MedWorm: Neurosurgery

Posterior atlantal lateral mass fixation technique with polyaxial screw and rod fixation system.

Turkish Neurosurgery — Sat, 05 Jul 2008 11:35:50 +0100

Posterior Atlantal Lateral Mass Fixation Technique With Polyaxial Screw And Rod Fixation System.

Turk Neurosurg. 2008;18(2):142-148

Authors: Calişaneller T, Yilmaz C, Ozdemır O, Caner H

OBJECTIVE: Atlantoaxial instability may result from various pathologic conditions and operative treatment may be required to correct the deformity, provide stability and prevent neurological deficits. We presented our clinic's experience using C1-C2 fusion with polyaxial screw and rod fixation for C1 and C2 instability for various reasons. METHODS and MATERIAL: Four patients with atlantoaxial instability were operated using polyaxial C1 lateral mass and C2 lateral mass or pedicle screws. The mean age of the patients was 44+/-14,07 years. RESULTS: Satisfactory screw placement was achieved in all patients. There were no vertebral artery injuries, C2 nerve root injuries or spinal cord injuries. No per-operative or early postoperative instrumentation failure was observed. CONCLUSIONS: C1 lateral mass/C2 pedicle polyaxial screw fixation is a safe technique and can be used to achieve rigid and immediate atlantoaxial stabilization.

PMID: 18597228 [PubMed - as supplied by publisher]

(Source: Turkish Neurosurgery)

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Effects of peripheral nerve ischemia-reperfusion model on serum cytokine levels.

Turkish Neurosurgery — Sat, 05 Jul 2008 11:35:50 +0100

Effects of Peripheral Nerve Ischemia-Reperfusion Model on Serum Cytokine Levels.

Turk Neurosurg. 2008;18(2):149-156

Authors: Bağdatoğlu OT, Polat G, Bağdatoğlu C, Atık U

AIM: Although the neuropathology of ischemic nerve fiber degeneration is relatively well known, its pathogenesis is poorly understood. Local cytokines, which have neuroprotective effects on inflammation and repair, participate in the process by undefined mechanisms. In this study, we evaluated the effects of ischemia and reperfusion on the sciatic nerve of the rat and investigated the probable effects of cytokines on this period. MATERIAL and METHODS: In the current study, ischemia and reperfusion injury of sciatic nerve was rendered by clamping the femoral artery and vein of the rat for three hours and was followed by varying durations of reperfusion. Activin A, TGF Beta1 and TGF, Beta2 levels were measured in serum samples. RESULTS: TGF Beta1 and Activin A were found to be increased in the ischemic groups compared with the control group (p < 0.05). Asignificant difference was found between the experimental groups after reperfusion (p < 0.05). There was no statistical significance for TGF Beta2 levels between the study groups (p > 0.05). CONCLUSION: Ischemia causes some important changes in biochemical parameters, and nerve injury continues for a while according to the reperfusion time. Ischemia-reperfusion injury of peripheral nerves caused by various reasons therefore affects the levels of cytokines.

PMID: 18597229 [PubMed - as supplied by publisher]

(Source: Turkish Neurosurgery)

Nitric oxide level and adenosine deaminase activity in cerebrospinal fluid of patients with subarachnoid hemorrhage.

Turkish Neurosurgery — Sat, 05 Jul 2008 11:35:50 +0100

Nitric Oxide Level and Adenosine Deaminase Activity in Cerebrospinal Fluid of Patients with Subarachnoid Hemorrhage.

Turk Neurosurg. 2008;18(2):157-164

Authors: Durmaz R, Ozkara E, Kanbak G, Arslan OC, Dokumacioğlu A, Kartkaya K, Atasoy MA

OBJECTIVE: Adenosine and nitric oxide (NO) are known as vasodilatators. We investigated adenosine deaminase (ADA) activity and NO concentration in the cerebrospinal fluid (CSF) of patients with subarachnoid hemorrhage (SAH). METHODS: Forty patients with SAH and 10 controls were included in the study. Nitrate level and ADA activity were measured in CSF. SAH patients were grouped according to the presence of angiographic vasospasm, Hunt and Hess grading, Glasgow Coma Scale (GCS) and Fisher Grade (FG). RESULTS: The level of NO markers in SAH patients decreased when compared to that in the control group (p < 0.05). However, NO markers in patients with vasospasm was higher than in that of patients without vasospasm (p < 0.05). ADA activity increased in patients with SAH (p < 0.01) and also patients with angiographic vasospasm (p < 0.05). ADA activity in the poor-grade SAH group was higher than that in the good-grade SAH group. The group with the lower GCS showed increased ADA activity compared to those with a higher GCS score (p < 0.01). Furthermore, patients with FG 4 had a higher level of ADA activity compared to FG 1 and 2 and FG 3 (p < 0.001 and p < 0.01, respectively). CONCLUSION: Decreased NO level may participate in the early development of vasospasm. However, the increased level of ADA activity in the SAH patients with the poor clinical and consciousness level may have resulted from the ischemic cerebral insult.

PMID: 18597230 [PubMed - as supplied by publisher]

(Source: Turkish Neurosurgery)

Macrocephaly and bitemporal arachnoid cysts not associated with glutaric aciduria type i in a child.

Turkish Neurosurgery — Sat, 05 Jul 2008 11:35:50 +0100

Macrocephaly and Bitemporal Arachnoid Cysts not Associated with Glutaric Aciduria Type I in a Child.

Turk Neurosurg. 2008;18(2):172-176

Authors: Serarslan Y, Melek IM, Sangün O, Akçora B, Akdemır G

A 45-month-old child who had bitemporal arachnoid cysts and macrocephaly unrelated to glutaric aciduria type 1 (GA 1) was reported. The patient was admitted to the emergency unit after head trauma at 11 months of age. CT and MRI showed bitemporal arachnoid cysts (BACs). Acylcarnitine profile was normal in serum using tandem mass spectrometry. Urine and blood screening tests were within normal range for metabolic disorders. There were no unusual organic acids in urine and blood samples. No additional clinical findings of metabolic disorders such as GA 1 developed during follow-up. The majority of children affected with GA 1 have macrocephaly and BACs on CT or MRI. These signs should alert neurosurgeons to the possibility of GA 1. Neurosurgeons evaluating patients with head trauma or suspected non-accidental head injury should include GA 1 in the differential diagnosis of BACs associated with macrocephaly, and an evaluation should be performed.

PMID: 18597232 [PubMed - as supplied by publisher]

(Source: Turkish Neurosurgery)

Giant distal superior cerebellar artery aneurysm: case report and review of the literature.

Turkish Neurosurgery — Sat, 05 Jul 2008 11:35:50 +0100

Giant Distal Superior Cerebellar Artery Aneurysm: Case Report and Review of the Literature.

Turk Neurosurg. 2008;18(2):177-182

Authors: Senvelı ME, Aciduman A, Belen D

Aneurysms arising from the distal portion of superior cerebellar artery are infrequently seen. They are usually assumed to result from local arterial wall disruption like proximal supratentorial artery aneurysms. Depending on institutional facilities, these particular aneurysms can be treated either by a microsurgical procedure or interventional radiological technique. In general, surgical clipping has been recommended for these lesions. In this report we describe a 44-year old man who presented with a subarachnoid hemorrhage in the right cerebellopontine angle and was diagnosed with a giant aneurysm arising from the cisternal portion of the right superior cerebellar artery. The patient underwent surgery; microsurgical clipping of the aneurysm through subtemporal craniotomy was performed with no difficulty. We conclude that surgical therapy is suitable for the majority of aneurysms arising from the distal portion of the superior cerebellar artery.

PMID: 18597233 [PubMed - as supplied by publisher]

(Source: Turkish Neurosurgery)

Cervical intradural lipoma with associated hemivertebra formation at c6 level: a case report.

Turkish Neurosurgery — Sat, 05 Jul 2008 11:35:50 +0100

Cervical Intradural Lipoma with Associated Hemivertebra Formation at C6 Level: A Case Report.

Turk Neurosurg. 2008;18(2):187-190

Authors: Moghaddam AM, Tanriöver N, Ulu MO, Muhammedrezaı S, Akar Z

INTRODUCTION and CASE DESCRIPTION: Intramedullary lipomas are rare tumours of the spinal cord and account for about 1% of all spinal neoplasms. These lesions can occur anywhere along the length of spinal cord, but are frequently localized to the lower thoracic and lumbosacral levels. The authors present a 18-year-old female with intractable shoulder and neck pain and progressive weakness in the upper extremities, harbouring a cervical intradural lipoma with intramedullary extension, along with concomitant scoliosis. CONCLUSION: Despite its benign nature, surgical treatment of these lesions in symptomatic patients generally provides satisfactory relief of symptoms. Radical removal of spinal intradural lipomas is not recommended since attempts at complete excision carry an unacceptable risk of postoperative morbidity and sufficient decompression with or without duraplasty generally provides a successful clinical outcome.

PMID: 18597235 [PubMed - as supplied by publisher]

(Source: Turkish Neurosurgery)

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Aplasia cutis congenita of the scalp, skull and dura associated with adams-oliver syndrome.

Turkish Neurosurgery — Sat, 05 Jul 2008 11:35:50 +0100

Aplasia Cutis Congenita of the Scalp, Skull and Dura Associated with Adams-Oliver Syndrome.

