bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tumoral Calcium Pyrophosphate Dihydrate Deposition Disease of the Ligamentum Flavum
Authors: Muthukumar Natarajan , Karuppaswamy Usharani 
Published: August 2004

AbstractOBJECTIVECalcium pyrophosphate dihydrate (CPPD) deposition disease (CPPDD), also known as pseudogout, is rarely known to affect the spine. The purpose of this article is to report our experience with six cases involving massive focal deposition of CPPD crystals in the ligamentum flavum.METHODSBetween January 1998 and June 2002, we treated six patients with CPPDD involving the ligamentum flavum of the cervical and thoracic spine. Their ages ranged from 45 to 70 years. There were five female patients and one male patient. The cervical spine was involved in two cases and the thoracic spine in four. All except one patient presented with an insidious onset of myelopathy. The remaining patient presented with paraplegia after trauma. None of the patients exhibited any systemic features of CPPDD or other metabolic conditions that can lead to CPPD deposition. Plain x-rays often yielded inconclusive results. Computed tomography and magnetic resonance imaging were useful in confirming the diagnoses. Decompressive laminectomy, with removal of the ossified ligamenta flava, was performed for all patients. Polarized-light microscopic examinations of the excised ligamenta flava revealed the characteristic rod-shaped, birefringent crystals.RESULTSFive of the six patients experienced significant improvements in their myelopathic symptoms after surgery. The remaining patient experienced improvements in sensations but no appreciable improvement in motor power. During the follow-up periods, which ranged from 7 months to 3 years, none of the patients presented with a recurrence of CPPD crystal deposition at the previously treated level. However, one patient who exhibited improvement after surgery presented 2 years later with a recurrence of myelopathic features attributable to ossification of the ligamentum flavum at a new level.CONCLUSIONTumoral CPPDD of the ligamentum flavum is rare. It commonly occurs among middle-age or elderly female patients and presents with progressive myelopathy. Computed tomography and magnetic resonance imaging are complementary in the diagnosis of this condition. Surgery, if performed early, leads to good improvement. However, long-term follow-up monitoring of these patients is necessary, because surgery provides only symptomatic relief and does not treat the underlying disease. With the increasing availability of magnetic resonance imaging, ossification of the ligamentum flavum is being more frequently recognized. In every case of ossified ligamentum flavum, the excised specimen should be examined with polarized-light microscopy. We think that this simple, inexpensive method will lead to the recognition of more cases of spinal CPPDD.
Quality of Reporting in Evaluations of Surgical Treatment of Trigeminal Neuralgia: Recommendations for Future Reports
Authors: Zakrzewska Joanna M. , Lopez Benjamin C. 
Published: August 2004

Abstract

OBJECTIVE
There are numerous reports on the surgical treatment of trigeminal neuralgia, but the studies do not use uniform outcome measures, which makes it difficult for patients and clinicians to determine which treatment may be most appropriate. The objectives of this study were to set quality criteria and standards for outcome reporting for the surgical treatment of trigeminal neuralgia (on the basis of international expert opinion), to identify and assess all studies of the surgical treatment of trigeminal neuralgia and evaluate the studies against those criteria, and to provide recommendations for submitting reports on the outcomes of surgical treatment of trigeminal neuralgia.

METHODS
The types of data that 11 neurosurgeons and 2 neurologists considered essential for articles reporting the outcomes of surgical treatment of trigeminal neuralgia were the quality criteria used by the two authors. Standards were established in terms of the minimal number and type of criteria that studies should meet to allow their use in a potential systematic review of pain outcomes of surgical treatment of trigeminal neuralgia. Studies were identified in MEDLINE searches and from other sources and were independently scored against those criteria by the two authors. The reproducibility of the method was checked with assessments of inter- and intra-rater reliability. A checklist for the reporting of studies was formulated.

RESULTS
A total of 281 studies were identified, of which 222 were scored. Seventy-one (32%) of the studies reached the minimal set standards, but only 28 (13%) could be used for assessment of pain outcomes, because they included actuarial analyses. There was good agreement between the two authors in the scoring of the studies, although some criteria required stricter definitions. A checklist for the reporting of future studies on the surgical treatment of trigeminal neuralgia was proposed.

