bluuebunny/crossref_metadata_2025_split huggingface dataset:
Results of Transsphenoidal Surgery in a Large Series of Patients with Pituitary Adenoma
Authors: Mortini Pietro , Losa Marco , Barzaghi Raffaella , Boari Nicola , Giovanelli Massimo 
Published: May 2005

Abstract

OBJECTIVE:
To report the efficacy and safety of microsurgical transsphenoidal surgery in a series of previously untreated patients with pituitary adenoma.

METHODS:
One thousand one hundred forty consecutive patients undergoing transsphenoidal resection of a pituitary adenoma at our department from January 1990 through December 2002 were included in our study. Postoperative results were classified uniformly during the period of the study. Patients were considered in remission of disease when strict hormonal and radiological criteria of cure were met.

RESULTS:
The most frequent tumor type was clinically nonfunctioning adenoma (NFPA) (33.2%), followed by growth hormone-secreting adenoma (28.1%), adrenocorticotropin-secreting adenoma (23.0%), prolactin-secreting adenoma (13.2%), and last, thyrotropin-secreting adenoma (2.5%). The patient population was 59.7% female and 40.3% male. Mean age was 43.0 ± 0.4 years. There were 788 macroadenomas (69.1%), and in 233 patients (20.4%), the tumor invaded one or both cavernous sinuses. The overall rate of early surgical success was achieved in 504 (66.1%) of the 762 patients with a hormone-active adenoma. Surgical outcome was better in patients with microadenomas than in patients with macroadenomas (78.9% and 55.5%, respectively), whereas tumors invading the cavernous sinus had a poorer outcome (7.4%). In patients with NFPA, no residual adenoma was present in 234 patients (64.8%). Normalization of visual defects occurred in 117 (40.5%) of the 289 patients with visual disturbances and improved in another 148 patients (51.2%). Three patients (0.3%) died as a consequence of surgery.

CONCLUSION:
Transsphenoidal surgery is an effective and safe treatment for most patients with pituitary adenoma and could be considered the first-choice therapy in all cases except for prolactinomas responsive to dopamine agonists. Other treatment methods, such as radiotherapy, stereotactic radiosurgery, and medical therapy, play an important role in patients not cured by surgery.
Safety and Feasibility of Convection-enhanced Delivery of Cotara for the Treatment of Malignant Glioma: Initial Experience in 51 Patients
Authors: Patel Sunil J. , Shapiro William R. , Laske Douglas W. , Jensen Randy L. , Asher Anthony L. , Wessels Barry W. , Carpenter Susan P. , Shan Joseph S. 
Published: May 2005

Abstract

OBJECTIVE:
We report the safety and feasibility of using convection-enhanced delivery to administer Cotara (Peregrine Pharmaceuticals, Inc., Tustin, CA), a novel radioimmunotherapeutic agent, to patients with malignant glioma.

METHODS:
Between April 1998 and November 2002, 51 patients with histologically confirmed malignant glioma received Cotara by convection-enhanced delivery. Most patients (88%) were treated with Cotara targeting tumor volume-dependent, single or multiple administrations of activity ranging from 0.5 to 3.0 mCi/cm3 of baseline clinical target volume. Two weeks after infusion, single-photon emission computed tomographic imaging determined the spatial distribution of Cotara. Patients were followed for as long as 41 months (average follow-up, 5 mo). Safety was evaluated on the basis of incidence of procedure-related, neurological, and systemic adverse events. Feasibility was evaluated in a subset of patients on the basis of the correlation between the prescribed activity and the actual activity administered to the targeted region.

RESULTS:
Fifty-one patients, 37 with recurrent glioblastoma multiforme, 8 with newly diagnosed glioblastoma multiforme, and 6 with recurrent anaplastic astrocytomas, were treated. Average tumor volume was 36 ± 27.6 cm3 (range, 5–168 cm3). Of the 67 infusions, 13 (19%), 52 (78%), and 2 (3%) delivered less than 90%, 100 ± 10%, and more than 110%, respectively, of the prescribed administered activity to the targeted region. Treatment-emergent, drug-related central nervous system adverse events included brain edema (16%), hemiparesis (14%), and headache (14%). Systemic adverse events were mild. Several patients had objective responses to Cotara.

