bluuebunny/crossref_metadata_2025_split huggingface dataset:
Construction of a New Posterior Communicating Artery in a Patient with Poor Posterior Fossa Circulation: Technical Case Report
Authors: Tulleken Cornelis A.F. , Streefkerk Henk Johan N. , van der Zwan Albert 
Published: July 2004

ABSTRACT

OBJECTIVE AND IMPORTANCE
The carotid and the vertebrobasilar circulation were connected, effectively creating a new posterior communicating artery (PComA). The excimer laser-assisted nonocclusive anastomosis technique is a new anastomosis technique whereby formerly untreatable patients may be treated with an intracranial artery-to-intracranial artery bypass procedure. This report is the first one in which an angiographically proved patent internal carotid artery-posterior cerebral artery segment P1 bypass is presented.

CLINICAL PRESENTATION
Our patient presented with repeated episodes of vertebrobasilar ischemia because of vertebral artery occlusion and stenosis.

INTERVENTION
An internal carotid artery-posterior cerebral artery segment P1 bypass procedure was performed. Because the patient experienced transient ischemia in the left cerebral hemisphere at the end of postoperative angiography procedure, no radiological intervention was performed, and the patient refused to undergo a new radiological intervention at a later stage.

TECHNIQUES
Both anastomoses were made using the excimer laser-assisted nonocclusive anastomosis technique.

CONCLUSION
Intraoperative flowmetry was performed using an ultrasound flowmeter, which disclosed blood flow of 35 ml/min through the bypass. We hope that this new PComA suffices to protect the patient from infarction in the territory of the vertebrobasilar circulation.
Persistent Iliac Crest Donor Site Pain: Independent Outcome Assessment
Authors: Heary Robert F. , Schlenk Richard P. , Sacchieri Theresa A. , Barone Dean , Brotea Cristian 
Published: July 2004

AbstractOBJECTIVE:This study objectively defines the incidence of donor site pain in an independent outcome analysis. In addition, this study identifies the significant discrepancies that are observed when independent outcome assessment results are compared with the incidences determined by review of the operating surgeon's documented findings.METHODS:A review of patients who underwent iliac bone graft harvesting by a single neurosurgeon was conducted. The presence of iliac crest donor site pain, at a time remote from surgery, as determined by specific questioning and recorded in the neurosurgeon's written evaluation was compared with independent assessment findings obtained in structured telephone questionnaire interviews. During a 4-year period, 105 patients met the inclusion criteria. Both the operating surgeon's and independent interviewer's follow-up evaluations were completed for all study patients. Pain was classified into three categories, i.e., no pain, acceptable pain, or unacceptable pain. Patients were also asked to assess the severity of their donor site pain by using a visual analog scale. Statistical analyses comparing the incidences of iliac crest donor site pain in the operating surgeon's evaluations and the independent assessments were performed.RESULTS:When evaluated at a time remote from surgery, the true incidence of iliac crest donor site pain after graft harvest procedures (34%) was significantly greater than previously appreciated by the neurosurgeon (8%). Although occasional or mild pain was observed for 31% of patients, only 3% of all patients experienced unacceptable pain.CONCLUSION:Independent outcome assessment values should be provided to patients in preoperative discussions regarding donor site morbidity. Objective outcome analysis, based on independent observations, is crucial for the most accurate interpretation of perceptions of iliac crest donor site pain.
Intraventricular Infusion of Vascular Endothelial Growth Factor Promotes Cerebral Angiogenesis with Minimal Brain Edema
Authors: Harrigan Mark R. , Ennis Steven R. , Masada Tetsuya , Keep Richard F. 
Published: July 2004

