Neurosurgery RSS : Gourt

Northern California - 1 Hour to the Bay Area :: California :: Fidelis Partners

NEUROLOGICAL SURGERY - NORTHERN CALIFORNIA ONE HOUR TO THE BAY AREA DIRECTORSHIP POTENTIAL * One-year Income based on training, experience and published data * Income range $415,000 to $719,000

Inquire for details :: Wisconsin :: Intelligent Placement Solutions, Inc

Office Hours/Call Schedule: Generally, patients are seen Monday through Friday in the clinic. Emergent cases come through the ER, staffed by full time emergency physicians. Call will be shared equally

Call for location :: Mississippi :: Medical Doctor Associates

Beautiful southern Mississippi community in need of surgical/clinic and 1:2 call coverage January 10 through February 19. Level II facility, craniotomy's are a plus. This is also a POTENTIAL PERMANENT

University City :: Kentucky :: Medical Search Consultants

Employed Position in Kentucky University CityThis is an excellent opportunity for a Neurosurgeon to join one other as a hospital-employed physician in this excellent 300+ bed medical center. This is

Great Location :: Pennsylvania :: Intelligent Placement Solutions, Inc

Neurosurgeon with spine experience. Exciting full-time opportunity for a neurosurgeon. This position involves general adult neurosurgery and neurosurgical trauma care. Must be comfortable with a broad

Great Location :: Missouri :: Onyx M.D.

A fellowship trained Pediatric Neurosurgeon is wanted at a facility in central Missouri. The current Pediatric Neurosurgeon will be leaving soon. This is a Level 1 trauma center that places a heavy

Great Location :: Maryland :: Onyx M.D.

A facility in Maryland is looking for a Board Certified/Board Eligible Neurosurgeon with interest in Spine. There is a lot of growth at this facility, and another surgeon is needed. The physician

Great Location :: Pennsylvania :: Onyx M.D.

A Neurosurgeon is needed for coverage of various weekends at a hospital in Pennsylvania. You will be joining an established Neurological practice of four physicians. The call is 1:4. This is a hospital

Mini Metro :: Michigan :: Stackpoole & Associates, LLC

Join three other board certified neurosurgeons in this designated neuroscience center of excellence! Heavy emphasis on spine surgery! Call 1:4! Collegial group! Great hospital and ancillary support!

SouthEast :: Alabama :: Intelligent Placement Solutions, Inc

Position:An Alabama Medical Center is seeking 2 neurosurgeons to join an employment model that includes:-Generous compensation base package with productivity bonus structure, employee benefits that include

Southern :: Michigan :: Medical Search International

BC/BE Neurosurgeon-Southern Michigan A hospital based group in Southern Michigan is seeking a BE/BC Neurosurgeon to join their successful practice. Emphasis on Spine Surgery is optional. Opportunity exists

Eastern :: Washington :: Medical Search International

We have a client in Eastern, WA that is recruiting a Neurosurgeon to join their growing surgery department. We would really like to have a candidate that has current spinal training and is comfortable

Western :: South Carolina :: Medical Search International

Solo practice with full support of the hospital. Competitive income guarantee and overhead expenses for first year. Great need in community. One hospital in area. The medical staff includes more than

Midwest :: Wisconsin :: Excel Recruiting Services

Neurosurgeon to join dynamic team of specialists including neurosurgeons, spine surgeons, neurologists, physiatrists, critical care specialists and radiologists. Very competitive salary plus production.

Albany :: New York :: New England Physician Recruitment Center

Neurosurgeon New York Albany region -650 bed tertiary care center , Academic Neurosurgeon with a subspecialty interest in either endovascular or spine. Responsibilities include patient care, education

Boston :: Massachusetts :: New England Physician Recruitment Center

. Neurosurgery: Boston area- group looking to add Neurosurgeon. Only one physician in practice currently, additional coverage provided by two other neurosurgeons Suburban Boston-minutes to

South :: Virginia :: Intelligent Placement Solutions, Inc

Opportunity for Incoming Neurosurgeon. Will establish & maintain their practice. 10 nights/month ER call (1:3 arrangement). Previous neurosurgeons case volumes averaged 25-30 per month with over 300 cases/year.

South :: South Carolina :: Intelligent Placement Solutions, Inc

Join a well-established and respected Neurosurgery practice. Call within the practice would be 1:4 and unassigned call would be 1:6. Practice is looking to place a BC/BE neurosurgeon with general neurosurgical

East :: Pennsylvania :: Intelligent Placement Solutions, Inc

A Pennsylvania hospital is seeking a B/C or B/E neurosurgeon to join another in a very productive practice. This is a hospital employed position. A very competitive comprehensive package is available.

West :: Georgia :: Intelligent Placement Solutions, Inc

Spine and Neurosurgery Center desires BC/BE NeuroSurgery partner. Outstanding reputation and skilled surgeons. Successful physician must have an interest in both Craniotomies and spinal surgery. Excellent

IMRIS Nabs NeuroArm for Stock - DOTmed.com (press release)

IMRIS Nabs NeuroArm for StockDOTmed.com (press release)An MR-compatible neurosurgery robot designed with space technology just got closer to the clinic. On Thursday, IMRIS announced ...

Yale researchers ID disease-treating proteins - Mass High Tech

PhysOrg.comYale researchers ID disease-treating proteinsMass High TechAnthony van den Pol, a professor of neurosurgery, and John Davis, a molecular biologist, have figured out how to use a mutation-prone virus engineered to ...Yale Scientists Shed Colorful Light On Novel ProteinsHealthNewsDigest.comall 6 news articles »

ONS gets accredited for MRI scanner - Greenwich Post

ONS gets accredited for MRI scannerGreenwich PostOrthopaedic and Neurosurgery Specialists PC (ONS) on Valley Drive has been awarded full accreditation for its MRI scanner as a result of a recent survey by ...

Dr. John F. Hickman became psychiatrist to heal people, build relationships - Dallas Morning News

Dr. John F. Hickman became psychiatrist to heal people, build relationshipsDallas Morning News"With neurosurgery, he could sometimes only give people months of life," Mrs. Hickman said. "He knew he could do more with psychiatry. ...and more »

Minimally invasive neurosurgery comes to Southern Surgical - Slidell Sentry News

Minimally invasive neurosurgery comes to Southern SurgicalSlidell Sentry NewsSouthern Surgical Hospital announced the addition of minimally invasive neurosurgery to its clinical services provided to the residents of Slidell and ...

The middle ground - Greater Baton Rouge Business Report

Greater Baton Rouge Business ReportThe middle groundGreater Baton Rouge Business Report... OLOL receives the most transfers among Louisiana hospitals for high-end treatments such as heart surgery, neurosurgery and other chronic conditions. ...

Neurosurgeon-Scientist Eric C. Holland, MD, PhD to Join Health Enhancement ... - CNNMoney.com (press release)

Neurosurgeon-Scientist Eric C. Holland, MD, PhD to Join Health Enhancement ...CNNMoney.com (press release)Dr. Holland joined MSKCC in 2001 from MD Anderson Cancer Center, and is now an Attending Physician in the Departments of Neurology and Neurosurgery, ...and more »

Honors and Other Things - UPENN Almanac

Honors and Other ThingsUPENN Almanac... department of neurosurgery, SOM—Characterization of genes on 1p and 19q loci of oligodendroglioma that modulate tumor angiogenesis and chemosensitivity.

NEUROSURGERY® Launches Neurosurgery Report - PR-USA.net (press release)

NEUROSURGERY® Launches Neurosurgery ReportPR-USA.net (press release)NEUROSURGERY®, the official journal of the Congress of Neurological Surgeons, is pleased to announce the unveiling of Neurosurgery Report ...

Histostem Participates in Successful Stem Cell Treatment for Acute Spinal Cord ... - CNNMoney.com (press release)

Histostem Participates in Successful Stem Cell Treatment for Acute Spinal Cord ...CNNMoney.com (press release)More details on the research process and results are available in the December 2009 issue of the Journal of Neurosurgery: Spine. ...and more »

Intraoperative Use of the Medtronic O-arm for Deep Brain Stimulation Procedures

Stereotact Funct Neurosurg 2010;88:109114 (DOI:10.1159/000280823)

Pallidotomy for Severe Tardive Jaw-Opening Dystonia

Stereotact Funct Neurosurg 2010;88:105108 (DOI:10.1159/000280822)

Asymptomatic Deep Venous Thrombosis after Deep Brain Stimulation for Parkinson Disease

Stereotact Funct Neurosurg 2010;88:9497 (DOI:10.1159/000280821)

ESSFN The Mission

Stereotact Funct Neurosurg 2010;88:66 (DOI:10.1159/000277367)

ASSFN Society News

Stereotact Funct Neurosurg 2010;88:65 (DOI:10.1159/000277366)

WSSFN Society News

Stereotact Funct Neurosurg 2010;88:64 (DOI:10.1159/000277365)

Complications and Side Effects of Deep Brain Stimulation in the Posterior Subthalamic Area

Stereotact Funct Neurosurg 2010;88:8893 (DOI:10.1159/000271824)

Clinical Accuracy of a Customized Stereotactic Platform for Deep Brain Stimulation after Accounting for Brain Shift