CONCLUSION:
The majority of Cotara infusions delivered between 90 and 110% of the prescribed administered activity to the targeted region. This method of administration has an acceptable safety profile compared with literature reports of other therapeutics delivered by convection-enhanced delivery.
Staged Stereotactic Irradiation for Acoustic Neuroma
Authors: Chang Steven D. , Gibbs Iris C. , Sakamoto Gordon T. , Lee Elizabeth , Oyelese Adetokunbo , Adler John R. 
Published: May 2005

AbstractOBJECTIVE:Stereotactic radiosurgery has proven effective in the treatment of acoustic neuromas. Prior reports using single-stage radiosurgery consistently have shown excellent tumor control, but only up to a 50 to 73% likelihood of maintaining hearing at pretreatment levels. Staged, frame-based radiosurgery using 12-hour interfraction intervals previously has been shown by our group to achieve excellent tumor control while increasing the rate of hearing preservation at 2 years to 77%. The arrival of CyberKnife (Accuray, Inc., Sunnyvale, CA) image-guided radiosurgery now makes it more practical to treat acoustic neuroma with a staged approach. We hypothesize that such factors may further minimize injury of adjacent cranial nerves. In this retrospective study, we report our experience with staged radiosurgery for managing acoustic neuromas.METHODS:Since 1999, the CyberKnife has been used to treat more than 270 patients with acoustic neuroma at Stanford University. Sixty-one of these patients have now been followed up for a minimum of 36 months and form the basis for the present clinical investigation. Among the treated patients, the mean transverse tumor diameter was 18.5 mm, whereas the total marginal dose was either 18 or 21 Gy using three 6- or 7-Gy fractions. Audiograms and magnetic resonance imaging were obtained at 6-months intervals after treatment for the first 2 years and then annually thereafter.RESULTS:Of the 61 patients with a minimum of 36 months of follow-up (mean, 48 mo), 74% of patients with serviceable hearing (Gardner-Robinson Class 1–2) maintained serviceable hearing at the last follow-up, and no patient with at least some hearing before treatment lost all hearing on the treated side. Only one treated tumor (2%) progressed after radiosurgery; 29 (48%) of 61 decreased in size and 31 (50%) of the 61 tumors were stable. In no patients did new trigeminal dysfunction develop, nor did any patient experience permanent injury to their facial nerve; two patients experienced transient facial twitching that resolved in 3 to 5 months.CONCLUSION:Although still preliminary, these results indicate that improved tumor dose homogeneity and a staged treatment regimen may improve hearing preservation in acoustic neuroma patients undergoing stereotactic radiosurgery.
Long-term Reliability of Endoscopic Third Ventriculostomy
Authors: Kadrian David , van Gelder James , Florida Danielle , Jones Robert , Vonau Marianne , Teo Charles , Stening Warwick , Kwok Bernard 
Published: May 2005

Abstract

OBJECTIVE:
To describe the short-term operative success and the long-term reliability of endoscopic third ventriculostomy (ETV) for treatment of hydrocephalus and to examine the influence of diagnosis, age, and previous shunt history on these outcomes.

METHODS:
We retrospectively analyzed 203 consecutive patients from a single institution who had ETV as long as 22.6 years earlier. Patients with hydrocephalus from aqueduct stenosis, myelomeningocele, tumors, arachnoid cysts, previous infection, or hemorrhage were included.

RESULTS:
The overall probability of successfully performing an ETV was 89% (84–93%). There was support for an association between the surgical success and the individual operating surgeon (odds ratios for success, 0.44–1.47 relative to the mean of 1.0, P = 0.08). We observed infections in 4.9%, transient major complications in 7.2%, and major and permanent complications in 1.1% of 203 procedures. Age was strongly associated with long-term reliability. The longest observed reliability for the 13 patients 0 to 1 month old was 3.5 years. The statistical model predicted the following reliability at 1 year after insertion: at 0 to 1 month of age, 31% (14–53%); at 1 to 6 months of age, 50% (32–68%); at 6 to 24 months of age, 71% (55–85%); and more than 24 months of age, 84% (79–89%). There was no support for an association between reliability and the diagnostic group (n = 181, P = 0.168) or a previous shunt. Sixteen patients had ETV repeated, but only 9 were repeated after at least 6 months. Of these, 4 procedures failed within a few weeks, and 2 patients were available for long-term follow-up.

