bluuebunny/crossref_metadata_2025_split huggingface dataset:
Three-dimensional Contrast Medium-enhanced Computed Tomographic Cisternography for Preoperative Evaluation of Surgical Anatomy of Intradural Paraclinoid Aneurysms of the Internal Carotid Artery: Technical Note
Authors: Ito Kiyoshi , Hongo Kazuhiro , Kakizawa Yukinari , Kobayashi Shigeaki 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE
Precise preoperative evaluation is especially important when internal carotid artery aneurysms in the paraclinoid region are clipped, because these vascular structures are located in close proximity to various important structures such as the optic nerve and anterior clinoid process. We report a new method for “simultaneously” describing the interrelationships among the aneurysm, internal carotid artery, optic nerve, and bony structures with three-dimensional contrast medium-enhanced computed tomographic (3-D CMECT) cisternography.

METHODS
Informed consent was obtained from the patient. An 8-ml injection of iotrolan (Isovist; Schering, Berlin, Germany) (240 mg I/ml) was administered into the lumbar intrathecal space. A computed tomographic scan of the head was obtained 2 hours later with a multislice Asteion computed tomographic scanner (Toshiba, Inc., Tokyo, Japan). An Alatoview workstation (Silicon Graphics, Mountain View, CA) was used to reconstruct the three-dimensional images.

RESULTS
These images, as generated by 3-D CMECT cisternography, were found to accurately demonstrate the interrelationships of the internal carotid artery, aneurysm, and surrounding structures preoperatively. The findings obtained from these images proved to be quite similar to the intraoperative findings. 3-D CMECT cisternography clarified whether the paraclinoid aneurysm was intradural or extradural.

CONCLUSION
3-D CMECT cisternography was found to provide a useful means for preoperative evaluation of lesions in the paraclinoid area.
Management of Intracranial Infectious Aneurysms: A Series of 16 Cases
Authors: Phuong Loi K. , Link Michael , Wijdicks Eelco 
Published: July 2004

Abstract

OBJECTIVE
The purpose of this study was to better define the management of intracranial infectious aneurysms.

METHODS
We present a retrospective review of the management of 16 patients with intracranial infectious aneurysms. The mean follow-up period was 86 months.

RESULTS
None of the patients had a rehemorrhage during antibiotic treatment. The mortality and long-term outcome from ruptured intracranial infectious aneurysms may be better than previously thought. There was no significant difference in long-term outcome between patients with single or multiple infectious aneurysms or between patients who underwent surgical resection and those who were treated only with antibiotics.

CONCLUSION
Operative treatment should be pursued for patients with ruptured infectious aneurysms. Patients with unruptured intracranial infectious aneurysms should be observed during antibiotic therapy and followed up with cerebral angiography. Surgical resection should be considered if the aneurysm enlarges and the patient's general medical condition allows general anesthesia to be tolerated.
Radiosurgical Treatment of Cavernous Sinus Meningiomas: Experience with 122 Treated Patients
Authors: Nicolato Antonio , Foroni Roberto , Alessandrini Franco , Bricolo Albino , Gerosa Massimo 
Published: July 2004

Abstract

OBJECTIVE
To evaluate the efficacy of gamma knife (GK) radiosurgery, in terms of neurological improvement and tumor growth control (TGC), for a large series of patients with cavernous sinus meningiomas.

METHODS
Between February 1993 and January 2002, 156 patients with cavernous sinus meningiomas (35 male and 121 female patients; mean age, 56.1 yr) were treated with GK radiosurgery in our department. GK radiosurgery was used as a first-choice treatment for 75 of 156 patients and as postoperative adjuvant therapy for 81 of 156 patients (all with Grade I meningiomas). Eligibility criteria for radiosurgery were as follows: symptomatic meningiomas and/or documented tumor progression on magnetic resonance imaging scans, conditions of high operative risk, patient refusal of microsurgery or reoperation, tumor volume of &lt;20 cm3, and location no less than 2 mm from the optic pathways.

RESULTS
Follow-up data for at least 12 months were available for 122 patients (median follow-up period, 48.9 mo). Clinical conditions were improved or stable for 118 of 122 patients (97%). Neurological recovery was observed for 78.5% of patients treated with GK radiosurgery alone and for 60.5% of patients treated with adjuvant therapy (P &lt; 0.05). Adequate TGC was documented for 119 of 122 tumors (97.5%), with shrinkage/disappearance in 75 of 122 cases (61.5%) and no variation in volume in 44 of 122 cases (36%); the overall actuarial progression-free survival rate at 5 years was 96.5%. Tumor size regression was observed for 80% of patients with follow-up periods of more than 30 months, compared with 43.5% of patients with follow-up periods of less than 30 months (P &lt; 0.0002). Radiosurgical sequelae were transient in 4 of 122 cases (3.0%) and permanent in 1 case (1%).