AbstractOBJECTIVE:Therapeutic cerebral angiogenesis, i.e., using angiogenic factors to enhance collateral vessel formation within the central nervous system, is a potential method for cerebral revascularization. Vascular endothelial growth factor (VEGF) is a potent endothelial cell mitogen that also increases capillary permeability, particularly in ischemic tissue. The purpose of this study was to assess the angiogenic and capillary permeability effects of chronic intraventricular infusion of exogenous VEGF in nonischemic brain tissue, because many patients with impaired cerebrovascular reserve do not exhibit chronic cerebral ischemia.METHODS:Recombinant human VEGF165 was infused into the right lateral ventricle of rats at a rate of 1 μl/h for 7 days, at concentrations of 1 to 25 μg/ml, with osmotic minipumps. Control animals received vehicle only. Vessels were identified in laminin immunohistochemical analyses. Capillary permeability and brain edema were assessed with Evans blue extravasation, [3H]inulin permeability, and brain water content measurements.RESULTS:Vessel density was dose-dependently increased by VEGF165 infusions, with significant increases occurring in animals treated with 5 or 25 μg/ml, compared with control animals (P &lt; 0.01). Significant enlargement of the lateral ventricles was observed for the highest-dose group but not for animals treated with other doses. Capillary permeability was assessed in animals treated with a dose of 5 μg/ml. An increase in capillary permeability in the diencephalon was identified with Evans blue extravasation and [3H]inulin permeability assessments; however, the brain water content was not significantly increased.CONCLUSION:Chronic intraventricular infusions of VEGF165 increased vascular density in a dose-dependent manner. There seems to be a therapeutic window, because infusion of VEGF165 at a concentration of 5 μg/ml resulted in a significant increase in vessel density with minimal associated brain edema and no ventriculomegaly.
De Novo Development of a Cavernous Malformation of the Brain: Significance of Factors with Paracrine and Endocrine Activity: Case Report
Authors: Lüdemann Wolf , Ellerkamp Verena , Stan Alexandru C. , Hussein Sami 
Published: July 2004

AbstractOBJECTIVE AND IMPORTANCE:De novo development of cavernous malformations is poorly documented in the literature.CLINICAL PRESENTATION:We report the case of a 37-year old woman with de novo growth of a cavernous malformation of the brain. The patient presented with a 12-month history of nonspecific headaches and paresthesias after two pregnancies. After computed tomographic scanning of the cranium, a cavernous malformation located parieto-occipitally within the right brain hemisphere was diagnosed. Control magnetic resonance imaging scans obtained 12 years earlier did not reveal a similar lesion.INTERVENTION:Surgery was performed, and the specimen was analyzed histopathologically.CONCLUSION:Immunohistochemistry demonstrated lack of expression of pituitary hormones as well as of androgen, estrogen, and progesterone hormone receptors. However, strong expression of both basic fibroblast growth factor and CD44 was detected in surrounding tissue, and expression of CD44 was noted within the matrix of the cavernous malformation.
New Trends in Neuromodulation for the Management of Neuropathic Pain
Authors: Aló Kenneth M. , Holsheimer Jan 
Published: July 2004

Abstract
SINCE ITS FIRST application in 1967, the methodology and technology of spinal cord stimulation for the management of chronic, intractable pain have evolved continuously. Despite these developments and improved knowledge of the effects of spinal anatomy and epidural contact configuration on paresthesia coverage, the clinical results of spinal cord stimulation—particularly the long-term effects—are still unsatisfactory in many patients. This dissatisfaction has come primarily from the failure of single-electrode configurations to provide consistent paresthesia coverage of the entire painful area. Therefore, new approaches were developed during the late 1990s that attempted to selectively cover one or more dermatomes with paresthesia as well as to provide sequential stimulation of different anatomic sites. These approaches have been applied both intraspinally and extraspinally by stimulating either the spinal nerves or the dorsal columns. To target parts of the latter, different methods have been developed and tested using either two-dimensional contact configurations or electronic field steering. These developments hold promise for improving long-term outcomes as well as increasing the number of pain conditions that can be treated with neuromodulation therapy. In this review, the history, theoretical basis, and evolution of these methodologies, as well as the ways in which they represent new trends in neuromodulation, are discussed.
Delayed Surgical Resection of Central Nervous System Germ Cell Tumors
Authors: Weiner Howard L. , Lichtenbaum Roger A. , Wisoff Jeffrey H. , Snow Robert B. , Souweidane Mark M. , Bruce Jeffrey N. , Finlay Jonathan L. 
Published: July 2004

Abstract

OBJECTIVE:
To determine the value of delayed surgical resection in patients with central nervous system germ cell tumors who exhibit less than complete radiographic response despite declining serum and cerebrospinal fluid (CSF) tumor markers after initial chemotherapy.

METHODS:
We retrospectively analyzed 126 patients enrolled on two international multicenter clinical trials (the First and Second International Central Nervous System Germ Cell Tumor Studies) for patients with newly diagnosed central nervous system germ cell tumors. After at least three cycles of chemotherapy, 10 of these patients underwent delayed surgical resection owing to evidence of residual radiographic abnormalities despite declining or completely normalized serum and CSF levels of α-fetoprotein and human chorionic gonadotropin.