Turk Neurosurg. 2008;18(2):191-193

Authors: Bılgıner B, Onal MB, Bahadir S, Akalan N

A 1-day-old boy with the characteristics of Adams-Oliver syndrome was presented. Adams-Oliver syndrome has a wide spectrum of anomalies ranging from aplasia cutis congenita, cutis marmorata telangiectatica congenita and transverse limb defects to lethal anomalies. Our patient had aplasia cutis congenita with scalp, skull and dura defect. He had also a large dura defect with herniation of brain tissue. Besides these he had bilateral clubfoot, cortical fissure and nail hypoplasia in the hands, scrotal hyperpigmentation and generalized cutis marmorata telangiectatica congenita. He was operated on the 3rd day of life. The herniated brain tissue was resected and the dura was repaired with a synthetic dural graft.

PMID: 18597236 [PubMed - as supplied by publisher]

(Source: Turkish Neurosurgery)

Vertebral body pneumatocyst in the cervical spine and review of the literature.

Turkish Neurosurgery — Sat, 05 Jul 2008 11:35:50 +0100

Vertebral Body Pneumatocyst in the Cervical Spine and Review of the Literature.

Turk Neurosurg. 2008;18(2):197-199

Authors: Coşar M, Eser O, Aslan A, Korkmaz S, Boyaci G, Değırmencı B, Albayrak R

Apneumatocyst in the cervical spine is extremely rare and to our knowledge only a few reports have been published in the English literature. Although the etiology and natural course of vertebral body pneumatocyst is unclear, nitrogen gas accumulation is claimed. A 65-year-old-man was admitted to the emergency department with neck pain and numbness and incapacity in his both hands and fingers. The radiological images revealed a vertebral located pneumatocyst in the C4 cervical vertebra. In this report, we present a case of cervical pneumatocyst located in the C4 vertebral body. The clinical and radiological features and natural course of the pneumatocyst were evaluated.

PMID: 18597238 [PubMed - as supplied by publisher]

(Source: Turkish Neurosurgery)

The redundant nerve root syndrome of the cauda equina.

Turkish Neurosurgery — Sat, 05 Jul 2008 11:35:50 +0100

The Redundant Nerve Root Syndrome of the Cauda Equina.

Turk Neurosurg. 2008;18(2):204-206

Authors: Hakan T, Celıkoğlu E, Aydoselı A, Demır K

The redundant nerve root syndrome is defined as the association of high-grade extradural lumbar spinal stenosis with large, elongated and tortuous nerve roots. Acquired elongation of nerve roots due to the mechanical trapping at the level of lumbar spinal stenosis is assumed to be the possible mechanism. It is believed that the cause is a squeezing force due to the chronic compression. The most common clinical symptoms are low back pain and leg pain. Although lumbar spinal canal stenosis is common, the entity has rarely been discussed in the literature. Here we present the MR imaging and intraoperative appearance of the condition with a brief discussion in a 71-year-old woman.

PMID: 18597240 [PubMed - as supplied by publisher]

(Source: Turkish Neurosurgery)

Cervical vertebral osteomyelitis and epidural abscess caused by candida albicans in a patient with chronic renal failure.

Turkish Neurosurgery — Sat, 05 Jul 2008 11:35:50 +0100

Cervical Vertebral Osteomyelitis and Epidural Abscess Caused by Candida Albicans in a Patient with Chronic Renal Failure.

Turk Neurosurg. 2008;18(2):207-210

Authors: Ozdemır N, Celık L, Oğuzoğlu S, Yildirim L, Bezırcıoğlu H

Although rare, the diagnosis of candidal vertebral osteomyelitis of the cervical spine should be considered in cases of quadriparesia occurring in hemodialysis patients. This disease leads to vertebral destruction and spinal cord compression. Candidal vertebral osteomyelitis constitutes a diagnostic problem for all physicians. The insidious progression of disease, the non-specificity of the clinic and laboratory findings, and the failure to recognize candida as a potential pathogen may lead to a diagnostic delay. Early diagnosis and treatment are fundamental points for prognosis. In this report, we present the fifth case of cervical vertebral osteomyelitis caused by Candida species in the literature. Our case is the second case of candidal vertebral osteomyelitis associated with epidural abscess of the cervical spine.

PMID: 18597241 [PubMed - as supplied by publisher]

(Source: Turkish Neurosurgery)

Management of spinal synovial cysts.

Turkish Neurosurgery — Sat, 05 Jul 2008 11:35:50 +0100

Management of Spinal Synovial Cysts.

Turk Neurosurg. 2008;18(2):211-214

Authors: Kahıloğullari G, Tuna H, Attar A

OBJECTIVE: The report aimed to present the outcome of surgical management of spinal synovial cyst. Methods: The study was a retrospective review of six patients surgically treated between January 2005 and September 2007. The patients were evaluated in preoperative and postoperative periods. Evaluation was done by questionnaire scoring system. According to this system, categories were; excellent,good, fair, and poor. Results: The duration of follow-up ranged between 3 months and 42 months (mean: 23.3 months; SD: 13.0). Synovial cysts were located in the lumbar spine in 4 of 6 patients. In the other 2 patients, they were in the cervical and thoracal regions. Three patients were female, and three were male. The results of the lumbar group were better than those of the other groups in early period. The findings of the follow-up evaluations were better than those determined in the early postoperative period in all the groups. Conclusions: Surgery is an effective treatment for spinal synovial cysts, especially for lumbar synovial cysts.

PMID: 18597242 [PubMed - as supplied by publisher]

(Source: Turkish Neurosurgery)

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Temporalis muscle metastasis of the uterine leiomyosarcoma: a case report.

Turkish Neurosurgery — Sat, 05 Jul 2008 11:35:50 +0100

Temporalis Muscle Metastasis of the Uterine Leiomyosarcoma: A Case Report.

Turk Neurosurg. 2008;18(2):215-218

Authors: Aslan E, Kuzeylı K, Cakir E, Reıs A

Leiomyosarcomas are malignant tumors of smooth muscle origin. These tumors are very rare in the head and neck region. The majority of leiomyosarcomas of the head and neck arise in the paranasal sinuses, oral cavity, jaws and superficial soft tissues like the scalp. A mass was observed in the right temporoparietal region of the scalp of a 76-year-old female. Two years before presentation, the patient was operated for primary uterine leiomyosarcoma. Over the ensuing years, the mass substantially increased in size. Radiologic findings revealed a mixed density mass of the right temporalis muscle. Histologic and immunohistochemical examination of the tumor showed a malignant mesenchymal neoplasm consisting of spindle-shaped atypical mesenchymal cells with marked pleomorphism and central cigar shaped nuclei arranged in fascicles. We report a rare case of uterine leiomyosarcoma metastatic to the temporalis muscle, proven by histopathology.

PMID: 18597243 [PubMed - as supplied by publisher]

(Source: Turkish Neurosurgery)

Dog bite causing ischemia and neurological deficit at the upper extremity: a case report.

Turkish Neurosurgery — Sat, 05 Jul 2008 11:35:50 +0100

Dog Bite Causing Ischemia and Neurological Deficit at the Upper Extremity: A Case Report.

Turk Neurosurg. 2008;18(2):219-221

Authors: Eser O, Kocaoğullari CU, Coşar M, Emmıler M, Cekırdekçı A

We present a case with median and radial nerve injuries together with brachial artery occlusion after a dog bite that is seen rarely in the literature. A 26 year-old man was admitted to our emergency department with a complaint of dog bite and weakness of fingers at the left upper extremity. There were bite impressions at the left arm. The physical examination of the patient revealed no brachial and radial artery pulse. The neurological examination revealed radial and median nerve deficits. The patient underwent a thromboembolectomy operation following laboratory and radiological evaluations. The nerve injuries were evaluated as partial and medical treatment was administered.

PMID: 18597244 [PubMed - as supplied by publisher]

(Source: Turkish Neurosurgery)

Psychosurgery.

Neurosurgical Focus — Thu, 03 Jul 2008 11:17:43 +0100

Psychosurgery.

Neurosurg Focus. 2008;25(1):E1

Authors: Elias WJ, Cosgrove GR

PMID: 18590377 [PubMed - in process]

(Source: Neurosurgical Focus)

From prefrontal leukotomy to deep brain stimulation: the historical transformation of psychosurgery and the emergence of neuroethics.

Neurosurgical Focus — Thu, 03 Jul 2008 11:17:43 +0100

From prefrontal leukotomy to deep brain stimulation: the historical transformation of psychosurgery and the emergence of neuroethics.

Neurosurg Focus. 2008;25(1):E10

Authors: Wind JJ, Anderson DE

The history of psychosurgery is described and analyzed. This historical perspective largely begins with analysis of the work of Egas Moniz in the development of the leukotomy, and follows the rise and fall of its popularity in the 1900s. The reemergence of psychosurgical procedures and the development of new therapeutic technologies such as vagus nerve stimulation and deep brain stimulation are discussed. In addition, an introduction to the field of neuroethics is provided, given its importance in any discussion about surgical therapy for psychiatric patients.

PMID: 18590378 [PubMed - in process]

(Source: Neurosurgical Focus)

Biological basis for the surgical treatment of depression.

Neurosurgical Focus — Thu, 03 Jul 2008 11:17:43 +0100

Biological basis for the surgical treatment of depression.