CONCLUSION
For the follow-up periods in our series (median, &gt;4 yr), GK radiosurgery seems to be both safe (permanent morbidity rate, 1%) and effective (97% neurological improvement/stability, 97.5% overall TGC, and 96.5% actuarial TGC at 5 yr). GK radiosurgery might be considered a first-choice treatment for selected patients with cavernous sinus meningiomas.
Spinal Cord Ependymoma: Radical Surgical Resection and Outcome
Authors: Hanbali Fadi , Fourney Daryl R. , Marmor Eric , Suki Dima , Rhines Laurence D. , Weinberg Jeffrey S. , McCutcheon Ian E. , Suk Ian , Gokaslan Ziya L. 
Published: July 2004

Abstract

OBJECTIVE
Several authors have noted increased neurological deficits and worsening dysesthesia in the postoperative period in patients with spinal cord ependymoma. We describe the neurological progression and pain evolution of these patients over the 1-year period after surgery. In addition, our favored method of en bloc tumor resection is illustrated, and the rate of complications, recurrence, and survival in this group of patients is addressed.

METHODS
We operated on 26 patients (12 male and 14 female) with low-grade spinal cord ependymomas between 1975 and 2001. The median age at diagnosis was 42 years. Tumors extended into the cervical cord in 13 patients, the thoracic cord in 7 patients, and the conus medullaris in 6 patients. Eleven patients had previous surgery and/or radiation therapy.

RESULTS
We achieved a gross total resection in 88% of patients, whereas 8% had a subtotal resection and 4% had a biopsy. Only 1 patient developed a recurrence over a mean follow-up period of 31 months.

CONCLUSION
We conclude that radical surgical resection of spinal cord ependymomas can be safely achieved in the majority of patients. A trend toward neurological improvement from a postoperative deficit can be expected between 1 and 3 months after surgery and continues up to 1 year. Postoperative dysesthesias begin to improve within 1 month of surgery and are significantly better by 1 year after surgery. The best predictor of outcome is the preoperative neurological status.
Allograft Implants for Posterior Lumbar Interbody Fusion: Results Comparing Cylindrical Dowels and Impacted Wedges
Authors: Barnes Bryan , Rodts Gerald E. , Haid Regis W. , Subach Brian R. , McLaughlin Mark R. 
Published: July 2004

AbstractOBJECTIVEWith the proliferation of implant types available for use in posterior lumbar interbody fusion (PLIF) procedures, the choices for surgeons have become increasingly complex. The goal of this study was to retrospectively review a series of 49 patients who underwent PLIF with the use of allograft cylindrical threaded cortical bone dowels (TCBDs) and allograft impacted wedges. Nerve root injury rates, fusion rates, and clinical outcomes of the allograft impacted wedge group are compared with those in the allograft cylindrical TCBD group.METHODSWe performed a retrospective chart and radiographic review of 49 patients. Twenty-seven patients underwent PLIF with impacted allograft wedges, and 22 patients underwent PLIF with allograft cylindrical TCBD. Permanent nerve root injury rates, fusion rates, and clinical outcomes were assessed on the basis of a minimum of 1 year of follow-up data in this nonconsecutive series.RESULTSPermanent nerve root injuries in the impacted wedge and TCBD groups were documented with physical examinations conducted pre- and postoperatively. The cylindrical TCBD group showed a 13.6% rate of permanent nerve root injury, and the impacted wedge group demonstrated a 0% rate, and these rates were statistically significant (analysis of variance, P = 0.049). The fusion rate at a mean of 13.9 months of follow-up was 95.4% in patients in whom the cylindrical TCBD was implanted and 88.9% after a mean of 17.4 months of follow-up in patients in whom impacted wedges were used. The fusion rate difference between the TCBD and impacted wedge groups was not significant. The satisfactory outcome rate was 72.7% for the TCBD group and 85.1% for the impacted wedge group, and the impacted wedge group was found to have a significantly higher rate of satisfactory outcomes (P = 0.016, analysis of variance). Analysis of the patient outcomes in the TCBD and impacted wedge groups according to sex, mean length of follow-up, workman's compensation claim rate, and smoking habit yielded no significant difference.CONCLUSIONWith a minimum of 1 year of follow-up in this nonconsecutive series of 49 patients, a comparison of the use of allograft TCBD versus allograft impacted wedges in PLIF procedures reveals a statistically significant increase in permanent nerve root injury rates with the use of cylindrical TCBD implants as compared with impacted allograft wedges. There is no difference between the two groups in terms of fusion rates, and clinical outcomes with the use of impacted wedges were significantly better.
Comparison of Posterior Approaches to the Posterior Incisural Space: Microsurgical Anatomy and Proposal of a New Method, the Occipital Bi-transtentorial/Falcine Approach
Authors: Kawashima Masatou , Rhoton Albert L. , Matsushima Toshio 
Published: July 2004

