bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early Endovascular Treatment of Ruptured Cerebral Aneurysms in Patients in Very Poor Neurological Condition
Authors: van Loon Johannes , Waerzeggers Yannic , Wilms Guido , Van Calenbergh Frank , Goffin Jan , Plets Christian 
Published: July 2004

Abstract

OBJECTIVE:
In patients in very poor neurological condition (World Federation of Neurosurgical Societies Grade V) with aneurysmal subarachnoid hemorrhage, early surgery to prevent rebleeding and to allow appropriate treatment of complications is often difficult. The aim of the present study was to evaluate whether early endovascular treatment followed by aggressive proactive treatment of complications (prophylactic hypervolemic hemodilution, hypertensive treatment in the event of systemic hypotension, and appropriate treatment of intracranial hypertension) is an acceptable management strategy for these patients.

METHODS:
We prospectively studied 11 consecutive patients who presented with acutely ruptured aneurysms and were in very poor neurological condition after resuscitation (World Federation of Neurosurgical Societies Grade V) but did not have a significant intracerebral hemorrhage. These patients received endovascular treatment with Guglielmi detachable coils (Boston Scientific/Target, Fremont, CA). Follow-up consisted of a clinical evaluation based on the Glasgow Outcome Scale. A control angiogram was obtained after 6 months in patients with favorable outcomes to evaluate the occlusion of the aneurysm.

RESULTS:
There were no deaths or complications directly related to the procedure. Two patients died as a consequence of increased intracranial pressure. The mean follow-up of the surviving patients was 12 months. Two patients had early rebleeding after the coiling and required further treatment. Four patients had good outcomes, two patients were moderately disabled, and three patients were severely disabled.

CONCLUSION:
This study demonstrates that early endovascular treatment of acutely ruptured cerebral aneurysms in patients evaluated as World Federation of Neurosurgical Societies Grade V allows for aggressive treatment of intracranial hypertension and vasospasm. More than half of the patients had favorable outcomes. Therefore, early endovascular treatment seems to be a valuable alternative to early surgery in patients who present with a very poor clinical grade after subarachnoid hemorrhage. The results of this study are promising but must be interpreted with caution, because a small number of patients were studied.
Detection of the Residual Lumen of Intracranial Aneurysms Immediately after Coil Embolization by Three-dimensional Digital Subtraction Angiographic Virtual Endoscopic Imaging
Authors: Kiyosue Hiro , Okahara Mika , Tanoue Shuichi , Nakamura Takaharu , Nagatomi Hirofumi , Mori Hiromu 
Published: July 2004

Abstract

OBJECTIVE:
Detection of a small residual lumen after coil embolization is often difficult because of the coil mass and the overlap of the cerebral arteries. The purpose of this study was to assess the usefulness of virtual endoscopic (VE) analysis of three-dimensional digital subtraction angiographic (DSA) images for evaluation of aneurysmal occlusion immediately after the procedure.

METHODS:
Twenty-seven intracranial aneurysms were treated with coil embolization using a three-dimensional DSA system. Biplane and rotational DSA scanning was performed before and immediately after the procedures. VE images were obtained at a separate workstation, after transfer of the rotational images. Two-dimensional (2D) DSA images and VE images obtained after the procedure were assessed with respect to aneurysmal occlusion. Morphological outcomes and other factors, including location, size, volumetric ratio (coil volume/aneurysm volume), and residual sites, were also evaluated.

RESULTS:
Seven aneurysms were evaluated as complete occlusion (CO) on both 2D DSA images and VE images. Twelve aneurysms exhibited residual lumina on both 2D DSA images and VE images. Five aneurysms were evaluated as CO on 2D DSA images and as incomplete occlusion on VE images. There were no recurrences among the aneurysms that were evaluated as CO on VE images. Two of five aneurysms that were evaluated as CO on 2D DSA images and as incomplete occlusion on VE images demonstrated regrowth in follow-up examinations. Residual sites and volumetric ratios were correlated with aneurysmal regrowth.