CONCLUSION
When assessed against the proposed criteria and standards, the quality of reporting was generally poor. The methods for reporting surgical outcomes for trigeminal neuralgia were not uniform; therefore, the comparability of results and techniques was low. Data should be collected and reported in a standardized way. A protocol for data collection and reporting on the surgical treatment of trigeminal neuralgia has been proposed. Further research is needed to evaluate this tool.
An Alternative Extradural Exposure to the Anterior Clinoid Process: The Superior Orbital Fissure as a Surgical Corridor
Authors: Coscarella Ernesto , Başkaya Mustafa K. , Morcos Jacques J. 
Published: August 2004

Abstract

OBJECTIVE
Dolenc has pioneered the extradural approach to the anterior clinoid process (ACP) in approaching the cavernous sinus, clinoidal space, and orbital apex. A key step is the division of the frontotemporal dural fold (FTDF). Less experienced surgeons may not be as versatile in their three-dimensional understanding of the superior orbital fissure and thus may risk injury to its contents. Through our cadaveric and subsequent clinical experience, we have devised a modification of the approach that permits safer handling of the contents of the superior orbital fissure.

METHODS
In five consecutive injected cadaveric heads (10 sides), we performed on one side a traditional extradural exposure of the ACP. On the other side, we performed our alternative dissection. Instead of exposing the ACP from medial to lateral and dividing the frontotemporal dural fold along the assumed path of safety, we followed the edge of the lesser wing from lateral to medial, uncovered the superior orbital fissure, and peeled the outer layer of the cavernous sinus medial to the foramen rotundum along the greater wing, thus uncovering the inferolateral surface of the ACP. This allowed dural division under full visualization.

RESULTS
The alternative method proved easier and more reliable in every case. We applied this technical modification in seven patients with no complications. Specifically, there was no injury to the oculomotor, lacrimal, frontal, or trigeminal nerves or branches. We present detailed anatomic expositions of the injected specimens.

CONCLUSION
This technical modification of the extradural approach of Dolenc is a simple, safe, and valuable adjunct to the exposure of the ACP. We recommend its use particularly by relatively inexperienced surgeons.
Tentorial Dural Arteriovenous Fistula Presenting with Various Visual Symptoms Related to Anterior and Posterior Visual Pathway Dysfunction: Case Report
Authors: Benndorf Goetz , Schmidt Stefanie , Sollmann Wolf-Peter , Kroppenstedt Stefan-Nikolaus 
Published: August 2004

Abstract

OBJECTIVE AND IMPORTANCE
Dural arteriovenous fistulae (DAVFs) not directly shunting into the cavernous sinus are an infrequent cause of visual dysfunction. An unusual case of a tentorial DAVF associated with visual symptoms related to dysfunction of the anterior and posterior visual pathway is presented.

CLINICAL PRESENTATION
A 38-year-old woman with a history of long-standing bilateral proptosis experienced a sudden onset of headache and visual disturbances. Ocular examination revealed bilateral episcleral and retinal venous congestion, optic disc paleness, right superior homonymous quadrantanopsia in both eyes, and concentric narrowing of the visual field of the right eye. Angiography revealed a DAVF supplied by a falx branch arising from the left vertebral artery and both middle meningeal arteries, which drained directly into the markedly dilated vein of Galen via the basal vein of Rosenthal and the cavernous sinus into both superior ophthalmic veins.

INTERVENTION
Endovascular treatment was performed in two consecutive sessions by transarterial embolization with n-butylcyanoacrylate, which resulted in occlusion of the fistula and complete clinical cure, confirmed at the 6-month follow-up examination.

CONCLUSION
Various neuro-ophthalmological findings may be caused by an arteriovenous lesion remote from the optic organ as a result of rerouting of venous drainage compromising the visual pathway at different locations. Transarterial embolization of a DAVF may result in complete cure if advantageous arterial anatomy allows for flow control and occlusion of the fistulous connection with liquid adhesives.
Melanocytic Colonization of a Meningothelial Meningioma: Histopathological and Ultrastructural Findings with Immunohistochemical and Genetic Correlation: Case Report
Authors: Nestor Scott L. , Perry Arie , Kurtkaya Ozlem , Abell-Aleff Patrice , Rosemblat Aldo M. , Burger Peter C. , Scheithauer Bernd W. 
Published: August 2004

Abstract

OBJECTIVE AND IMPORTANCE
Melanocytic colonization of nonpigmented extracranial tumors has been reported in adenocarcinomas, squamous cell carcinomas, skin appendage tumors, and dermatofibrosarcoma protuberans. To our knowledge, melanocytic colonization of a meningioma has not previously been described.

