Most Recent Articles Published on Neurosurgery

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A Parallel Study of mRNA and microRNA Profiling of Peripheral Blood in Young Adult Women.

Front Genet. 2011;2:49

Authors: Sredni ST, Gadd S, Jafari N, Huang CC

Abstract
Background: Aging is a complex process that involves the interplay of genetic, epigenetic, and environmental factors. Identifying aging-related biomarkers holds great potential for improving our understanding of complex physiological changes, thereby providing a means to investigate the mechanism by which aging influences various diseases. Method and Results: We performed a parallel study of microRNA and gene expression profiling of peripheral blood in a group of healthy young adult women, among which 13 were aged 22-25 and 9 were aged 36-39?years old. We identified a significantly distinct pattern of microRNA, but not gene expression profiling, between these two young adult women groups. We also performed correlation analysis of expression levels between all pairs of age-associated microRNAs and genes and identified a weak global correlation between these two types of expression levels. A significant involvement of estrogen regulation was observed by pathway analysis of the most differentially expressed microRNAs that included miR-155, -18a, -142, -340, -363, -195, and -24. Conclusion: Our results suggest that the change in global microRNA expression in the peripheral blood is associated with normal aging in young adult women. This change may precede global gene expression changes. Future studies are needed to investigate the regulatory mechanism of the estrogen-related microRNAs and associated diseases.

PMID: 22303345 [PubMed - in process]

Peripheral blood RNA expression profiling in illicit methcathinone users reveals effect on immune system.

Front Genet. 2011;2:42

Authors: Sikk K, Kõks S, Soomets U, Schalkwyk LC, Fernandes C, Haldre S, Aquilonius SM, Taba P

Abstract
Methcathinone (ephedrone) is relatively easily accessible for abuse. Its users develop an extrapyramidal syndrome and it is not known if this is caused by methcathinone itself, by side-ingredients (manganese), or both. In the present study we aimed to clarify molecular mechanisms underlying this condition. We used microarrays to analyze whole-genome gene expression patterns of peripheral blood from 20 methcathinone users and 20 matched controls. Gene expression profile data were analyzed by Bayesian modeling and functional annotation. Of 28,869 genes on the microarrays, 326 showed statistically significant differential expression with FDR adjusted p-values below 0.05. Quantitative real-time PCR confirmed differential expression for the most of the genes selected for validation. Functional annotation and network analysis indicated activation of a gene network that included immunological disease, cellular movement, and cardiovascular disease functions (enrichment score 42). As HIV and HCV infections were confounding factors, we performed additional stratification of subjects. A similar functional activation of the "immunological disease" category was evident when we compared subjects according to injection status (past versus current users, balanced for HIV and HCV infection). However, this difference was not large therefore the major effect was related to the HIV status of the subjects. Mn-methcathinone abusers have blood RNA expression patterns that mostly reflect their HIV and HCV infections.

PMID: 22303338 [PubMed - in process]

Cancellation of elective operations on the day of intended surgery in a Hong Kong hospital: point prevalence and reasons.

Hong Kong Med J. 2012 Feb;18(1):5-10

Authors: Chiu CH, Lee A, Chui PT

Abstract
OBJECTIVE. To determine the point prevalence of elective surgical case cancellations and the reasons. DESIGN. Cross-sectional study. SETTING. Teaching hospital, Hong Kong. PATIENTS. Operating theatre records of elective surgery cancellations from 1 January 2009 to 31 December 2009 were retrospectively reviewed. MAIN OUTCOME MEASURES. Cancellation of scheduled elective surgery on the day of surgery and the corresponding reasons. RESULTS. Of 6234 cases scheduled, 476 were cancelled, which yielded a point prevalence of 7.6%, with a 95% confidence interval of 7.0-8.3%. The highest number of cancellations occurred in patients scheduled for major general surgical procedures (n=94, 20%), major urological procedures (n=64, 13%), major orthopaedic surgery (n=38, 8%), and ultra-major cardiothoracic surgery (n=29, 6%). The most common category for cancellation was facility (73%), followed by work-up (17%), patient (10%), and surgeon (1%). No available operating room time due to overrun of the previous surgery was the most common reason for case cancellation (n=310). Compared to general surgery, the odds of no available operating time was significantly less in orthopaedics (odds ratio=0.26; 95% confidence interval, 0.17-0.39), otolaryngology (0.25; 0.13-0.46), neurosurgery (0.36; 0.16-0.70), paediatrics (0.53; 0.31-0.87), gynaecology (0.18; 0.11-0.29), ophthalmology (0.19; 0.07-0.41), and dentistry (0.10; 0.00-0.60). CONCLUSIONS. Case cancellations were mainly due to facility factors, such as no operating room time being available. The odds of having no operating room time available varied between surgical specialties.

