bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cellular Engineering: Molecular Repair of Membranes to Rescue Cells of the Damaged Nervous System
Authors: Borgens Richard B. 
Published: July 2004

Abstract

PURPOSE
The acute administration of hydrophilic polymers (polyethylene glycol) can immediately seal nerve membranes, preventing their continuing dissolution and secondary axotomy. Polymer application can even be used to reconnect, or fuse, the proximal and distal segments of severed axons in completely transected adult mammalian spinal cord.

CONCEPT
The sealing or fusion of damaged nerve membranes leads to a very rapid (minutes or hours) recovery of excitability in severely damaged nerve fibers, observed as a rapid return of nerve impulse conduction in vitro, as well as an in vivo recovery of spinal cord conduction and behavioral loss in spinal cord-injured adult guinea pigs.

RATIONALE
Surfactant application produces a rapid repair of membrane breaches through mechanisms of interaction between the polymers and the aqueous phase of damaged membranes, and their ability to insert into, or seal, the hydrophobic core of the axolemma exposed by mechanical damage.

DISCUSSION
This new technology applied to severe neurotrauma offers a clinically safe and practical means to rescue significant populations of spinal cord nerve fibers within 8 hours after damage—preventing their continued dissolution and secondary axotomy by secondary injury mechanisms. Application of this novel technology to other injuries to the peripheral and central nervous system is discussed, as well as a general application to soft tissue trauma.
Metastatic Hepatocellular Carcinoma Presenting as Epidural Hematoma: Case Report
Authors: McIver Jon I. , Scheithauer Bernd W. , Rydberg Charlotte H. , Atkinson John L.D. 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE
A case of acutely symptomatic epidural hematoma caused by metastatic hepatocellular carcinoma (HCC) to the cranium is reported. This is a rare case of metastatic HCC without known primary presenting as an epidural hematoma.

CLINICAL PRESENTATION
The patient presented with an acute onset of headache, aphasia, and right hemiparesis 2 weeks after he experienced minor trauma to the cranium. An emergency computed tomographic scan of the head revealed the presence of a left parietal epidural hematoma.

INTERVENTION
An emergency evacuation of the epidural hematoma was performed, and metastatic HCC was diagnosed.

CONCLUSION
The patient's neurological deficits were reversed with surgical intervention, and he is now undergoing palliative chemotherapy. This was the first clinical manifestation of HCC in this patient. This case reaffirms the neurosurgeon's role in the complex, multidisciplinary care of patients with craniospinal metastasis.
Accumulation of Intraventricular Fat in an Intracranial Epidermoid Tumor: Case Report
Authors: Kwon Taek-Hyun , Park Youn-Kwan , Chung Hung-Seob , Lee Hoon-Kap 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE
A fat component within the ventricles or subarachnoid space in fat-containing tumors such as an epidermoid or a dermoid has been observed in rare instances. However, there have been no reports regarding an increase in the size of such a fat component. We describe the case of an epidermoid tumor with intraventricular fat that showed an increase in size and amount.

CLINICAL PRESENTATION
A 26-year-old woman was admitted with headache and diplopia. Computed tomography and magnetic resonance imaging of the brain revealed a fat-containing suprasellar tumor and widespread fat globules in adjacent sulci and cisterns and within the frontal horn of the lateral ventricle.

INTERVENTION
The patient underwent a pterional craniotomy. Removal of the suprasellar tumor was nearly total. Histopathological examination revealed an epidermoid tumor. Sequential magnetic resonance imaging throughout the ensuing 65-month period revealed no evidence of tumor recurrence; however, the intraventricular fat remained and increased in size. The patient underwent surgery via the transcallosal approach at 69 months after the initial operation, and the presence of free-floating oily fat globules was confirmed.