Neurosurg Focus. 2008;25(1):E2

Authors: Abosch A, Cosgrove GR

An estimated 20% of patients with major depression are refractory to existing therapies. The purpose of this review is to provide a theoretical and neuroscientific framework in which to interpret new work in the field of surgical treatment for depression. This review focuses on existing clinical and imaging data, current disease models, and results of recent case reports and patient series that together may inform the construction of appropriate clinical trials for the surgical treatment of refractory depression.

PMID: 18590379 [PubMed - in process]

(Source: Neurosurgical Focus)

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Potential surgical targets for deep brain stimulation in treatment-resistant depression.

Neurosurgical Focus — Thu, 03 Jul 2008 11:17:43 +0100

Potential surgical targets for deep brain stimulation in treatment-resistant depression.

Neurosurg Focus. 2008;25(1):E3

Authors: Hauptman JS, DeSalles AA, Espinoza R, Sedrak M, Ishida W

OBJECT: The goal of this study was to evaluate the definition of treatment-resistant depression (TRD), review the literature regarding deep brain stimulation (DBS) for TRD, and identify potential anatomical and functional targets for future widespread clinical application. METHODS: A comprehensive literature review was performed to determine the current status of DBS for TRD, with an emphasis on the scientific support for various implantation sites. RESULTS: The definition of TRD is presented, as is its management scheme. The rationale behind using DBS for depression is reviewed. Five potential targets have been identified in the literature: ventral striatum/nucleus accumbens, subgenual cingulate cortex (area 25), inferior thalamic peduncle, rostral cingulate cortex (area 24a), and lateral habenula. Deep brain stimulation electrodes thus far have been implanted and activated in only the first 3 of these structures in humans. These targets have proven to be safe and effective, albeit in a small number of cases. CONCLUSIONS: Surgical intervention for TRD in the form of DBS is emerging as a viable treatment alternative to existing modalities. Although the studies reported thus far have small sample sizes, the results appear to be promising. Various surgical targets, such as the subgenual cingulate cortex, inferior thalamic peduncle, and nucleus accumbens, have been shown to be safe and to lead to beneficial effects with various stimulation parameters. Further studies with larger patient groups are required to adequately assess the safety and efficacy of these targets, as well as the optimal stimulation parameters and long-term effects.

PMID: 18590380 [PubMed - in process]

(Source: Neurosurgical Focus)

Ablative neurosurgery for mental disorders: is there still a role in the 21st century? a personal perspective.

Neurosurgical Focus — Thu, 03 Jul 2008 11:17:43 +0100

Ablative neurosurgery for mental disorders: is there still a role in the 21st century? A personal perspective.

Neurosurg Focus. 2008;25(1):E4

Authors: Eljamel MS

OBJECT: The author presents his personal perspective on ablative neurosurgical techniques used to perform bilateral anterior cingulotomy (BACI) and bilateral anterior capsulotomy (BACA) for ameliorating the symptoms of refractory obsessive-compulsive disorder (OCD) and treatment refractory depression (TRD). With depression predicted to be the second most common cause of disability in the world by the year 2020 and the birth of electric neurostimulation representing an attractive alternative treatment option for TRD and OCD, it is desirable to revisit the pros and cons of these treatment options. METHODS: The author reviewed the surgical methods and outcome (including neuroimaging findings) in all cases in which ablative neurosurgery was performed at Ninewells Hospital and Medical School over the last 2 decades. RESULTS: The advantages of ablative procedures (BACI and BACA) from patients' and psychiatrists' perspectives are that the ablative procedures are one-off procedures that do not require lifelong commitment to program the stimulation devices, fix hardware failures, or change exhausted batteries. From the perspective of healthcare funding bodies, the relatively low cost of these treatments is an advantage. The main disadvantages of BACI and BACA are the perceived higher complication rates, the irreversibility of the surgical lesions, and the stigma associated with brain destruction in psychiatric patients that are still unpalatable in the community at large. However, some patients still choose a one-off procedure in preference to any other options presented to them. CONCLUSIONS: There is still place for BACI and BACA in modern neurosurgery for mental disorders, at least in the short term for those who do not want to commit to lifelong device programming and maintenance.

PMID: 18590381 [PubMed - in process]

(Source: Neurosurgical Focus)

The neurosurgical treatment of addiction.

Neurosurgical Focus — Thu, 03 Jul 2008 11:17:43 +0100

The neurosurgical treatment of addiction.

Neurosurg Focus. 2008;25(1):E5

Authors: Stelten BM, Noblesse LH, Ackermans L, Temel Y, Visser-Vandewalle V

Addiction or substance dependence is a psychiatric disorder that affects many individuals in the general population. Different theories concerning the neurobiological aspects of addiction have been proposed. Special attention has been paid to models concerning dysregulation of the reward circuit and the inhibitory control system within the cortico-basal ganglia-thalamocortical pathways. In the past, attempts have been made to treat patients suffering from addiction by performing psychosurgery. Lesions were created in specific brain regions that were believed to be dysfunctional in addiction. Procedures such as cingulotomy, hypothalamotomy, and resection of the substantia innominata and the nucleus accumbens have been described as a treatment for severe addictive disorders. Deep brain stimulation, a neurosurgical treatment that has been proven to be a safe alternative for lesions in the treatment of movement disorders, has more recently been proposed as treatments for severe psychiatric conditions such as treatment-refractory obsessive-compulsive disorder and depression. With the expanding knowledge of the neurobiology of addiction, deep brain stimulation could be a future option in the treatment arsenal of addiction.

PMID: 18590382 [PubMed - in process]

(Source: Neurosurgical Focus)

Stereotactic amygdalotomy in the management of severe aggressive behavioral disorders.

Neurosurgical Focus — Thu, 03 Jul 2008 11:17:43 +0100

Stereotactic amygdalotomy in the management of severe aggressive behavioral disorders.

Neurosurg Focus. 2008;25(1):E6

Authors: Mpakopoulou M, Gatos H, Brotis A, Paterakis KN, Fountas KN

OBJECT: Stereotactic amygdalotomy has been utilized as a surgical treatment for severe aggressive behavioral disorders. Several clinical studies have been reported since the first description of the procedure. In the current study, the authors reviewed the literature and evaluated the surgical results, neuropsychological outcome, and complication rate in patients who had undergone stereotactic amygdalotomy for severe aggressive behavioral disorders. METHODS: The PubMed database was searched using the following terms: "amygdalotomy," "amygdalectomy," "amygdaloidectomy," "psychosurgery," "aggressive disorder," and "behavioral disorder." Clinical series with more than 5 patients undergoing stereotactic amygdalotomy for aggressive or other behavioral disorders were included in this review. The surgical technique, anatomical target, improvement in psychiatric symptomatology, postoperative employment and social rehabilitation, postoperative neurocognitive function, procedure-related complications, and long-term follow-up were evaluated. RESULTS: Thirteen clinical studies met our inclusion criteria. Reported postoperative improvement in aggressive behavior varied between 33 and 100%. Procedure-related complication rates ranged from 0 to 42%, whereas the mortality rate was as high as 3.8%. In the majority of the reviewed clinical series, the performance of stereotactic amygdalotomy did not compromise a patient's learning, language, and intellectual capabilities. The long-term follow-up, although very limited, revealed that initially observed improvement was maintained in most cases. CONCLUSIONS: Stereotactic amygdalotomy can be considered a valid surgical treatment option for carefully selected patients with medically refractory aggressive behavioral disorders. Recent advances in imaging and stereotactic navigation can further improve outcome and minimize the complication rate associated with this psychosurgical procedure.

PMID: 18590383 [PubMed - in process]

(Source: Neurosurgical Focus)

Electrical stimulation in the lateral hypothalamus in rats in the activity-based anorexia model.

Neurosurgical Focus — Thu, 03 Jul 2008 11:17:43 +0100

Electrical stimulation in the lateral hypothalamus in rats in the activity-based anorexia model.

Neurosurg Focus. 2008;25(1):E7

Authors: Welkenhuysen M, Van Kuyck K, Das J, Sciot R, Nuttin B

OBJECT: One quarter of patients with anorexia nervosa have a poor outcome and continue to suffer chronically or die. Electrical brain stimulation may be of therapeutic benefit in some of these patients; however, the brain target for inducing symptom relief is unknown. In this study, the authors evaluated the effects of acute and chronic electrical stimulation in the lateral hypothalamus on food intake, locomotor activity, and survival time in rats in an activity-based anorexia model. METHODS: In an acute experiment, the authors electrically stimulated at 100 Hz and 0, 25, 50 and 75% of the maximal stimulation amplitude (that is, the amplitude leading to severe side effects) in the lateral hypothalamus on consecutive days during 4 test sessions in 10 rats and evaluated food intake and locomotor activity. In a chronic experiment, they compared food intake, wheel revolutions, and survival time between 6 rats that underwent electrical stimulation in the lateral hypothalamus (50% of maximal stimulation amplitude) and 8 rats that did not undergo stimulation. RESULTS: In the acute experiment, overall electrical stimulation (25, 50, and 75% combined) and stimulation at 75% of the maximal stimulation amplitude significantly decreased the locomotor activity. However, if the authors omitted results of 1 rat, in which the electrode tip was not located in the lateral hypothalamus on one side but rather in the supraoptic chiasm, the remaining results did not yield significance. No other differences were observed. CONCLUSIONS: When the findings of the current study are extrapolated to patients with anorexia nervosa, the authors do not expect major effects on symptoms with electrical stimulation at high frequency in the lateral hypothalamus.