Stereotact Funct Neurosurg 2010;88:8187 (DOI:10.1159/000271823)

CT-Based, Fiducial-Free Frameless Stereotaxy for Difficult Ventriculoperitoneal Shunt Insertion: Experience in 26 Consecutive Patients

Stereotact Funct Neurosurg 2010;88:7580 (DOI:10.1159/000271822)

How to Assess Active Contact Coordinates in Deep Brain Stimulation Surgery? Comparison of Three Methods for Determining the Position of the Active Contact

Stereotact Funct Neurosurg 2010;88:6774 (DOI:10.1159/000271821)

Safety and Function of a New Clinical Intracerebral Microinjection Instrument for Stem Cells and Therapeutics Examined in the Göttingen Minipig

Stereotact Funct Neurosurg 2010;88:5663 (DOI:10.1159/000268743)

Pedunculopontine Nucleus Deep Brain Stimulation in a Patient with Primary Progressive Freezing Gait Disorder

Stereotact Funct Neurosurg 2010;88:5155 (DOI:10.1159/000268742)

Microsurgical and Stereotactic Radiofrequency Amygdalohippocampectomy for the Treatment of Mesial Temporal Lobe Epilepsy: Different Volume Reduction, Similar Clinical Seizure Control

Stereotact Funct Neurosurg 2010;88:4250 (DOI:10.1159/000268741)

Contents Vol. 87, 2009

Stereotact Funct Neurosurg 2009;87:IIV (DOI:10.1159/000264378)

Subject Index Vol. 87, 2009

Stereotact Funct Neurosurg 2009;87:405406 (DOI:10.1159/000264377)

Author Index Vol. 87, 2009

Stereotact Funct Neurosurg 2009;87:403404 (DOI:10.1159/000264376)

ESSFN The Mission

Stereotact Funct Neurosurg 2009;87:402 (DOI:10.1159/000264375)

ASSFN Society News

Stereotact Funct Neurosurg 2009;87:401 (DOI:10.1159/000264374)

WSSFN Society News

Stereotact Funct Neurosurg 2009;87:400 (DOI:10.1159/000264373)

Analysis of Factors Associated with Volumetric Data Errors in Gamma Knife Radiosurgery

Stereotact Funct Neurosurg 2009;87:17 (DOI:10.1159/000177622)

Implant design may influence delayed heterotopic ossification after total disk arthroplasty in lumbar spine.

Related Articles Implant design may influence delayed heterotopic ossification after total disk arthroplasty in lumbar spine. Surg Neurol. 2009 Dec;72(6):747-51; discussion 751 Authors: Kerr EJ, Jawahar A, Kay S, Cavanaugh DA, Nunley PD BACKGROUND: As total disk arthroplasty (TDA) gains increasing acceptance as an alternative to fusion for degenerative disk disease of the lumbar spine, new complications are encountered by the physicians during and after the procedure. We hereby report a complication after TDA in the lumbar spine that is in variance from previously proposed theories and suggests the possibility of implant design as one of the etiologic factors. The purpose of the present submission is to report a case of delayed heterotopic ossification (HO) after TDA that suggests that the keel-based design of the implant might have contributed to the etiology. CASE DESCRIPTION: The patient underwent TDA for L3-4 degenerative disk disease and had fusion surgery for L5-S1 disease about 6 months later. During follow-up, development of significant HO was noticed at the L3 and L4 level. Radiologic studies revealed the origin of HO to be the keel cut made in the body of L3 to accommodate the keel-based artificial disk. CONCLUSION: The exact etiology of HO after TDA is not clear. The presented anecdote points toward vertebral body trauma due to the design of the implant as a possible factor that needs to be studied more elaborately. PMID: 20082839 [PubMed - indexed for MEDLINE]

Addendum to "In this issue...".

Related Articles Addendum to "In this issue...". Surg Neurol. 2009 Dec;72(6):651 Authors: Ausman JI PMID: 20082838 [PubMed - indexed for MEDLINE]

Anterior interosseous syndrome vs flexor pollicis longus tendon rupture: electrodiagnosis or sonography?

Related Articles Anterior interosseous syndrome vs flexor pollicis longus tendon rupture: electrodiagnosis or sonography? Surg Neurol. 2009 Dec;72(6):647-8 Authors: Kara M, Malas FU, Kaymak B, Ozçakar L PMID: 20082837 [PubMed - indexed for MEDLINE]

Transcranial/transnasal approach for nonpituitary sellar lesions.

Related Articles Transcranial/transnasal approach for nonpituitary sellar lesions. Surg Neurol. 2009 Dec;72(6):643-4; author reply 644-7 Authors: Panigrahi M, Varaprasad G PMID: 20082835 [PubMed - indexed for MEDLINE]

What will you do with the rest of your life?

Related Articles What will you do with the rest of your life? Surg Neurol. 2009 Dec;72(6):642 Authors: Ausman JI PMID: 20082834 [PubMed - indexed for MEDLINE]

A rabbit model for efficacy evaluation of endovascular coil materials.

Related Articles A rabbit model for efficacy evaluation of endovascular coil materials. Surg Neurol. 2009 Dec;72(6):620-7; discussion 627 Authors: Ebara M, Yuki I, Murayama Y, Saguchi T, Nien YL, Vinters HV, Vinuela F, Abe T BACKGROUND: To investigate biomaterials seeking for their possible use for aneurysm treatment, in vivo screening tests using a number of potential materials are required. However, there is no established animal model that is suitable for such purpose. Some models require special preparation of tested materials for transcatheter delivery and others are inappropriate in view of their cost-effectiveness. The purpose of this study is to establish an animal model that overcomes these limitations and help us select potential materials before the preclinical evaluation. METHODS: Bilateral CCAs in a rabbit were surgically ligated, and a 2-cm segment of either a bare platinum coil or a polymeric coil (a platinum coil coated with PLGA 10/90) was implanted into each blind-ended arterial segment (n = 26). They were harvested at day 1, 7, 10, 14, or 30, respectively. Angiographic and histologic evaluations as well as quantitative analysis on the development of the organized thrombus were performed. RESULTS: One day after the implantation, both platinum and PLGA coils were surrounded by immature thrombus that was induced by blood flow stagnation in the arterial segment. At day 7, minimal thrombus organization was observed around both types of materials. At postimplantation days 10 and 14, fibrocellular responses, the early findings of the thrombus organization process, were observed in both material groups. Such histologic findings were more prominent in the PLGA coil group as compared to the platinum coil group (day 10, P = .051; day 14, P = .011). Well-organized thrombus was observed in both material groups at day 30 without showing statistical difference (P = .12). CONCLUSION: Given the cost-effectiveness, the simple material preparation process, and its feasible histologic evaluation methods, this new animal model can be useful in screening other potential biomaterials for the development of new coil devices. PMID: 20082832 [PubMed - indexed for MEDLINE]

Intracranial angioplasty with Gateway-Wingspan system for symptomatic atherosclerotic stenosis: preliminary results of 27 Chinese patients.

Related Articles Intracranial angioplasty with Gateway-Wingspan system for symptomatic atherosclerotic stenosis: preliminary results of 27 Chinese patients. Surg Neurol. 2009 Dec;72(6):607-11; discussion 611 Authors: Zhao ZW, Deng JP, He SM, Qin HZ, Gao L, Gao GD BACKGROUND: We investigated the safety of treatment of symptomatic intracranial atherosclerotic stenoses with the Gateway-Wingspan system and its initial effect on prevention of ischemic events. METHODS: Twenty-seven cases of symptomatic intracranial atherosclerotic stenoses were treated with angioplasty with a Wingspan stent. Location of stenoses, extent of stenoses before and after angioplasty, success rate of treatment, occurrence of procedural complications, and changes in recurrence of symptoms of ischemic events 30 days after treatment were recorded. RESULTS: Twenty-nine angioplasties with the Wingspan system were successfully carried out in 29 stenoses in 27 patients. Of 29 stenoses, 17 were in the posterior circulation, and 12, in the anterior circulation. The degree of stenoses was reduced from baseline 71.8% (56%-87.8%) to 24.9% (0%-45%) after stenting. Complications were seen in four patients (14.8%), 3 of which were lesion-related infarction of a perforated artery, and 1 was a non-lesion-related infarction. Two complications led to transient neurologic dysfunction, one led to defect of the visual field, and one led to hemiplegia. The prevalence of morbidity and serious morbidity were 7.4% and 3.7%, respectively, and no death occurred. No new ischemic events happened during 30 days after stenting. CONCLUSION: Angioplasty with the Wingspan system to treat symptomatic intracranial atherosclerotic stenoses appears to be safe. Its initial effect on prevention of ischemic events is acceptable. PMID: 20082830 [PubMed - indexed for MEDLINE]

Comparison of postoperative cognitive function in patients undergoing surgery for ruptured and unruptured intracranial aneurysm.