CONCLUSION
In the case of a fat-containing tumor with free fat in the cerebrospinal fluid spaces, careful serial examination is necessary, with particular attention to the possibility of changes in size.
New Method for Obliterative Treatment of an Anterior Wall Aneurysm in the Internal Carotid Artery: Encircling Silicone Sheet Clip Procedure—Technical Case Report
Authors: Kurokawa Yasutaka , Wanibuchi Masahiko , Ishiguro Masanori , Inaba Ken-ichi 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE
Aneurysms on the anterior surface of the internal carotid artery (ICA) have been shown to be somewhat different from ordinary berry aneurysms because they are rather small, grow rapidly in a short time, and easily lead to rupture, especially during surgery. The most difficult problem is that this type of aneurysm cannot be eliminated easily by an ordinary clipping procedure without causing apparent arterial stenosis or occlusion.

CLINICAL PRESENTATION
A 52-year-old man experienced a subarachnoid hemorrhage because of a ruptured aneurysm located on the anterior surface of the ICA. The tiny aneurysmal body, which was covered with a layer of brain tissue, was successfully exposed. The ICA seemed to be atherosclerotic, and the aneurysmal portion was solitary and had a reddish color.

TECHNIQUE
A large silicone sheet encircling clip (Vascwrap; Mizuho Ikakogyo Co., Ltd., Tokyo, Japan) was selected for this patient. The proximal margin of the silicone sheet was incised with a V-shaped cut, and the middle part of the sheet, which covered the diagonal part of the ICA, was trimmed to make it shorter. The blade of the fenestrated clip was applied to obliterate the aneurysm and was attached to the normal arterial wall together with this modified Vascwrap sheet to create a small space between the normal arterial wall and the surrounding Vascwrap sheet. Then tiny pieces of Teflon fiber (E.I. duPont de Nemours and Co., Wilmington, DE) was inserted from both margins, and the whole Vascwrap sheet was sealed with fibrin glue to ensure good adhesion.

CONCLUSION
This method seemed adequate in treating this difficult aneurysm without causing postoperative regrowth or occlusion of the patient's ICA.
Easy Sellar Reconstruction in Endoscopic Endonasal Transsphenoidal Surgery with Polyester-Silicone Dural Substitute and Fibrin Glue: Technical Note
Authors: Cappabianca Paolo , Cavallo Luigi Maria , Mariniello Giuseppe , de Divitiis Oreste , Romero Alicia Del Carmen Becerra , de Divitiis Enrico 
Published: July 2004

Abstract

OBJECTIVE
To describe a simple method of sellar reconstruction after endoscopic endonasal transsphenoidal surgery that will allow rapid watertight closure of the sellar floor.

METHODS
A bent sheet of a polyester-silicone dural substitute, fashioned for this purpose with scissors, is introduced into the sella after removal of the lesion. Because of the consistency of the sheet, it opens spontaneously and becomes stuck. Autologous fat tissue or gelatin foam is positioned thereafter, followed by another layer of the dural substitute; a film of fibrin glue completes the sealing.

RESULTS
Fifteen patients underwent this method and no postoperative cerebrospinal leak or other complication was experienced.

CONCLUSION
This easy method of sellar reconstruction represents an effective and fast possibility to perform the final step of the endoscopic transsphenoidal procedure, which otherwise may cause maneuverability problems in the limited space of one nostril.
Image-guided Placement of Eye Muscle Electrodes for Intraoperative Cranial Nerve Monitoring
Authors: Alberti Olaf , Sure Ulrich , Riegel Thomas , Bertalanffy Helmut 
Published: July 2004

Abstract

OBJECTIVE
Monitoring of the oculomotor system during cranial base or brainstem surgery requires extraocular intraorbital insertion of electromyography electrodes. We investigated the use of image-guidance technology for anatomically correct intraorbital electrode placement.

METHODS
For neuronavigation, an optical tracking system was used in a standard fashion. Needle electrodes were inserted percutaneously into the lateral rectus, inferior rectus, and superior oblique muscle along the axis of a hand-held pointer or by means of an electrode applicator to allow direct tracking with the navigation system. Electromyographic monitoring was performed by multichannel recordings of free running or evoked activity from the selected muscles.