CONCLUSION:
VE imaging can demonstrate a residual lumen more frequently than can 2D DSA imaging and is useful for evaluating aneurysmal occlusion after coil embolization.
Intracranial Trigeminal Neuroma Involving the Infratemporal Fossa: Case Report and Review of the Literature
Authors: Akhaddar Ali , El Mostarchid Brahim , Zrara Ibtissame , Boucetta Mohamed 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE:
Intracranial trigeminal neuroma extending extracranially is not a common finding. We report the case of a patient with a right cystic trigeminal neuroma arising in the middle temporal fossa and infratemporal areas. The clinical, radiological, and intraoperative features of these unusual lesions are discussed, and the relevant literature is reviewed.

CLINICAL PRESENTATION:
A 35-year-old woman presented with a 4-year history of right serous otitis media associated with recent right facial paresthesia. A neurological examination revealed hypesthesia in the mandibular division of the right trigeminal nerve. Computed tomographic and magnetic resonance imaging scans demonstrated a 6 × 6 × 4-cm well-enhancing cystic mass arising from the middle temporal fossa and extending extracranially to the infratemporal fossa through the enlarged foramen ovale.

INTERVENTION:
The tumor was extradural and originated from the right mandibular nerve. It was subtotally removed via a subtemporal-intradural and extradural approach. A pathological examination revealed a cystic neuroma. The patient has remained well during 12 months of follow-up, and no evidence of recurrence has been noted on magnetic resonance imaging studies.

CONCLUSION:
Unilateral serous otitis media by obstruction of the eustachian tube is a rare initial manifestation of trigeminal neuroma. We emphasize the benefit of neuroradiological examinations (both computed tomographic scanning and magnetic resonance imaging), which provided the clearest preoperative localization of this large intra- and extracranial tumor. A combined frontotemporal and infratemporal fossa approach is preferred, considering the difficulty of surgical removal. The prognosis for most patients was good. Twenty-five previously reported cases were also reviewed.
The Sizer-Dissector for Aneurysm Clip Selection: Technical Note
Authors: Giannotta Steven L. 
Published: July 2004

Abstract

OBJECTIVE:
Appropriate clip selection frequently becomes a matter of trial and error because of inadequate dissection of the pathway for each clip blade. To facilitate selection of the proper clip size, a series of dissectors have been designed that mimic the exact caliber of each category of Sugita clips.

METHODS:
Three lines of sizer-dissectors reflecting the wire size of the most commonly used Sugita clips were developed by attaching a single aneurysm clip blade to a rounded microdissector handle. Each sizer-dissector is scaled in millimeters and is available in straight and angled configurations. Once dissection is presumed to be complete, the device is passed through the pathway of the intended aneurysm clip blades, and the clip with the appropriate caliber and length for permanent occlusion is selected.

RESULTS:
During dissection and clip ligation of 83 aneurysms, the sizer-dissector was used to select the blade length in 16 lesions and the blade caliber in 5 lesions. There were no complications associated with deployment of the device.

CONCLUSION:
By use of the sizer-dissector before attempting clip placement, clip selection is facilitated, safety is enhanced, and clip wastage is reduced.
Degloving Transfacial Approach with Le Fort I and Nasomaxillary Osteotomies: Alternative Transfacial Approach
Authors: Kyoshima Kazuhiko , Matsuo Kiyoshi , Kushima Hideo , Oikawa Susumu , Idomari Koji , Kobayashi Shigeaki 
Published: July 2004

Abstract

OBJECTIVE:
We present surgical results obtained with the use of an alternative transfacial approach to the central cranial base.

METHODS:
A degloving transfacial approach, which is a combination of the midface degloving procedure, the Le Fort I osteotomy with a pediculated cartilaginous septum, and a nasomaxillary osteotomy, was used in 13 procedures for 8 patients. The lower clivus and upper cervical spine were approached via a submucosal route, without opening of the oropharyngeal mucosa. The wall of the nasopharynx was closed with the mucosa of the bony septum. Several patients had previously undergone other surgical procedures and received radiotherapy.

