bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cellular Transplantation and Spinal Cord Injury
Authors: Barami Kaveh , Diaz Fernando G. 
Published: September 2004

ABSTRACTSPINAL CORD INJURY is often characterized by immediate and irreversible loss of sensory and motor functions below the level of injury. Cellular transplantation in various experimental models of spinal cord injury has been used as a strategy for reducing deficits and improving functional recovery. The general strategy has been aimed at promoting regeneration of intrinsic injured axons with the development of alternative pathways that facilitate a partial functional connection. Other objectives of cellular transplantation studies have included replacement of lost cellular elements, alleviation of chronic pain, and modulation of the inflammatory response after injury. This review focuses on the cell types that have been used in spinal cord transplantation studies in the context of evolving biological perspectives, technological advances, and new therapeutic strategies and serves as a point of reference for future studies.
Clinically Silent Corticotroph Tumors of the Pituitary Gland
Authors: Scheithauer Bernd W. , Jaap Alan J. , Horvath Eva , Kovacs Kalman , Lloyd Ricardo V. , Meyer Fredric B. , Laws Edward R. , Young William F. 
Published: September 2004

ABSTRACT

OBJECTIVE
To determine the clinical presentation, imaging characteristics, microscopic and ultrastructural characteristics, and treatment outcomes of patients with clinically silent pituitary corticotroph adenomas.

METHODS
All silent corticotroph adenomas diagnosed at the Mayo Clinic during the years 1975 through 1997 were selected from the files of the Mayo Tissue Registry.

RESULTS
We studied 23 cases, occurring in 16 male and 7 female patients (age range, 11–79 yr; mean age, 48 yr), who presented with headaches (50%), visual field defects (61%), extraocular muscle paresis (13%), hypopituitarism (26%), and galactorrhea/amenorrhea (43%/29% of the female patients). No patients exhibited clinical hypercortisolism. All tumors were macroadenomas (2.4 ± 0.8 cm; range, 1.5–4.0 cm) and exhibited suprasellar extension in 87% of the cases and hemorrhage, necrosis, and/or cystic changes in 61%. All tumors stained were variably periodic acid-Schiff-, adrenocorticotropic hormone-, and β-endorphin-positive, particularly Subtype I lesions. Ultrastructural classification was performed in 19 cases. In a comparison of Subtype I and II tumors, differences were observed with respect to sex (male/female, 1.4:1 versus 6:1), preoperative hyperprolactinemia (5 of 16 versus 0 of 6 cases), preoperative hypopituitarism (9 of 16 versus 5 of 7 cases), radiographic or gross invasion (7 of 16 versus 5 of 7 cases), and partial or total postoperative pituitary failure (6 of 16 versus 6 of 6 cases). The overall median postoperative follow-up period was 4.9 years (range, 0.3–16.6 yr); 54% of the patients had persistent or recurrent tumors.

CONCLUSION
Clinically silent corticotroph adenomas behave in an aggressive manner and are characterized by the following: lack of clinical signs or symptoms of Cushing's syndrome and normal cortisol levels; no or only minor elevations of serum adrenocorticotropic hormone levels; macroadenomas with hemorrhagic infarction; and presentation dominated by mass effect symptoms. The high persistence/recurrence rate underscores the need for long-term follow-up.
Spasmodic Torticollis Due to Neurovascular Compression of the Spinal Accessory Nerve by the Anteroinferior Cerebellar Artery: Case Report
Authors: Alafaci Concetta , Salpietro Francesco M. , Montemagno Gaspare , Grasso Giovanni , Tomasello Francesco 
Published: September 2004

ABSTRACT

OBJECTIVE AND IMPORTANCE
Spasmodic torticollis is a neuromuscular disorder characterized by uncontrollable clonic and intermittently tonic spasm of the neck muscles. We report a case of spasmodic torticollis attributable to neurovascular compression of the right XIth cranial nerve by the right anteroinferior cerebellar artery (AICA).

CLINICAL PRESENTATION
A 72-year-old man with a 2-year history of right spasmodic torticollis underwent magnetic resonance imaging, which demonstrated compression of the right XIth cranial nerve by an abnormal descending loop of the right AICA.

INTERVENTION
The patient underwent microvascular decompression surgery. During surgery, it was confirmed that an abnormal loop of the right AICA was compressing the right accessory nerve. Compression was released by the interposition of muscle between the artery and the nerve.