RESULTS
We have used this method in 10 patients; 5 had cranial base tumors and 5 underwent operations for brainstem lesions. No additional instruments or resources were required compared with the routine setup, and no intraorbital structures were injured. Successful monitoring of oculomotor, trochlear, or abducent nerve function was possible in each case.

CONCLUSION
This method may have the potential to increase the safety and success rate of intraoperative electro-ophthalmography during microsurgery focused on preservation of neurological function.
Clinical Validation of True Frameless Stereotactic Biopsy: Analysis of the First 125 Consecutive Cases
Authors: Paleologos Theophilos S. , Dorward Neil L. , Wadley John P. , Thomas David G.T. 
Published: July 2004

Abstract

OBJECTIVE
A lockable guide device, adjustable for positioning, was used to obtain samples for tissue analysis during brain biopsy procedures performed using an interactive image guidance system. Clinical validation of this technique, which was developed for true frameless stereotactic biopsies, and analyses of the histological yield, complication rate, and patient demographic characteristics for a large series of frameless stereotactic biopsies were the purposes of this study.

METHODS
Demographic, radiological, surgical, and clinical data were prospectively collected for a series of 125 frameless stereotactic biopsies performed using the technique described in detail previously.

RESULTS
Eighty-six procedures were magnetic resonance imaging-directed and 39 were computed tomography-directed. The mean diameter of the biopsied lesions was 36 mm, and the mean distance from the skin was 35.8 mm. Sixteen percent of the patients harbored multiple lesions, and 5.6% of the biopsied lesions were infratentorial. The mean operative time (including the entire anesthetic time) was 1.5 hours. The smear examination findings were corroborated by conclusive histological results in 96% of the cases, and definitive positive diagnoses were obtained in 122 cases (97.6%). Ten patients experienced surgical complications, but the sustained morbidity rate was 2.4% (including the death of a patient who was in critical clinical condition preoperatively and who died 2 mo later as a result of a chest infection; mortality rate, 0.8%).

CONCLUSION
This true frameless stereotactic biopsy technique was associated with low morbidity and mortality rates and an excellent diagnostic yield, with overall results at least as good as those observed for frame-based stereotaxy. The excellent accuracy results demonstrated previously and statistically significant reductions in operative time, as well as improved image presentation, target selection, and simplicity, support the use of this frameless stereotactic technique in preference to frame-based biopsy techniques.
Image-guided Hypo-fractionated Stereotactic Radiosurgery to Spinal Lesions
Authors: Ryu Stephen I. , Chang Steven D. , Kim Daniel H. , Murphy Martin J. , Le Quynh-Thu , Martin David P. , Adler John R. 
Published: July 2004

Abstract

OBJECTIVE
This article demonstrates the technical feasibility of noninvasive treatment of unresectable spinal vascular malformations and primary and metastatic spinal tumors by use of image-guided frameless stereotactic radiosurgery.

METHODS
Stereotactic radiosurgery delivers a high dose of radiation to a tumor volume or vascular malformation in a limited number of fractions and minimizes the dose to adjacent normal structures. Frameless image-guided radiosurgery was developed by coupling an orthogonal pair of x-ray cameras to a dynamically manipulated robot-mounted linear accelerator that guides the therapy beam to treatment sites within the spine or spinal cord, in an outpatient setting, and without the use of frame-based fixation. The system relies on skeletal landmarks or implanted fiducial markers to locate treatment targets. Sixteen patients with spinal lesions (hemangioblastomas, vascular malformations, metastatic carcinomas, schwannomas, a meningioma, and a chordoma) were treated with total treatment doses of 1100 to 2500 cGy in one to five fractions by use of image-guided frameless radiosurgery with the CyberKnife system (Accuray, Inc., Sunnyvale, CA). Thirteen radiosurgery plans were analyzed for compliance with conventional radiation therapy.

RESULTS
Tests demonstrated alignment of the treatment dose with the target volume within ± 1 mm by use of spine fiducials and the CyberKnife treatment planning system. Tumor patients with at least 6 months of follow-up have demonstrated no progression of disease. Radiographic follow-up is pending for the remaining patients. To date, no patients have experienced complications as a result of the procedure.