RESULTS:
The follow-up periods ranged from 4 months to 6.4 years. The same procedure was repeated three times for one patient, with intervals of 5.5 and 1.5 months, and twice for three patients, with intervals of 8.2, 6.3, and 1.3 years. A maxillary antrotomy or bifrontal craniotomy with removal of the orbital bar was combined with this technique. No significant or insurmountable technical problems were encountered, even among patients who had undergone previous surgery or radiotherapy.

CONCLUSION:
Our technique is relatively simple, with good cosmetic results, and affords sufficient access to the central cranial base from the frontal base down to the upper cervical spine, especially for epidural lesions located in the midline between the carotid arteries. It offers much lower risks of damage to vital neurovascular structures, as well as of meningeal or pharyngeal infectious problems, wound dehiscence, and cerebrospinal fluid leakage. This procedure can be repeated without any increase in difficulty.
Cerebellar Aspergillosis: Case Report and Literature Review
Authors: Erdogan Ersin , Beyzadeoglu Murat , Arpaci Fikret , Celasun Bülent 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE:
An unusual, but not unique, case of cerebellar aspergillosis associated with autologous peripheral blood stem cell transplantation for breast cancer is presented.

CLINICAL PRESENTATION:
A 45-year-old woman with breast cancer underwent chemotherapy and radiotherapy as well as autologous peripheral blood stem cell transplantation. She developed a cerebellar aspergillosis abscess that was treated successfully with two surgical resections.

INTERVENTION:
After removal of pus and the abscess wall, the patient received local application of amphotericin B (AmB). She received AmB 1 mg/kg/d for 3 months and itraconazole 100 mg/kg/d for 1 year. After 3 months of AmB treatment, magnetic resonance imaging revealed that disease had not recurred.

CONCLUSION:
In cases of central nervous system aspergillosis, to increase the therapeutic efficiency, AmB can also be applied to the abscess cavity. Computed tomographic and contrast-enhanced magnetic resonance imaging scans play an important role in establishing early diagnosis in high-risk, immunocompromised patients.
Head Injury and Posttraumatic Movement Disorders
Authors: Krauss Joachim K. , Jankovic Joseph 
Published: July 2004

Abstract
WE REVIEW THE phenomenology, pathophysiology, pathological anatomy, and therapy of posttraumatic movement disorders with special emphasis on neurosurgical treatment options. We also explore possible links between craniocerebral trauma and parkinsonism. The cause-effect relationship between head injury and subsequent movement disorder is not fully appreciated. This may be related partially to the delayed appearance of the movement disorder. Movement disorders after severe head injury have been reported in 13 to 66% of patients. Although movement disorders after mild or moderate head injury are frequently transient and, in general, do not result in additional disability, kinetic tremors and dystonia may be a source of marked disability in survivors of severe head injury. Functional stereotactic surgery provides long-term symptomatic and functional benefits in the majority of patients. Thalamic radiofrequency lesioning, although beneficial in some patients, frequently is associated with side effects such as increased dysarthria or gait disturbance, particularly in patients with kinetic tremor secondary to diffuse axonal injury. Deep brain stimulation is used increasingly as an option in such patients. It remains unclear whether pallidal or thalamic targets are more beneficial for treatment of posttraumatic dystonia. Trauma to the central nervous system is an important causative factor in a variety of movement disorders. The mediation of the effects of trauma and the pathophysiology of the development of posttraumatic movement disorders require further study. Functional stereotactic surgery should be considered in patients with disabling movement disorders refractory to medical treatment.
Patient-evaluated Outcome after Surgery for Basal Meningiomas
Authors: Akagami Ryojo , Napolitano Mario , Sekhar Laligam N. 
Published: July 2004

Abstract

OBJECTIVE:
To study the outcomes of patients with basal meningiomas treated by one primary surgeon with a philosophy of aggressive surgical management to establish an index of satisfaction and patient-evaluated outcome.