PMID: 22302904 [PubMed - in process]

Pseudotumoral form of neuroschistosomiasis: report of three cases in ganzi, china.

Am J Trop Med Hyg. 2012 Feb;86(2):268-72

Authors: Wan H, Masataka H, Zhang LP, Zheng DF

Abstract
Abstract. The authors report three rare cases of neuroschistosomiasis lacking extracranial involvement. No parasitic eggs were detected in the stool with the Kato-Katz thick smear methods. Computed tomography of the brains showed hypodense signals, and magnetic resonance imaging showed isointense signals on T1-weighted images, hyperintense signals on T2-weighted images, and intensely enhancing nodules in the brain after intravenous administration of gadolinium. High-grade gliomas were suspected, and operations or radiosurgery was performed. Cerebral schistosomiasis was confirmed in all cases by biopsy of the brain lesions, revealing granulomas containing embedded Schistosoma japonicum eggs. All cases were definitively diagnosed as brain schistosomiasis japonica. Praziquantel and corticosteroids were administered, and the prognoses were good for all case patients. Although the aforementioned pattern of imaging examinations is not present in all cases of neuroschistosomiasis, a diagnosis of neuroschistosomiasis should be considered when this pattern of imaging is observed; cerebrospinal fluid serological exams are also recommended.

PMID: 22302862 [PubMed - in process]

Prospective hemorrhage risk of intracerebral cavernous malformations.

Neurology. 2012 Feb 1;

Authors: Flemming KD, Link MJ, Christianson TJ, Brown RD

Abstract
OBJECTIVE:Our goal was to describe the prospective risk and timing of symptomatic hemorrhage in a large cohort of followed patients with intracerebral cavernous malformations (ICMs). METHODS:All patients between 1989 and 1999 with the radiographic diagnosis of intracerebral cavernous malformation were identified retrospectively. The records and radiographic data were reviewed, and follow-up after diagnosis was obtained. An incidence rate was used to calculate annual risk of symptomatic hemorrhage. Predictive factors for outcomes used univariate and multivariable analysis with p < 0.05. RESULTS:A total of 292 patients were identified (47.3% male) with 2,035 patient years of follow-up. Seventy-four patients presented with hemorrhage, 108 with symptoms not related to hemorrhage (seizure or focal deficit), and 110 as asymptomatic. The overall annual rate of hemorrhage in those presenting initially with hemorrhage, with symptoms not related to hemorrhage, or as an incidental finding was 6.19%, 2.18%, and 0.33%, respectively. Patients who presented initially with symptomatic hemorrhage (hazard ratio 5.14; 95% confidence interval [CI] 2.54-10.4; p < 0.001) were at higher risk for future hemorrhage, and hemorrhage risk decreased with time. Male gender (hazard ratio 2.36; 95% CI 1.14-4.89; p = 0.02), and multiplicity of ICMs (hazard ratio 2.65; 95% CI 1.30-5.43; p = 0.01) also increased the risk of hemorrhage. The median time from first to second hemorrhage was 8 months. CONCLUSIONS:This study provides an estimate of prospective annual symptomatic hemorrhage risk in patients with ICMs stratified by initial presenting symptom. Prior hemorrhage, male gender, and multiplicity of ICMs may predict future hemorrhage. Hemorrhage risk decreases with time in those initially presenting with hemorrhage.

PMID: 22302553 [PubMed - as supplied by publisher]

Serologic diagnosis of NMO: A multicenter comparison of aquaporin-4-IgG assays.

Neurology. 2012 Feb 1;

Authors: Waters PJ, McKeon A, Leite MI, Rajasekharan S, Lennon VA, Villalobos A, Palace J, Mandrekar JN, Vincent A, Bar-Or A, Pittock SJ

Abstract
OBJECTIVES:Neuromyelitis optica (NMO) immunoglobulin G (IgG) (aquaporin-4 [AQP4] IgG) is highly specific for NMO and related disorders, and autoantibody detection has become an essential investigation in patients with demyelinating disease. However, although different techniques are now used, no multicenter comparisons have been performed. This study compares the sensitivity and specificity of different assays, including an in-house flow cytometric assay and 2 commercial assays (ELISA and transfected cell-based assay [CBA]). METHODS:Six assay methods (in-house or commercial) were performed in 2 international centers using coded serum from patients with NMO (35 patients), NMO spectrum disorders (25 patients), relapsing-remitting multiple sclerosis (39 patients), miscellaneous autoimmune diseases (25 patients), and healthy subjects (22 subjects). RESULTS:The highest sensitivities were yielded by assays detecting IgG binding to cells expressing recombinant AQP4 with quantitative flow cytometry (77%; 46 of 60) or visual observation (CBA, 73%; 44 of 60). The fluorescence immunoprecipitation assay and tissue-based immunofluorescence assay were least sensitive (48%-53%). The CBA and ELISA commercial assays (100% specific) yielded sensitivities of 68% (41 of 60) and 60% (36 of 60), respectively, and sensitivity of 72% (43 of 60) when used in combination. CONCLUSIONS:The greater sensitivity and excellent specificity of second-generation recombinant antigen-based assays for detection of NMO-IgG in a clinical setting should enable earlier diagnosis of NMO spectrum disorders and prompt initiation of disease-appropriate therapies.

