bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transcranial Motor Evoked Potential Recording in a Case of Kernohan's Notch Syndrome: Case Report
Authors: Binder Devin K. , Lyon Russ , Manley Geoffrey T. 
Published: August 2004

Abstract

OBJECTIVE AND IMPORTANCE
Compression of the cerebral peduncle against the tentorial incisura contralateral to a supratentorial mass lesion, the so-called Kernohan-Woltman notch phenomenon, can be an important cause of false localizing motor signs. Here, we demonstrate a case in which clinical, radiological, and electrophysiological findings were used together to define this syndrome.

CLINICAL PRESENTATION
A 21-year-old man sustained a left temporal depressed cranial fracture from a motor vehicle accident. Serial computed tomographic examinations demonstrated no evolution of hematomas or contusions, and he was managed nonsurgically with ventriculostomy for intracranial pressure control. Throughout his course in the neurosurgical intensive care unit, he displayed persistent left hemiparesis.

INTERVENTION
Further radiological and electrophysiological studies were undertaken in an attempt to explain his left hemiparesis. Brain magnetic resonance imaging demonstrated T2 prolongation in the central portion of the right cerebral peduncle extending to the right internal capsule. Electrophysiological studies using transcranial electrical motor evoked potentials revealed both a marked increase in voltage threshold, as well as a reduction in the complexity of the motor evoked potential waveform on the hemiparetic left side. This contrasted to significantly lower voltage threshold as well as a highly complex motor evoked potential waveform recorded on the relatively intact contralateral side.

CONCLUSION
This is the first time that clinical, radiological, and electrophysiological findings have been correlated in a case of Kernohan's notch syndrome. Compression of the contralateral cerebral peduncle against the tentorial incisura can lead to damage and ipsilateral hemiparesis. The anatomic extent of the lesion can be defined by magnetic resonance imaging and the physiological extent by electrophysiological techniques.
Unusual Presentations of Cerebral Solitary Fibrous Tumors: Report of Four Cases
Authors: Kim K. Anthony , Gonzalez Ignacio , McComb J. Gordon , Giannotta Steven L. 
Published: August 2004

Abstract

OBJECTIVE AND IMPORTANCE
Four rare cases of central nervous system solitary fibrous tumors (C-SoFTs) are described. This tumor has not previously been reported in children or in deep cortical structures. Three of these tumors occurred in the posterior fossa. Only four cases in the posterior fossa have been described previously. Nine years after its debulking from the posterior fossa, one tumor disseminated to the spine, lung, and liver. Only one such aggressive C-SoFT has been described previously.

CLINICAL PRESENTATION
A 7-year-old child had had 1 year of right-sided weakness at presentation. Magnetic resonance imaging scans revealed a left basal ganglia lesion. A 49-year-old woman and a 30-year-old man presented after experiencing headaches for months. Magnetic resonance imaging scans in these patients revealed a tumor in the fourth ventricle and right jugular foramen, respectively. A 55-year-old man had spinal, liver, and lung dissemination of a previous posterior fossa tumor at presentation.

INTERVENTION AND TECHNIQUE
All four patients underwent craniotomy for resection or subtotal removal of the tumor. Intraoperative observations noted solid well-encapsulated tumors. Immunohistochemistry confirmed C-SoFTs in all four cases.

CONCLUSION
C-SoFTs are rare central nervous system, typically dural-based, tumors. They frequently are overlooked in the differential diagnosis of solid central nervous system tumors. Our findings suggest that these tumors can occur at any age and in most locations, regardless of proximity to the meninges (basal ganglia and ventricle), suggesting that the cells of origin are not meningothelial, but rather the mesenchyme of the cerebral vasculature. T1- and T2-weighted magnetic resonance imaging was notable for areas of hypointensity and of hyperintensity best described as patchy or a ying-yang appearance in all cases. Delayed extracranial metastasis may be noted.
Surgical Management of a Ruptured Posterior Choroidal Intraventricular Aneurysm Associated with Moyamoya Disease Using Frameless Stereotaxy: Case Report and Review of the Literature
Authors: Ali M. Jafer , Bendok Bernard R. , Getch Christopher C. , Gottardi-Littell Numa R. , Mindea Stefan , Batjer H. Hunt 
Published: August 2004

Abstract

OBJECTIVE AND IMPORTANCE
Prevention of rebleeding is the most important aspect of the management of hemorrhagic moyamoya disease, because rebleeding causes significant morbidity and mortality.