CONCLUSION
The patient's postoperative course was uneventful, and his symptoms were fully relieved at the 2-year follow-up examination. This is the first reported case of spasmodic torticollis attributable to compression by the AICA; usually, the blood vessels involved are the vertebral artery and the posteroinferior cerebellar artery.
Radiosurgery for Hemangiomas of the Cavernous Sinus and Orbit: Technical Case Report
Authors: Thompson Todd P. , Lunsford L. Dade , Flickinger John C. 
Published: September 2004

ABSTRACT

OBJECTIVE AND IMPORTANCE
Hemangiomas of neurosurgical interest are histologically benign vascular tumors that most often occur in the orbit or cavernous sinus. Hemangiomas can be diagnosed by their characteristic radiographic and angiographic appearance and their tendency to bleed excessively during attempted removal. Intracranial or intraorbital hemangiomas require treatment when they become symptomatic.

CLINICAL PRESENTATION
We report four hemangioma patients who presented with ocular symptoms or signs, such as orbital pain, ophthalmoplegia, proptosis, or impaired visual acuity. Before our evaluation, two patients had each had incomplete resections aborted because of excessive blood loss, one patient had undergone a nondiagnostic transsphenoidal biopsy, and one patient had had an unsuccessful embolization.

INTERVENTION
All four patients were treated with gamma knife radiosurgery. Tumors received a minimal tumor dose that ranged from 14 to 19 Gy. Follow-up evaluations were performed 6 to 24 months after radiosurgery and revealed a reduction in tumor volume in three patients and no tumor progression in the fourth. All patients had symptomatic improvement, but one had persistent diplopia.

CONCLUSION
In this early experience, stereotactic radiosurgery proved to be an effective management strategy that avoided the potentially serious complications associated with surgery or embolization of cavernous sinus hemangiomas.
Predicting Delayed Ischemic Deficits after Aneurysmal Subarachnoid Hemorrhage Using a Transient Hyperemic Response Test of Cerebral Autoregulation
Authors: Lam Joseph M. K. , Smielewski Peter , Czosnyka Marek , Pickard John D. , Kirkpatrick Peter J. 
Published: September 2004

Abstract

OBJECTIVE
To assess whether the development of delayed ischemic deficits (DIDs) after aneurysmal subarachnoid hemorrhage can be predicted using transcranial Doppler ultrasonography and the transient hyperemic response test (THRT).

METHODS
An increase in the middle cerebral artery peak flow velocity (FV) of more than 9% of baseline values after 5 to 9 seconds of carotid artery compression was defined as a normal THRT result, indicating good autoregulatory reserve. The transcranial Doppler criteria for vasospasm were a FV of more than 120 cm/s and a Lindegaard ratio of more than 3. Twenty patients with no immediate postoperative neurological deficits were studied. The FVs at all of the major cerebral arteries were measured daily after surgery, and the THRT results were assessed bilaterally.

RESULTS
Five of six patients with abnormal THRT results in the first examination after surgery (primary THRT impairment) developed DIDs; none of the remaining patients developed DIDs (Fisher exact test, P = 0.0004). All five patients with DIDs initially exhibited low FVs but all subsequently developed increases in FVs to values of more than 150 cm/s and four exhibited FVs of more than 200 cm/s. The time of onset of DIDs corresponded to the time of onset of moderate vasospasm (FV &gt; 150 cm/s). None of the patients with initially normal THRT results developed DIDs, although four patients did exhibit late (secondary) THRT impairment, which was associated with FVs of more than 120 cm/s.

CONCLUSION
When the effects of primarily impaired (after surgery) autoregulation are magnified by vasospasm, the risk of DIDs seems to be very high. Vasospasm alone does not seem to cause DIDs. The development of DIDs could therefore be predicted using the THRT for patients after aneurysm clipping.
Radiosurgery for Childhood Intracranial Arteriovenous Malformations
Authors: Levy Elad I. , Niranjan Ajay , Thompson Todd P. , Scarrow Alan M. , Kondziolka Douglas , Flickinger John C. , Lunsford L. Dade 
Published: September 2004

Abstract

OBJECTIVE
The optimal management of intracranial arteriovenous malformations (AVMs) in children remains controversial. Children with intracranial AVMs present a special challenge in therapeutic decision-making because of the early recognition of their future life-long risks of hemorrhage if they are treated conservatively. The goals of radiosurgery are to achieve complete AVM obliteration and to preserve neurological function. We present long-term outcomes for a series of children treated using radiosurgery.