PMID: 22302543 [PubMed - as supplied by publisher]

A meningioma with peripheral rim enhancement on MRI.

Brain Tumor Pathol. 2012 Feb 3;

Authors: Yuan YQ, Hou M, Wu H, Wang F

Abstract
Meningiomas are common, typically benign intracranial neoplasms with well-demarcated borders. Meningiomas with indistinct boundaries have been reported. These can invade surrounding structures, and present surgical and diagnostic challenges. We present the case of an unusual meningioma in a 53-year-old male in which preoperative magnetic resonance imaging (MRI) revealed an irregular lesion with clear boundaries and peripheral rim enhancement. Intraoperatively, however, no cleavage plane was apparent. Histological examination showed an increase of fibroconnective tissue with proliferation of dilated vessels in the periphery of the tumor concordant with the rim. Immunohistochemical staining of the tumor was positive for EMA and CD34, but negative for CEA, Ki67, and GFAP. Immunohistochemical staining of proliferating vessels in the periphery of the tumor was positive for CD34. A so-called 'capsule' structure was suggested according to MRI findings and pathological examination. The tumor was diagnosed as a mixed type meningioma, WHO grade I.

PMID: 22302538 [PubMed - as supplied by publisher]

Stereotactic radiosurgery for central neurocytoma: a quantitative systematic review.

J Neurooncol. 2012 Feb 1;

Authors: Park HK, Chang SD

Abstract
Central neurocytoma was originally described as a rare benign neuronal tumor. However, progression and local recurrences after surgery are well recognized. Stereotactic radiosurgery is another option for treatment of CN. In order to evaluate the efficacy of SRS, we performed a quantitative systematic review of the available data on SRS for CN. To identify eligible studies, systematic searches for all CNs treated with SRS were conducted in major scientific publication databases. English studies published prior to May 2011 were reviewed and summarized with reference to the inclusion and exclusion criteria. Tumor local control was analyzed. Heterogeneity and publication bias were assessed, and the summary control rate and 95% confidence interval (CI) were calculated from the raw data. Of 35 eligible studies, five with a total of 64 CNs were included in this quantitative analysis. Four studies reported a mean or median follow-up time of >60 months. The test of heterogeneity was non-significant among the included studies. Publication bias was observed as indicated by an asymmetric funnel plot. There was non-significance in Begg's test and Egger's test. The estimated cumulative rate of neuro-imaging tumor control was 91.1% (95% CI = 80.2-96.3%) at a mean follow-up of 59.3 months (range 6-140 months). The P-value was <0.0001 under a random-effect model. Sensitivity analysis showed a similar summary control rates (89.5-93.7%). Based on the summary local control rate of SRS for CN found in this quantitative analysis, we suggest that single session SRS is an effective and safe alternative therapy for recurrent or residual CN. However, the results of our analysis are limited by the predominance of case series studies due to scarcity of published research. Further randomized trials of CN patients via multicenter consortia should be considered for supplementing the weak points in our quantitative analysis.

PMID: 22302467 [PubMed - as supplied by publisher]

Frequency of mutations in the genes associated with hereditary sensory and autonomic neuropathy in a UK cohort.

J Neurol. 2012 Feb 1;

Authors: Davidson GL, Murphy SM, Polke JM, Laura M, Salih MA, Muntoni F, Blake J, Brandner S, Davies N, Horvath R, Price S, Donaghy M, Roberts M, Foulds N, Ramdharry G, Soler D, Lunn MP, Manji H, Davis MB, Houlden H, Reilly MM

Abstract
The hereditary sensory and autonomic neuropathies (HSAN, also known as the hereditary sensory neuropathies) are a clinically and genetically heterogeneous group of disorders, characterised by a progressive sensory neuropathy often complicated by ulcers and amputations, with variable motor and autonomic involvement. To date, mutations in twelve genes have been identified as causing HSAN. To study the frequency of mutations in these genes and the associated phenotypes, we screened 140 index patients in our inherited neuropathy cohort with a clinical diagnosis of HSAN for mutations in the coding regions of SPTLC1, RAB7, WNK1/HSN2, FAM134B, NTRK1 (TRKA) and NGFB. We identified 25 index patients with mutations in six genes associated with HSAN (SPTLC1, RAB7, WNK1/HSN2, FAM134B, NTRK1 and NGFB); 20 of which appear to be pathogenic giving an overall mutation frequency of 14.3%. Mutations in the known genes for HSAN are rare suggesting that further HSAN genes are yet to be identified. The p.Cys133Trp mutation in SPTLC1 is the most common cause of HSAN in the UK population and should be screened first in all patients with sporadic or autosomal dominant HSAN.