Related Articles Comparison of postoperative cognitive function in patients undergoing surgery for ruptured and unruptured intracranial aneurysm. Surg Neurol. 2009 Dec;72(6):592-5; discussion 595 Authors: Otawara Y, Ogasawara K, Kubo Y, Kashimura H, Ogawa A, Yamadate K BACKGROUND: Patients with SAH often experience cognitive decline. Previous studies used normal volunteers, published normal test values, and orthopedic patients as controls to identify factors for postoperative cognitive decline. The present study excluded the effects of surgery by comparing cognitive function after surgical repair in patients with aneurysmal SAH and patients with unruptured intracranial aneurysm. METHODS: This study recruited 117 patients with SAH due to ruptured aneurysm and 39 patients with incidentally found unruptured intracranial aneurysms. The cognitive test battery consisted of the Japanese translation of the WAIS-R, the Japanese translation of the WMS, and the recall trial of the ROCF. Postoperative neuropsychological test scores for the patients with SAH and control subjects were compared using group-rate and event-rate analysis. The relationship between clinical variable and postoperative cognitive decline in the patients with SAH was evaluated by univariate analysis using the Mann-Whitney U test or chi(2) test. RESULTS: Group-rate analysis showed that the WAIS-R and ROCF scores were significantly lower in the SAH group than in the control group. Event-rate analysis demonstrated that the incidence of cognitive decline in the patients with SAH (73 [62.4%] of the 117 patients) was significantly higher than that in the control subjects (12 [30.8%] of 39 patients). The Hunt and Hess grade was significantly higher in patients with postoperative cognitive decline. CONCLUSION: The cognitive function after SAH was significantly correlated with Hunt and Hess grade on admission when using patients with postoperative unruptured intracranial aneurysm as the control group. PMID: 20082828 [PubMed - indexed for MEDLINE]

Neuromodulation of the superior hypogastric plexus: a new option to treat bladder atonia secondary to radical pelvic surgery?

Related Articles Neuromodulation of the superior hypogastric plexus: a new option to treat bladder atonia secondary to radical pelvic surgery? Surg Neurol. 2009 Dec;72(6):573-6 Authors: Possover M, Chiantera V BACKGROUND: The aim of this study is to report on the impact of neuromodulation to the superior hypogastric plexus in patients with bladder atonia secondary to pelvic surgery. METHODS: In 4 consecutive patients with bladder atonia secondary to pelvic surgery, we performed a laparoscopic implantation of a neurostimulator--LION procedure--to the entire superior hypogastric plexus. RESULTS: Of the 4 reported patients, 3 are able to partially void or empty their bladder. CONCLUSIONS: If the presented results could be obtained in further patients and maintained in long-term follow-up, the LION procedure to the superior hypogastric plexus could change the management of bladder function in patients with bladder atonia. PMID: 20082827 [PubMed - indexed for MEDLINE]

Fuzzy Logic in neurosurgery: predicting poor outcomes after lumbar disk surgery in 501 consecutive patients.

Related Articles Fuzzy Logic in neurosurgery: predicting poor outcomes after lumbar disk surgery in 501 consecutive patients. Surg Neurol. 2009 Dec;72(6):565-72; discussion 572 Authors: Shamim MS, Enam SA, Qidwai U BACKGROUND: Despite a lot of research into patient selection, a significant number of patients fail to benefit from surgery for symptomatic lumbar disk herniation. We have used Fuzzy Logic-based fuzzy inference system (FIS) for identifying patients unlikely to improve after disk surgery and explored FIS as a tool for surgical outcome prediction. METHODS: Data of 501 patients were retrospectively reviewed for 54 independent variables. Sixteen variables were short-listed based on heuristics and were further classified into memberships with degrees of membership within each. A set of 11 rules was formed, and the rule base used individual membership degrees and their values mapped from the membership functions to perform Boolean Logical inference for a particular set of inputs. For each rule, a decision bar was generated that, when combined with the other rules in a similar way, constituted a decision surface. The FIS decisions were then based on calculating the centroid for the resulting decision surfaces and thresholding of actual centroid values. The results of FIS were then compared with eventual postoperative patient outcomes based on clinical follow-ups at 6 months to evaluate FIS as a predictor of poor outcome. RESULTS: Fuzzy inference system has a sensitivity of 88% and specificity of 86% in the prediction of patients most likely to have poor outcome after lumbosacral miscrodiskectomy. The test thus has a positive predictive value of 0.36 and a negative predictive value of 0.98. CONCLUSION: Fuzzy inference system is a sensitive method of predicting patients who will fail to improve with surgical intervention. PMID: 20082825 [PubMed - indexed for MEDLINE]

Technology or judgment?

Related Articles Technology or judgment? Surg Neurol. 2009 Dec;72(6):564 Authors: Ausman JI PMID: 20082824 [PubMed - indexed for MEDLINE]

Power: how to get it and how to use it for the future.

Related Articles Power: how to get it and how to use it for the future. Surg Neurol. 2009 Dec;72(6):563 Authors: Ausman JI PMID: 20082823 [PubMed - indexed for MEDLINE]

A note of gratitude to the readers of Surgical Neurology.

Related Articles A note of gratitude to the readers of Surgical Neurology. Surg Neurol. 2009 Dec;72(6):561-2 Authors: Ausman JI PMID: 20082822 [PubMed - indexed for MEDLINE]

Fuzzy Logic.

Related Articles Fuzzy Logic. Surg Neurol. 2009 Dec;72(6):557-8 Authors: Ausman JI PMID: 20082819 [PubMed - indexed for MEDLINE]

Clinical evaluation and follow-up outcome of presurgical plan by Dextroscope: a prospective controlled study in patients with skull base tumors.

Related Articles Clinical evaluation and follow-up outcome of presurgical plan by Dextroscope: a prospective controlled study in patients with skull base tumors. Surg Neurol. 2009 Dec;72(6):682-9; discussion 689 Authors: Yang de L, Xu QW, Che XM, Wu JS, Sun B BACKGROUND: Patient-specific approach design, comprehensive evaluation on perioperative data, and follow-up of postoperative life quality (KPS) were carried out to evaluate the application of VR technology of Dextroscope in procedures of patients with skull base tumors. METHODS: Eighty-four patients with skull base tumors involved in this research were randomized into 2 groups (test group and control group), each with 42 patients. Before operation, image data such as MR, MRA, or CTA of head were collected and imported into the Dextroscope workstation. The detailed preoperative plans were made in the test group, but no Dextroscope plans in control group. The resection rate of tumors, preoperative evaluation including the duration of operation, total blood loss, the postoperative LOS, the number of cases with cerebrovascular injury complications in operation, and postoperative KPS of patients on discharge and the sixth month follow-up in the 2 groups were recorded and compared. RESULTS: The total resection rate of tumors was 83.33% in test group and 71.42% in the control group (P > .05). The total resection rate of meningioma was 86.67% in test group and 76.47% in control group. The total resection rates of trigeminal Schwannoma in the 2 groups were all 100% (P > .05). The duration of operation and the postoperative LOS of each patient were 5.25 +/- 0.64 hours and 8.50 +/- 1.10 days in the test group and 7.36 +/- 0.87 hours and 12.50 +/- 1.52 days in the control group, respectively (P < .05). Total blood loss of each patient was 456.75 +/- 55.76 mL in the test group and 523.85 +/- 66.78 mL in the control group (P > 05). There were 3 cases with complications of cerebral vessels injury in the test group and 7 cases in the control group (P < .05). During follow-up, KPS of patients in the test group on discharge (85.75 +/- 9.68) was significantly superior to that in the control group (81.66 +/- 9.24; P < .05). The KPS of patients on the sixth-month follow-up in the test group was 92.35 +/- 9.95, which was significantly superior to that in the control group (85.6 +/- 9.34; P < .05). Karnofsky performance scores of patients in the test group improved significantly from discharge to the sixth month after procedure (P < .05), whereas there were adverse results in the test group (P < .05). The 2 cases with CSF leakage were cured completely. CONCLUSION: The preoperative plans with VR technology in patients with skull base tumor or CSF leakage operations can help certain the diagnosis, individually locate the position of skull base lesions, and design patient-specific approach, which also facilitate to shorten operation duration and the postoperative LOS, reduce total blood loss and injury of vessels in operation, and improve the postoperative KPS. PMID: 19850330 [PubMed - indexed for MEDLINE]

Surgical technique for a cystic-type metastatic brain tumor: transformation to a solid-type tumor using hydrofiber dressing.

Related Articles Surgical technique for a cystic-type metastatic brain tumor: transformation to a solid-type tumor using hydrofiber dressing. Surg Neurol. 2009 Dec;72(6):703-6; discussion 706 Authors: Okuda T, Teramoto Y, Yugami H, Kataoka K, Kato A BACKGROUND: Many metastatic brain tumors have a distinct border with normal brain tissue, which facilitates tumor removal. However, residual tumor tissue may be present after surgery when metastatic brain tumors are of cystic type. We have developed a method using hydrofiber dressing to transform cystic-type into solid-type tumors. METHODS: Hydrofiber dressing is a sodium carboxymethylcellulose hydrocolloid polymer with high fluid-absorptive capacity. This material was originally used as a dressing for exudative wounds. Hydrofiber dressing was used for 8 patients with cystic-type metastatic brain tumor. Tumor removal was performed after hydrofiber dressing was inserted into the cyst cavity to transform the tumor into a solid-type tumor. RESULTS: Transformation of cystic-type metastatic brain tumors into smaller solid-type tumors using hydrofiber dressing facilitated en bloc resection of tumor. The dressing also absorbed residual cyst fluid and was thus also effective in preventing intraoperative dissemination of tumor cells. This approach enabled ideal en bloc resection in all patients. There were no adverse events. CONCLUSIONS: These findings suggest hydrofiber dressing may be useful in surgery for cystic-type metastatic brain tumors. PMID: 19836065 [PubMed - indexed for MEDLINE]

Extracranial-intracranial bypass surgery at high magnification using a new high-resolution operating microscope: technical note.