PMID: 18590384 [PubMed - in process]

(Source: Neurosurgical Focus)

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Lennart heimer: concepts of the ventral striatum and extended amygdala.

Neurosurgical Focus — Thu, 03 Jul 2008 11:17:43 +0100

Lennart Heimer: concepts of the ventral striatum and extended amygdala.

Neurosurg Focus. 2008;25(1):E8

Authors: Elias WJ, Ray DK, Jane JA

Dr. Lennart Heimer, the famous neuroanatomist of Swedish descent, died last year but left a legacy that will impact the neurosciences and potentially psychosurgery for years to come. He developed an anatomical technique for demonstrating the terminal boutons that helped to delineate basal forebrain anatomy. During these studies, he realized the relationship of basal forebrain structures to the limbic system, thus initiating the concept of the ventral striatum and parallel basal ganglia circuitry. Heimer excelled as a teacher as well and honed his brain dissection technique to one of the most effective tools for understanding neuroanatomy. His legendary sessions with neurosurgical residents resulted in his recognition as one of the world's leading fiber tract dissectors. His gentle, engaging manner has been documented in several media formats.

PMID: 18590385 [PubMed - in process]

(Source: Neurosurgical Focus)

Modern psychosurgery before egas moniz: a tribute to gottlieb burckhardt.

Neurosurgical Focus — Thu, 03 Jul 2008 11:17:43 +0100

Modern psychosurgery before Egas Moniz: a tribute to Gottlieb Burckhardt.

Neurosurg Focus. 2008;25(1):E9

Authors: Manjila S, Rengachary S, Xavier AR, Parker B, Guthikonda M

The history of modern psychosurgery has been written in several ways, weaving around many pioneers in the field during the 19th century. Often neglected in this history is Gottlieb Burckhardt (1836-1907), who performed the first psychosurgical procedures as early as 1888, several decades before the work of Egas Moniz (1874-1955). The unconventional and original case series of Burckhardt, who claimed success in 50% of patients (3 of 6), had met with overt criticism from his contemporary medical colleagues. The authors describe 2 illustrative cases of cortical extirpation performed by Burckhardt and review his pioneering case series for surgical outcome, despite the ambiguity in postoperative evaluation criteria. Although Burckhardt discontinued the project after publication of his surgical results in 1891, neurosurgeons around the world continued to investigate psychosurgery and revitalized his ideas in 1910; psychosurgery subsequently developed into a full-fledged neurosurgical specialty.

PMID: 18590386 [PubMed - in process]

(Source: Neurosurgical Focus)

Monocyte chemoattractant protein-1 predicts outcome and vasospasm following aneurysmal subarachnoid hemorrhage.

Journal of Neurosurgery — Tue, 01 Jul 2008 04:00:00 +0100

Monocyte chemoattractant protein-1 predicts outcome and vasospasm following aneurysmal subarachnoid hemorrhage.

J Neurosurg. 2008 Jul;109(1):38-43

Authors: Kim GH, Kellner CP, Hahn DK, Desantis BM, Musabbir M, Starke RM, Rynkowski M, Komotar RJ, Otten ML, Sciacca R, Schmidt JM, Mayer SA, Connolly ES

Object Despite efforts to elucidate both the molecular mechanism and the clinical predictors of vasospasm after aneurysmal subarachnoid hemorrhage (ASAH), its pathogenesis remains unclear. Monocyte chemoattractant protein-1 (MCP-1) is a chemokine that has been firmly implicated in the pathophysiology of vasospasm and in neural tissue injury following focal ischemia in both animal models and human studies. The authors hypothesized that MCP-1 would be found in increased concentrations in the blood and cerebrospinal fluid (CSF) of patients with ASAH and would correlate with both outcome and the occurrence of vasospasm. Methods Seventy-seven patients who presented with ASAH were prospectively enrolled in this study between July 2001 and May 2002. Using an enzyme-linked immunosorbent assay, MCP-1 levels were measured in serum daily and in CSF when available. The mean serum and CSF MCP-1 concentrations were calculated for each patient throughout the entire hospital stay. Neurological outcome was evaluated at discharge or 14 days posthemorrhage using the modified Rankin Scale. Vasospasm was evaluated on angiography. Results The serum MCP-1 concentrations correlated with negative outcome such that a 10% increase in concentration predicted a 25% increase in the probability of a poor outcome, whereas the serum MCP-1 levels did not correlate with vasospasm. Concentrations of MCP-1 in the CSF, however, proved to be significantly higher in patients with angiographically demonstrated vasospasm. Conclusions These findings suggest a role for MCP-1 in neurological injury and imply that it may act as a biomarker of poor outcome in the serum and of vasospasm in the CSF.

PMID: 18593272 [PubMed - in process]

(Source: Journal of Neurosurgery)

The importance of the cortical subarachnoid space in understanding hydrocephalus.

Journal of neurosurgery. Pediatrics — Tue, 01 Jul 2008 04:00:00 +0100

The importance of the cortical subarachnoid space in understanding hydrocephalus.

J Neurosurg Pediatrics. 2008 Jul;2(1):1-11

Authors: Rekate HL, Nadkarni TD, Wallace D

Object In this paper the authors define the role of the cortical subarachnoid space (CSAS) in poorly understood forms of hydrocephalus to cerebrospinal fluid (CSF) dynamics to improve understanding of the importance of the CSAS and its role in selecting patients for endoscopic third ventriculostomy (ETV). The secondary purpose of this work was to define testable hypotheses to explain enigmatic disorders of CSF dynamics and to suggest how these concepts could be tested. Methods The magnitude of the contribution of the CSAS is explored using the solid geometry of concentric spheres. With this starting point, clinical conditions in which CSF dynamics are not easily understood are explored regarding the potential role of the CSAS. Overall, problems of CSF dynamics are easily understood. Insights may be gained when the results of a pathological process or its treatment vary from what has been expected. Results Acute changes in ventricular volume at the time that hydrocephalus develops, the failure of shunts, and the changes in ventricular volume with shunt repair may occur very rapidly. Changes in the volume of water in the brain, especially in the brain substance itself, are unlikely to occur at this rapid rate and may be interpreted as a simple redistribution of the CSF between the ventricle and CSAS with no initial change in the actual volume of brain parenchyma. Problems such as pseudotumor cerebri, shunt failure with nonresponsive ventricles, and negative-pressure hydrocephalus can be explained by assessing the ability of ventricular CSF to flow to the CSAS and the ability of this fluid to exit this compartment. Ventricular enlargement at the time of shunt failure implies a failure of flow between the ventricles and CSAS, implying that all patients who show this phenomenon are potential candidates for ETV. Conclusions The important role of the CSAS in the pathophysiology of various forms of hydrocephalus has been largely ignored. Attention to the dynamics of the CSF in this compartment will improve understanding of enigmatic conditions of hydrocephalus and improve selection criteria for treatment paradigms such as ETV. These concepts lead to clearly defined problems that may be solved by the creation of a central database to address these issues.

PMID: 18590387 [PubMed - as supplied by publisher]

(Source: Journal of neurosurgery. Pediatrics)

Hydrocephalus and adjustable valves.

Journal of neurosurgery. Pediatrics — Tue, 01 Jul 2008 04:00:00 +0100

Hydrocephalus and adjustable valves.

J Neurosurg Pediatrics. 2008 Jul;2(1):12-3

Authors: Rekate HL

PMID: 18590388 [PubMed - in process]

(Source: Journal of neurosurgery. Pediatrics)

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Management of hydrocephalus in infants by using shunts with adjustable valves.

Journal of neurosurgery. Pediatrics — Tue, 01 Jul 2008 04:00:00 +0100

Management of hydrocephalus in infants by using shunts with adjustable valves.

J Neurosurg Pediatrics. 2008 Jul;2(1):14-8

Authors: Weinzierl MR, Rohde V, Gilsbach JM, Korinth M

Object Previous reports suggest that the use of adjustable differential-pressure valves may improve shunt performance. The absence of a flow- or siphon-controlled mechanism, however, is a concern. The goal of this prospective study was to assess the efficacy of valve adjustments in preventing slitlike ventricles in children < 6 months old after the first shunt insertion. Methods A total of 15 infants < 6 months of age who were undergoing initial shunt placement were included. Imaging was performed preoperatively, at 14 days postoperatively, and every 4 weeks thereafter. Ventricle size was assessed using ultrasonography and MR imaging or cerebral CT scanning at 1 and 2 years postoperatively. Clinical follow-up duration was 24 months for all patients. Valve settings were changed by 50 mm H(2)O if ventricle size decreased by 30% compared to preoperative size. Results The valve pressure setting was increased to 200 mm H(2)O in 11 children within the follow-up time, whereas ventricle size decreased from 0.6 +/- 0.08 to 0.39 +/- 0.09 (frontal/occipital horn ratio, mean +/- standard deviation). There was neither clinical nor radiological evidence of underdrainage. Conclusions The adjustable differential-pressure valve used in this study was not effective in preventing slitlike ventricles in the majority of patients. Despite the small number of patients, this study provides a rationale for examining whether new shunt designs (gravitational shunt valves) are superior to conventional shunt systems in managing challenging hydrocephalus problems.