PMID: 22302274 [PubMed - as supplied by publisher]

Types and severity of operated supraclavicular brachial plexus injuries caused by traffic accidents.

Acta Neurochir (Wien). 2012 Feb 3;

Authors: Kaiser R, Waldauf P, Haninec P

Abstract
BACKGROUND: Brachial plexus injuries occur in up to 5% of polytrauma cases involving motorcycle accidents and in approximately 4% of severe winter sports injuries. One of the criteria for a successful operative therapy is the type of lesion. Upper plexus palsy has the best prognosis, whereas lower plexus palsy is surgically untreatable. The aim of this study was to evaluate a group of patients with brachial plexus injury caused by traffic accidents, categorize the injuries according to type of accident, and look for correlations between type of palsy (injury) and specific accidents. METHODS: A total of 441 brachial plexus reconstruction patients from our department were evaluated retrospectively (1993 to 2011). Sex, age, neurological status, and the type and cause of injury were recorded for each case. Patients with BPI caused by a traffic accident were assessed in detail. RESULTS: Traffic accidents were the cause of brachial plexus injury in most cases (80.7%). The most common type of injury was avulsion of upper root(s) (45.7%) followed by rupture (28.2%), complete avulsion (16.9%) and avulsion of lower root(s) (9.2%). Of the patients, 73.9% had an upper, 22.7% had a complete and only 3.4% had a lower brachial plexus palsy. The main cause was motorcycle accidents (63.2%) followed by car accidents (23.5%), bicycle accidents (10.7%) and pedestrian collisions (3.1%) (p?<?0.001). Patients involved in car accidents had a higher percentage of lower avulsion (22.7%) and a lower percentage of upper avulsion (29.3%), whereas cyclists had a higher percentage of upper avulsion (68.6%) based on the data from the entire group of patients (p?<?0.001). Lower plexus palsy was significantly increased in patients after car accidents (9.3%, p?<?0.05). In the two main groups (car and motorcycle accidents), significantly more upper and fewer lower palsies were present. In the bicycle accident group, upper palsy was the most common (89%). CONCLUSION: Study results indicate that the most common injury was an upper plexus palsy. It was characteristic of bicycle accidents, and significantly more common in car and motorcycle accidents. The results also indicate that it is important to consider the potential of a brachial plexus injury after serious traffic accidents and to examine both upper extremities in detail even if some motor function is preserved.

PMID: 22302237 [PubMed - as supplied by publisher]

Single low dose adjuvant Gamma knife radiosurgery for Thyrotropin secreting pituitary adenoma.

Acta Neurochir (Wien). 2012 Feb 3;

Authors: Kasliwal MK, Gupta A, Sharma MS

PMID: 22302236 [PubMed - as supplied by publisher]

Computer-aided volumetric analysis as a sensitive tool for the management of incidental meningiomas.

Acta Neurochir (Wien). 2012 Feb 1;

Authors: Chang V, Narang J, Schultz L, Issawi A, Jain R, Rock J, Rosenblum M

Abstract
INTRODUCTION: Meningiomas are typically slow-growing lesions that, depending on the location, can be relatively benign. Knowing their exact rate of growth can be helpful in determining whether surgery is necessary. METHODS: In this study we retrospectively reviewed the meningioma practices of the two senior authors (JR, MR). Our goal was to measure meningioma growth using a variety of methods (linear using diameters, and volumetric using the computer-aided perimeter and cross-sectional diameter methods) to compare rates of growth among the methods. Of 295 meningioma patients seen over an 8-year period, we identified a cohort of 31 patients with at least 30 months of follow-up. Volumes were calculated using medical imaging software with T1 post-contrast magnetic resonance imaging. Doubling times and growth rates were calculated. RESULTS: Of the 31 patients, 26 (84%) were shown to have growing meningiomas. The perimeter methodology measured higher growth rates than the diameter method for both doubling times as well as percentage annual growth (p?<?0.01). The mean doubling time was 13.4 years (range, 2.1-72.8 years) and 17.9 years (range, 4-92.3 years) comparing perimeter and diameter methods, respectively. The mean percentage of annual growth was 15.2% (range, 1.8-61.7%) and 5.6% (range, 0.7-12.2%), comparing perimeter and diameter methods, respectively. Linear growth was calculated at 0.7 mm/year. CONCLUSION: Overall, we found that computer-aided perimeter methods showed a more accurate picture of tumor progression than traditional methods, which generally underestimated growth.