CONCLUSION:
Age was the only factor statistically associated with the long-term reliability of ETV. Patients less than 6 months old had poor reliability.
Functional Outcome after Central Corpectomy in Poor-grade Patients with Cervical Spondylotic Myelopathy or Ossified Posterior Longitudinal Ligament
Authors: Rajshekhar Vedantam , Kumar G Samson Sujith 
Published: May 2005

AbstractOBJECTIVE:We studied the long-term functional outcome in poor-grade patients (Nurick Grades 4 and 5) with cervical spondylotic myelopathy (CSM) or ossified posterior longitudinal ligament after central corpectomy (CC). We sought to determine whether there were any prognostic factors that could predict functional outcome in these patients.METHODS:Functional outcome data were collected for 72 patients (68 men and 4 women; mean age, 49.7 yr; range, 30–67 yr) with CSM (60 patients) or OPLL (12 patients) of Nurick Grades 4 (55 patients) and 5 (17 patients). Uninstrumented CC was performed at 1 level in 12 patients, at 1 level combined with a discoidectomy at another level in 4 patients, at 2 levels in 50 patients, and at 2 levels plus a discoidectomy in 5 patients. The age at presentation (≤50 yr or &gt;50 yr), grade before surgery (4 or 5), the number of levels operated (1 or &gt;1), diagnosis (CSM or ossified posterior longitudinal ligament), and duration of myelopathic symptoms (≤12 mo or &gt;12 mo) were studied for their effect on the functional outcome noted at the last follow-up. Functional outcome was graded as poor (no change in Nurick grade), fair (improvement of one Nurick grade), good (improvement of two Nurick grades), and cure (follow-up Nurick grade of 0 or 1).RESULTS:The follow-up ranged from 9 to 104 months (mean, 36.3 mo). One patient died 3 weeks after CC after surgery for a perforated duodenal ulcer. There was transient operative morbidity in 12 patients (16.9%). The mean Nurick score improved from 4.24 to 2.47 (P &lt; 0.001). Of the 54 patients (76%) who improved in their Nurick grade, the functional outcome was graded as fair in 13 patients (18.3%), good in 24 patients (33.8%), and cure in 17 patients (23.9%). The functional outcome was poor in 17 patients (23.9%). Functional improvement after CC was uniformly correlated with myelopathic symptoms of 12 months' duration or shorter. The other favorable prognostic indicators for improvement after CC were a diagnosis of CSM and preoperative Nurick Grade 5; however, patients with a preoperative Nurick grade of 4 were more likely to experience a cure.CONCLUSION:More than three-fourths of patients with poor-grade CSM improve in their functional status after CC, with nearly 24% of patients obtaining a cure. Because patients with a duration of myelopathic symptoms of 12 months or less had the best functional outcome, early decompressive surgery should be offered to patients with poor-grade CSM.
Bilateral Subthalamic Nucleus Stimulation for Parkinson's Disease: A Systematic Review of the Clinical Literature
Authors: Hamani Clement , Richter Erich , Schwalb Jason M. , Lozano Andres M. 
Published: May 2005

Abstract

OBJECTIVE:
To evaluate the benefits and adverse effects of bilateral subthalamic nucleus stimulation in the treatment of Parkinson's disease (PD) by systematically reviewing the published literature.

METHODS:
A search of the PubMed database using the key words subthalamic, nucleus, and stimulation yielded 624 articles published between 1966 and December 2003. Only articles that included original, nonduplicated descriptions of patients with PD treated with bilateral subthalamic nucleus stimulation were selected for further analysis.

RESULTS:
A total of 38 studies from 34 neurosurgical centers in 13 countries were identified for critical review. The outcomes for 471 patients with PD treated with bilateral subthalamic nucleus stimulation were assessed according to the Unified Parkinson's Disease Rating Scale in both on-medication and off-medication conditions. With stimulation, Unified Parkinson's Disease Rating Scale motor scores in the off-medication condition improved by 50% after 6 months, 56% after 12 months, 51% after 2 years, and 49% after 5 years compared with preoperative off-medication scores. At 12 months of subthalamic nucleus stimulation, the mean improvement in tremor was 81%, in rigidity was 63%, in bradykinesia was 52%, in gait was 64%, and in postural instability was 69% when compared with preoperative off-medication subscores. On-medication dyskinesias were reduced by 94%, as assessed 12 months after stimulation using the Unified Parkinson's Disease Rating Scale IV complications of therapy score. There was an overall 52% reduction in the l-dopa-equivalent dose intake after 12 months of stimulation. Most adverse effects were mild to moderate. There was a 1 to 2% incidence of severe adverse effects (death or permanent neurological deficits related to intracerebral hemorrhages). Nineteen percent of the patients had adverse effects related to stimulation that could be reversed by changing stimulation parameters. There was a 9% incidence of adverse effects related to the hardware (infections, lead and pulse generator problems).