METHODS
The findings for 53 consecutive children who underwent at least 36 months of imaging follow-up monitoring after radiosurgery were reviewed. The median age at the time of treatment was 12 years (range, 2–17 yr). Thirty-one children (58%) presented after their first intracranial hemorrhaging episodes, two (4%) after their second hemorrhaging episodes, and one (2%) after five hemorrhaging episodes. Nineteen children (36%) presented with unruptured AVMs, and a total of 25 children (47%) exhibited neurological deficits. AVMs were graded as Spetzler-Martin Grade I (2%), Grade II (23%), Grade III (36%), Grade IV (9%), or Grade VI (30%). The median AVM volume was 1.7 ml (range, 0.11–10.2 ml). The median marginal dose was 20 Gy (range, 15–25 Gy).

RESULTS
Results were stratified according to AVM volumes (Group 1, ≤3 ml; Group 2, &gt;3 ml to ≤10 ml; Group 3, &gt;10 ml). Twenty-eight patients (80%) in Group 1 and 11 (64.7%) in Group 2 achieved complete obliteration. The only patient in Group 3 did not achieve obliteration. Complications included brainstem edema (n = 1) and transient pulmonary edema (n = 1). Four patients experienced hemorrhaging episodes, 30, 40, 84, and 96 months after radiosurgery. Multivariate logistic regression analysis demonstrated that only volume was significantly correlated with obliteration rates (P = 0.0109).

CONCLUSION
Radiosurgery is safe and efficacious for selected children with AVMs. The obliteration rates and the attendant low morbidity rates suggest a primary role for stereotactic radiosurgery for pediatric AVMs.
Craniopharyngiomas of the Third Ventricle: Trans-Lamina Terminalis Approach
Authors: Maira Giulio , Anile Carmelo , Colosimo Cesare , Cabezas Daniel 
Published: September 2004

Abstract

OBJECTIVE
Craniopharyngiomas usually grow on the cisternal surface of the hypothalamic region; these tumors can also grow from the infundibulum or tuber cinereum on the floor of the third ventricle, developing exclusively into the third ventricle. The aim of the present work was to establish the usefulness of the pterional trans-lamina terminalis approach for the removal of these tumors.

METHODS
Eight patients who were surgically treated for craniopharyngiomas located exclusively within the third ventricle were considered. The initial symptoms were acute hydrocephalus in two cases, psychological disturbances in two, amenorrhea in two, headaches in one, and hypopituitarism in one. The diagnoses were established, in all cases except one, with magnetic resonance imaging. In all cases, the tumor completely filled the third ventricle.

RESULTS
Total removal of the lesion was achieved in seven cases. One patient underwent partial removal. In the immediate postoperative period, no major complications were observed. Five patients required replacement hormonal therapy. All patients returned to a normal life. Many months after surgery, two patients exhibited psychological disturbances and died, the first because of voluntary withdrawal of replacement therapy (12 mo after surgery) and the second because of a severe imbalance in body fluids and electrolytes, with a subsequent hyperosmolar coma (27 mo after surgery). Only one patient who underwent initial total removal experienced a small recurrence of the lesion (30 mo after surgery); after 3 years, the lesion exhibited unchanged size.

CONCLUSION
In our experience, the trans-lamina terminalis approach is a valid choice for the removal of purely intraventricular craniopharyngiomas. These tumors can be removed without significant sequelae related to the surgical approach. The proximity to the hypothalamus requires accurate neuroendocrine and electrolyte control in the postoperative period, in some cases even years after surgery.
Three-dimensional Reconstructed Images after Rotational Angiography in the Evaluation of Intracranial Aneurysms: Surgical Correlation
Authors: Tanoue Shuichi , Kiyosue Hiro , Kenai Hiroyuki , Nakamura Takaharu , Yamashita Masanori , Mori Hiromu 
Published: September 2004