PMID: 22302235 [PubMed - as supplied by publisher]

Brain Tissue Oxygenation and Cerebral Perfusion Pressure Thresholds of Ischemia in a Standardized Pig Brain Death Model.

Neurocrit Care. 2012 Feb 3;

Authors: Purins K, Enblad P, Wiklund L, Lewén A

Abstract
BACKGROUND: Neurointensive care of traumatic brain injury (TBI) patients is currently based on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) targeted protocols. Monitoring brain tissue oxygenation (B(ti)pO(2)) is of considerable clinical interest, but the exact threshold level of ischemia has been difficult to establish due to the complexity of the clinical situation. The objective of this study was to use the Neurovent-PTO (NV) probe, and to define critical cerebral oxygenation- and CPP threshold levels of cerebral ischemia in a standardized brain death model caused by increasing the ICP in pig. Ischemia was defined by a severe increase of cerebral microdialysis (MD) lactate/pyruvate ratio (L/P ratio > 30). METHODS: B(ti)pO(2), L/P ratio, Glucose, Glutamate, Glycerol and CPP were recorded using NV and MD probes during gradual increase of ICP by inflation of an epidural balloon catheter with saline until brain death was achieved. RESULTS: Baseline level of B(ti)pO(2) was 22.9 ± 6.2 mmHg, the L/P ratio 17.7 ± 6.1 and CPP 73 ± 17 mmHg. B(ti)pO(2) and CPP decreased when intracranial volume was added. The L/P ratio increased above its ischemic levels, (>30) when CPP decreased below 30 mmHg and B(ti)pO(2) to <10 mmHg. CONCLUSIONS: A severe increase of ICP leading to CPP below 30 mmHg and B(ti)pO(2) below 10 mmHg is associated with an increase of the L/P ratio, thus seems to be critical thresholds for cerebral ischemia under these conditions.

PMID: 22302179 [PubMed - as supplied by publisher]

Outcomes of transsphenoidal surgery in prolactinomas: improvement of hormonal control in dopamine agonist resistant patients.

Eur J Endocrinol. 2012 Feb 2;

Authors: Primeau V, Raftopoulos C, Maiter D

Abstract
Context: Few studies have recently re-examined the efficacy of neurosurgery in prolactinoma patients operated for various indications.Objective: To analyze outcomes of patients with a prolactinoma treated by transsphenoidal surgery, to identify factors associated with remission and relapse and to evaluate if surgical debulking allows a better hormonal control in patients with preoperative resistance to dopamine agonists (DA).Patients and methods: This was a retrospective review of patients with a benign prolactinoma followed pre- and post-operatively in our Department and treated by transsphenoidal surgery (n=63; 45 women; mean age: 31 ± 14 years)Results: Post-operative remission was obtained in 63% of microprolactinomas, in 60% of non invasive macroprolactinomas and in none of the invasive macroprolactinomas. Better remission rate was independently predicted by lower diagnostic prolactin levels and the lack of abnormal postoperative residual tissue (p<0.05). A recurrence of hyperprolactinemia was observed in 34 % of the patients after a median follow-up period of 36 [7-164] months. In patients with preoperative DA resistance treated again after surgery, there was a significant reduction of prolactin levels postoperatively (26 [6-687] ng/ml) vs. preoperatively (70 [22-1514] ng/ml; p<0.01) under a lower DA dose, and about half of patients had prolactin normalization.Conclusions: Recurrence of hyperprolactinemia is observed in one third of prolactinoma patients after surgical remission and may occur as late as 13 years after surgery. Resistance to DA can be considered as a good surgical indication, as partial tumor resection allows a better hormonal control with a lower dose of dopamine agonists.

PMID: 22301915 [PubMed - as supplied by publisher]

Primary pediatric skull tumors.

Pediatr Neurosurg. 2011;47(3):198-203

Authors: Hayden Gephart MG, Colglazier E, Paulk KL, Vogel H, Guzman R, Edwards MS

Abstract
Background/Aims: To review the pathological distribution of pediatric primary skull tumors, and to determine the diagnostic value of lesion location, patient age and lesion size. Methods: A retrospective chart review identified 51 consecutive pediatric patients with 54 primary skull tumors, treated between 2005 and 2010. Results: The most common diagnoses were dermoid cysts (n = 34) and fibrous dysplasia (n = 5). While dermoid tumors could reside anywhere (sensitivity = 0.41), a midline lesion had a specificity of 0.9 and a positive predictive value of 0.88. All of the fibrous dysplasia lesions were laterally placed, with a negative predictive value (NPV) of 1. Patient age < or >5 years had a high sensitivity and NPV for dermoid cysts and fibrous dysplasia, respectively. Size appeared to be sensitive (0.91, 0.8), but not specific (0.6, 0.78), with good NPV (0.8, 0.97) when considering dermoid cysts (?2 cm) or fibrous dysplasia (>2 cm), respectively.Conclusion:Dermoid cysts followed by fibrous dysplasia are the most common primary skull tumors. Lesion location, patient age and lesion size give important clues as to the diagnosis. For the majority of cases, a clinical diagnosis based on CT is sufficient for presurgical evaluation.