RESULTS:
Eight of these patients demonstrated nongerminomatous germ cell tumor elements at the time of initial diagnosis. In these patients, either serum or CSF tumor markers were elevated initially. Two patients demonstrated pure germinomas with normal levels of serum and CSF tumor markers. After chemotherapy, radiographic evaluation revealed a partial response in seven patients, a minor response in one patient, and stable disease in two patients. All 10 patients had either normal or decreasing levels of serum and CSF tumor markers before second-look surgery. At delayed surgical resection, 7 of the 10 patients underwent gross total resection, and 3 patients underwent subtotal resection of residual lesions. Pathological findings at second-look surgery demonstrated three patients to have mature teratomas, two with immature teratomas, and five with necrotic or scar tissue alone. To date, 7 of the 10 patients have had no recurrence during an average follow-up time of 36.9 months (range, 3–96 mo). Three of four patients with nongerminomatous germ cell tumors who had tumor markers that were decreased, but not normalized, before second-look surgery eventually developed tumor dissemination/progression, and they required subsequent radiation therapy despite having teratoma or necrosis/scar tissue at delayed surgery. In contrast, three of four patients with nongerminomatous germ cell tumors and completely normalized markers did not progress and did not require radiation therapy.

CONCLUSION:
Delayed surgical resection should be considered in patients with central nervous system germ cell tumors who have residual radiographic abnormalities and normalized tumor markers, because these lesions are likely to be teratoma or necrosis/scar tissue. However, second-look surgery should be avoided in patients whose tumor markers have not normalized completely.
Characteristics of Ventricular Shunt Malfunctions among Patients with Neurocysticercosis
Authors: Kelley Rosemarie , Duong Duc H. , Locke George E. 
Published: July 2004

Abstract

OBJECTIVE:
Ventricular shunts used to relieve hydrocephalus among patients with neurocysticercosis have been plagued by high shunt malfunction rates. We examined the characteristics of shunt malfunctions among patients with neurocysticercosis.

METHODS:
This is a retrospective chart review of data for 122 patients who were admitted with a diagnosis of cysticercosis during a 5.5-year period. Cases of hydrocephalus requiring shunt placement were reviewed with respect to the segment of shunt obstruction, disease activity at the time of shunt placement, and the effects of antihelminthic treatment on shunt failures and longevity.

RESULTS:
Twenty-one patients required 49 operations for relief of hydrocephalus, including 22 new shunt placements, 23 revisions, and 4 cyst extirpations. Of these shunt failures, 78% occurred within the first 12 months and 96% within 3 years. Of the failures that occurred in the distal segment, 75% occurred within 6 months. By comparison, 33% of proximal segment obstructions and 50% of the total number of valve obstructions occurred within the first 6 months. Of the shunts placed during the vesicular stage of infection, 63% required revisions, compared with 29% of those placed during the colloidal through calcified stages. Nineteen shunts were placed during the vesicular stage, and nine patients received a full course of antihelminthic treatment after shunt placement. In less than 6 months, 33% of the cases involving shunt placement followed by antihelminthic treatment exhibited shunt failure, compared with 90% of the cases without antihelminthic treatment (P &lt; 0.05, χ2 test).

CONCLUSION:
Among patients with vesicular stage cysticercosis, placement of a ventriculoperitoneal shunt followed by a course of antihelminthic medication seems to promote shunt longevity.
Quantitative Assessment of Surgical Decompression of the Cervical Spine with Cine Phase Contrast Magnetic Resonance Imaging
Authors: Tominaga Teiji , Watabe Noriaki , Takahashi Toshiyuki , Shimizu Hiroaki , Yoshimoto Takashi 
Published: July 2004

Abstract

OBJECTIVE:
We measured cerebrospinal fluid flow velocity by use of cine phase contrast magnetic resonance imaging to quantitate the effectiveness of surgical decompression in patients with cervical myelopathy.