Related Articles Extracranial-intracranial bypass surgery at high magnification using a new high-resolution operating microscope: technical note. Surg Neurol. 2009 Dec;72(6):690-4 Authors: Matsumura N, Shibata T, Umemura K, Nagao S, Horie Y BACKGROUND: We report a precise technique for EC-IC bypass surgery using a stereoscopic high-resolution microscope at magnifications of 40x and 50x. METHODS: A stereoscopic operating microscope (Mitaka MM50 Surgical Microscope; Mitaka Kohoki Co, Tokyo, Japan) was used in STA-MCA anastomosis. This microscope has 2 optical systems, a standard zooming system, a newly developed high-magnification system, and 4 fixed working distances of 200, 250, 300 and 350 mm, with highest magnifications of 50.4x at 200 mm and 40.3x at 250 mm. High resolution is achieved by a new lens design in the optical system, which makes the image of the object very clear at high magnification. The magnification can be changed depending on the circumstances in a given procedure. The STA-MCA anastomoses were performed using this microscope. RESULTS: Very small vessels were observable, and arterial anastomosis could be performed precisely at high magnification. All anastomoses were patent on postoperative angiograms. CONCLUSIONS: Use of the new microscope allows visualization and manipulation of small vessels at high magnification and high resolution and may be very useful in EC-IC bypass surgery. PMID: 19828184 [PubMed - indexed for MEDLINE]

Successful treatment of intraorbital lymphangioma with tissue fibrin glue.

Related Articles Successful treatment of intraorbital lymphangioma with tissue fibrin glue. Surg Neurol. 2009 Dec;72(6):722-4; discussion 724 Authors: Hayasaki A, Nakamura H, Hamasaki T, Makino K, Yano S, Morioka M, Kuratsu J BACKGROUND: Although surgical resection is the first treatment choice in patients with cystic lymphangioma, the complete resection of orbital lymphangioma is often difficult. After partial resection of the cyst wall, some cystic lymphangiomas recur. The injection of tissue fibrin glue may prevent the recurrence of orbital lymphangioma. CASE DESCRIPTION: We present a 2-year-old girl with left progressive exophthalmos. Magnetic resonance imaging revealed a cystic mass lesion behind the left eyeball. At the first operation, the cyst wall was partially resected, and all cyst fluid was totally removed by suction. One week after the first operation, the cyst showed regrowth. At a second procedure, we injected tissue fibrin glue into the cyst. The cyst was completely sealed, and there was no recurrence. CONCLUSION: Tissue fibrin glue is adhesive and hemostatic and highly useful in the treatment of orbital cystic lymphangioma. PMID: 19828182 [PubMed - indexed for MEDLINE]

The combined approach to intracranial aneurysm treatment.

Related Articles The combined approach to intracranial aneurysm treatment. Surg Neurol. 2009 Dec;72(6):596-606; discussion 606 Authors: Alexander BL, Riina HA BACKGROUND: A consecutive series of patients with intracranial aneurysms in the practice of one neurovascular surgeon was retrospectively reviewed to illustrate that one physician can become proficient in microneurosurgery as well as endovascular surgery and achieve favorable outcomes in both disciplines. This supports one model of training for cerebrovascular surgeons that includes the complimentary practice of open microneurovascular surgery with endovascular surgery. METHODS: The senior author (HAR) treated 351 patients with 413 aneurysms between July 2001 and March 2007. Of these, 172 patients (216 aneurysms) were treated with open microneurosurgical techniques and 179 patients (197 aneurysms) were treated using endovascular techniques. RESULTS: Complete obliteration was attained in 94.3% of clipped aneurysms, and 61.9% and 65.9% of coiled aneurysms immediately and after at least 6 months of follow-up, respectively. At latest evaluation, 93% of endovascular patients and 90% of microneurosurgical patients had good clinical outcomes (GOS, 4 or 5; mean follow-up, 23 months; combines ruptured and unruptured cohorts). Procedure-related mortality included 1 surgical patient and 2 endovascular patients. CONCLUSIONS: Because the fields of microvascular and endovascular surgeries are both technically complex, there has been concern that hybrid cerebrovascular surgeons cannot perform each technique with the skill necessary to achieve good outcomes. When compared to clipping and coiling reviews in the neurosurgical literature, we illustrate that one hybrid neurovascular surgeon is capable of attaining great facility in both techniques and that this type of physician will represent one practice model of cerebrovascular specialist in the future. This has potential implications for the training of hybrid cerebrovascular surgeons. PMID: 19818994 [PubMed - indexed for MEDLINE]

Do we need a neurosurgical Interpol?

Related Articles Do we need a neurosurgical Interpol? Surg Neurol. 2009 Dec;72(6):628-9 Authors: Sbeih I PMID: 19818479 [PubMed - indexed for MEDLINE]

Intramedullary spinal cysticercosis cured with medical therapy: case report and review of literature.

Related Articles Intramedullary spinal cysticercosis cured with medical therapy: case report and review of literature. Surg Neurol. 2009 Dec;72(6):765-8; discussion 768-9 Authors: Chhiber SS, Singh B, Bansal P, Pandita KK, Razdan S, Singh J BACKGROUND: Spinal intramedullary cysticercosis is a very uncommon manifestation of NCC, which is caused by the larvae of Taenia solium. CASE DESCRIPTION: We report a case of spinal intramedullary cysticercosis who presented subacutely. Magnetic resonance imaging dorsal spine and CSF ELISA clinched the diagnosis. Eight weeks of medical therapy resulted in complete clinicoradiological cure. CONCLUSION: Surgery used to be the mainstay treatment for spinal intramedullary cysticercosis; however, early diagnosis and medical therapy with albendazole and dexamethasone can obviate the need for surgery in many patients. PMID: 19818478 [PubMed - indexed for MEDLINE]

Freehand C1 lateral mass screw fixation technique: our experience.

Related Articles Freehand C1 lateral mass screw fixation technique: our experience. Surg Neurol. 2009 Dec;72(6):676-81 Authors: Simsek S, Yigitkanli K, Seckin H, Akyol C, Belen D, Bavbek M BACKGROUND: Although C1 lateral mass fixation technique is frequently performed in upper cervical instabilities, it requires the guidance of fluoroscopic imaging. The fluoroscopy guidance is time-consuming and has the risks of accumulative radiation. Biplane fluoroscopy is also difficult in upper cervical pathologic conditions because of the use of cranial fixations. This study aimed to demonstrate that unicortical C1 lateral mass screws could be placed safely and rapidly without fluoroscopy guidance. METHODS: Between 2002 and 2008, 32 C1 lateral mass screws were inserted in 17 consecutive patients with various pathologic conditions involving either atlantoaxial or occipitocervical instability. RESULTS: C1 screw lengths ranged from 18 to 32 mm. The atlantoaxial fixation was performed in 13 patients, and C1 lateral mass screws were added to the occipitocervical construct in 3 patients, to the posterior cervical construct in 2 patients, and to the cervicothoracic construct in 1 patient. In 2 patients, because C1 lateral mass screws could not be inserted unilaterally, C1 pedicle screw analogs were inserted. There were no screw malpositions or neurovascular complications related to screw insertion. Operation time and intraoperative bleeding of the isolated atlantoaxial fixations were retrospectively evaluated. The mean follow-up was 32.3 months (range, 7-59 months). No screw loosening or construct failure was observed within this period. Postoperatively, 4 patients complained of hypoesthesia, whereas one patient had superficial wound infection. CONCLUSION: C1 lateral mass screws may be used safely and rapidly in upper cervical instabilities without intraoperative fluoroscopy guidance and the use of the spinal navigation systems. Preoperative planning and determining the ideal screw insertion point, the ideal trajections, and the lengths of the screws are the most important points. PMID: 19818472 [PubMed - indexed for MEDLINE]

Cervical osteomyelitis and epidural abscess treated with a pectoralis major muscle flap.

Related Articles Cervical osteomyelitis and epidural abscess treated with a pectoralis major muscle flap. Surg Neurol. 2009 Dec;72(6):761-4; discussion 764 Authors: Fujioka M, Oka K, Kitamura R, Yakabe A BACKGROUND: Spinal osteomyelitis and epidural abscess are uncommon but have a potentially disastrous outcome, although the surgical techniques and antimicrobial therapy have advanced. CASE DESCRIPTION: We present a case of cervical osteomyelitis and epidural abscess resulting from pharyngeal squamous cell carcinoma ablation, which were treated with a pectoralis major muscle flap successfully. CONCLUSION: Muscle flap insertion to the cervical contaminated wound enables radical removal of the contaminated tissue, and the muscle flaps for dead-space obliteration and neovasculation were obligatory for successful management of the infected complex wound. Furthermore, the inserted pectoralis major muscle flap can divide vertebrae and epidural canal from these origins of infection. We believe that this technique is simple, can be performed in a one-stage management, has minimal associated morbidity, and thus, is advocated as a desirable treatment option in the treatment of cervical osteomyelitis and epidural abscess. PMID: 19665205 [PubMed - indexed for MEDLINE]

Attempting homicide by inserting sewing needle into the brain Report of 6 cases and review of literature.