PMID: 22301489 [PubMed - in process]

Peculiarities in cases of spina bifida cystica managed recently in South-East Nigeria: could antimalarial drugs be a major but unrecognized etiologic factor?

Pediatr Neurosurg. 2011;47(3):194-7

Authors: Emejulu JK, Okwaraoha BO

Abstract
Background: Spina bifida is a long-known disease arising from the incomplete fusion of the caudal neuropore in the first month of intrauterine life. It is thought to have a multifactorial etiology, the most important of which is folic acid deficiency. In evaluating its etiology, the role of antifolate agents like antimalarial drugs is rarely given a strong mention. Methods/Patients: This is a 44-month prospective study of consecutive cases of spina bifida cystica presenting to the Neurosurgery Unit of Nnamdi Azikiwe University Teaching Hospital, Nnewi, South-East Nigeria. Data collection was with a structured proforma from presentation, and collation done with Microsoft Excel broadsheet and data analysis with SPSS and ?(2) test. Results: A total of 41 cases of spina bifida were attended to within the period, with 92.7% cases of spina bifida cystica. Most presented by >12-24 months, with a consistent history of maternal ingestion of antimalarial drugs during the first trimester of pregnancy. Conclusion: Spina bifida cystica was diagnosed mostly in children whose mothers ingested antimalarial drugs during the first trimester of gestation. There may be a need to critically evaluate the contribution of antimalarial drugs to the etiopathogenesis of this malformation and develop safer antimalarial treatment in pregnancy.

PMID: 22301488 [PubMed - in process]

Cervical spine surgery: anterior microsurgery.

Instr Course Lect. 2012;61:451-9

Authors: Hilibrand A, Smith JS

Abstract
Anterior cervical decompression and fusion is one of the most commonly used procedures to treat myelopathy and radiculopathy. With the addition of the surgical microscope, enhanced visualization of the microanatomy has allowed the safe and efficient treatment of compressive pathology. It is important to understand the critical steps required to successfully treat cervical spine pathology from an anterior approach with the assistance of a surgical microscope, the factors involved in choosing a decompressive method, the technical considerations for intervertebral grafting, and the use of cervical plating. The knowledge of surgical pearls may optimize spinal cord and nerve root decompression, increase fusion rates, and give patients the best chance for a successful clinical outcome.

PMID: 22301253 [PubMed - in process]

Explaining Clinical Effects of Deep Brain Stimulation through Simplified Target-Specific Modeling of the Volume of Activated Tissue.

AJNR Am J Neuroradiol. 2012 Feb 2;

Authors: Mädler B, Coenen VA

Abstract
BACKGROUND AND PURPOSE:Although progress has been made in understanding the optimal anatomic structures as target areas for DBS, little effort has been put into modeling and predicting electromagnetic field properties of activated DBS electrodes and understanding their interactions with the adjacent tissue. Currently, DBS is performed with the patient awake to assess the effectiveness and the side effect spectrum of stimulation. This study was designed to create a robust and rather simple numeric and visual tool that provides sufficient and practical relevant information to visualize the patient's individual VAT.MATERIALS AND METHODS:Multivariate polynomial fitting of previously obtained data from a finite-element model, based on a similar DBS system, was used. The model estimates VAT as a first-approximation sphere around the active DBS contact, using stimulation voltages and individual tissue-electrode impedances. Validation uses data from 2 patients with PD by MR imaging, DTI, fiber tractography, and postoperative CT data.RESULTS:Our model can predict VAT for impedances between 500 and 2000 ? with stimulation voltages up to 10 V. It is based on assumptions for monopolar DBS. Evaluation of 2 DBS cases showed a convincing correspondence between predicted VAT and neurologic (side) effects (internal capsule activation).CONCLUSIONS:Stimulation effects during DBS can be readily explained with this simple VAT model. Its implementation in daily clinical routine might help in understanding the types of tissues activated during DBS. This technique might have the potential to facilitate DBS implantations with the patient under general anesthesia while yielding acceptable clinical effectiveness.

PMID: 22300931 [PubMed - as supplied by publisher]

Multimodal Reperfusion Therapy for Large Hemispheric Infarcts in Octogenarians: Is Good Outcome a Realistic Goal?