CONCLUSION
This experience demonstrates the feasibility of image-guided robotic radiosurgery for previously untreatable spinal lesions.
Cutaneous Necrosis after Superficial Temporal Artery-to-Middle Cerebral Artery Anastomosis: Is It Predictable or Avoidable?
Authors: Katsuta Toshiro , Inoue Tooru , Arakawa Shuji , Uda Ken 
Published: July 2004

Abstract

OBJECTIVE
This study was carried out to determine whether a relationship exists between cutaneous necrosis after superficial temporal artery-to-middle cerebral artery anastomosis and background risk factors or surgical methods, and to determine whether such necrosis is predictable or avoidable.

METHODS
Forty-seven patients (a total of 51 sides) with atherosclerotic lesions of the internal carotid artery or middle cerebral artery who underwent superficial temporal artery-to-middle cerebral artery anastomosis at the National Kyushu Medical Center Hospital between September 1, 1994, and August 31, 1999, were reviewed. Each procedure was analyzed to determine whether cutaneous necrosis was present postoperatively around the donor site, whether preexisting risk factors (hypertension, diabetes mellitus, hyperlipidemia, ischemic heart disease, and arteriosclerosis obliterans) were present, and whether a flap or cutdown method or a single or double anastomosis was performed.

RESULTS
Postoperative necrosis was clearly related to arteriosclerosis obliterans (P &lt; 0.003). The tendency for a relationship between necrosis and smoking was noted. Although statistical analysis failed to demonstrate a significant difference, necrosis was found with the flap method but not with the cutdown method.

CONCLUSION
Further study is needed using greater numbers to clarify the relationship between the surgical method and the presence of necrosis. To prevent cutaneous necrosis, however, it may be preferable to use the cutdown method in patients with the preexisting risk factors of arteriosclerosis obliterans or in smokers.
Transsylvian Keyhole Functional Hemispherectomy
Authors: Schramm Johannes , Kral Thomas , Clusmann Hans 
Published: July 2004

Abstract

OBJECTIVE
To describe the technical steps, advantages, and limitations of a quicker, minimal-exposure, functional hemispherectomy procedure developed from a hemispherical deafferentation technique previously described.

METHODS
The surgical approach using the transsylvian/transsulcal passage to the ventricular system, with the anatomic orientation points and key features for planning of the small trepanation, is described. Through a linear incision, a craniotomy (4 × 4 to 4 × 5 cm) is placed over the sylvian fissure. Transsylvian exposure of the circular sulcus allows transcortical exposure of the entire ventricular system, from the frontal horn to the temporal horn encircling the insular cortex. The frontobasal and mesial white matter is disconnected via the intraventricular approach, with a callosotomy. An amygdalohippocampectomy completes the dissection. The experience with 20 patients who were treated using the transsylvian keyhole hemispherectomy technique is summarized.

RESULTS
The operation time was significantly shorter (mean, 3.6 h) than with the Rasmussen technique (mean, 6.3 h) and 25% shorter than with the transcortical perisylvian technique (mean, 4.9 h). The proportion of patients requiring blood replacements was lower (15 versus 58%), as was the mean amount of transfused blood. The mean follow-up period was 46 months; 88% of patients were in Engel Outcome Class I, 6% in Class III, and 6% in Class IV.

CONCLUSION
The transsylvian keyhole procedure has been demonstrated to further reduce operation time and the need for blood replacement. It is most easily performed in cases with enlarged ventricles or perinatal ischemic cysts and is not recommended for hemimegalencephaly. The immediate seizure relief was satisfying. This minimal-exposure approach seems to be a satisfying alternative among possible functional hemispherectomy procedures.
Carotid Endarterectomy: Can We Select Surgical Candidates at High Risk for Stroke and Low Risk for Perioperative Complications?
Authors: Lanzino Giuseppe , Couture Daniel , Andreoli Alvaro , Guterman Lee R. , Hopkins L. Nelson 
Published: July 2004