CONCLUSION:
Bilateral subthalamic nucleus stimulation is effective in the treatment of PD. Further refinements in patient selection and surgical technique may lessen the incidence of complications associated with this procedure.
Meningeal Melanocytoma Associated with Ipsilateral Nevus of Ota Presenting as Intracerebral Hemorrhage: Case Report
Authors: Hino Ken , Nagane Motoo , Fujioka Yasunori , Shiokawa Yoshiaki 
Published: May 2005

Abstract

OBJECTIVE AND IMPORTANCE:
The authors report a rare case of meningeal melanocytoma presenting with unconsciousness, which was caused by an intracerebral hematoma and associated with a history of ipsilateral nevus of Ota.

CLINICAL PRESENTATION:
A 75-year-old woman developed nevus of Ota in the first and second divisions of the right trigeminal nerve territory, which had been treated with a skin graft 40 years earlier. She noticed right exophthalmos but left it untreated for 2 years and then became comatose owing to orbital and intracranial tumors, the latter manifesting with hemorrhage.

INTERVENTION:
She underwent craniotomy, during which the tumor was partially removed with intracerebral hematoma. Histopathologically, the tumor was diagnosed as meningeal melanocytoma. Western blot analysis demonstrated a retained protein expression of cell cycle inhibitor p16INK4A and a high level of antiapoptotic Bcl-2 in the resected tumor.

CONCLUSION:
The combination of nevus of Ota and meningeal melanocytoma has been reported in only four cases in the literature, including the current case. This is the first case coinciding with intracerebral hemorrhage, suggesting the necessity for careful follow-up with radiological images.
A Highly Vascular Intracranial Solitary Fibrous Tumor Treated with Radiotherapy and Toremifene: Case Report
Authors: Macfarlane Rebecca Gillian , Galloway Malcolm , Plowman Piers Nicholas , Thomas David Glyndor Treharne 
Published: May 2005

AbstractOBJECTIVE AND IMPORTANCE:A case of an unusual intracranial solitary fibrous tumor with features of high vascularity and resultant difficulty at resection is presented. The use of surgery, radiotherapy, and toremifene has been successful with no recurrence after 18 months.CLINICAL PRESENTATION:A 33-year-old male patient presented with a 1-year history of loss of vision on the left side and a 3-month history of headache and lethargy. Magnetic resonance imaging showed a lobulated mass (7.6 × 4.5 cm) in the left temporal fossa and left parasellar, sellar, and suprasellar regions, with a “dural tail” more typical of meningioma. Vascular supply was from both the internal carotid arteries and the left middle meningeal artery, precluding embolization.INTERVENTION:At the time of the craniotomy, a highly vascular tumor was found. Intraoperative hemorrhage limited resection to 20% of the tumor. The histological diagnosis was of a solitary fibrous tumor with an unusually angiomatoid architecture. After the operation, radiotherapy and toremifene were administered. A dramatic reduction in the size of the tumor was seen with no recurrence to date.CONCLUSION:The use of surgery, radiotherapy, and toremifene in treatment of a vascular intracranial solitary fibrous tumor has been successful and warrants further research.
Solitary Thoracic Osteochondroma: Case Report and Review of the Literature
Authors: Brastianos Priscilla , Pradilla Gustavo , McCarthy Edward , Gokaslan Ziya L. 
Published: May 2005

Abstract

OBJECTIVE AND IMPORTANCE:
Osteochondromas are common benign bone tumors that rarely arise in the vertebral column. Intraspinal presentation of these tumors is usually circumscribed to the cervical regions with few tumors presenting in the thoracic vertebrae. We report a case of a thoracic solitary osteochondroma arising from within the vertebral body, review the cases reported in the literature, and propose recommendations for the surgical management of these challenging lesions.

CLINICAL PRESENTATION:
A 26-year-old woman presented with clinical signs of spinal cord compression consisting of right lower extremity weakness and left lower extremity numbness. Magnetic resonance imaging showed a small enhancing epidural mass behind the vertebral body of T12.

INTERVENTION:
A T12 corpectomy was performed with thoracolumbar fixation and fusion.