METHODS:
Forty-seven patients with cervical myelopathy attributable to either spondylosis or ossification of the posterior longitudinal ligament were studied. Thirty-five patients underwent anterior cervical decompression and fusion; 12 others underwent expansive laminoplasty. Patients were examined preoperatively and postoperatively by use of a 1.5-T scanner with a pulse-gated cine phase contrast sequence. Cerebrospinal fluid flow direction and velocity in the ventral subarachnoid space were determined at the C1 and T1 levels. Forty-four healthy control subjects were examined to determine normal flow velocity parameters. Severity of cervical myelopathy was evaluated preoperatively and postoperatively by use of Japan Orthopedic Association scores to calculate the extent of recovery.

RESULTS:
Preoperatively, cerebrospinal fluid flow velocity in the caudal direction was significantly lower at both C1 and T1 than velocities measured in healthy controls. Both decompressive procedures essentially returned patient velocities to control values. Clinical recovery from myelopathy did not differ between anterior and posterior decompression. Postoperative increase in flow velocity correlated with clinical recovery after posterior (P &lt; 0.0008) but not anterior decompression.

CONCLUSION:
Cine phase contrast magnetic resonance imaging provides quantitative assessment of cervical spine decompression, with particularly good clinical applicability to posterior procedures.
Neuronavigation by Intraoperative Three-dimensional Ultrasound: Initial Experience during Brain Tumor Resection
Authors: Unsgaard Geirmund , Ommedal Steinar , Muller Tomm , Gronningsaeter Aage , Nagelhus Hernes Toril A. 
Published: July 2004

Abstract

OBJECTIVE:
Three-dimensional (3-D) ultrasound is an intraoperative imaging modality used in neuronavigation as an alternative to magnetic resonance imaging (MRI). This article summarizes 4 years of clinical experience in the use of intraoperative 3-D ultrasound integrated into neuronavigation for guidance in brain tumor resection.

METHODS:
Patients were selected for inclusion in the study on the basis of the size and location of their lesion. Preoperative 3-D MRI data were registered and used for planning as in other conventional neuronavigation systems. Intraoperative 3-D ultrasound images were acquired three to six times, and tumor resection was guided on the basis of these updated 3-D images.

RESULTS:
Intraoperative 3-D ultrasound represents a good solution to the problem of brain shift in neuronavigation because it easily provides an updated, and hence more accurate, map of the patient's true anatomy in all phases of the operation. Ultrasound makes it possible to follow the progression of the operation, and it improves the radicality of tumor resection by detecting tumor tissue that would remain if the imaging technology had not been used (in 53% of the cases). Integration of 3-D ultrasound with navigation technology solves the orientation problem experienced previously with two-dimensional ultrasound in neurosurgery. The technology makes it possible to directly compare intraoperative ultrasound and MRI data regarding visualization of the lesion. Ultrasound image quality is useful for guiding surgical procedures.

CONCLUSION:
Intraoperative 3-D ultrasound seems to provide a time- and cost-effective way to update high-quality 3-D maps used in neuronavigation.
Occurrence of a Glioblastoma-associated Tenascin-C Isoform in Cerebral Cavernomas and Neighboring Vessels
Authors: Viale Giuseppe L. , Castellani Patrizia , Dorcaratto Alessandra , Pau Antonio , Sehrbundt Elke , Siri Annalisa , Birò Attila , Zardi Luciano 
Published: July 2004

Abstract

OBJECTIVE:
Regrowth of cerebral cavernomas after apparently complete excision, de novo occurrence, and evidence of proliferation-related patterns raise the question as to their intrinsic growth potential. A particular isoform (Type III repeat c) of the glycoprotein tenascin-C (TN-C), typically associated with the vessels of anaplastic gliomas, is regarded as a marker of vascular proliferation in lesions growing within brain tissue. This study sought to ascertain whether this isoform is expressed in cerebral cavernomas to gain further insight into the growth potential of these lesions.

METHODS:
Sixteen cerebral cavernomas and three fragments of normal brain underwent immunohistochemical examinations via two antibody fragments obtained by phage display technology. Previous characterization demonstrated that the fragment TN-12 recognizes the epidermal growth factor-like repeat, common to all TN-C isoforms. On the contrary, the fragment TN-11 was found to be highly specific for the Type III repeat c isoform.

RESULTS:
Accumulation of total TN-C was found in the vascular walls and in the interspaces between the blood cavities of all examined cavernomas. When the antibody fragment TN-11 was used, staining of the subendothelial layers occurred in both the bulk of the cavernomas and vessels of the white matter surrounding the lesions, but staining was absent in the control specimens.