Related Articles Attempting homicide by inserting sewing needle into the brain Report of 6 cases and review of literature. Surg Neurol. 2009 Dec;72(6):635-41; discussion 641 Authors: Amirjamshidi A, Ghasvini AR, Alimohammadi M, Abbassioun K BACKGROUND AND OBJECTIVES: Child abuse with sewing needle is a rare but well-known homicide attempt threatening the life of victims. Information about diagnosis and treatment of such cases either in the acute or chronic phases is lacking and ambiguous in the literature. This study intends to report the experience of 6 victims of homicide attempt who presented to the authors in different decades of life and were managed in different ways. This may deliver some evidences to the literature regarding management of further cases encountered by neurosurgeons. MATERIAL AND METHODS: The authors had the chance of managing 6 patients referred to their trauma center harboring one or more sewing needles within their cranium. There were 3 male and 3 female patients, with 2 patients in their first decade of life, and the others, each in either decade of life. The youngest was 6, and the eldest 51 year old. The elder patients were having vague headaches, for which a plain skull x-ray or CT of the brain lead to the diagnosis of persisting intracranial foreign bodies. Chronic headache was the main complaint of the patients. Four patients underwent surgical removal of the sewing needle, and 2 are being followed. RESULTS: Among the 4 patients who underwent surgery, 1 died after a short period of 'akinetic mutism.' Headache and limb paresthesia improved 6 months after the operation in 2 cases, and the other 1 remained unchanged. The cases under observation have been doing well. Biochemical analysis of the rusted needle showed a composite of oxidant form of some of the elements of needle such as Fe, Mn, and Cr. CONCLUSION: In spite of standard algorithms proposed for management of penetrating head wounds, selection of the best treatment in the victims harboring sewing needles in their brain needs close cooperation between neurosurgeons, pediatricians, psychiatrists, and social workers. Furthermore, there is no absolute indication for removing sewing intracranial needles detected in the later decades of life. PMID: 19665203 [PubMed - indexed for MEDLINE]

En bloc sacrectomy and reconstruction: technique modification for pelvic fixation.

Related Articles En bloc sacrectomy and reconstruction: technique modification for pelvic fixation. Surg Neurol. 2009 Dec;72(6):752-6; discussion 756 Authors: Newman CB, Keshavarzi S, Aryan HE BACKGROUND: When the management of sacral tumors requires partial or complete sacrectomy, the spinopelvic apparatus must be reconstructed. This is a challenging and infrequently performed operation, and as such, many spine surgeons are unfamiliar with techniques available to carry out these procedures. CASE DESCRIPTION: A 34-year-old man presented with severe low back pain, mild left ankle dorsiflexion weakness, and left S1 paresthesias. Imaging revealed a large sacral mass extending into the L5/S1 and S1/S2 neural foramina as well as the presacral visceral and vascular structures. Needle biopsy of this mass demonstrated a low-grade chondrosarcoma. A 2-stage anterior/posterior en bloc sacrectomy with a novel modification of the Galveston L-rod pelvic ring reconstruction was carried out. Our modification takes advantage of new materials and implant technology to offer another alternative in reconstruction of the spinopelvic junction. CONCLUSION: Understanding the anatomy and biomechanics of the spinopelvic apparatus and the lumbosacral junction, as well as having a familiarity with the various techniques available for carrying out sacrectomy and pelvic ring reconstruction, will enable the spine surgeon to effectively manage sacral tumors. PMID: 19665193 [PubMed - indexed for MEDLINE]

Wound-peritoneal shunts: part of the complex management of anterior dural lacerations in patients with ossification of the posterior longitudinal ligament.

Related Articles Wound-peritoneal shunts: part of the complex management of anterior dural lacerations in patients with ossification of the posterior longitudinal ligament. Surg Neurol. 2009 Dec;72(6):630-4; discussion 634 Authors: Epstein NE BACKGROUND: The complex management of dural lacerations occurring after the resection of multilevel ossification of the posterior longitudinal ligament (OPLL) requires further clarification. METHODS: Both preoperative MR and CT studies documented multilevel ventral cord compression attributed to OPLL with kyphosis in 82 patients requiring multilevel anterior corpectomy/fusion (ACF) (average, 2.6 levels) followed by posterior fusion (PF) (average, 6.6 levels) under the same anesthetic. The 5 patients who developed intraoperative dural lacerations/penetration demonstrated the single-layer sign (2 patients: large central mass) or the double-layer sign (3 patients: hyperdense/hypodense/hyperdense layers) on preoperative 2-dimensional CT studies. All 5 patients were managed with complex dural repair (sheep pericardial grafts, fibrin sealant, microfibrillar collagen) and had shunts placed (wound-peritoneal and lumboperitoneal). RESULTS: After complex dural repair/shunting, all 5 intraoperative dural lacerations (DLs) resolved. The application of low-pressure wound-peritoneal shunts was unique to this study (Uni-Shunts, Codman, Johnson and Johnson, Dorchester, Mass). The proximal end is placed lateral/parallel to the fibula strut graft/plate complex, whereas the distal catheter is tunneled into the peritoneum in the right upper quadrant (always prepared and draped in anticipation of the need for a shunt). CONCLUSIONS: Of 82 patients undergoing multilevel anterior corpectomy for OPLL/kyphosis, 5 developed intraoperative DLs successfully managed with a complex dural repair, wound-peritoneal, and lumboperitoneal shunting procedures. PMID: 19665178 [PubMed - indexed for MEDLINE]

Human cadaver brain infusion model for neurosurgical training.

Related Articles Human cadaver brain infusion model for neurosurgical training. Surg Neurol. 2009 Dec;72(6):700-2 Authors: Olabe J, Olabe J, Sancho V BACKGROUND: Microneurosurgical technique and anatomical knowledge require extensive laboratory training before mastering these skills. There are diverse training models based on synthetic materials, anesthetized animals, cadaver animals, or human cadaver. Human cadaver models are especially beneficial because they are the closest to live surgery with the greatest disadvantage of lacking hemodynamic factors. We developed the "brain infusion model" to provide a simple but realistic training method minimizing animal use or needs for special facilities. METHODS: Four human cadaveric brains donated for educational purposes were explanted at autopsy. Carotids and vertebral arteries were cannulated with plastic tubes and fixed with suture. Water was flushed through the tubings until the whole arterial vasculature was observed as clean. The cannulated specimens were fixed with formaldehyde. Tap water infusion at a flow rate of 10 L/h was infused through the arterial tubings controlled with a drip regulator filling the arterial tree and leaking into the interstitial and cisternal space. RESULTS: Multiple microneurosurgical procedures were performed by 4 trainees. Cisternal and vascular dissection was executed in a very realistic fashion. Bypass anastomosis was created as well as aneurysm simulation with venous pouches. Vessel and aneurysm clipping and rupture situations were emulated and solution techniques were trained. CONCLUSION: Standard microsurgical laboratories regularly have scarce opportunities for working with decapitated human cadaver heads but could have human brains readily available. The human brain infusion model presents a realistic microneurosurgical training method. It is inexpensive and easy to set up. Such simplicity provides the adequate environment for developing microsurgical techniques. PMID: 19664809 [PubMed - indexed for MEDLINE]

Dermoid tumor with diastematobulbia.

Related Articles Dermoid tumor with diastematobulbia. Surg Neurol. 2009 Dec;72(6):717-21; discussion 721 Authors: Prabhu K, Daniel RT, Mani S, Chacko AG BACKGROUND: Dermoid tumors are rare congenital lesions and account for 0.2% to 1.8% of all intracranial tumors. Dermoid tumor with diastematobulbia is very rare. CASE DESCRIPTION: We report a dermoid tumor in an adult female with an unusual location and morphology. The lesion had 2 major components with different material within the cysts. The posterior part of the dermoid had presented on the floor of the fourth ventricle and had split the pons into 2 distinct halves. The anterior part of the lesion was situated in the prepontine cistern and encircling the anterior half of the brainstem. The lesion was radically excised, and the postoperative images showed return of the 2 halves of the pons to appose each other in the midline. CONCLUSION: This case report demonstrates the anatomical peculiarities of this extremely unusual presentation of a dermoid cyst with diastematobulbia. Total excision of the lesion through a dorsal approach resulted in a good outcome. PMID: 19608253 [PubMed - indexed for MEDLINE]

Removal of cavernous malformation of the Meckel's cave by extradural pterional approach using Heros muscle dissection technique.