AJNR Am J Neuroradiol. 2012 Feb 2;

Authors: Arkadir D, Eichel R, Gomori JM, Ben Hur T, Cohen JE, Leker RR

Abstract
BACKGROUND AND PURPOSE:MMRT may be beneficial in a subset of patients with large hemispheric stroke who cannot be treated with systemic thrombolysis. Because most previous studies only included relatively young patients, the outcome of very old patients given MMRT remains unknown.MATERIALS AND METHODS:Consecutive patients with large hemispheric stroke treated with MMRT and admitted to intensive care were included. We compared neurologic and functional outcomes between patients younger and older than 80 years.RESULTS:We included 14 patients older than 80 years and compared them with 66 patients who were younger than 80. Cerebrovascular risk factor profile, admission NIHSS scores, stroke etiology and pathogenesis, and procedure-related variables did not differ between the groups except for a higher prevalence of smoking in younger patients. Excellent target vessel recanalization (Thrombolysis in Myocardial Infarction score of 3) and good outcome at 90 days (modified Rankin Score ?2) were more common in younger patients (45% versus 14%, P = .047, and 41% versus 0%, P = .008, respectively). In contrast, mortality rates were higher in octogenarians (43% versus 17%, respectively).CONCLUSIONS:In this study, very old patients had higher chances of mortality and a very low probability of achieving functional independence even after MMRT. Further prospective studies are needed to examine the futility of MMRT in the very old.

PMID: 22300926 [PubMed - as supplied by publisher]

Noninvasive Evaluation of Cerebral Arteriovenous Malformations by 4D-MRA for Preoperative Planning and Postoperative Follow-Up in 56 Patients: Comparison with DSA and Intraoperative Findings.

AJNR Am J Neuroradiol. 2012 Feb 2;

Authors: Hadizadeh DR, Kukuk GM, Steck DT, Gieseke J, Urbach H, Tschampa HJ, Greschus S, Kovàcs A, Möhlenbruch M, Bostroem A, Schild HH, Willinek WA

Abstract
BACKGROUND AND PURPOSE:4D-MRA is a promising technique in the diagnosis and follow-up of cAVMs. The purpose of this study was to compare 4D-MRA in the pre- and postoperative evaluation of cAVMs with DSA or intraoperative findings as the standards of reference regarding qualitative and quantitative parameters.MATERIALS AND METHODS:Fifty-six consecutive patients with cAVMs (30 women) underwent both 4D-MRA and DSA. Preoperative 4D-MRA was excluded from analysis in 1 patient (movement artifacts). Twenty-five patients underwent surgery on cAVMs and underwent both imaging modalities pre- and postoperatively. 4D-MRA was performed with either 0.5-mol/L gadolinium-diethylene-triamine pentaacetic acid (group 1: voxel size, 1.1 × 1.1 × 1.4 mm(3); 608 ms/dynamic frame; 19 patients) or 1.0-mol/L gadobutrol (group 2: voxel size, 1.1 × 1.1 × 1.1 mm(3); 572 ms/dynamic frame; additional alternating view sharing; 37 patients). Two readers independently reviewed 4D-MRA and DSA regarding the Spetzler-Martin classification, arterial feeders, and postoperative residual filling. Vessel sharpness, vessel diameter, and VBC of 4D-MRA were quantified.RESULTS:Preoperative Spetzler-Martin classification 4D-MRA and DSA ratings matched in 55/55 patients (Spetzler-Martin grades: I, 12; II, 22; III, 15; IV, 5; V, 1), and 93/100 arterial feeders were correctly identified by preoperative 4D-MRA (7 additional arterial feeders identified by DSA only: group 1, 3/19; group 2, 4/36). Postoperative 4D-MRA and DSA matched in 25/25 patients (residual filling, 1/25). Vessel sharpness and diameters did not differ substantially between the 2 groups. VBC was significantly higher in group 2 (P < .005).CONCLUSIONS:4D-MRA is a reliable tool that allows predicting Spetzler-Martin classification and postoperative residual filling; it hence allows substituting DSA in the pre- and postoperative evaluation of patients with cerebral AVMs.

PMID: 22300925 [PubMed - as supplied by publisher]

Is management of acute traumatic brain injury effective? A literature review of published Cochrane Systematic Reviews.