PMID: 18590389 [PubMed - in process]

(Source: Journal of neurosurgery. Pediatrics)

Concurrent use of a lumboperitoneal shunt with programmable valve and ventricular access device in the treatment of pseudotumor cerebri: review of 40 cases.

Journal of neurosurgery. Pediatrics — Tue, 01 Jul 2008 04:00:00 +0100

Concurrent use of a lumboperitoneal shunt with programmable valve and ventricular access device in the treatment of pseudotumor cerebri: review of 40 cases.

J Neurosurg Pediatrics. 2008 Jul;2(1):19-24

Authors: Nadkarni TD, Rekate HL, Wallace D

Object The authors evaluated the efficacy of treating patients with pseudotumor cerebri (PTC) and headaches due to increased intracranial pressure (ICP) by using a lumboperitoneal (LP) shunt with a programmable valve and ventricular access device (VAD). Methods Forty patients in whom PTC was diagnosed were treated using LP shunts with programmable valves and wand-guided placement of a VAD. All patients had papilledema and high opening pressure during spinal tap. The mean follow-up was 18 months (range 3-72 months). When patients complained of headaches that suggested shunt malfunction, the ventricular reservoir was tapped at bedside to assess ICP. The programmable valve was adjusted based on the patient's headache and ICP. Results The VAD was tapped in 21 patients, and the LP valve was redialed in 14. Shunt malfunction was diagnosed accurately. The 10 patients undergoing revision were all found to have shunt obstruction except 1 whose valve was replaced because it could not be reprogrammed. No patient treated with a shunt developed a Chiari malformation. The VAD was exposed in 4 patients with infection or wound breakdown. The LP shunt was revised in 2 patients who developed a pseudomeningocele. In 1 patient, a small bowel obstruction responded to conservative management. Seven patients had headaches despite documented normal ICP. That is, the headaches were unrelated to shunt function, and these patients were referred to a pain management clinic. Conclusions Lumboperitoneal shunts with programmable valves effectively controlled the outflow of lumbar cerebrospinal fluid to ameliorate the symptoms of PTC. The VAD permitted assessment of ICP and thus, indirectly, LP shunt function, and benefits outweighed risks. The programmable valve permitted cerebrospinal fluid flow to be adjusted based on patients' clinical status and ICP to be measured by the VAD.

PMID: 18590390 [PubMed - as supplied by publisher]

(Source: Journal of neurosurgery. Pediatrics)

Efficacy of intraoperative wound irrigation for preventing shunt infection.

Journal of neurosurgery. Pediatrics — Tue, 01 Jul 2008 04:00:00 +0100

Efficacy of intraoperative wound irrigation for preventing shunt infection.

J Neurosurg Pediatrics. 2008 Jul;2(1):25-8

Authors: Hayashi T, Shirane R, Kato T, Tominaga T

Object Although a cerebrospinal fluid shunt procedure is one of the most frequently performed operations in pediatric neurosurgery, the infection rate due to the procedure is not low. The authors have hypothesized that the key to reducing surgical shunt infections is to reduce bacteria from the operating field and wound. This hypothesis has been tested in a prospective nonrandomized controlled study at the authors' department. Methods Beginning in August 2006, during shunt procedures the authors began routinely irrigating the operating field and wound with amikacin containing saline, using a jet of fluid from a syringe. Prior to this new routine no irrigation techniques were used, providing an adequate control group for comparing the effect of the irrigation technique. Data obtained in all patients undergoing shunt insertions or revisions for hydrocephalus performed between October 1, 2003, and November 30, 2007, were reviewed. Results A total of 101 shunt procedures were performed in 63 patients (34 females and 29 males) during the study period. The mean age of all patients was 48.2 +/- 61.8 months. A total of 61 shunt procedures were performed before August 2006, and 40 were performed after August 2006. There was no statistical difference between the ages of patients in the 2 groups (p = 0.64). Eight total infections occurred during the 90 days of the postoperative period (7.9% overall infection rate). All 8 infections occurred before implementation of the irrigation technique (13.1% infection rate), but no infections were noted after beginning use of the irrigation procedure (0% infection rate). There was a statistically significant difference in the infection rate between the 2 groups (p = 0.021). Conclusions Use of an irrigation strategy aimed at reducing bacteria from the operating field and wound can be considered an effective procedure for preventing shunt infection.

PMID: 18590391 [PubMed - in process]

(Source: Journal of neurosurgery. Pediatrics)

Changing the paradigm of 1-stage total callosotomy for the treatment of pediatric generalized epilepsy.

Journal of neurosurgery. Pediatrics — Tue, 01 Jul 2008 04:00:00 +0100

Changing the paradigm of 1-stage total callosotomy for the treatment of pediatric generalized epilepsy.

J Neurosurg Pediatrics. 2008 Jul;2(1):29-36

Authors: Shim KW, Lee YM, Kim HD, Lee JS, Choi JU, Kim DS

Object The authors propose that anterior callosotomy-thought to have some advantages over total callosotomy-is not superior to total callosotomy for prevention of seizure propagation or other complications. Methods The study comprised 34 patients in whom generalized epilepsy syndrome or frontal lobe seizures with a secondary generalization were diagnosed. Preoperatively, all patients suffered from disabling drop attacks or intense head-drop seizures, and some patients also experienced other types of seizures. The male/female ratio was 22:12, and patients ranged in age between 1 to 19 years (mean 8.7 years). The follow-up period ranged from 1.08 to 5.0 years (mean 2.58 years). Seizure outcome, parental assessment of daily function, and parental satisfaction with the outcome was assessed postoperatively. Results After undergoing 1-stage total callosotomy, drop attacks disappeared completely in 25 patients during the follow-up period, and in 6 patients the frequency of drop attacks decreased to < 10% of baseline. With regard to other types of seizures, seizures resolved completely in 12 patients, and in another 18 seizure frequency decreased. Two patients experienced a transient disconnection syndrome for 2 and 4 weeks. One patient experienced ataxic hemiparesis for 3 weeks before it completely abated. The overall daily function of the patients improved, and all parents were satisfied with the surgical outcome. Conclusions For pediatric generalized epilepsy syndrome, 1-stage total callosotomy will be the first choice in treatment for controlling generalized seizures.

PMID: 18590392 [PubMed - in process]

(Source: Journal of neurosurgery. Pediatrics)

Effect of preoperative skull block on pediatric moyamoya disease.

Journal of neurosurgery. Pediatrics — Tue, 01 Jul 2008 04:00:00 +0100

Effect of preoperative skull block on pediatric moyamoya disease.

J Neurosurg Pediatrics. 2008 Jul;2(1):37-41

Authors: Ahn HJ, Kim JA, Lee JJ, Kim HS, Shin HJ, Chung IS, Kim JK, Gwak MS, Choi SJ

Object Stable hemodynamics, normocapnia, and adequate pain relief are considered important factors in the reduction of neurological complications in pediatric patients undergoing encephaloduroarteriomyosynangiosis (EDAMS) operations for the treatment of moyamoya disease. A preoperative skull block may reduce hemodynamic fluctuations and hypo- or hyperventilation due to emergence delirium or oversedation and provide adequate pain relief, thereby reducing postoperative morbidity. Methods Pediatric patients (age 3-13 years) undergoing EDAMS surgery for moyamoya disease were randomly divided into a nerve block (NB) group (18 cases) or control group (21 cases). The treatment group patients received a preoperative NB (0.25% 5-8 ml bupivacaine mixed with 20-40 mg methylprednisolone) targeting the supraorbital, supratrochlear, auriculotemporal, and posterior auricular nerves. Patients in the control group did not receive NB. General anesthesia with sevoflurane was induced in both groups. Results In the NB group, stable hemodynamic parameters were obtained with a lower sevoflurane concentration than in the control group. For delirious awakening, the odds ratio in the control group was 4.9 compared with the NB group. Pain and analgesic requirement were higher in the control patients than in the NB-treated patients during the postanesthesia care unit stay. However, the arterial CO(2) tension in the postanesthesia care unit did not differ between the 2 groups. The odds ratio in the control group for the rate of morbidity (cerebral infarction and reversible ischemic neurological deficits) during the first 24 hours following the operation was 3.2 compared with the NB group. Conclusions The use of skull block during EDAMS surgery provided easy hemodynamic control, calm awakening, and better pain relief and may be related to the reduced postoperative morbidity.

PMID: 18590393 [PubMed - in process]

(Source: Journal of neurosurgery. Pediatrics)

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Comparison of posterior fossa decompression with and without duraplasty for the surgical treatment of chiari malformation type i in pediatric patients: a meta-analysis.

Journal of neurosurgery. Pediatrics — Tue, 01 Jul 2008 04:00:00 +0100

Comparison of posterior fossa decompression with and without duraplasty for the surgical treatment of Chiari malformation Type I in pediatric patients: a meta-analysis.