CLINICAL PRESENTATION
We report an unusual case of a 70-year-old African-American woman who presented with a large frontoparietal meningioma that extended through the calvarium.

INTERVENTION
Craniotomy with gross total resection of the tumor was performed. Histochemistry, immunocytochemistry, ultrastructural analysis, and molecular genetic study via fluorescence in situ hybridization confirmed melanocytic colonization of a meningothelial meningioma.

CONCLUSION
With the inclusion of meningothelial meningioma, the spectrum of tumors affected by melanocytic colonization continues to expand.
Cervical Cord Compression with Myelopathy Caused by Bilateral Persistence of the First Intersegmental Arteries: Case Report
Authors: Takahashi Toshiyuki , Tominaga Teiji , Hassan Tamer , Yoshimoto Takashi 
Published: August 2004

Abstract

OBJECTIVE AND IMPORTANCE
Cervical myelopathy induced by vascular compression is rare. We report a case caused by bilateral persistence of the first intersegmental arteries (a vertebral artery anomaly). Myelopathy was successfully treated with vascular decompression.

CLINICAL PRESENTATION
A 66-year-old woman presented with gradually worsening paroxysmal neck and arm pain. Magnetic resonance imaging and angiography demonstrated anomalous intradural courses of both vertebral arteries, compressing the dorsal aspect of the cervical spinal cord.

INTERVENTION
Microvascular decompression was performed with transposition of the arteries, followed by anchoring of the arteries to the dorsolateral dura mater with Gore-Tex bands (W.L. Gore & Associates, Inc., Flagstaff, AZ).

CONCLUSION
The pain disappeared promptly after surgery. Surgical decompression, with anchoring of an anomalous vertebral artery to the dura, can relieve pain and other symptoms resulting from vascular cord compression.
Shunt Malfunction Caused by Mischievous Twisting of the Valve by the Patient: Case Report
Authors: Nabika Shinya , Oki Shuichi , Sumida Masayuki , Isobe Naoyuki 
Published: August 2004

Abstract

OBJECTIVE AND IMPORTANCE
We report an instructive case of repetitive shunt obstruction caused by mischievous turning of the valve by the patient.

CLINICAL PRESENTATION
A 7-year-old boy underwent shunt replacement for hydrocephalus caused by intraventricular hemorrhage at birth; the shunt had been revised a month earlier. The boy experienced occasional episodes of headache and vomiting after the revision. A shunt survey revealed a twisted tube just proximal to the valve.

INTERVENTION
After the valve was returned to its original position, the symptoms resolved. The patient confessed to a recent habit of turning the valve.

CONCLUSION
Although turning of the valve may be a potential cause of shunt obstruction, the use of craniography and/or a shunt series should be able to reveal these changes.
Pilocytic Astrocytomas in Children: Prognostic Factors—A Retrospective Study of 80 Cases
Authors: Fernandez Carla , Figarella-Branger Dominique , Girard Nadine , Bouvier-Labit Corinne , Gouvernet Joanny , Paredes Armando Paz , Lena Gabriel 
Published: August 2004

Abstract

OBJECTIVE
Pilocytic astrocytomas (PA) are Grade I brain tumors characterized by an excellent prognosis. In some cases, however, the patient has a bad outcome. The aim of our study was to search for the clinicopathological factors underlying the prognosis for patients with this disease.

METHODS
We reviewed the clinical, neuroradiological, and histopathological features of 80 PAs (33 cerebellar, 18 optochiasmatic, 16 brainstem, 7 spinal cord, 3 thalamic, 2 optic nerve, and 1 hemispheric) in pediatric patients.

RESULTS
Pathological examination revealed 58 classic PAs and 20 pilomyxoid astrocytomas, which are a histological variant of PAs. Two cases remained unclassified. The mean overall follow-up period was 58 months, the 5-year progression-free survival rate was 75%, and the 5-year survival rates were 100 and 92% after total and partial removal. Univariate statistical analysis revealed that partial resection, optochiasmatic PA localization, and pilomyxoid variant were associated with a worse prognosis, but the latter two parameters were too closely related to the extent of resection to be independent prognostic factors in multivariate analysis. Among the patients who underwent partial surgical removal, only invasion of the surrounding structures was related to prognosis.