Abstract
DESPITE EVIDENCE OF the efficacy of carotid endarterectomy from the large randomized multicenter trials completed in the 1990s, the physician who treats patients with carotid artery stenosis still is faced with a difficult management decision. More recently, subgroup analyses have been conducted of asymptomatic and symptomatic patients enrolled in these trials to identify clinical and radiological factors that increase the rates of morbidity and mortality associated with surgery, as well as those that increase the risk of stroke without surgery. Knowledge of these factors is important to recommend the best course of action for the individual patient. In this article, we summarize the conclusions of some of the subgroup analyses from the major carotid endarterectomy trials.
Unusual Brain Metastases from Papillary Thyroid Carcinoma: Case Report
Authors: Aguiar Paulo H. , Agner Celso , Tavares Fernanda R. , Yamaguchi Nise 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE
Brain metastases from papillary carcinoma of the thyroid gland are unusual. No consensus regarding management has yet been reached. We report a case, review the current literature, and explain our approach on the basis of clinical, pathological, and radiological data.

CLINICAL PRESENTATION
A 33-year-old woman presented with signs of intracranial hypertension. The diagnostic evaluation included chest tomography, head computed tomography, brain magnetic resonance imaging with and without contrast enhancement, total-body scanning, and cerebral scintigraphy. Multiple supratentorial lesions and one right cerebellopontine angle lesion were observed. Histopathological analysis of the surgical specimen confirmed papillary carcinoma of the thyroid gland.

INTERVENTION
A ventriculoperitoneal shunt was placed and a right suboccipital craniotomy was performed, with complete removal of the cerebellopontine angle tumor. Total-brain irradiation with 40 Gy/lesion followed the initial operation. One year after surgery, the patient presented with signs of increased intracranial pressure. A new left frontal lobe lesion with massive peritumoral edema was identified on magnetic resonance imaging scans. The edema was treated clinically and a left frontal craniotomy was performed, with complete resection of the tumor. The patient is currently faring well, with residual expressive aphasia.

CONCLUSION
Surgery followed by radiotherapy seems to be a good alternative for the treatment of this specific type of metastasis. Thorough clinical and radiological evaluation, followed by genetic analysis of the surgical specimen, particularly with respect to the potential for tumor invasion under specific conditions, is recommended. The information obtained contributes to better management and better overall long-term outcomes for these patients.
Peritumoral Brain Edema in Intracranial Meningiomas: Effects of Radiological and Histological Factors
Authors: Tamiya Takashi , Ono Yasuhiro , Matsumoto Kengo , Ohmoto Takashi 
Published: July 2004

ABSTRACT

OBJECTIVE
We examined the radiological and histological features influencing the development of peritumoral brain edema (PTBE) among patients with meningiomas.

METHODS
Factors causing PTBE were retrospectively analyzed for 125 patients with primary intracranial meningiomas. These factors included tumor size, tumor location, brain-tumor interface, signal intensity on T2-weighted scans, contrast enhancement, and cyst formation (as observed on magnetic resonance imaging scans), as well as tumor vascularity and blood supply (as observed in digital subtraction angiography studies). We defined the edema/tumor volume ratio as the edema index, and we used this index to evaluate PTBE.

RESULTS
A relationship between the tumor size and the volume of PTBE was observed. Convexity and middle fossa meningiomas demonstrated the greatest increases in mean edema indices. Meningothelial, anaplastic, microcystic, and angiomatous subtypes exhibited higher edema indices than did other types. Multivariate analysis demonstrated two significant radiological factors: cortical penetration (as defined by the disappearance of the arachnoid layer on magnetic resonance imaging scans) (relative risk, 2.067;P = 0.0148) and vascular supply from the pial-cortical arteries (as observed on angiograms) (relative risk, 2.087;P = 0.0082).

CONCLUSION
Tumor infiltration into adjacent brain parenchyma and a pial-cortical blood supply are critical factors for the development of PTBE among patients with meningiomas.