J Neurosurg Pediatrics. 2008 Jul;2(1):42-9

Authors: Durham SR, Fjeld-Olenec K

Object Surgery for Chiari malformation Type I (CM-I) is one of the most common neurosurgical procedures performed in children, although there is clearly no consensus among practitioners about which surgical method is preferred. The objective of this meta-analysis was to compare the outcome of posterior fossa decompression with duraplasty (PFDD) and posterior fossa decompression without duraplasty (PFD) for the treatment of CM-I in children. Methods The authors searched Medline-Ovid, The Cochrane Library, and the conference proceedings of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons (2000-2007) for studies meeting the following inclusion criteria: 1) surgical treatment of CM-I; 2) surgical techniques of PFD and PFDD being reported in a single cohort; and 3) patient age < 18 years. Results Five retrospective and 2 prospective cohort studies involving a total of 582 patients met the criteria for inclusion in the meta-analysis. Of the 582 patients, 316 were treated with PFDD and 266 were treated with PFD alone. Patient age ranged from 6 months to 18 years. Patients undergoing PFDD had a significantly lower reoperation rate (2.1 vs 12.6%, risk ratio [RR] 0.23, 95% confidence interval [CI] 0.08-0.69) and a higher rate of cerebrospinal fluid-related complications (18.5 vs 1.8%, RR 7.64, 95% CI 2.53-23.09) than those undergoing PFD. No significant differences in either clinical improvement (78.6 vs 64.6%, RR 1.23, 95% CI 0.95-1.59) or syringomyelia decrease (87.0 vs 56.3%, RR 1.43, 95% CI 0.91-2.25) were noted between PFDD and PFD. Conclusions Posterior fossa decompression with duraplasty is associated with a lower risk of reoperation than PFD but a greater risk for cerebrospinal fluid-related complications. There was no significant difference between the 2 operative techniques with respect to clinical improvement or decrease in syringomyelia.

PMID: 18590394 [PubMed - in process]

(Source: Journal of neurosurgery. Pediatrics)

Surgical management of the chiari malformation type i-the way forward.

Journal of neurosurgery. Pediatrics — Tue, 01 Jul 2008 04:00:00 +0100

Surgical management of the Chiari malformation Type I-the way forward.

J Neurosurg Pediatrics. 2008 Jul;2(1):50-1

Authors: Piatt JH

PMID: 18590395 [PubMed - in process]

(Source: Journal of neurosurgery. Pediatrics)

Intraoperative ultrasonography as a guide to patient selection for duraplasty after suboccipital decompression in children with chiari malformation type i.

Journal of neurosurgery. Pediatrics — Tue, 01 Jul 2008 04:00:00 +0100

Intraoperative ultrasonography as a guide to patient selection for duraplasty after suboccipital decompression in children with Chiari malformation Type I.

J Neurosurg Pediatrics. 2008 Jul;2(1):52-7

Authors: McGirt MJ, Attenello FJ, Datoo G, Gathinji M, Atiba A, Weingart JD, Carson B, Jallo GI

Object Indications for duraplasty in treatment of Chiari malformation Type I (CM-I) remain unclear. In the present study, the authors evaluate their surgical experience to determine whether intraoperative ultrasonography is effective in the selection of patients with CM-I who can be adequately treated with craniectomy alone without duraplasty. Methods The authors reviewed the records of 256 children who underwent first-time hindbrain decompression for CM-I. Craniectomy alone (without duraplasty) was performed when intraoperative ultrasonography suggested adequate decompression of the subarachnoid spaces ventral and dorsal to the tonsils after suboccipital craniectomy alone. Duraplasty was performed if intraoperative ultrasonography demonstrated persistent dural compression of the tonsils following craniectomy. Symptom recurrence as a function of time was compared between cases of duraplasty versus suboccipital decompression alone stratified by extent of tonsillar herniation. Results Duraplasty was performed in 140 patients (55%), and suboccipital decompression alone was performed in 116 patients (45%). Patients underwent follow-up for 29 +/- 15 months. Symptoms included headache in 192 patients (75%) and lower cranial nerve and brainstem dysfunction in 68 (27%). In 38 patients (15%) there was tonsillar herniation rostral to the C-1 lamina, in 195 (76%) it extended between the C-1 and C-2 lamina, and in 23 patients (9%) there was herniation caudal to the lower border of the C-2 lamina. In children with tonsillar herniation caudal to C-1, ultrasonography-guided suboccipital decompression alone was associated with a 2-fold increase in the risk of symptom recurrence compared with those who also underwent duraplasty (p = 0.01). In children with tonsillar herniation rostral to C-1, outcome was equivalent between suboccipital decompression alone and duraplasty (p = 0.41). Conclusions In the setting of moderate-to-severe tonsillar CM-I, intraoperative ultrasonography demonstrating decompression of the subarachnoid spaces ventral and dorsal to the tonsils may not effectively select patients in whom bone decompression alone is sufficient. Duraplasty may be warranted in cases of tonsillar herniation that extends below the C-1 lamina regardless of intraoperative ultrasonography findings. More objective cerebrospinal fluid flow or volumetric measures may be needed intraoperatively to guide duraplasty in patients with more pronounced tonsillar herniation.

PMID: 18590396 [PubMed - in process]

(Source: Journal of neurosurgery. Pediatrics)

Combined endoscopy-assisted cranionasal approach for resection of infantile myofibromatosis of the ethmoid and anterior skull base.

Journal of neurosurgery. Pediatrics — Tue, 01 Jul 2008 04:00:00 +0100

Combined endoscopy-assisted cranionasal approach for resection of infantile myofibromatosis of the ethmoid and anterior skull base.

J Neurosurg Pediatrics. 2008 Jul;2(1):58-62

Authors: Galassi E, Pasquini E, Frank G, Marucci G

The advent and widespread development of endonasal endoscopic techniques have recently expanded the frontiers of skull base surgery. The reduced invasiveness, wider and adjustable visualization of the operative field, and lack of postoperative cosmetic defects are well-known advantages of the endonasal endoscopic approaches compared with traditional surgical exposures both in adults and in children. The need to avoid disruption of facial growth centers and permanent tooth roots represents a further special consideration in favor of these endoscopic techniques in children. The authors report on a case of solitary myofibroma involving the ethmoid, mesial orbits, and anterior skull base with intracranial intradural expansion in a 17-month-old girl. The occurrence of such proliferative disease along the skull base is exceedingly rare. The tumor was successfully excised via an endoscopy-assisted cranionasal approach in which a transcranial microsurgical exposure was combined with endonasal endoscopic access to ensure a radical resection and optimize skull base reconstruction. To the authors' knowledge, the patient in this case is the youngest reported patient in the literature who has undergone treatment with this surgical strategy. The outcome in this patient underscores the feasibility and safety of endoscopic endonasal surgery even in toddlers and early childhood.

PMID: 18590397 [PubMed - in process]

(Source: Journal of neurosurgery. Pediatrics)

Extraventricular neurocytoma in neurofibromatosis type 1.

Journal of neurosurgery. Pediatrics — Tue, 01 Jul 2008 04:00:00 +0100

Extraventricular neurocytoma in neurofibromatosis Type 1.

J Neurosurg Pediatrics. 2008 Jul;2(1):63-7

Authors: Raja AI, Yeaney GA, Jakacki RI, Hamilton RL, Pollack IF

Neurocytomas are rare tumors of the central nervous system that are typically located in the ventricular system. The authors report a case of a child with neurofibromatosis Type 1 (NF1) who had a tumor of the optic nerves and chiasm with signal abnormality extending through the diencephalon, as well as an occipital lobe mass, which was presumed to be part of the visual pathway neoplasm. Because the occipital lobe lesion slowly increased in size over time, while the other areas remained stable, a biopsy was performed. Pathological evaluation revealed an extraventricular neurocytoma of extraventricular neurocytoma. To the authors' knowledge, neurocytomas have not been previously reported in patients with NF1. Because visual pathway gliomas are extremely common in children with NF1, they are often treated empirically as low-grade gliomas without histological confirmation. The importance of obtaining a biopsy in lesions that have atypical imaging features is highlighted.

PMID: 18590398 [PubMed - in process]

(Source: Journal of neurosurgery. Pediatrics)

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Ventriculoatrial shunt catheter displacement in a child with partial anomalous pulmonary venous return.

Journal of neurosurgery. Pediatrics — Tue, 01 Jul 2008 04:00:00 +0100

Ventriculoatrial shunt catheter displacement in a child with partial anomalous pulmonary venous return.

J Neurosurg Pediatrics. 2008 Jul;2(1):68-70

Authors: Elhammady MS, Benglis DM, Bhatia S, Sandberg DI, Ragheb J

Ventriculoatrial (VA) shunts remain the most used alternative to ventriculoperitoneal shunts in infants with hydrocephalus. The authors report a case of an acute VA shunt malfunction as a result of distal catheter displacement in an 18-month-old girl with partial anomalous pulmonary venous return. The child presented with respiratory compromise, and a chest radiograph revealed a lung infiltrate and normal position of the distal shunt catheter tip. Computed tomography demonstrated stable ventricle size in comparison with previous studies. As the patient's respiratory distress progressed, she required intubation, mechanical ventilation with high airway pressures and inspired oxygen concentrations, muscle relaxants, and sedation. A routine morning chest radiograph several days after admission revealed displacement of the distal catheter into the left innominate vein. Later that day the child's pupils were noted to be large and unreactive and a distal shunt malfunction was diagnosed. Complications of VA shunts and the presumed mechanism by which the catheter became displaced are discussed.

PMID: 18590399 [PubMed - in process]

(Source: Journal of neurosurgery. Pediatrics)

Retrieval of ventricular catheter with the aid of endoscopy.