CONCLUSION:
The distribution of the Type III repeat c isoform of TN-C, a putative marker of vascular proliferation, within cerebral cavernomas is consistent with the hypothesis of a growth potential of cerebral cavernomas. Enlargement of these lesions might involve recruitment of neighboring vasculature, which is possibly dependent on environmental conditions.
Exposure of the Dorsal Root Ganglion in Rats to Pulsed Radiofrequency Currents Activates Dorsal Horn Lamina I and II Neurons
Authors: Higuchi Yoshinori , Nashold Blaine S. , Sluijter Menno , Cosman Eric , Pearlstein Robert D. 
Published: July 2004

Abstract

OBJECTIVE:
Application of pulsed radiofrequency (RF) currents to the dorsal ganglion has been reported to produce long-term relief of spinal pain without causing thermal ablation. The present study was undertaken to identify spinal cord neurons activated by exposure of the dorsal ganglion to pulsed RF currents in rats.

METHODS:
Left-sided hemilaminectomy was performed in adult Sprague-Dawley rats to expose the C6 dorsal root ganglion. An RF electrode (0.5 mm diameter) with a thermocouple for temperature monitoring was positioned on the exposed ganglion, and rats were assigned to one of three treatment groups: pulsed RF treatment (20 ms of 500-kHz RF pulses delivered at a rate of 2 Hz for 120 s to produce tissue heated to 38°C), continuous RF (continuous RF currents for 120 s to produce tissue heated to 38°C), or sham treatment (no RF current; electrode maintained in contact with ganglion for 120 s).

RESULTS:
Treatment with pulsed RF but not continuous RF was associated with a significant increase in the number of cFOS-immunoreactive neurons in the superficial laminae of the dorsal horn as observed 3 hours after treatment.

CONCLUSION:
Exposure of the dorsal ganglion to pulsed RF currents activates pain-processing neurons in the dorsal horn. This effect is not mediated by tissue heating.
Intraparenchymal Tension Pneumatocele Complicating Frontal Sinus Osteoma: Case Report
Authors: Johnson David , Tan Leong 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE
A relatively rare condition of intraparenchymal tension pneumatocele secondary to a frontal sinus osteoma eroding posteriorly and breaching dura mater is described. The scanty body of literature on this subject is briefly summarized, and the importance of this condition as a result of its life-threatening but readily treatable intracranial mass effect is outlined.

CLINICAL PRESENTATION
The patient presented with acute deterioration in conscious state and lateralizing signs from the mass effect of gas under tension. Two weeks earlier, he had experienced vague and subtle changes in personality noticeable only to his family.

INTERVENTION
The patient was cured by a frontal craniotomy, partial excision of the osteoma, and suture repair of the dural defect after evacuation of the pressurized air cavity.

CONCLUSION:
This rare condition should be urgently treated in the event of acute deterioration. To prevent a life-threatening situation from arising, elective surgery should be considered for patients known to have air sinus osteomas that are at risk of erosion into the cranial cavity.
Intracranial Aneurysm and Vasculopathy after Surgery and Radiation Therapy for Craniopharyngioma: Case Report
Authors: Pereira Paulo , Cerejo Antonio , Cruz Joaquim , Vaz Rui 
Published: July 2004

AbstractOBJECTIVE AND IMPORTANCE:This case report illustrates the possible occurrence of intracranial aneurysms after surgery and radiation-induced vasculopathy.CLINICAL PRESENTATION:An internal carotid bifurcation aneurysm was diagnosed in a 19-year-old woman in a routine follow-up examination by magnetic resonance imaging 5 years after subtotal removal of a giant cystic craniopharyngioma treated by postoperative external radiotherapy. The presence of the aneurysm was confirmed by angiography.INTERVENTION:It was decided to treat the aneurysm by embolization with Guglielmi detachable coiling. However, at the beginning of the procedure, a few weeks after the diagnosis, a dramatic reduction in the carotid artery blood flow was observed, along with signs of thrombosis inside the aneurysm. In light of these findings, the procedure was aborted. Four months later, another angiographic examination confirmed the exclusion of the aneurysm and compensatory flow through the external carotid artery.CONCLUSION:During the assessment of patients who have undergone postoperative radiotherapy, the potential for the development of aneurysms and radiation-induced vasculopathy exists and should be kept in mind. Considering the potential for spontaneous thrombosis of these aneurysms, cautious judgment is recommended before making a decision to treat them.