CONCLUSION
PAs are benign tumors, but some clinicopathological factors, such as partial resection, optochiasmatic location, invasion of surrounding structures, and the pilomyxoid variant, have a worse prognosis.
Proton Beam Radiosurgery for Vestibular Schwannoma: Tumor Control and Cranial Nerve Toxicity
Authors: Weber Damien C. , Chan Annie W. , Bussiere Marc R. , Harsh Griffith R. , Ancukiewicz Marek , Barker Fred G. , Thornton Allan T. , Martuza Robert L. , Nadol Joseph B. , Chapman Paul H. , Loeffler Jay S. 
Published: August 2004

Abstract

OBJECTIVE
We sought to determine the tumor control rate and cranial nerve function outcomes in patients with vestibular schwannomas who were treated with proton beam stereotactic radiosurgery.

METHODS
Between November 1992 and August 2000, 88 patients with vestibular schwannomas were treated at the Harvard Cyclotron Laboratory with proton beam stereotactic radiosurgery in which two to four convergent fixed beams of 160-MeV protons were applied. The median transverse diameter was 16 mm (range, 2.5–35 mm), and the median tumor volume was 1.4 cm3 (range, 0.1–15.9 cm3). Surgical resection had been performed previously in 15 patients (17%). Facial nerve function (House-Brackmann Grade 1) and trigeminal nerve function were normal in 79 patients (89.8%). Eight patients (9%) had good or excellent hearing (Gardner-Robertson [GR] Grade 1), and 13 patients (15%) had serviceable hearing (GR Grade 2). A median dose of 12 cobalt Gray equivalents (range, 10–18 cobalt Gray equivalents) was prescribed to the 70 to 108% isodose lines (median, 70%). The median follow-up period was 38.7 months (range, 12–102.6 mo).

RESULTS
The actuarial 2- and 5-year tumor control rates were 95.3% (95% confidence interval [CI], 90.9–99.9%) and 93.6% (95% CI, 88.3–99.3%). Salvage radiosurgery was performed in one patient 32.5 months after treatment, and a craniotomy was required 19.1 months after treatment in another patient with hemorrhage in the vicinity of a stable tumor. Three patients (3.4%) underwent shunting for hydrocephalus, and a subsequent partial resection was performed in one of these patients. The actuarial 5-year cumulative radiological reduction rate was 94.7% (95% CI, 81.2–98.3%). Of the 21 patients (24%) with functional hearing (GR Grade 1 or 2), 7 (33.3%) retained serviceable hearing ability (GR Grade 2). Actuarial 5-year normal facial and trigeminal nerve function preservation rates were 91.1% (95% CI, 85–97.6%) and 89.4% (95% CI, 82–96.7%). Univariate analysis revealed that prescribed dose (P = 0.005), maximum dose (P = 0.006), and the inhomogeneity coefficient (P = 0.03) were associated with a significant risk of long-term facial neuropathy. No other cranial nerve deficits or cancer relapses were observed.

CONCLUSION
Proton beam stereotactic radiosurgery has been shown to be an effective means of tumor control. A high radiological response rate was observed. Excellent facial and trigeminal nerve function preservation rates were achieved. A reduced prescribed dose is associated with a significant decrease in facial neuropathy.
Brachial Plexus Variations in Human Fetuses
Authors: Uysal İsmihan İlknur , Şeker Muzaffer , Karabulut Ahmet Kağan , Büyükmumcu Mustafa , Ziylan Taner 
Published: August 2004