AbstractOBJECTIVETo evaluate the diagnostic accuracy of three-dimensional reconstructed images from rotationalsubtraction angiography in the surgical treatment of intracranial aneurysms.METHODSTwenty-two patients with 34 intracranial aneurysms underwent biplane angiography (40 degrees per s, 4.5 degrees per image, 8.8 frames per s). Three-dimensional (3-D) reconstructed images were obtained at a separate Advantage 3.1 workstation (General Electric, Milwaukee, WI) after the rotational images were transferred. The available visualization techniques included maximum intensity projection, shaded surface display, and virtual endoluminal view. All images were evaluated in correlation with intrasurgical visual data recorded onvideotapes.RESULTS3-D reconstructed images correlated well with surgical findings. The shape of the aneurysms, their neck size, and their relationships to the parent vessels and other branches were depicted clearly, especially compared with images obtained by two-dimensional conventionalsubtraction angiography and magnetic resonance angiography.CONCLUSION3-Dsubtraction angiography enables the surgeon to understand the 3-D structure of lesions and is very useful in planning the surgical treatment of cerebral aneurysms.
Carotid Stenting and “Extarterectomy” in the Management of Head and Neck Cancer Involving the Internal Carotid Artery: Technical Case Report
Authors: Nussbaum Eric S. , Levine Samuel C. , Hamlar David , Madison Michael T. 
Published: September 2004

Abstract

OBJECTIVE AND IMPORTANCE
Head and neck cancer that invades the internal carotid artery (ICA) represents a significant management challenge. We describe a novel technique that allows for aggressive tumor removal without disrupting blood flow through the affected ICA.

CLINICAL PRESENTATION
A 62-year-old man was referred to our institution for management of a neck malignancy involving the ICA. Cerebral angiography suggested that there was good collateral flow from the opposite hemisphere, but the patient reported visual loss in the ipsilateral eye during balloon test occlusion of the ICA.

INTERVENTION
A self-expanding stent was deployed in the ICA; it spanned the entire length of the artery involved by tumor. One month later, the patient underwent tumor resection. During surgery, a long ICA arteriotomy was performed directly down to the mesh of the stent. A neoendothelium had formed within the stent, which prevented arterial bleeding. The carotid wall was dissected from the stent without difficulty and removed en bloc with the surrounding tumor. The exposed stent was wrapped circumferentially with a synthetic patch material. The patient tolerated the procedure well, and postoperative angiography demonstrated normal filling of the ICA.

CONCLUSION
We describe a novel approach to a patient with head and neck cancer involving the cervical ICA. Preliminary stenting, which allows time for endothelialization before surgery, may permit aggressive tumor resection without interrupting flow through the ICA. This technique obviates the need for complicated carotid reconstruction procedures and avoids the risk of delayed ischemia from carotid sacrifice.
Electrical Bone Graft Stimulation for Spinal Fusion: A Review
Authors: Oishi Masaki , Onesti Stephen T. 
Published: September 2004

AbstractALTHOUGH ELECTRICAL STIMULATION to aid bone fusion is well established in the treatment of long-bone fractures, its use as an aid in spinal fusion is not as well documented. This article presents the history and scientific basis of electrical stimulation to aid bone fusion and extensively reviews the clinical literature. It is intended to provide an objective review of the indications and limitations of electrical stimulation to enhance spinal fusion and to serve as a reference source for further study.
Parameters for Contralateral Approach to Ophthalmic Segment Aneurysms of the Internal Carotid Artery
Authors: Kakizawa Yukinari , Tanaka Yuichiro , Orz Yasser , Iwashita Tomomi , Hongo Kazuhiro , Kobayashi Shigeaki 
Published: September 2004

Abstract

OBJECTIVE
This study was undertaken to define more accurately the feasibility and indications of the contralateral pterional approach to ophthalmic segment aneurysms of the internal carotid artery (ICA).