Journal of neurosurgery. Pediatrics — Tue, 01 Jul 2008 04:00:00 +0100

Retrieval of ventricular catheter with the aid of endoscopy.

J Neurosurg Pediatrics. 2008 Jul;2(1):71-4

Authors: Pettorini BL, Frassanito P, Tamburrini G, Massimi L, Caldarelli M, Di Rocco C

Multilocular hydrocephalus usually requires placement of multiple ventricular catheters for the treatment of secondary cysts and intraventricular septation. The formation of strong adhesions can embed the catheters so that they cannot be removed without a higher risk of intraventricular hemorrhage. Moreover, the devices could represent a nidus for infection and a risk for formation and enlargement of intraventricular secondary cysts. Neuroendoscopy allows the surgeon safely to reach the ventricular catheters that have been left or lost in the ventricular cavity, and to remove them via a minimally invasive approach. In this paper, the authors document another application of ventricular endoscopy in the management of this kind of hydrocephalus. The removal of an unnecessary and no longer useful prosthetic device that is a possible focus of infection justifies endoscopic treatment, which, in this experience, is not associated with morbidity.

PMID: 18590400 [PubMed - in process]

(Source: Journal of neurosurgery. Pediatrics)

Quantitative diffusion tensor imaging and intellectual outcomes in spina bifida.

Journal of neurosurgery. Pediatrics — Tue, 01 Jul 2008 04:00:00 +0100

Quantitative diffusion tensor imaging and intellectual outcomes in spina bifida.

J Neurosurg Pediatrics. 2008 Jul;2(1):75-82

Authors: Hasan KM, Sankar A, Halphen C, Kramer LA, Ewing-Cobbs L, Dennis M, Fletcher JM

Object Patients with spina bifida (SB) have variable intellectual outcomes. The authors used diffusion tensor (DT) imaging to quantify whole-brain volumes of gray matter, white matter, and cerebrospinal fluid (CSF), and perform regional quantitative microstructural assessments of gray matter nuclei and white matter tracts in relation to intellectual outcomes in patients with SB. Methods Twenty-nine children with myelomeningoceles and 20 age- and sex-matched children with normal neural tube development underwent MR imaging with DT image acquisition and assessments of intelligence. The DT imaging-derived metrics were the fractional anisotropy (FA), axial (parallel), and transverse (perpendicular) diffusivities. These metrics were also used to segment the brain into white matter, gray matter, and CSF. A region-of-interest analysis was conducted of the white and gray matter structures implicated in hydrocephalus. Results The amount of whole-brain gray matter was decreased in patients with SB, with a corresponding increase in CSF (p < 0.0001). Regional transverse diffusivity in the caudate nucleus was decreased (p < 0.0001), and the corresponding FA was increased (p < 0.0001), suggesting reduced dendritic branching and connectivity. Fractional anisotropy in the posterior limb of the internal capsule increased in the myelomeningocele group (p = 0.02), suggesting elimination of some divergent fascicles; in contrast, the FA in several white matter structures (such as the corpus callosum genu [p < 0.001] and arcuate fasciculus) was reduced, suggesting disruption of myelination. Diffusion tensor imaging-metrics involving gray matter volume and the caudate nucleus, but not other structures, predicted variations in IQ (r = 0.37-0.50; p < 0.05). Conclusions Diffusion tensor imaging-derived metrics provide noninvasive neuronal surrogate markers of the pathogenesis of SB and predict variations in general intellectual outcomes in children with this condition.

PMID: 18590401 [PubMed - in process]

(Source: Journal of neurosurgery. Pediatrics)

Intracranial pressure waves: characterization of a pulsation absorber with notch filter properties using systems analysis.

Journal of neurosurgery. Pediatrics — Tue, 01 Jul 2008 04:00:00 +0100

Intracranial pressure waves: characterization of a pulsation absorber with notch filter properties using systems analysis.

J Neurosurg Pediatrics. 2008 Jul;2(1):83-94

Authors: Zou R, Park EH, Kelly EM, Egnor M, Wagshul ME, Madsen JR

Object The relationship between the waveform of intracranial pressure (ICP) and arterial blood pressure can be quantitatively characterized using a newly developed technique in systems analysis, the time-varying transfer function. This technique considers the arterial blood pressure as an input signal composed of multiple frequencies represented in the output ICP according to the transfer function imposed by the intracranial system on the input signal. The transfer function can change with time and with physiological manipulations. The authors examined data obtained from canine experiments involving manipulations of ICP. Methods The authors analyzed 11 experiments from 3 normal mongrel dogs under conditions of normal ICP and with changes in ICP made by bolus injection, infusion, or withdrawal of cerebrospinal fluid by using time-varying transfer function. Results During normal ICP periods, the gain of the transfer function displayed a deep notch (>/= 1 log unit) centered at or near the cardiac frequency. In systems terms, the intracranial compartment under normal conditions appears to act as a notch filter attenuating the cardiac frequency input relative to other frequencies. Epochs of ICP elevation showed suppression of the notch, and the notch was restored when ICP returned to normal. Conclusions The intracranial system in these animals could be considered to include a pulsation absorber for which the target frequency appears to be close to the cardiac frequency. One possible source for such an absorber mechanism might be the free movement of cerebrospinal fluid, implying that impairment of this motion may have important clinical implications in various neurological conditions such as hydrocephalus.

PMID: 18590402 [PubMed - in process]

(Source: Journal of neurosurgery. Pediatrics)

Achondroplasia.

Journal of neurosurgery. Pediatrics — Tue, 01 Jul 2008 04:00:00 +0100

Achondroplasia.

J Neurosurg Pediatrics. 2008 Jul;2(1):95

Authors: Thomeer RT, van Dijk JM, Peul WC

Object Achondroplasia is a hereditary form of dwarfism caused by a defect in endochondral bone formation, resulting in skeletal abnormalities including short stature, shortened limb bones, macrocephaly, and small vertebral bodies. In the pediatric population, symptomatic spinal stenosis occurs at all spinal levels due to the abnormally narrow bone canal. In this study, clinical outcomes were assessed in children with achondroplasia after spinal canal decompression. Methods A retrospective review was conducted involving pediatric patients with heterozygous achondroplasia and symptomatic stenosis after decompressive procedures at the authors' institution within a 9-year period. Measured outcomes included resolution of symptoms, need for repeated surgery, presence of fusion, development of deformity, and complications. Forty-four pediatric patients underwent a total of 60 decompressive procedures. The average patient age at surgery was 12.7 years (range 5-21 years). Forty-nine operations were performed for initial treatment of stenosis, and 11 were performed as revision surgeries on previously operated levels. A large proportion of patients (> 60%) required additional cervicomedullary decompressions, most often preceding the symptoms of spinal stenosis. Of the initial procedures, decompression locations included 32 thoracolumbar (65%), 10 lumbar (20%), four cervical (8%), two cervicothoracic (4%), and one thoracic (2%). Forty-three of the decompressive procedures (72%) included spinal fusion procedures. Of the 11 revisions, five were fusion procedures for progressive deformity at levels previously decompressed but not fused (all thoracolumbar), five were for decompressions of symptomatic junctional stenosis with extension of fusion, and one was for repeated decompression at the same level due to recurrence of symptomatic stenosis. Conclusions Decompression of the spinal canal in pediatric patients with achondroplasia can be accomplished safely with significant clinical benefit. Patients with a history of cervicomedullary compression may be at an increased risk of developing symptomatic stenosis prior to adolescence. Fusion procedures are recommended in patients with a large decompression overlying a thoracolumbar kyphosis to avoid progressive postoperative deformity.

PMID: 18590403 [PubMed - in process]

(Source: Journal of neurosurgery. Pediatrics)

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Craniocervical junction fusions in patients with hindbrain herniation and syringohydromyelia.

Journal of Neurosurgery.Spine — Tue, 01 Jul 2008 04:00:00 +0100

Craniocervical junction fusions in patients with hindbrain herniation and syringohydromyelia.

J Neurosurg Spine. 2008 Jul;9(1):1-9

Authors: Fenoy AJ, Menezes AH, Fenoy KA

Object Patients with hindbrain herniation or the so-called Chiari malformation Type I (CM-I) and/or syringohydromyelia are treated with dorsal decompression alone; however, a small percentage of patients with other associated abnormalities require concomitant dorsal craniocervical junction (CCJ) fusion. The authors surveyed the indications for CCJ fusions in this population. Methods A retrospective review of University of Iowa medical records and radiographs obtained between 1996 and 2005 was performed. Inclusion criteria encompassed patients with diagnoses of CM-I and/or syringohydromyelia requiring dorsal CCJ fusions, and others with CCJ abnormalities who had CM-I and/or syringohydromyelia. Results Two hundred thirty-four patients were identified, all of whom were symptomatic at presentation. Their ages ranged from 2.5 to 86 years; 33% of the patients were < 16 years of age. Patients were categorized as follows, with some being assigned to > 1 category: Group I, congenital or acquired CCJ abnormalities with reducible bone compression (25% of patients); Group II, previous anterior CCJ/upper brainstem decompression (44%); Group III, occipitocervical complex instability with CM-I and/or syringohydromyelia but without CCJ bone abnormalities requiring adjunctive posterior fossa decompression (26%); and Group IV, musculoligamentous instability, either from pathological states or from muscle dehiscence from repeated posterior fossa procedures (14%). Instrumentation was used in 96% of patients, with all 96% receiving semirigid fixation with titanium loop and sublaminar cables; all fusion constructs incorporated autologous bone. At last follow-up evaluation, fusion was radiographically complete in 97%, and symptom improvement was seen in 92%. Conclusions Dorsal CCJ fusions are required in patients with CM-I and/or syringohydromyelia who have concomitant CCJ abnormalities (Groups I and II). A definite group (CM-I and/or syringohydromyelia) without bone abnormality exists (Groups III and IV). This may be due to muscle weakness secondary to a high syrinx.