AbstractOBJECTIVEWe examined the anatomic variations of the brachial plexus (BP) in human fetuses.METHODSThis study was performed with 200 BPs from spontaneously aborted fetuses without detectable malformations. The plexuses were dissected, and the normal position and/or morphological variations of the BP were determined and photographed.RESULTSThere were no variations in 93 plexuses, and 107 plexuses were observed to have different variations. Morphological variations were observed more frequently among female fetuses and right sides. The BPs were composed mostly of the C5, C6, C7, and C8 nerves and the T1 nerve (71.5%). A prefixed plexus was observed in 25.5% of cases, and a postfixed plexus was observed in 2.5% of cases. In one case (0.5%), the C4 and T2 nerves joined the formation. The inferior trunk was not formed in 9% of cases. The superior trunk was not formed in 1% of cases. In one plexus, the superior trunk was formed by the ventral rami of the C4 and C5 nerves. In one case, the inferior trunk was formed by the ventral rami of the T1 and T2 nerves. Division variations were observed most frequently. There were also variations in the terminal branches, such as the roots of the median nerve joining in the distal part of the arm (8.5%), the axillary nerve being separate from the posterior division of the superior trunk (2.5%), and a connection existing between the median and musculocutaneous nerves (1%).CONCLUSIONKnowledge of BP variations is important for surgeons who perform surgical procedures in the cervical and axillary regions.
A Reappraisal of Angioplasty and Stenting for the Treatment of Vertebral Origin Stenosis
Authors: Albuquerque Felipe C. , Fiorella David , Han Patrick , Spetzler Robert F. , McDougall Cameron G. 
Published: August 2004

Abstract

OBJECTIVE
To assess the rate of restenosis after vertebral origin angioplasty and stenting (VOAS).

METHODS
We reviewed the records of 33 patients (24 men, 9 women; age range, 49–81 yr; mean, 64.5 yr) who underwent VOAS during a period of 5 years and followed each for the development of adverse sequelae through a prospectively maintained database. A neuroradiologist not involved in the stenting procedures assessed original and follow-up angiograms for evidence of restenosis. Restenosis was quantified as insignificant (0–24%), mild (25–49%), moderate (50–74%), or severe (75–100%).

RESULTS
Of the 33 patients, 30 presented with transient ischemic attacks or stroke. Most (31 of 33 patients) manifested other brachiocephalic stenoses, including 27 patients with occlusion, hypoplasia, or stenosis of the contralateral vertebral artery. Angiographic follow-up (mean, 16.2 mo) was obtained in 30 patients (2 patients died before follow-up, and 1 refused). Restenosis was mild in seven patients, moderate in eight, and severe in five. The combined rate of moderate-to-severe restenosis was 43.3%. No complications resulted in permanent morbidity. One patient died as a result of a stroke in a different vascular distribution 4 months after VOAS. Another patient died as a result of basilar thrombosis in which emergent stenting had been undertaken in an effort to perform thrombolysis.

CONCLUSION
Despite a technical success rate of 97% and a low incidence of complications, VOAS is associated with a high rate of moderate-to-severe restenosis.
Results of Endovascular Treatment of Internal Carotid Artery Stenoses with a Newly Developed Balloon Protection Catheter
Authors: Terada Tomoaki , Tsuura Mitsuharu , Matsumoto Hiroyuki , Masuo Osamu , Yamaga Hiroo , Tsumoto Tomoyuki , Itakura Toru 
Published: August 2004

Abstract

OBJECTIVE
A new balloon protection catheter to prevent distal emboli during internal carotid artery percutaneous transluminal angioplasty and stenting was developed, and its efficacy was evaluated in both an experimental model and clinical cases.

METHODS
The balloon protection catheter was navigated over a steerable 0.014-inch guidewire to negotiate tight stenoses and sharp bends, which would cause difficulties for the passage of a flow-directed balloon catheter. Percutaneous transluminal angioplasty and stenting were performed for 85 consecutive patients with 87 stenotic lesions of the cervical internal carotid artery, with two different methods using this protection system. Distal protection was provided only after dilation for the initial 38 lesions (Group I), but the latter 49 lesions were treated in both the pre- and postdilation periods (Group II). The effects of using the balloon protection catheter with the embolic debris clearance technique were evaluated with pre- and postoperative magnetic resonance imaging for each group.

RESULTS
The balloon protection catheter was introduced beyond the stenosis in all cases. In Group I, one symptomatic embolic stroke was caused by distal embolization resulting from atheromatous plaque, and high-intensity areas appeared on diffusion-weighted magnetic resonance imaging scans in 47% of cases. In contrast, in Group II, there were no strokes related to the procedure, although one patient with multiple risk factors died suddenly on the second day after stenting. Diffusion-weighted imaging scans demonstrated small, high-intensity areas in 19% of cases in Group II. The overall morbidity/mortality rate in our series was 2.3%.

CONCLUSION
Our new balloon protection catheter was reliably navigated across internal carotid artery stenoses and reduced distal embolism in clinical cases.