CLINICAL PRESENTATION
A 26-year-old male patient with a history of moyamoya disease since the age of 3 years and multiple strokes was in a semicomatose state at presentation. He was found to have intraventricular and periventricular hemorrhages abutting the atrium of the right ventricle. His hospital course was complicated by a second hemorrhage. Both bleeding events were believed to be secondary to a ruptured right lateral posterior choroidal aneurysm.

INTERVENTION
The aneurysm was excised and revealed histopathology consistent with a true saccular aneurysm. Frameless stereotactic guidance was used during surgery to minimize damage to collateral vessels and to shorten the surgical corridor.

CONCLUSION
The management of hemorrhagic moyamoya disease should be modified based on the source of hemorrhage and its relation to a specifically located aneurysm. In the case of aneurysms arising from the choroidal artery, the general belief is that most of these represent pseudoaneurysms and have a tendency to regress spontaneously. Because of the rebleeding risk, we recommend early intervention in treating ruptured intracranial aneurysms using the least invasive surgical techniques.
Giant Vertebrobasilar Aneurysms: Endovascular Treatment and Long-term Follow-up
Authors: Lubicz Boris , Leclerc Xavier , Gauvrit Jean-Yves , Lejeune Jean-Paul , Pruvo Jean-Pierre 
Published: August 2004

Abstract

OBJECTIVE:
To report long-term imaging follow-up and clinical outcome of 13 patients with a giant vertebrobasilar aneurysm treated by parent artery occlusion (PAO).

METHODS:
From 1994 to 2000, 13 consecutive patients with a giant vertebrobasilar aneurysm were treated by PAO. Symptoms were related to mass effect in nine patients and to a subarachnoid hemorrhage in four. Endovascular treatment consisted of aneurysm trapping in nine patients and occlusion of one or both vertebral arteries in four. We assessed the clinical outcome and imaging findings in all patients during a 28-month period.

RESULTS:
Endovascular treatment resulted in clinical improvements in eight patients, worsening of symptoms in four, and death in one. One woman with a ruptured vertebral aneurysm died from a rebleeding after PAO without trapping. One man developed a brainstem infarction after lower basilar artery occlusion and incurred hemiparesis. In three patients, symptoms of mass effect increased after the procedure. Long-term follow-up revealed good or excellent clinical outcome in all patients and a sharp decrease in size of the thrombosed aneurysm in nine patients. One basilar aneurysm recanalized despite selective coiling and subsequent bilateral vertebral artery occlusion; one vertebral aneurysm and one basilar aneurysm did not decrease in size despite complete occlusion.

CONCLUSION:
Giant vertebrobasilar aneurysms are rare and challenging lesions for both neurosurgeons and neurointerventionalists. Their treatment by endovascular PAO remains safe and effective. Early clinical worsening may be observed, but long-term follow-up shows good or excellent results in most patients. This treatment can be carried out with minimal morbidity and mortality using clinical and angiographic monitoring.
Diagnosis and Management of Pineocytomas
Authors: Deshmukh Vivek R. , Smith Kris A. , Rekate Harold L. , Coons Stephen , Spetzler Robert F. 
Published: August 2004

Abstract

OBJECTIVE:
Pineocytomas are associated with the most favorable prognosis of all pineal tumors. However, a subset of pineocytomas may have a predilection for recurrence and therefore behave aggressively.

PATIENTS AND METHODS:
Records of nine patients (five men, four women; mean age, 44 yr; range, 24–63 yr) with histologically diagnosed pineocytomas consecutively treated between 1990 and 2003 were reviewed retrospectively to identify factors predictive of aggressiveness. Eight patients presented with hydrocephalus and four with tectal compression. Three patients underwent gross total resection, and six underwent subtotal resection or biopsy.

RESULTS:
Three local recurrences necessitated reoperation. One recurrence involved the obex of the fourth ventricle. The mean time to recurrence was 3.5 years (range, 1–7 yr). There was no correlation between histological features and tumor recurrence. Patients undergoing radiosurgery showed stable or attenuated local disease (mean follow-up, 19.3 mo; range, 6–36 mo). Mean radiographic follow-up was 34 months (range, 6 mo to 10 yr). Mean clinical follow-up was 36 months (range, 1 mo to 10 yr).