Related Articles Removal of cavernous malformation of the Meckel's cave by extradural pterional approach using Heros muscle dissection technique. Surg Neurol. 2009 Dec;72(6):733-6; discussion 736 Authors: Seçkin H, Patel N, Avci E, Dempsey RJ, Başkaya MK BACKGROUND: We report on a patient with trigeminal neuralgia caused by an extraaxial cavernous malformation (CM) located within Meckel's cave. The lesion was removed via a pterional extradural approach with a modified temporalis muscle dissection technique, which was first described by Heros and Lee. Cadaveric dissections were performed to demonstrate the wider exposure gained by this approach. METHODS: A 56-year-old man presented with a history of episodic shocklike, right-sided facial pain for 10 years. Neurologic examination revealed diminished sensation in the mandibular division of the right trigeminal nerve. Magnetic resonance imaging showed an ipsilateral enhancing lesion in Meckel's cave. RESULTS: After placement of a lumbar drain, a right extradural pterional approach was undertaken. By reflecting the temporalis muscle posterolaterally, the craniotomy was extended so that the line of sight was level with the floor of the middle fossa. This allowed access to the lesion without needing to remove the zygoma. The lesion was resected with microsurgical technique. The patient's pain improved significantly after resection, and histopathologic examination confirmed the diagnosis of CM. CONCLUSIONS: Extraaxial middle fossa CMs arising solely from Meckel's cave are rare. These lesions are safely and simply approached by posteriorly deflecting the temporalis muscle during a pterional craniotomy, avoiding excessive elevation of the anterior temporal lobe or further bony removal. PMID: 19608252 [PubMed - indexed for MEDLINE]

Preparing the ethical future of deep brain stimulation.

Related Articles Preparing the ethical future of deep brain stimulation. Surg Neurol. 2009 Dec;72(6):577-86; discussion 586 Authors: Bell E, Mathieu G, Racine E BACKGROUND: Deep brain stimulation is an approved and effective neurosurgical intervention for motor disorders such as PD and ET. Deep brain stimulation may also be effective in treating a number of psychiatric disorders, including treatment refractory depression and OCD. Although DBS is a widely accepted therapy in motor disorders, it remains an invasive and expensive procedure. The ethical and social challenges of DBS need further examination, and discussion and emerging applications of DBS in psychiatry may also complicate the ethical landscape of DBS. METHODS: To identify and characterize current and emerging issues in the use of DBS, we reviewed the neurosurgical literature on DBS as well as the interdisciplinary medical ethics and relevant psychological and sociological literatures. We also consulted the USPTO database, FDA regulations and report decisions, and the business reports of key DBS manufacturers. RESULTS: Important ethical and social challenges exist in the current and extending practice of DBS, notably in patient selection, informed consent, resource allocation, and in public understanding. These challenges are likely to be amplified if emerging uses of DBS in psychiatry are approved. CONCLUSIONS: Our review of ethical and social issues related to DBS highlights that several significant challenges, although not insurmountable, need much closer attention. A combination of approaches previously used in neuroethics, such as expert consensus workshops to establish ethical guidelines and public engagement to improve public understanding, may be fruitful to explore. PMID: 19608246 [PubMed - indexed for MEDLINE]

Psychiatric symptom changes after corticoamygdalohippocampectomy in patients with medial temporal lobe epilepsy through Symptom Checklist 90 Revised.

Related Articles Psychiatric symptom changes after corticoamygdalohippocampectomy in patients with medial temporal lobe epilepsy through Symptom Checklist 90 Revised. Surg Neurol. 2009 Dec;72(6):587-91; discussion 591 Authors: Guangming Z, Wenjing Z, Guoqiang C, Yan Z, Fuquan Z, Huancong Z BACKGROUND: Corticoamygdalohippocampectomy (anterior temporal lobe resection plus amygdalohippocampectomy) is common in epilepsy surgery. Pre- and postoperative psychiatric disorders occurred sometimes in patients with refractory medial TLE. We want to know if CAH has an affirmative effect on the psychiatric symptom of patients with medial TLE through a quantitative method. METHODS: Sixty-two patients with medial TLE who had CAH accomplished SCL-90-R questionnaires thrice (presurgical and postsurgical 1 and 2 years). Average GSI scores in SCL-90-R were calculated and statistically analyzed. RESULTS: There was no statistical difference in the presurgical average GSI scores between Engel I and Engel II to IV subgroup. Postoperative 1 and 2 years' average GSI scores of Engel II to IV subgroup were both statistically higher than those of Engel I subgroup. There were no statistical differences between other subgroups in different time. Postsurgical 1 and 2 years' average GSI scores of the whole group and Engel I subgroup were statistically lower than those of presurgery. Postoperative 2 years' average GSI scores of the whole group and Engel I subgroup were statistically lower than those of postsurgical 1 year. For Engel II to IV subgroup, there were no statistical differences among the average GSI scores in different time. CONCLUSION: Corticoamygdalohippocampectomy could improve the psychiatric symptoms of patients with TLE as assessed by the SCL-90-R. This improvement was related to the therapeutic effect and was not related to sex, lateralization, and MRI abnormality. PMID: 19608243 [PubMed - indexed for MEDLINE]

Posterior fossa intracranial inflammatory pseudotumor: a case report and literature review.

Related Articles Posterior fossa intracranial inflammatory pseudotumor: a case report and literature review. Surg Neurol. 2009 Dec;72(6):712-6; discussion 716 Authors: Lin YJ, Yang TM, Lin JW, Song MZ, Lee TC BACKGROUND: Intracranial inflammatory pseudotumors are rare. This study describes an intracranial inflammatory pseudotumor at the left cerebellopontine angle. It is the second documented posterior fossa intracranial inflammatory pseudotumor, and it was treated by surgery and radiotherapy. CASE DESCRIPTION: A 49-year-old man presented with dizziness for 3 months and mild hoarseness for 1 month. Brain CT detected an intracranial tumor at the left cerebellopontine angle. Magnetic resonance imaging revealed a 3.6-cm heterogeneously enhancing mass. Suboccipital craniectomy with ventriculostomy was performed. The mass was well defined with a smooth surface, enclosed the low cranial nerves, and adhered to the dura matter. Pathologic examination revealed fibrous collagenous stroma with dense infiltrates of small lymphocytes and uninucleated histiocytes. Immunopositivity for T-200 and CD-68 was noted. Special staining for mycobacteria and fungus was negative. Serologic tests were positive for EBEA-Ab, EBNA-Ab, and EB-VCA-IgG. An inflammatory pseudotumor was diagnosed. Local recurrence was found 6 months later with a left oculomotor nerve palsy. Whole-brain irradiation with a total dose of 1200 cGy in 6 fractionations was done. Remission was found in follow-up neuroimages, and no recurrence was noted in 2 years' follow-up. CONCLUSION: Based on serologic findings and a literature review, the pathogenetic mechanism of this rare intracranial tumor is believed to be chronic reactive EBV infection. We propose that radiotherapy may be the best treatment option in the case of local recurrent intracranial inflammatory pseudotumors. PMID: 19608242 [PubMed - indexed for MEDLINE]

Distal intracranial catheterization of patients with tortuous vascular anatomy using a new hybrid guide catheter.

Related Articles Distal intracranial catheterization of patients with tortuous vascular anatomy using a new hybrid guide catheter. Surg Neurol. 2009 Dec;72(6):737-40; discussion 740 Authors: Simon SD, Ulm AJ, Russo A, Albanese E, Mericle RA BACKGROUND: A hybrid guide catheter mates the traditional strong guide catheter with a thin, soft distal tip, allowing placement further into the distal cervical or proximal cranial circulation. CASE DESCRIPTION: We present 5 cases in which traditional guide catheters were unable to successfully navigate tortuous anatomy or provide stable support for intervention. CONCLUSION: Hybrid guide catheters provided safe, stable support for successful treatment. Hybrid guide catheters allow for treatment for patients who previously were not candidates for neuroendovascular surgery. PMID: 19608241 [PubMed - indexed for MEDLINE]

Initial clinical experience with image-guided linear accelerator-based spinal radiosurgery for treatment of benign nerve sheath tumors.

Related Articles Initial clinical experience with image-guided linear accelerator-based spinal radiosurgery for treatment of benign nerve sheath tumors. Surg Neurol. 2009 Dec;72(6):668-74; discussion 674-5 Authors: Selch MT, Lin K, Agazaryan N, Tenn S, Gorgulho A, DeMarco JJ, DeSalles AA BACKGROUND: Stereotactic radiosurgery has proven a safe and effective treatment of cranial nerve sheath tumors. A similar approach should be successful for histologically identical spinal nerve sheath tumors. METHODS: The preliminary results of linear accelerator-based spinal radiosurgery were retrospectively reviewed for a group of 25 nerve sheath tumors. Tumor location was cervical 11, lumbar 10, and thoracic 4. Thirteen tumors caused sensory disturbance, 12 pain, and 9 weakness. Tumor size varied from 0.9 to 4.1 cm (median, 2.1 cm). Radiosurgery was performed with a 60-MV linear accelerator equipped with a micro-multileaf collimator. Median peripheral dose and prescription isodose were 12 Gy and 90%, respectively. Image guidance involved optical tracking of infrared reflectors, fusion of amorphous silicon radiographs with dynamically reconstructed digital radiographs, and automatic patient positioning. Follow-up varied from 12 to 58 months (median, 18). RESULTS: There have been no local failures. Tumor size remained stable in 18 cases, and 7 (28%) demonstrated more than 2 mm reduction in tumor size. Of 34 neurologic symptoms, 4 improved. There has been no clinical or imaging evidence for spinal cord injury. One patient had transient increase in pain and one transient increase in numbness. CONCLUSIONS: Results of this limited experience indicate linear accelerator-based spinal radiosurgery is feasible for treatment of benign nerve sheath tumors. Further follow-up is necessary, but our results imply spinal radiosurgery may represent a therapeutic alternative to surgery for nerve sheath tumors. Symptom resolution may require a prescribed dose of more than 12 Gy. PMID: 19608232 [PubMed - indexed for MEDLINE]

Single-center experience with the Neuroform stent for endovascular treatment of wide-necked intracranial aneurysms.