Abstract

OBJECTIVE
Direct surgical approaches to the posterior incisural space, including the pineal region, remain as challenges for neurosurgeons. The purposes of this study were 1) to compare the surgical views in the various posterior approaches to the posterior incisural space and 2) to propose a new approach, which is a modification of the occipital transtentorial approach.

METHODS
Ten adult cadaveric specimens (20 sides) were studied, using ×3 to ×40 magnification, after perfusion of the arteries and veins with colored silicone. Intraoperative views in the posterior approaches to lesions were examined in stepwise dissections. In addition, the efficacy of the occipital bi-transtentorial/falcine approach was studied.

RESULTS
The posterior incisural space has a roof, a floor, and anterior and lateral walls and extends backward to the level of the tentorial apex. The operative views defined by each approach differ in the extent to which they allow observation of the anatomic structures in the posterior incisural space. The occipital bi-transtentorial/falcine approach permits better observation of the contralateral half of the quadrigeminal cistern.

CONCLUSION
Precise surgical anatomic knowledge of each approach is required for the treatment of lesions in the posterior incisural space, because the operative fields obtained with different approaches differ significantly. The occipital bi-transtentorial/falcine approach provides greater contralateral exposure of the posterior incisural space than does the occipital transtentorial approach.
Imaging the Cerebrovascular Tree in the Cadaveric Head for Planning Surgical Strategy
Authors: Zhao Jin-Cheng , Chen Chi , Rosenblatt Sami S. , Meyer Joel R. , Edelman Robert R. , Batjer H. Hunt , Ciric Ivan S. 
Published: July 2004

Abstract

OBJECTIVE
The objective of the study was to identify whether an integration of cadaveric dissections with preoperative imaging information may enable a better understanding of pathological anatomy, especially vascular lesions, and thus allow for greater precision in surgical planning.

METHODS
We selected a computed tomographic contrast agent and experimentally determined the proportion of it that could mix compatibly with the silicone compound. The resultant mixture was injected into the cerebrovascular systems of six fresh human cadaveric heads. The specimens underwent computed tomography for the purpose of digital virtual exposures in parallel with laboratory dissections performed on these specimens.

RESULTS
The 1:8 ratio of contrast agent to silicone rubber was determined to be appropriate for both computed tomography and subsequent laboratory dissection of the specimens. The blood vessels in computed tomographic scans demonstrated a higher attenuation than surrounding soft tissues. The opacity consistency of the injected vessels was a critical parameter for a clear three-dimensional rendering of the vascular structures in the natural surroundings of the skull base. Static and dynamic three-dimensional images of the cadaveric vascular tree were obtained as viewed through surgical corridors of various skull base approaches.

CONCLUSION
We demonstrated a new cadaveric preparation model for imaging and dissection. This model allows for static and dynamic three-dimensional examination of the surgical anatomy from a neurosurgeon's perspective. It may facilitate the study of cerebrovascular system morphology/pathology in relation to the skull base as a tool for surgical planning.
Peripheral Primitive Neuroectodermal Tumor of the Jugular Foramen: Case Report
Authors: Yamazaki Takamasa , Kuroki Takao , Katsume Mikiro , Kameda Noriaki 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE
Peripheral primitive neuroectodermal tumor (pPNET) is a rare type of tumor, most commonly found in the limbs of children and young adults. The authors report an extremely rare case of pPNET located at the jugular foramen whose clinical course demonstrated rapid progression.

CLINICAL PRESENTATION
A 23-year-old man presented with a 2-month history of progressive hoarseness and dysphagia. The neuroradiological appearance of the lesion was a jugular foramen tumor.