METHODS
Between 1995 and 1999, 46 patients with ophthalmic segment aneurysms of the ICA were surgically treated in our institution. Eleven of the 46 aneurysms were operated using the contralateral pterional approach. All aneurysms were successfully clipped without complications; three patients required bone resection around the aneurysm neck. We studied the 11 patients who were treated with the contralateral approach by defining six parameters to assess the feasibility of the approach and to predict the necessity for bone resection: 1) Parameter A, the distance between the anterior aspect of the optic chiasm and the limbus sphenoidale; 2) Parameter B, the distance between the bilateral optic nerves at the entrance to the optic canal; 3) Parameter C, the interrelation of the optic nerve and the ICA, expressed as a/b in which a is the length from the midline to the optic nerve and b is the length from the midline to the ICA; 4) Parameter D, the size of the aneurysm neck; 5) Parameter E, the direction of the aneurysm from the ICA wall on the anteroposterior angiogram; and 6) Parameter F, the distance from the medial side of the estimated distal dural ring to the proximal aneurysm neck on the lateral angiogram.

RESULTS
Parameters A to F were 8.8 mm (range, 5.4–11.1 mm), 14.5 mm (range, 10.4–22.2 mm), 0.9 mm (range, 0.6–1.3 mm), and 3.0 mm (range, 2.3–4.7 mm), 5 to 160 degrees, and 1.3 mm (range, 0.3–2.4 mm), respectively. All patients had excellent operative outcomes without visual dysfunction. Three patients required drilling of the bone around the optic canal on the craniotomy side; bone drilling was not required when Parameter E was between 30 and 160 degrees and Parameter F was more than 1 mm.

CONCLUSION
Parameters A to D are important for assessing the feasibility of the contralateral approach to ICA-ophthalmic segment aneurysms, and Parameters E and F are most useful for calculating the difficulty of this approach.
Frameless Stereotactic Neurosurgery Using Intraoperative Magnetic Resonance Imaging: Stereotactic Brain Biopsy
Authors: Moriarty Thomas M. , Quinones-Hinojosa Alfredo , Larson Paul S. , Alexander Eben , Gleason P. Langham , Schwartz Richard B. , Jolesz Ferenc A. , Black Peter McL. 
Published: September 2004

Abstract

OBJECTIVE
To assess the application accuracy of intraoperative magnetic resonance imaging for frameless stereotactic surgery, and to evaluate the performance of intraoperative magnetic resonance imaging for the brain biopsy, a standard stereotactic procedure.

METHODS
A series of spatial coordinate and phantom experiments were performed to analyze the application accuracy of the system. A prospective analysis of 68 consecutive patients undergoing stereotactic brain biopsy was then performed.

RESULTS
The spatial coordinate experiments revealed a mean overall error in acquisition of 0.2 mm. The phantom experiments demonstrated a 1:1 correlation between the magnetic resonance image of a stereotactically guided probe and its relationship to a target and the actual relationship of the probe and target. Sixty-eight brain biopsies were successfully performed in all intracranial compartments except the sella. The radiographic abnormality was localized successfully in all patients (100%). Sixty-six (97.1%) of the biopsies yielded diagnostic tissue. Two biopsies (2.9%) were complicated by intraparenchymal hemorrhage. One expanding temporal lobe hemorrhage was evacuated by immediate craniotomy in the magnet with no postoperative sequelae. A deep hemorrhage from a lymphoma was managed conservatively with interval resolution of symptoms. There were no infections. There was no perioperative mortality.

CONCLUSION
Intraoperative magnetic resonance imaging allows excellent target localization, provides true real-time imaging to account for anatomic changes during surgery, and permits intraoperative confirmation that the biopsy needle has reached the targeted lesion. Immediate postoperative imaging in the operating room allows assessment of adverse events and the potential for immediate management of hemorrhagic complications.
Occlusive Hyperemia: A Radiosurgical Phenomenon?
Authors: Pollock Bruce E. 
Published: September 2004

Abstract

OBJECTIVE
Causes of neurological deficits after arteriovenous malformation (AVM) radiosurgery, including hemorrhage, radiation injury, and delayed cyst formation, are described.

CONCEPT
Occlusive hyperemia has been described as a reason for neurological deterioration after AVM resection. Thrombosis of draining veins or dural sinuses is thought to cause postoperative bleeding or neurological deficits secondary to venous hypertension. In a similar manner, local hemodynamic changes can occur in the brain adjacent to an AVM after radiosurgery if venous outflow is obstructed. Two patients are presented whose cases demonstrate this phenomenon.

CONCLUSION
Patients can experience clinical worsening after AVM radiosurgery from premature thrombosis of draining veins. Local hemodynamic changes could explain why imaging changes thought to be radiation related occur more frequently after radiosurgery of AVMs than of tumors.