Related Articles Single-center experience with the Neuroform stent for endovascular treatment of wide-necked intracranial aneurysms. Surg Neurol. 2009 Dec;72(6):612-9 Authors: Wajnberg E, de Souza JM, Marchiori E, Gasparetto EL BACKGROUND: Stent-assisted coiling is an accepted endovascular treatment (EVT) for wide-necked intracranial aneurysms. The Neuroform stent (Target Therapeutics, Fremont, Calif) is a flexible nitinol self-expandable stent that was designed to potentially overcome the limitations of balloon expandable coronary stents in the intracranial circulation. The aim of this study was to reenforce the use of this stent for EVT of wide-necked cerebral aneurysms. METHODS: Between March 2005 and March 2008, 24 patients harboring wide-necked cerebral aneurysms were treated with stent reconstruction of the aneurysm neck. Inclusion criteria restricted the group to adult patients with wide-necked intracranial aneurysms (ruptured and unruptured lesions). Immediate postprocedure angiography studies were performed to determine successful coil occlusion of the aneurysm as well as patency of the parent vessel. We assessed the clinical history, aneurysm dimensions, and technical detail of the procedures, including any difficulties with stent placement and deployment, degree of aneurysm occlusion, and complications. Clinical outcome was assessed with the Glasgow Outcome Scale (GOS). RESULTS: The stent was easily navigated and precisely positioned in 24 of 26 cases. However, technical difficulties occurred in 9 patients, including difficulties in crossing the stents interstice in 6 cases, inadvertent stent delivery (n = 1), and incapacity of stent delivery (n = 1) and incapacity of crossing the neck (n = 1). These latter 2 cases were classified as failures of the stent-assisted technique. A single procedural complication occurred, involving transient nonocclusive intrastent thrombus formation, which was treated uneventfully with abciximab. Seventeen patients experienced excellent clinical outcomes (GOS 5), with good outcomes (GOS 4) in 5 patients and a poor outcome (GOS 3) in 2 patients. There were no treatment-related deaths or neurologic complications (mean clinical follow-up, 12 months). Angiographic results consisted of 17 complete occlusions, 4 neck remnants, and 3 incomplete occlusions. CONCLUSIONS: The Neuroform stent is very useful for EVT of wide-necked intracranial aneurysms because it is easy to navigate and to deploy accurately. In most cases, the stent can be deployed precisely, even in very tortuous carotid siphons. Although in some cases delivery and deployment was challenging, clinically significant complications were not observed. PMID: 19604557 [PubMed - indexed for MEDLINE]

Multiple dynamic cavernous malformations in a girl: long-term follow-up.

Related Articles Multiple dynamic cavernous malformations in a girl: long-term follow-up. Surg Neurol. 2009 Dec;72(6):728-32 Authors: Chen L, Zhao Y, Chen Z, Tee M, Mao Y, Zhou LF BACKGROUND: Cavernous malformations have generally been viewed as fairly benign vascular lesions with low potential for causing massive hemorrhage. CASE DESCRIPTION: We present an interesting case of multiple CMs, several of which were formed de novo and exhibited aggressive biological behavior resulting in recurrent episodes of intracranial hemorrhage over a 10-year period. This case illustrates a dynamic and aggressive form of CMs. Recent advances in our understanding of the molecular pathogenesis of CMs implicate genetics as an important pathogenic factor, which is the most likely etiology of this patient's presentation. CONCLUSION: Special challenges exist in managing young children with multiple, highly aggressive CMs. PMID: 19604555 [PubMed - indexed for MEDLINE]

Acute surgical removal of low-grade (Spetzler-Martin I-II) bleeding arteriovenous malformations.

Related Articles Acute surgical removal of low-grade (Spetzler-Martin I-II) bleeding arteriovenous malformations. Surg Neurol. 2009 Dec;72(6):662-7 Authors: Pavesi G, Rustemi O, Berlucchi S, Frigo AC, Gerunda V, Scienza R BACKGROUND: Early surgical removal of cerebral AVMs is a relatively infrequent therapeutic option when dealing with a cerebral hemorrhage caused by AVM rupture: even in the case of low-grade AVMs, delayed treatment is, if possible, preferred because it is considered safer for patients and more comfortable for surgeons. To assess whether acute surgery may be a safe and effective management, we conducted a retrospective analysis of our early surgery strategy for ruptured low-grade AVMs. METHODS: We reviewed 27 patients with SM grade I-II AVM treated during 2004 to 2008 in the acute stage of bleeding (within the first 6 days after bleed). All patients showed a cerebral AVM on DSA at admission, and surgical removal was controlled by postoperative angiography. Neurological outcomes were assessed with GOS. The average length of follow-up was 22 months (48-3 months). RESULTS: Before surgery, 16 (59%) patients showed a GCS of 8 or less, 2 of them presenting an acute rebleeding after first hemorrhage. All patients underwent radical AVM surgical removal and hematoma evacuation in a single-stage procedure. Most patients (78%) were operated within the first day of hemorrhage. A favorable functional outcome (GOS: good recovery or moderate disability) was observed in 23 patients (85%). Mortality was 7.4%. Outcome was not significantly correlated with GCS at presentation and with presence of preoperative anisocoria. CONCLUSIONS: Early surgery for grade I-II AVMs is a safe and definitive treatment, achieving both immediate cerebral decompression and patient protection against rebleeding, reducing time of hospital stay and allowing a more rapid rehabilitative course whenever necessary. PMID: 19604554 [PubMed - indexed for MEDLINE]

Emergency endovascular stent graft and coil placement for internal carotid artery injury during transsphenoidal surgery.

Related Articles Emergency endovascular stent graft and coil placement for internal carotid artery injury during transsphenoidal surgery. Surg Neurol. 2009 Dec;72(6):741-6 Authors: Park YS, Jung JY, Ahn JY, Kim DJ, Kim SH BACKGROUND: An internal carotid artery (ICA) injury is an uncommon but potentially fatal complication of transsphenoidal surgery. CASE DESCRIPTION: We report a 61-year-old male patient with a right cavernous ICA injury sustained during transsphenoidal surgery and who underwent endovascular Stent graft placement. The ICA trapping was not indicated because of the absence of the left A1 on preoperative magnetic resonance angiography. During Stent graft placement, the ICA wall could not be completely fit with a stent due to its stiff nature and the carotid curve. The gap between the stent and the ICA wall was filled using a coiling procedure on the first postoperative day. CONCLUSIONS: Endovascular Stent graft placement for posttranssphenoidal carotid artery injury is a useful technical adjunct to the management strategy and has the potential to minimize the risk of having to sacrifice the ICA. In cases of incomplete reconstruction of the Stent graft placement due to its stiff nature and the carotid curve, an additional coiling procedure could be helpful to obliterate the gap between the stent and the ICA wall. To avoid carotid injury during transsphenoidal surgery, careful preoperative evaluation of vascular structures and meticulous surgical technique are necessary. PMID: 19604552 [PubMed - indexed for MEDLINE]

Factors affecting the outcome after treatment for metastatic melanoma to the brain.

Related Articles Factors affecting the outcome after treatment for metastatic melanoma to the brain. Surg Neurol. 2009 Dec;72(6):707-11 Authors: Carrubba CJ, Vitaz TW BACKGROUND: Because of the difficulties inherent to the treatment of metastatic melanoma to the brain including high rates of disease progression and local treatment failure, we attempted to determine the prognostic factors that impacted the outcome of these patients, and reviewed patient outcome based on primary treatment with either surgical resection or SRS. METHODS: A retrospective review identified 37 patients treated for metastatic melanoma between July 2002 and April 2007. Information was obtained documenting systemic disease, preoperative symptoms, tumor size and location, disease recurrence, primary and secondary treatments, and survival time. RESULTS: Two patients were alive as of March 2008. The median survival time for patients primarily treated with surgical resection was 9.7 months compared to 7.9 months for patients initially treated with SRS. Solitary brain metastases and the absence of both preoperative hemorrhage and lung metastases served as prognostic factors increasing survival in both groups. Four patients undergoing primary treatment with SRS required subsequent surgical intervention secondary to radiation necrosis (3 patients) or local recurrence (1 patient). All 4 had lesions greater than 1.5 cm. For surgical patients, planned postoperative treatment with either radiosurgery or radiation therapy increased survival time to 12.3 months vs 7.3 months. CONCLUSIONS: Patients with positive prognostic factors including solitary brain lesions, absence of hemorrhage preoperatively, and absence of lung disease are viable candidates for aggressive, surgical intervention followed by adjuvant therapy with radiosurgery or conventional radiation therapy. Other patients should be considered for more conservative treatment with radiosurgery or other palliative treatments. PMID: 19604550 [PubMed - indexed for MEDLINE]

Rhabdomyolysis after transnasal repair of anterior basal encephalocele.

