable in the management of patients with clinoidal meningiomas in the past, and little attention has been directed at improving their visual function. The purpose of this article is to advocate an available cranial base technique for removing these difficult tumors and to delineate the technique's advantages that aid in achieving an improved extent of tumor resection and enhancing the patients' overall outcome, particularly their visual outcome.

METHODS
A retrospective analysis was performed on 15 consecutive patients with clinoidal meningiomas (including a patient with hemangiopericytoma) who underwent surgical resection at the Cleveland Clinic Foundation between June 1995 and January 2000. A cranial base technique consisting of extradural anterior clinoidectomy, coupled with optic canal unroofing and optic sheath opening, was used in 13 patients, and standard pterional craniotomy was used in 2. Eight of 15 patients had significant visual deficits preoperatively. All patients had thorough preoperative and postoperative ophthalmological evaluations. The follow-up period ranged from 6 to 60 months (mean, 37.2 mo).

RESULTS
Total resection was achieved in 13 (86.7%) of the 15 patients in this series, and the majority of the patients with preoperative visual impairment experienced significant improvement (6 of 8 patients; 75%).

CONCLUSION
In the majority of patients with clinoidal meningiomas, total resection may be achieved with minimal complications. For large tumors encasing the optic nerve and internal carotid artery, or for those tumors causing preoperative visual impairment, use of the cranial base technique delineated in this study may lead to significant improvement in the patients' visual and overall outcomes.
Intraoperative Magnetic Resonance Imaging Combined with Neuronavigation: A New Concept
Authors: Nimsky Christopher , Ganslandt Oliver , Kober Helmut , Buchfelder Michael , Fahlbusch Rudolf 
Published: July 2004

Abstract

OBJECTIVE
Intraoperative image data may be used not only to evaluate the extent of a tumor resection but also to update neuronavigation, compensating for brain shift. To date, however, intraoperative magnetic resonance imaging (MRI) can be combined only with navigation microscopes that are separated from the magnetic field, thus requiring time-consuming intraoperative patient transport. To help solve this problem, we investigated whether a new navigation microscope can be used within the fringe field of the MRI scanner.

METHODS
The navigation microscope was placed at the 5-G line of a 0.2 MRI device. Patients were positioned lying down directly on the table of the scanner, with their heads placed approximately 1.5 m from the center of the magnet, fixed in an MRI-compatible ceramic head holder. Standard operating instruments were used. For intraoperative imaging, we slid the table into the center of the magnet in less than 30 seconds.

RESULTS
By use of this setup, we operated on 22 patients. In all patients, anatomic neuronavigation could be used in combination with intraoperative MRI. In addition, in 12 patients, functional data from magnetoencephalographic or functional MRI studies were integrated, resulting in functional neuronavigation. We did not encounter adverse effects of the low magnetic field during navigation. Moreover, intraoperative imaging was not disturbed by the navigation microscope and vice versa.

CONCLUSION
Functional neuronavigation and intraoperative MRI can be used essentially simultaneously without the need for lengthy intraoperative patient transport. The combination of intraoperative imaging with functional neuronavigation offers the opportunity for more radical resections and fewer complications.