METHODS:
We collected prospective data for patients with basal meningiomas who were operated on by one primary surgeon (LNS) during a 7-year period from 1993 to 2000. The outcomes in 269 patients were ascertained through follow-up visits, mailed follow-up questionnaires, and telephone interviews by two other surgeons (RA and MN). The mean patient age was 50 ± 13.6 years. The mean estimated tumor diameter was 3.07 ± 1.24 cm. There were 62 males and 207 females. Mean follow-up was 49 ± 26 months. Twenty-seven percent of patients were Levine-Sekhar (LS) Grade 0, 43% were LS Grade I, 24% were LS Grade II, and 6% were LS Grade III. Gross total resection was achieved in 66% of patients. Extent of resection correlated (P &lt; 0.05) with LS grade. Thirty-seven patients received adjuvant treatments, and six patients required reoperations. Perioperative mortality was 1.1%. Eighty percent of patients were discharged home, 17% were discharged to rehabilitation facilities, and 1.5% were discharged to nursing homes. Postoperative complications were observed in 30% of patients.

RESULTS:
During the follow-up study, of a total of 269 patients, 30 patients could not be contacted, and 11 patients had died of unrelated causes. The mean follow-up Karnofsky Performance Scale score of the patients was 83 ± 10. Ninety-seven percent of patients were very satisfied/satisfied with their treatments (P &lt; 0.001). Forty-three percent of patients were employed, and 83% of patients were employable. Their expectations of treatment were met in 90% of patients (P &lt; 0.001), 95% thought surgery had been a good treatment choice (P &lt; 0.001), and 95% would recommend the same treatment for a family member (P &lt; 0.001).

CONCLUSION:
These results demonstrate that patient satisfaction can remain high and satisfactory outcome can be achieved with surgical management in patients with these complex lesions.
Spontaneous Thrombosis of a Residual Arteriovenous Malformation in Eloquent Cortex after Surgery: Case Report
Authors: Bendok Bernard R. , Getch Christopher C. , Ali Mir Jafer , Parish Todd , Batjer H. Hunt 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE:
The presence of a residual arteriovenous malformation (AVM) on postoperative angiograms is typically an indication for prompt return to the operating room to complete resection, because of the risk of early hemorrhage. This approach, however, may involve risks of neurological deficits when the residual AVM is in eloquent cortex. We present a case of complete thrombosis of a residual AVM after surgery. This residual AVM tissue was located in eloquent cortex. Complete spontaneous thrombosis of residual AVMs after surgery has only rarely been reported. This phenomenon raises questions regarding the most appropriate management for residual AVMs in eloquent cortex.

CLINICAL PRESENTATION:
The patient was a 43-year-old, right-handed, male patient with an AVM centered in the left precentral gyrus. The patient presented with medically intractable seizures and progressive right hemiparesis. After AVM resection, angiography revealed a residual AVM with early venous drainage. Angiography performed 1 week later demonstrated a persisting AVM nidus without early venous drainage. Angiography performed 3 months later demonstrated complete thrombosis of the residual AVM.

INTERVENTION:
The patient has been monitored for more than 1 year, without additional symptoms or therapy.

CONCLUSION:
We continue to advocate prompt return to the operating room when postoperative angiography reveals a residual AVM with persistent shunting. When the residual AVM is in eloquent cortex and is small, with a single draining vein, however, observation of the patient (with strict blood pressure control) and repeat angiography after 1 week represent an alternative strategy that is supported by this case report. As this case demonstrates, it is possible for small residual AVMs to thrombose. This may avert the need for reoperation for residual AVMs in eloquent cortex, with the potential for neurological deficits.
Prenatal Diagnosis of Terminal Myelocystocele in the Fetal Surgery Era: Case Report
Authors: Midrio Paola , Silberstein Howard J. , Bilaniuk Larissa T. , Adzick N. Scott , Sutton Leslie N. 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE:
We report a case of a child with terminal myelocystocele (TMC). This case exemplifies the importance of performing a multidisciplinary evaluation and magnetic resonance imaging in the patient with suspected meningomyelocele when fetal surgery is being considered.

CLINICAL PRESENTATION:
This patient was evaluated at the Center for Fetal Diagnosis and Treatment and considered for fetal surgery to repair meningomyelocele.

TECHNIQUE:
A follow-up based on both ultrasound and magnetic resonance imaging was performed throughout pregnancy.