CONCLUSION:
A subset of pineocytomas demonstrates the potential for symptomatic recurrence. We advocate an attempt at gross total tumor resection for all symptomatic patients with tectal plate compression, reserving radiosurgery for small, subtotally resected, or recurrent lesions. Patients must be followed closely for recurrence. Radiosurgery seems to be beneficial for local tumor control. Further investigation is needed to identify histological markers for pineocytomas that behave aggressively.
The Unique Characteristics of “Upper” Lumbar Disc Herniations
Authors: Sanderson Scott P. , Houten John , Errico Thomas , Forshaw David , Bauman Joel , Cooper Paul R. 
Published: August 2004

AbstractOBJECTIVE:To compare the characteristics, presentation, and surgical outcome of patients with microdiscectomies at L1–L2 and L2–L3 with those we treated at L3–L4. We further sought to compare these results with those reported in the literature for discectomies at the L4–L5 and L5–S1 levels.METHODS:We reviewed the clinical data collected from 69 patients who had 72 L1–L2, L2–L3, and L3–L4 microdiscectomies performed from 1989 to 1999 at the New York University Medical Center. Patients who had surgery at L1–L2 or L2–L3 were grouped and compared with those treated at the L3–L4 level. Patients' charts were retrospectively reviewed at a mean of 12.9 months after surgery for presenting signs and symptoms, patient characteristics, and surgical outcome. Long-term follow-up via telephone interview was obtained at an average of 81.3 months after surgery.RESULTS:In the L1–L2 + L2–L3 group, 58% of the patients had previous lumbar disc surgery, compared with only 10% of those in the L3–L4 group, and 20% in the L1–L2 + L2–L3 group required a fusion during the procedure compared with only 10% in the L3–L4 group. These differences are both statistically significant. The short-term chart review demonstrates that only 58% and 53% of patients in the L1–L2 + L2–L3 group were improved with regard to radicular and back pain, respectively, whereas those in the L3–L4 group reported 94 and 87% rates of improvement in the same categories, both highly statistically significant findings. The long-term follow-up confirmed a highly statistically significantly worse outcome in the L1–L2 + L2–L3 group, with only 33% of patients reporting an improvement in their economic or functional status, compared with an 88% rate of improvement in the L3–L4 group. The outcome of our patients with L3–L4 herniations was similar to that reported in the literature for herniations at L4–L5 and L5–S1.CONCLUSION:Herniated discs at the L1–L2 or L2–L3 level are different entities from those at lower levels of the lumbar spine. The surgical outcome in terms of postoperative back and radicular pain is worse for herniated discs at L1–L2 and L2–L3 compared with those treated at L3–L4. Our patients with L1–L2 or L2–L3 surgically treated herniated discs were more likely to have had previous lumbar surgery and required a fusion more often than their counterparts with L3–L4 herniated discs.
Superficial Temporal Artery-to-Middle Cerebral Artery Bypass Grafting for Cerebral Revascularization
Authors: Wanebo John E. , Zabramski Joseph M. , Spetzler Robert F. 
Published: August 2004

Abstract
SUPERFICIAL TEMPORAL ARTERY-to-middle cerebral artery bypass procedures are an important tool in the armamentarium of cerebrovascular surgeons for the treatment of carotid occlusion and revascularization for complex aneurysms and brain tumors. This article enumerates the essential steps in performing superficial temporal artery-to-middle cerebral artery bypass procedures. The nuances of this technique reflect the extensive experience of the senior authors (RFS, JMZ).
Trigeminal Neuralgia Caused by Venous Compression
Authors: Matsushima Toshio , Huynh-Le Phuong , Miyazono Masayuki 
Published: August 2004

Abstract

OBJECTIVE:
The purpose of this study is to clarify whether venous compression on the trigeminal nerve really causes trigeminal neuralgia or not, and to identify which veins are the offending veins.

METHODS:
We used microvascular decompression in operations on 121 patients with typical trigeminal neuralgia. We analyzed the intraoperative findings and surgical results in these 121 cases.

RESULTS:
In 7 of the 121 cases, only the vein was identified as a compressive factor on the trigeminal nerve. In 6 of these 7 cases, single venous compression was found, whereas the remaining case had two offending veins. The transverse pontine vein was most frequently found as the offending vein near Meckel's cave. All patients showed complete relief of trigeminal pain after decompression of the veins, but four of them developed facial numbness after surgery, which tended to be slight and did not require any treatment.

CONCLUSION:
Our surgical experiences showed that venous compression could cause trigeminal neuralgia by itself and that the transverse pontine vein should be carefully observed because it is most frequently the offending vein.
Comparison of Endovascular and Surface Cooling during Unruptured Cerebral Aneurysm Repair
Authors: Steinberg Gary K. , Ogilvy Christopher S. , Shuer Lawrence M. , Connolly E. Sander , Solomon Robert A. , Lam Arthur , Kassell Neal F. , Baker Christopher J. , Giannotta Steven L. , Cockroft Kevin M. , Bell-Stephens Teresa E. , Allgren Robin L. 
Published: August 2004

Abstract

OBJECTIVE:
To compare endovascular versus surface methods for the induction and reversal of hypothermia during neurosurgery in a multicenter, prospective, randomized study.