PMID: 18590404 [PubMed - in process]

(Source: Journal of Neurosurgery.Spine)

Impact of preoperative neurological status on perioperative morbidity associated with anterior and posterior cervical fusion.

Journal of Neurosurgery.Spine — Tue, 01 Jul 2008 04:00:00 +0100

Impact of preoperative neurological status on perioperative morbidity associated with anterior and posterior cervical fusion.

J Neurosurg Spine. 2008 Jul;9(1):10-16

Authors: Shamji MF, Cook C, Tackett S, Brown C, Isaacs RE

Object Cervical spine fusion is performed for various indications in patient populations ranging from young and healthy to aged and frail. Whereas disease pathoanatomy dictates the surgical approach, preoperative neurological status does not necessarily implicate a specific technique. Although one expects anterior decompression to be performed over fewer segments in healthier patients who experience fewer complications and faster recovery, the impact of pre-operative myelopathy on perioperative complications remains unclear. No large-scale study has evaluated rates of common complications for cervical fusion or their association with surgical approach and neurological status. Methods Data for 96,773 patients who underwent cervical fusion for degenerative disease between 1988 and 2003 were collected from the Nationwide Inpatient Sample database. Patients were grouped according to surgical approach (anterior versus posterior) and preoperative neurological status (myelopathic versus nonmyelopathic). Multivariate regression was used to evaluate group effects on selected postoperative complications, length of stay, and disposition at the time of hospital discharge. Although this technique can control for the observed covariates, the absence of key information such as the number of fused levels precludes statistical comparison between patients who underwent anterior or posterior approaches. Results In this study the authors confirmed that preoperative neurological status impacts perioperative morbidity. For example, patients who were nonmyelopathic and underwent an anterior approach were 7 years younger than the rest of the cohort, and they had a mortality rate of 0.05%. Transfusion was required in 0.34%, and venous thromboembolism occurred in 0.04%. Conversely, these rates were > 13-fold higher in patients with myelopathy who underwent a posterior approach. Furthermore, independent of approach, preoperative myelopathy is highly prognostic of death, pneumonia, transfusion, infection, length of stay, and posthospital disposition. These outcomes at least doubled, with some increasing > 10-fold. Conclusions This nationwide study clarifies the frequency and associations of inpatient complications encountered when treating cervical spine disease. Whereas immediate complications due to anterior approaches are limited, patients with myelopathy who undergo a posterior approach have a more sobering outlook. This study shows that clinical myelopathy augments rates of complication during cervical fusion, regardless of the approach. The exclusion of pathoanatomical data from the Nationwide Inpatient Sample database, of key importance in guiding the surgical approach, prevents any conclusions being drawn about the merits and disadvantages of anterior versus posterior surgery.

PMID: 18590405 [PubMed - as supplied by publisher]

(Source: Journal of Neurosurgery.Spine)

Rheumatoid arthritis as a risk factor for a narrow c-2 pedicle: 3d analysis of the c-2 pedicle screw trajectory.

Journal of Neurosurgery.Spine — Tue, 01 Jul 2008 04:00:00 +0100

Rheumatoid arthritis as a risk factor for a narrow C-2 pedicle: 3D analysis of the C-2 pedicle screw trajectory.

J Neurosurg Spine. 2008 Jul;9(1):17-21

Authors: Miyata M, Neo M, Ito H, Yoshida M, Fujibayashi S, Nakamura T

Object Vertebral artery (VA) injury is a potentially serious complication of C-2 pedicle screw (PS) fixation. Although this surgery is frequently performed in patients with rheumatoid arthritis (RA), few studies have compared the risk of VA injury in patients with and without RA. In this study, the authors compare the morphological risk of VA injury relating to C-2 PS fixation in patients with and without RA. Methods A total of 110 3D CT images of the cervical spine including the axis were evaluated. Fifty patients with RA and 60 patients without RA were included in the study. The maximum PS diameter (MPSD) that could be used at C-2 without breaching the cortex was measured in 3D using a computer-assisted navigation system. A narrow-pedicle carrier was defined as a patient with an MPSD of 4 mm or less. Results In the RA group, 42 of 100 MPSDs were </= 4 mm, and 30 of 50 patients (60%) were narrow-pedicle carriers. In the non-RA group, 10 of 120 MPSDs (8%) were </= 4 mm, and 8 of 60 (13%) patients were narrow-pedicle carriers. The MPSD, the anteroposterior (AP) diameter of C-3, and the ratio of MPSD to the AP diameter of C-3 were significantly smaller in the RA group than in the non-RA group. Multiple logistic regression analysis showed that RA and narrow C-3 AP diameter were significant risk factors for a narrow-pedicle carrier. Conclusions Rheumatoid arthritis is a significant risk factor for a narrow C-2 pedicle. When performing PS placement at C-2, particularly in patients with RA, thorough preoperative evaluation of the bone architecture is very important for avoiding inadvertent injury to the VA.

PMID: 18590406 [PubMed - in process]

(Source: Journal of Neurosurgery.Spine)

Nonsteroidal antiinflammatory drugs for postoperative pain management after lumbar spine surgery: a meta-analysis of randomized controlled trials.

Journal of Neurosurgery.Spine — Tue, 01 Jul 2008 04:00:00 +0100

Nonsteroidal antiinflammatory drugs for postoperative pain management after lumbar spine surgery: a meta-analysis of randomized controlled trials.

J Neurosurg Spine. 2008 Jul;9(1):22-31

Authors: Jirarattanaphochai K, Jung S

Object The authors undertook this meta-analysis to assess the efficacy and safety of nonsteroidal antiinflammatory drugs (NSAIDs) in addition to opioid analgesics on perioperative pain management in lumbar spine surgery. Methods The authors searched MEDLINE, Excerpta Medica (EMBASE), The Cochrane Library, CINAHL, PsycINFO, Allied and Complementary Medicine (AMED), and Science Citation Index Expanded databases. In addition, they manually searched key journals and their references. They included randomized trials comparing the use of NSAIDs in addition to opioid analgesics versus opioid analgesics alone after posterior lumbar discectomy, laminectomy, or spinal fusion. Two independent reviewers performed an assessment of the quality of the methods. Results Seventeen studies comprising 400 patients who received NSAIDs in addition to opioid analgesics and 389 patients receiving opioid analgesics alone were included. Patients receiving NSAIDs in addition to opioid analgesics had lower pain scores and consumed fewer opioids than the group receiving opioid analgesics alone. There was no difference in the incidence of adverse effects. Conclusions This meta-analysis provides evidence that the addition of NSAIDs to opioid analgesics in lumbar spine surgery provided better pain control than opioid analgesics alone.

PMID: 18590407 [PubMed - in process]

(Source: Journal of Neurosurgery.Spine)

Management of sciatica due to lumbar disc herniation in the netherlands: a survey among spine surgeons.

Journal of Neurosurgery.Spine — Tue, 01 Jul 2008 04:00:00 +0100

Management of sciatica due to lumbar disc herniation in the Netherlands: a survey among spine surgeons.

J Neurosurg Spine. 2008 Jul;9(1):32-39

Authors: Arts MP, Peul WC, Koes BW, Thomeer RT,

Object Although clinical guidelines for sciatica have been developed, various aspects of lumbar disc herniation remain unclear, and daily clinical practice may vary. The authors conducted a descriptive survey among spine surgeons in the Netherlands to obtain an overview of routine management of lumbar disc herniation. Methods One hundred thirty-one spine surgeons were sent a questionnaire regarding various aspects of different surgical procedures. Eighty-six (70%) of the 122 who performed lumbar disc surgery provided usable questionnaires. Results Unilateral transflaval discectomy was the most frequently performed procedure and was expected to be the most effective, whereas percutaneous laser disc decompression was expected to be the least effective. Bilateral discectomy was expected to be associated with the most postoperative low-back pain. Recurrent disc herniation was expected to be lowest after bilateral discectomy and highest after percutaneous laser disc decompression. Complications were expected to be highest after bilateral discectomy and lowest after unilateral transflaval discectomy. Nearly half of the surgeons preferentially treated patients with 8-12 weeks of disabling leg pain. Some consensus was shown on acute surgery in patients with short-lasting drop foot and those with a cauda equina syndrome, and nonsurgical treatment in patients with long-lasting, painless drop foot. Most respondents allowed postoperative mobilization within 24 hours but advised their patients not to resume work until 8-12 weeks postoperatively. Conclusions Unilateral transflaval discectomy was the most frequently performed procedure. Minimally invasive techniques were expected to be less effective, with higher recurrence rates but less postoperative low-back pain. Variety was shown between surgeons in the management of patients with neurological deficit. Most responding surgeons allowed early mobilization but appeared to give conservative advice in resumption of work.

PMID: 18590408 [PubMed - as supplied by publisher]

(Source: Journal of Neurosurgery.Spine)

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