CONCLUSION:
Although a definitive diagnosis of TMC was not established prenatally, the patient was not offered fetal surgery, based on multiple selection criteria. We correlate the pathophysiology of TMC with the radiographic and amniocentesis findings. TMC must be considered in the differential diagnosis in a fetus with a dysraphic defect.
Endovascular Treatment for Poorest-grade Subarachnoid Hemorrhage in the Acute Stage: Has the Outcome Been Improved?
Authors: Inamasu Joji , Nakamura Yoshiki , Saito Ryoichi , Kuroshima Yoshiaki , Mayanagi Keita , Ichikizaki Kiyoshi 
Published: July 2004

Abstract

OBJECTIVE
Patients with poor-grade subarachnoid hemorrhage (SAH) have been considered good candidates for endovascular treatment. The results of treatment of Grade V SAH, the poorest grade, however, have not been fully elucidated.

METHODS
The clinical characteristics and outcome parameters of 22 World Federation of Neurosurgical Societies Grade V SAH patients treated endovascularly in the acute stage between 1998 and 2000 are summarized and compared with those of 18 Grade V SAH patients treated conservatively between 1995 and 1997.

RESULTS
Among the 22 patients treated endovascularly, 8 patients (36.4%) survived. The rate was significantly higher than that of the 18 patients treated conservatively (5.6%), only one of whom survived. The favorable outcome rate, however, was not significantly different between the two groups (4.5% versus 6.0%). Subdivision of both treatment groups according to Glasgow Coma Scale (GCS) score showed that the improved survival among those treated endovascularly was attributable to the improved survival in those with a preprocedural GCS score of 6 but not of 4 or 5.

CONCLUSION
Endovascular treatment of the 22 World Federation of Neurosurgical Societies Grade V SAH patients improved their survival rate but not their favorable outcome rate in comparison with conservative treatment. Further accumulation of clinical data is essential to determine whether endovascular treatment can improve the functional outcome of those with GCS scores of 6 and whether there is no role for endovascular treatment in those with GCS scores of 4 or 5.
Carotid Endarterectomy
Authors: Bailes Julian E. 
Published: July 2004

Abstract

CAROTID ENDARTERECTOMY IS a procedure that has withstood the test of time and scientific scrutiny to remain an important technique for the surgical prevention of stroke. Several aspects of this operation are critical for success, i.e., improving on the natural history of carotid artery stenosis. The procedure is described in a stepwise manner, with emphasis on key steps for avoiding thrombotic or embolic complications.
Surgical Transvenous Embolization of a Carotid-Cavernous Dural Fistula with Cortical Drainage via a Petrosal Vein: Two Technical Case Reports
Authors: Hara Tsuyoshi , Hamada Jun-ichiro , Kai Yutaka , Ushio Yukitaka 
Published: July 2004

Abstract

OBJECTIVE AND IMPORTANCE
We present two interesting cases involving carotid-cavernous dural fistulae draining only or predominantly into the petrosal vein after previous incomplete, complicated, endovascular treatments. Transvenous embolization with Guglielmi detachable coils, via the petrosal vein, during surgical exposure completely obliterated the fistulae.

CLINICAL PRESENTATION
A 64-year-old man manifesting left ocular symptoms after incomplete embolization of a left carotid-cavernous dural fistula and a 56-year-old woman manifesting left hemiparesis after complicated embolization of a right carotid-cavernous dural fistula were referred to our hospital. A percutaneous transvenous approach was attempted in both cases, but the catheter could not reach the fistula site. A combined open surgical and endovascular approach was then used.

INTERVENTION
The hemispheric branch of the petrosal vein was exposed via a retromastoid craniectomy. The catheter was then directly introduced into the hemispheric branch, followed by navigation into the fistula site. The fistula was completely embolized with Guglielmi detachable coils.

CONCLUSION
The technique of surgical transvenous embolization via a petrosal vein is a valuable alternative for the treatment of carotid-cavernous dural fistulae that drain only or predominantly into the petrosal vein, when the percutaneous transvenous route is not accessible.