METHODS:
Patients undergoing elective open craniotomy for repair of an unruptured cerebral aneurysm (n = 153) were randomly assigned (2:1) to undergo whole-body hypothermia to 33°C, either with an endovascular cooling device placed in the inferior vena cava via the femoral vein (n = 92) or with a surface convective air blanket (n = 61). Active rewarming was accomplished using the same devices.

RESULTS:
Cooling rates in endovascular and surface blanket groups averaged 4.77 and 0.87°C/h, respectively (P &lt; 0.001). When the first temporary arterial or aneurysm clip was placed, 99% of endovascular patients and 20% of surface blanket patients had reached the target of 33°C (P &lt; 0.001). Obese patients were cooled efficiently with the endovascular approach (3.56°C/h). Rewarming rates averaged 1.88°C/h for endovascular patients and 0.69°C/h for surface blanket patients (P &lt; 0.001). By the end of surgery, 89 and 53% of these patients, respectively, had rewarmed to at least 35°C (P &lt; 0.001). On leaving the operating room, 14% of endovascular patients and 28% of surface blanket patients were still intubated (P = 0.035). The overall safety of the two procedures was comparable. No clinically significant catheter-related thrombotic, bleeding, or infectious complications were reported in the endovascular group.

CONCLUSION:
Endovascular cooling provided superior induction, maintenance, and reversal of hypothermia compared with the surface blanket, without an increase in complications. Endovascular cooling may have clinical benefit for patients undergoing cerebrovascular surgery, as well as patients with acute stroke, head injury, or acute myocardial infarction.
Volumetric Assessment of Glioma Removal by Intraoperative High-field Magnetic Resonance Imaging
Authors: Nimsky Christopher , Fujita Atsushi , Ganslandt Oliver , von Keller Boris , Fahlbusch Rudolf 
Published: August 2004

Abstract

OBJECTIVE:
To investigate the contribution of high-field intraoperative magnetic resonance imaging (iMRI) for further reduction of tumor volume in glioma surgery.

METHODS:
From April 2002 to June 2003, 182 neurosurgical procedures were performed with a 1.5-T magnetic resonance system. Among patients who underwent these procedures, 47 patients with gliomas (14 with World Health Organization Grade I or II glioma, and 33 with World Health Organization Grade III or IV glioma) who underwent craniotomy were investigated retrospectively. Completeness of tumor resection and volumetric analysis were assessed with intraoperative imaging data.

RESULTS:
Surgical procedures were influenced by iMRI in 36.2% of operations, and surgery was continued to remove residual tumor. Additional further resection significantly reduced the percentage of final tumor volume compared with first iMRI scan (6.9% ± 10.3% versus 21.4% ± 13.8%; P &lt; 0.001). Percentages of final tumor volume also were significantly reduced in both low-grade (10.3% ± 11.5% versus 25.8% ± 16.3%; P &lt; 0.05) and high-grade gliomas (5.4% ± 9.9% versus 19.5% ± 13.0%; P &lt; 0.001). Complete resection was achieved finally in 36.2% of all patients (low-grade, 57.1%; high-grade, 27.3%). Among the 17 patients in whom complete tumor resection was achieved, 7 complete resections (41.2%) were attributable to further tumor removal after iMRI. We did not encounter unexpected events attributable to high-field iMRI, and standard neurosurgical equipment could be used safely.

CONCLUSION:
Despite extended resections, introduction of high-field iMRI in conjunction with functional navigation did not translate into an increased risk of postoperative deficits. The use of high-field iMRI increased radicality in glioma surgery without additional morbidity.
Predicting Stroke Risk in Pediatric Moyamoya Disease with Xenon-enhanced Computed Tomography
Authors: McAuley David J. , Poskitt Ken , Steinbok Paul 
Published: August 2004

Abstract

OBJECTIVE:
To determine whether estimates of regional cerebral blood flow (rCBF) using xenon computed tomography (XeCT) in children with moyamoya disease can predict stroke risk before and after treatment.

METHOD:
Seven patients with moyamoya disease underwent 22 serial Xe computed tomographic scans. Estimates of rCBF were obtained at three computed tomographic levels by use of a 5-minute inhalation of 28% Xe. Acetazolamide challenge was performed in eight scans. For comparison of abnormal vessel distribution and areas of infarction, 17 intra-arterial digital subtraction angiograms, 47 computed tomographic scans, and 15 magnetic resonance imaging scans were available. Follow-up exceeded 36 months in all patients. Mean follow-up for the interventional group was 65.2 months (n =5; range, 37–109 mo) and 38 months for the nonoperative patients (n =2; 36 and 40 mo).