CONCLUSION:
Our case is atypical in that the tumor arose from the posterior portion of the T12 body, causing spinal cord dysfunction that necessitated an anterior approach to T12 for corpectomy with thoracolumbar fixation and fusion. Surgical intervention was effective in completely resolving the patient's right lower extremity weakness.
Neural Damage Caused by Cerebral Hyperperfusion after Arterial Bypass Surgery in a Patient with Moyamoya Disease: Case Report
Authors: Ogasawara Kuniaki , Komoribayashi Nobukazu , Kobayashi Masakazu , Fukuda Takeshi , Inoue Takashi , Yamadate Keiko , Ogawa Akira 
Published: May 2005

Abstract

OBJECTIVE AND IMPORTANCE:
The prognosis of cerebral hyperperfusion syndrome after vascular reconstructive surgery, including extracranial-intracranial arterial bypass, is not poor unless intracerebral hemorrhage develops secondary to hyperperfusion.

CLINICAL PRESENTATION:
A 48-year-old man with symptomatic moyamoya disease with misery perfusion in the right cerebral hemisphere underwent double right superficial temporal artery-to-middle cerebral artery bypasses. The postoperative course was uneventful until the patient developed headache and agitated delirium on the 4th postoperative day.

INTERVENTION:
Perfusion computed tomographic imaging demonstrated hyperperfusion in the right temporal lobe. The symptoms resolved by institution of intensive blood pressure control. Positron emission tomography performed 2 months after surgery demonstrated a postoperative reduction of the cerebral metabolic rate of oxygen in the right temporal lobe, where brain atrophy was observed on magnetic resonance images 3 months postoperatively. Neuropsychological testing performed 3 months postoperatively showed worsening digit span, which adversely affected the patient's quality of life.

CONCLUSION:
The current case suggests that cerebral hyperperfusion after vascular reconstructive surgery can cause irreversible neural damage, which results in cognitive impairment.
Ruptured Arteriovenous Malformation in the Auditory Nerve: Technical Case Report
Authors: Oya Soichi , Matsui Toru , Asai Akio 
Published: May 2005

Abstract

OBJECTIVE AND IMPORTANCE:
Arteriovenous malformations in the cranial nerves are very rare, and only one case has been reported in the literature. To our knowledge, this is the first case report of an arteriovenous malformation in the auditory nerve.

CLINICAL PRESENTATION:
A 30-year-old woman presented with a subarachnoid hemorrhage resulting from rupture of an arteriovenous malformation in the auditory nerve.

INTERVENTION:
During the operation, the auditory nerve bundle was found to be severely damaged and a nidus was identified inside the bundle.

CONCLUSION:
Although arteriovenous malformations are thought to arise in the 4th to 8th weeks of gestation, this case might indicate a more specific time of emergence based on embryogenesis of the cranial nerves.
Prophylaxis for Deep Venous Thrombosis in Craniotomy Patients: A Decision Analysis
Authors: Danish Shabbar F. , Burnett Mark G. , Ong Joseph G. , Sonnad Seema S. , Maloney-Wilensky Eileen , Stein Sherman C. 
Published: May 2005

Abstract

OBJECTIVE:
We sought to determine the most efficient perioperative prophylactic strategy for deep venous thrombosis (DVT) in craniotomy patients by use of a decision analysis model.

METHODS:
We conducted a structured review of the relevant literature and compiled the reported incidences of DVT, pulmonary embolism, and postoperative intracranial hemorrhage (ICH) in craniotomy patients. We also obtained from the literature estimates of the likelihood and the impact of various outcomes of these complications. Data from 810 craniotomies performed at our own institution were also examined. The decision analytic model was then used to compare the effectiveness of pneumatic compression boots with pneumatic compression boots combined with either unfractionated or low-molecular-weight heparin. The model dealt with variability by using both sensitivity analysis and Monte Carlo simulation.

RESULTS:
As expected, the addition of heparin lowered the incidence of both DVT and pulmonary embolism, but at the cost of increasing ICH. Because the deleterious effects of ICH were so much greater than the benefits from heparinization, overall outcomes were best with mechanical prophylaxis alone. This was especially true for low-molecular-weight heparin, which is associated with a relatively high risk of ICH. Our own institutional data support the findings in the literature. Although the differences are modest, they reach statistical significance in the case of low-molecular-weight heparin.

CONCLUSION:
Using decision analytic modeling, we have shown that mechanical prophylaxis yields outcomes in craniotomy patients superior to those of either unfractionated or low-molecular-weight heparin.