INTERVENTION
The patient underwent a partial resection of the tumor through a far lateral suboccipital craniotomy. After surgery, the patient experienced an unexpected deterioration in consciousness. Magnetic resonance images on postoperative Day 18 revealed rapid and large expansion of the residual tumor into the posterior fossa. No adjuvant therapy was administered, and the patient died 6 weeks after diagnosis.

CONCLUSION
The pathological diagnosis of the surgical specimen was pPNET, according to the findings of hematoxylin and eosin and immunohistochemical stainings. To the best of our knowledge, this is the first reported case of pPNET at the jugular foramen.
Supratentorial Convexity Leptomeningeal Schwannoma: Case Report
Authors: Nakayama Keiko , Nakayama Tetsuo , Matsuoka Yoshimi , Kono Kinuko 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE
Leptomeningeal schwannomas are very rare; to our knowledge, only one case has been previously reported. The possible histogenesis and differential diagnosis of intracranial schwannomas not related to cranial nerves are discussed.

CLINICAL PRESENTATION
A 53-year-old man presented with a sudden onset of seizures. Computed tomographic scans revealed a small hypodense mass in the peripheral aspect of the left frontal lobe. The mass was hypointense on T1-weighted and hyperintense on T2-weighted magnetic resonance imaging scans, with ring enhancement after contrast medium administration.

INTERVENTION
A craniotomy was performed for total removal of the tumor, revealing a well-demarcated, firm, spherical tumor beneath the dura. The tumor was easily separated from the brain. Histologically, the tumor was observed to be within the subarachnoid space, intimately attached to the pia mater. The adjacent brain tissue and dura mater were free of tumor cells. The histological diagnosis was schwannoma.

CONCLUSION
Computed tomographic and magnetic resonance imaging findings in our case were consistent with those for a schwannoma, although the subarachnoid space is an extremely rare location for schwannomas. We emphasize that schwannomas may arise in the subarachnoid space.
Thoracoscopic Approaches to the Thoracic Spine: Experience with 241 Surgical Procedures
Authors: Han Patrick P. , Kenny Kathy , Dickman Curtis A. 
Published: July 2004

Abstract

INTRODUCTION
Microsurgical thoracoscopic approaches to the thoracic spine allow access to the spinal cord, spinal nerves, disc spaces, vertebral bodies, paravertebral soft tissues, and sympathetic chain with minimal invasiveness.

METHODS
Between January 1994 and January 2000, 241 thoracoscopic procedures were performed: 164 thoracic sympathectomies, 60 discectomies, 5 neurogenic tumor resections, 8 corpectomies and spinal reconstructions, 2 anterior releases, and 2 biopsies. Cases were reviewed to evaluate the efficacy, surgical results, and complications of the thoracoscopic procedures.

RESULTS
An adequate sympathectomy was achieved in all 164 sympathectomies. There was 100% relief of palmar and 95% relief of axillary hyperhidrosis. Reflex sympathetic dystrophy responded poorly to sympathectomy with recurrent pain. Thoracoscopic discectomy achieved complete decompression in 98% of patients. Gross total tumor resection was achieved in all five paraspinal neurogenic tumors. There was no operative mortality. Morbidity compared favorably with open surgical approaches to the thoracic spine.

CONCLUSION
Thoracoscopic spinal surgery is an effective technique that provides full, direct access to the ventral thoracic spine. Its morbidity rate appears to be lower than that associated with open thoracotomy. It improves patient comfort and cosmetic results and shortens recovery. This technique has become the authors' surgical approach of choice for removing benign intrathoracic paraspinal neurogenic tumors and central herniated thoracic discs and for performing biopsies and thoracic sympathectomies. The senior author still prefers open surgical approaches for most thoracic corpectomies and spinal reconstruction procedures.
Thoracoscopic-assisted Treatment of Thoracic and Lumbar Fractures: A Series of 371 Consecutive Cases
Authors: Khoo Larry T. , Beisse Rudolf , Potulski Michael 
Published: July 2004