Related Articles Rhabdomyolysis after transnasal repair of anterior basal encephalocele. Surg Neurol. 2009 Dec;72(6):757-60 Authors: Van Gompel JJ, Khan YA, Bloomfield EL, Pallanch JF, Atkinson JL BACKGROUND: Postoperative Rhabdomyolysis (RM) is rare after neurosurgical procedures. Furthermore, it has not been observed after transnasal approaches. The authors report a case of idiopathic RM occurring after transnasal resection of a sincipital encephalocele. CASE DESCRIPTION: A 32-year-old woman underwent a transnasal resection of a sincipital encephalocele after 6 years of intermittent clear nasal drainage. Postoperatively, she experienced severe back pain, peripheral neuropathy, associated with a markedly elevated creatinine kinase, and severe RM. The patient was treated with hydration and forced urine alkalization and treated symptomatically for her pain and neuropathy. She ultimately made a full recovery without complication. CONCLUSION: Rhabdomyolysis is a rare but known complication of neurosurgical procedures. We report the first known case report of RM after a transnasal procedure. Furthermore, a review of documented postneurosurgical cases of RM is presented and reveals that the causes and risk factors for this complication after neurosurgery are similar to those in other surgical subspecialties. PMID: 19604548 [PubMed - indexed for MEDLINE]

Severe hypotension with intracisternal application of papaverine after clipping of an intracranial aneurysm.

Related Articles Severe hypotension with intracisternal application of papaverine after clipping of an intracranial aneurysm. Surg Neurol. 2009 Dec;72(6):770-1 Authors: Singla N, Mathuriya SN, Mohindra S, Umredkar AA, Adhikari S, Gupta SK, Gupta V PMID: 19604547 [PubMed - indexed for MEDLINE]

Resolution of syringomyelia after release of tethered cord.

Related Articles Resolution of syringomyelia after release of tethered cord. Surg Neurol. 2009 Dec;72(6):657-61 Authors: Hsu AR, Hou LC, Veeravagu A, Barnes PD, Huhn SL BACKGROUND: Syringomyelia is an abnormal cystic dilatation of the spinal cord caused by excessive accumulation of CSF. Patients can develop various neurologic deficits secondary to untreated syringomyelia, some of which can be permanent despite surgical intervention. CASE DESCRIPTION: The authors present a patient with syringomyelia, aortic coarctation, and tethered cord syndrome. Serial radiographic imaging demonstrated initial significant reduction of the thoracic syrinx after coarctation repair and release of tethered cord. However, subsequent follow-up imaging revealed partial recurrence. CONCLUSION: This case provides evidence of a possible cause-effect relationship between syringomyelia and tethered cord. It demonstrates the indication of surveillance imaging of the entire spine to ensure that all potential etiologies of syringomyelia are identified and treated. Furthermore, it illustrates the complex dynamic nature of syrinx physiology and reinforces the importance of serial follow-up studies after surgical intervention. PMID: 19604546 [PubMed - indexed for MEDLINE]

Microsurgical training on an in vitro chicken wing infusion model.

Related Articles Microsurgical training on an in vitro chicken wing infusion model. Surg Neurol. 2009 Dec;72(6):695-9 Authors: Olabe J, Olabe J BACKGROUND: Microneurovascular anastomosis and aneurysm clipping require extensive training before mastering the technique and are a surgical challenge. We developed the "infused chicken wing method" to provide a simple but realistic training method minimizing animal use and need for special facilities for animal care and anesthesia. METHODS: Fresh chicken wings were used in this model. The main brachial artery was cannulated, and water was infused at 140 mm Hg followed by anatomical neurovascular dissection. Multiple microsurgical training exercises were performed under microscope vision including terminoterminal, lateroterminal, laterolateral vascular anastomosis, and nerve anastomosis. Different complexity aneurysms were created using venous patches, clipping, rupture, and vascular reconstruction techniques were performed. RESULTS: This novel training model is inexpensive, easily obtainable, and no live animals are required. The diameter and characteristics of arteries and veins used are similar to those of the human brain. Great microsurgical technique progress may be obtained. CONCLUSIONS: The infused chicken wing artery model presents a realistic microvascular training method. It is inexpensive and easy to set up. Such simplicity provides the adequate environment for developing microsurgical technique. PMID: 19329164 [PubMed - indexed for MEDLINE]

Quantitative analysis of motor neurons of the levator ani muscle in fetal rats with spina bifida occulta.

Related Articles Quantitative analysis of motor neurons of the levator ani muscle in fetal rats with spina bifida occulta. Surg Neurol. 2009 Dec;72(6):652-6; discussion 656 Authors: Li Y, Hou XY, Yuan ZW, Wang WL BACKGROUND: With the combination of microsurgery and microinjection techniques, we investigated the development of motor neurons in the spinal cord of fetal rats with spina bifida occulta by injecting the retrograde trace FG into the levator ani muscle. METHODS: The fetal rats were divided into 3 groups. On the day 9 of gestation, 6 mature Wistar rats (weighing 250-300 g) in the control group (group 1) were subcutaneously injected with 0.5 mL of normal saline at their hind limbs at 9:00 am and 4:00 pm. At these 2 time points, 15 rats in the treatment group (group 2 and group 3) were subcutaneously injected with 20% sodium valproate solution (400 mg/kg of body weight) at their hind limbs, too. On the day 20 of gestation, pregnant rats were anesthetized with 10% chloral hydrate (300 mg/kg of body weight) intraperitoneally, and then fetal microsurgery and microinjection were performed to expose the levator ani muscle, whereas 5% FG was administered with microinjector. Twenty-four hours later, transcardial perfusion of 4% paraformaldehyde in phosphate-buffered saline (PBS) was given to the operated fetus. After the spine sample was stained with Alcian blue GX, the image of stained spine was measured using a computer system for the distance of the 2 cartilaginous ends of the vertebra arch. Then, the lumbosacral spinal cord was cryopreserved in 20% sucrose in PBS for a later serial transverse cryosection after 24 hours. The FG-labeled motor neurons were visualized with a wide-band ultraviolet-fluorescent filter, and the number of the FG-labeled motor neurons was recorded. Nine fetal rats survived in group 1. Eighteen fetal rats survived in the treatment group, including 7 (with no malformation) of 18 fetuses in group 2 and 11 fetuses with spina bifida occulta in group 3. RESULTS: The FG-labeled motor neurons in the ventral horn of normal spinal cord clustered at the dorsolateral and dorsomedial corner of the ventral horn. The FG-labeled motor neurons in the ventral horn of deformed spinal cord were less than that of normal spinal cord, and the motor neurons were scattered around the space between the dorsomedial and dorsolateral corners. The number of FG-labeled motor neurons was 244 +/- 41 in group 3, 426 +/- 36 in group 1, and 397 +/- 20 in group 2. The data were statistically significant if P < .05. CONCLUSION: The motor neurons that innervate the levator ani muscle in fetal rats with spina bifida occulta are fewer than the normal fetal rats, and they are arranged in abnormal distribution. PMID: 19328533 [PubMed - indexed for MEDLINE]

Cerebral ischemia due to compression of the brain by ossified and hypertrophied muscle used for encephalomyosynangiosis in childhood moyamoya disease.

Related Articles Cerebral ischemia due to compression of the brain by ossified and hypertrophied muscle used for encephalomyosynangiosis in childhood moyamoya disease. Surg Neurol. 2009 Dec;72(6):725-7 Authors: Touho H BACKGROUND: Encephalomyosynangiosis is one of the indirect method in which ischemic brain surface is covered by temporal muscle for the treatment of moyamoya disease. CASE DESCRIPTIONS: A 14-year-old girl who had been treated with bilateral STA-MCA anastomosis and EMS in 1999 was admitted on January 5, 2005. She showed transient incomplete palsy on the left side of the face and the ipsilateral upper extremity. On the day of admission, MRIs/MRA and 3-dimensional regional CBF measurement using stable xenon and CT scanning were conducted after performance of plain CT scanning. The MRI and CT studies showed that ossified and hypertrophied temporal muscle used for EMS to the right MCA territory compressed the brain just under the muscle. MRA demonstrated well-developed collaterals to the territories of the bilateral MCAs via the previously performed anastomosis. The CBF studies disclosed a low CBF value just under ossified and hypertrophied muscle used for EMS on the right side. She showed same transient ischemic attacks repetitively after January 5, 2005. CONCLUSIONS: The repetitive attacks with the transient motor palsy on her left side was thought to be caused by direct compression of the brain by the ossified and hypertrophied muscle used for EMS and decrease in CBF just under it, and its removal was thought to be the treatment of choices. However, the patient and her parents refused the surgical procedure, and she is treated conservatively at present. PMID: 17967485 [PubMed - indexed for MEDLINE]