RESULTS:
Of six Xe computed tomographic scans obtained at diagnosis, four revealed regions of oligemia, augmented vertebrobasilar flow, and regions of carotid steal after acetazolamide. In the delay between diagnosis and treatment, three patients had strokes in ischemic areas identified by XeCT. Of the 10 posttreatment scans obtained from 4 patients, 2 revealed improved tissue perfusion with angiography confirming successful encephaloduroangiomyosynangiosis. In 2 others, XeCT performed 6 months posttreatment revealed improved perfusion without angiographic change, and angiography at 1 year revealed failed encephaloduroangiomyosynangiosis and new native collaterals. None of the patients with improved rCBF had new strokes. Eleven of 14 Xe computed tomographic scans were obtained within 30 days of angiography. Comparison of these studies demonstrates that regions of oligemia were confined to areas associated with vessel stenosis and little neovascularity or collateral pathways.

CONCLUSION:
XeCT, particularly with acetazolamide challenge, objectively quantifies rCBF. Our preliminary data suggest that it may permit assessment of stroke risk in children with moyamoya disease and may predict surgical outcome earlier than angiography.
Correlation between Withdrawal Symptoms and Medication Pump Residual Volume in Patients with Implantable SynchroMed Pumps
Authors: Taha Jamal , Favre Jacques , Janszen Michele , Galarza Marcelo , Taha Assad 
Published: August 2004

Abstract

OBJECTIVE:
To investigate whether patients with implantable SynchroMed pumps (Medtronic, Inc., Minneapolis, MN) develop symptoms of drug withdrawal at residual medication volumes that exceed 2 ml (the alarm residual volume recommended by the manufacturer).

METHODS:
The data sheets of 88 patients with implantable SynchroMed pumps were retrospectively reviewed. The following parameters were analyzed: development of symptoms of drug withdrawal; drugs used in the pump; disease state; drug residual volume in the pump; intake of orally administered medications; time of development of withdrawal symptoms; drug flow volume through the pump; daily intrathecally administered drug dose; and drug concentration in the pump.

RESULTS:
Of 88 patients, 21 (24%) consistently developed symptoms of drug withdrawal 1 to 7 days before the drug residual volume reached a mean of 2.7 ml (range, 2.1–3.8 ml; median, 2.6 ml). Symptoms first developed 1 to 18 months after surgery. In all patients, symptoms of drug withdrawal subsided after pump refill and did not recur after the alarm volume was increased to 4 ml. Symptom development did not correlate with intake of orally administered medication, drug flow volume through the pump, intrathecally administered drug dose, drug concentration in the pump, drugs used in the pump, or disease state.

CONCLUSION:
Some patients develop symptoms of drug withdrawal at residual volumes that exceed 2 ml. We could not identify factors that predict this occurrence. Withdrawal symptoms did not recur when the alarm volume was increased to 4 ml.
Solitary Fibrous Tumor of the Spinal Cord: Case Report and Review of the Literature
Authors: Kawamura Mitsuhiro , Izawa Kazutaka , Hosono Noboru , Hirano Hiroshi 
Published: August 2004

Abstract

OBJECTIVE AND IMPORTANCE:
A solitary fibrous tumor (SFT) is a rare neoplasm of probable mesenchymal origin that was first reported in the pleura but can occur in different sites. Only six cases of SFT arising from the spinal cord have been reported.

CLINICAL PRESENTATION:
We report a case of primary SFT occurring in the thoracic spinal cord in a 64-year-old man with Brown-Séquard syndrome. Magnetic resonance imaging revealed an intradural mass at the level of T2–T3.

INTERVENTION:
Total T2–T3 laminectomies were performed. The tumor appeared to be adherent to the right lateral aspect of the cord but not attached to the meninges. On histological examination, the tumor exhibited spindle cell proliferation with abundant dense collagen but without a hemangiopericytomatous pattern. Immunohistochemically, the tumor cells were reactive with CD34 and vimentin only.

CONCLUSION:
We report a rare case of SFT occurring in the thoracic spinal cord. Histologically and immunohistochemically, we confirmed the diagnosis of SFT. Low signal intensity on T1- and T2-weighted images corresponded to the histological findings. When a spinal cord tumor exhibits a signal pattern similar to this, SFT should be included in the differential diagnosis. Because of the rarity of reports on this condition, the clinical manifestations and course of SFT of the spinal cord are unknown, and careful long-term follow-up is recommended.