AbstractOBJECTIVEConventional approaches for the treatment of thoracic and thoracolumbar fractures require extensive surgical exposure, often leading to significant postoperative pain and morbidity. Thoracoscopic spinal surgery was performed to reduce the morbidity of these approaches while still achieving the primary goals of spinal decompression, reconstruction, and stabilization.METHODSBetween May 1996 and May 2001, 371 patients with fractures of the thoracic and thoracolumbar spine (T3–L3) were treated with a thoracoscopically assisted procedure. In the first 197 patients, a conventional open anterior plating system was used. The last 174 patients were treated with the MACS-TL system (Aesculap, Tuttlingen, Germany), which was designed specifically for endoscopic placement, thereby significantly reducing operative times.RESULTSSeventy-three percent of the fractures were located at the thoracolumbar junction. In 49% of patients, mobilization of the diaphragm was performed to expose the fracture, with later repair. Both x-ray canal compromise and neural deficit were present in 15% of patients. In 35% of patients, a stand-alone anterior thoracoscopic reconstruction was performed. In 65% of patients, a supplemental posterior pedicle-screw construct was also placed either before or after the anterior construct. A steep learning curve was present, with an average operating time of 300 minutes in the first 50% of cases and an average of 180 minutes with the MACS-TL system. The severe complication rate was low (1.3%), with one case each of aortic injury, splenic contusion, neurological deterioration, cerebrospinal fluid leak, and severe wound infection. Compared with a group of 30 patients treated with open thoracotomy, thoracoscopically treated patients required 42% less narcotics for pain treatment after the operation.CONCLUSIONA complete anterior thoracoscopically assisted reconstruction of thoracic and thoracolumbar fractures can be safely and effectively accomplished, thereby reducing the pain and morbidity associated with conventional thoracotomy and thoracolumbar approaches. Although the learning curve is steep, the functional and cosmetic benefits to the patient warrant the difficult training process.
Microendoscopic Decompressive Laminotomy for the Treatment of Lumbar Stenosis
Authors: Khoo Larry T. , Fessler Richard G. 
Published: July 2004

AbstractOBJECTIVEBy modifying existing microendoscopic discectomy techniques, we previously developed a novel surgical treatment of lumbar stenosis and validated its ability to achieve a thorough decompression in a cadaveric study. We now describe our clinical experience with this new, minimally invasive microendoscopic decompressive laminotomy (MEDL) technique.METHODSA MEDL was performed in 25 patients with classic features of lumbar stenosis. By use of a fluoroscopically guided percutaneous technique, the working portal was docked on the lamina with minimal soft-tissue injury. With the angle of the endoscope combined with an oblique entry, a bilateral bony and ligamentous decompression was achieved under the midline, thereby preserving the supraspinous–interspinous ligaments and contralateral musculature. A second group of 25 patients treated with open decompression was used for comparison.RESULTSEffective circumferential decompression was achieved in the majority of patients. The results for the MEDL group were as follows: operative time, 109 minutes per single level; blood loss, 68 ml; and postoperative stay, 42 hours. The results for the open-surgery group were as follows: operative time, 88 minutes; blood loss, 193 ml; and postoperative stay, 94 hours. The MEDL group needed significantly less narcotic medication after surgery. Overall, 16% of the MEDL patients reported resolution of their back pain, 68% improved symptomatically, and 16% remained unchanged. The outcome of the open group was very similar.CONCLUSIONCompared with an equivalent open technique, MEDL appears to offer a similar short-term clinical outcome with a significant reduction in operative blood loss, postoperative stay, and use of narcotics. This lower surgical stress, decreased tissue trauma, and quicker recovery are particularly important in this elderly population of patients.
Is Laparoscopic Anterior Lumbar Interbody Fusion a Useful Minimally Invasive Procedure?
Authors: Liu John C. , Ondra Stephen L. , Angelos Peter , Ganju Aruna , Landers Misty L. 
Published: July 2004

AbstractOBJECTIVELaparoscopic anterior lumbar interbody fusion (LALIF) has been demonstrated to be safe and effective. Its use as a standard surgical technique has been recommended for arthrodesis in the lumbosacral region. We reviewed our experience with LALIF for safety, effectiveness, and usefulness.METHODSRetrospective review of 14 patients who underwent LALIF was performed. All patients had a diagnosis of degenerative disc disease with medically retractable mechanical back pain.RESULTSNo intraoperative vascular or neurological injury was encountered. An average operating time of 300 minutes with blood loss of 60 ml was found. The average hospital stay was 3.4 days. At 3 to 6 months after surgery, 80% fusion rates were achieved.CONCLUSIONAlthough LALIF is a safe and effective procedure, it has many disadvantages, which make it a less than optimal procedure for routine use. Other minimally invasive approaches to the anterior lumbar spine result in similar beneficial results without the drawbacks associated with LALIF.