Chin J Traumatol. 2012 Feb 1;15(1):17-22

Authors: Lei J, Gao GY, Jiang JY

Abstract
Objective: To evaluate all the possible therapeutic measures concerning the acute management of traumatic brain injury (TBI) mentioned in Cochrane Systematic Reviews published in the Cochrane Database of Systematic Reviews (CDSR). Methods: An exhausted literature search for all published Cochrane Systematic Reviews discussing therapeutic rather than prevention or rehabilitative interventions of TBI was conducted. We retrieved such databases as CDSR and Cochrane Injury Group, excluded the duplications, and eventually obtained 20 results, which stand for critical appraisal for as many as 20 different measures for TBI patients. The important data of each systematic review, including total population, intervention, outcome, etc, were collected and presented in a designed table. Besides, we also tried to find out the possible weakness of these clinical trials included in each review. Results: Analysis of these reviews yielded meanfuling observations: (1) The effectiveness of most ordinary treatments in TBI is inconclusive except that corticosteroids are likely to be ineffective or harmful, and tranexamic acid, nimodipine and progesterone show a promising effect in bleeding trauma, traumatic subarachnoid hemorrhage, TBI or severe TBI. (2) A majority of the systematic reviews include a small number of clinical trials and the modest numbers of patients, largely due to the uncertainty of the effectiveness. (3) The quality of most trials reported in the systematic reviews is more or less questionable. (4) In addition, lots of other complex factors together may lead to the inconclusive results demonstrated in the Cochrane Systematic Reviews. Conclusions: For clinical physicians, to translate these conclusions into practice with caution is essential. Basic medication and nursing care deserve additional attention as well and can be beneficial. For researchers, high quality trials with perfect design and comprehensive consideration of various factors are urgently required.

PMID: 22300914 [PubMed - in process]

One-stage apertura thoracis superior approach for four-vessel occlusion in rats.

Chin J Traumatol. 2012 Feb 1;15(1):13-6

Authors: Liu J, Liu WB, Ji XT, Fei Z, Cheng G

Abstract
Objective: There are a great number of modified models based on the four-vessel occlusion (4VO) model of Pulsinelli and Brierley which has been used worldwide for brain ischemia research. However, up to now the problems of collateral circulations of 4VO and the difficulty in arranging a surgery to occlude the basilar artery in other models are not satisfactorily solved yet. In this study, an improved 4-vessel occlusion (I4VO) rat model which is easy to handle and able to decrease the effect of collateral circulation is reported.Methods: The common carotid arteries and the beginning of the subclavical arteries of rats were occluded for different time by one-stage apertura thoracis superior approach. Neurological deficit scores defined by the modified Garcia scoring system and histopathological method were used to evaluate the effects of this model up to 7 days after reperfusion.Results: The neurological scores in the 15-min and 25-min groups decreased significantly at 24, 48 and 72 hours after reperfusion (P less than 0.05), and the histopathologic study showed that there were stable, symmetrical changes of lesions in bilateral hippocampus in all the ischemia samples from two ischemia groups compared with sham operated group (P less than 0.05).Conclusion: This modified model is safe, easy, reliable, stable, mini-invasive as well as time-saving in making bilateral hemispheric ischemia, which can effectively decrease collateral circulations and meanwhile lead to stable lesions in hippocampus and cortex.

PMID: 22300913 [PubMed - in process]

Surgical treatment of unruptured intracranial aneurysms in a low-volume hospital - Outcome and review of literature.

Clin Neurol Neurosurg. 2012 Jan 31;

Authors: Seule MA, Stienen MN, Gautschi OP, Richter H, Desbiolles L, Leschka S, Hildebrandt G

Abstract
BACKGROUND: The aim of this study was to evaluate surgical outcome of unruptured intracranial aneurysms (UIAs) in a low-volume hospital and compare the results with the recent literature. METHODS: A retrospective review of all consecutive craniotomies for UIA from July 1999 through June 2009 was performed. Morbidity was defined as modified Rankin Scale (mRS)?3 and evaluated six weeks after surgery. Cognitive function was evaluated at rehabilitation-to-home discharge. A PubMed database search (2001-2011) seeking retrospective, single-center studies reporting on surgical outcome of UIAs was performed. RESULTS: There were 47 procedures performed in 42 patients to treat 50 UIAs (mean of 5 annual craniotomies). The mean age was 54.7±12.1 years and mean aneurysm size was 7.6±4.0mm. Favorable outcome (mRS 0-2) at six weeks after surgery was achieved in 45 of 47 procedures (95.7%). Aneurysm size?12mm was statistically significant related to adverse outcome defined as mRS change?1 (71% vs. 29%; p=0.018). Five patients (10.6%) with favorable neurological outcome (mRS 2) presented with cognitive impairment at rehabilitation-to-home discharge. There was no significant difference in overall morbidity and mortality comparing low- and high-volume hospitals (4.0% vs. 4.8%; p=0.85). CONCLUSIONS: Low-volume hospitals may achieve good results for surgical treatment of UIAs. The results indicate that defining numeric operative volume thresholds is not feasible to guide centralization of aneurysm treatment.

PMID: 22300889 [PubMed - as supplied by publisher]

The time course of retrograde trans-synaptic degeneration following occipital lobe damage in humans.

Brain. 2012 Feb 1;

Authors: Jindahra P, Petrie A, Plant GT

Abstract
Following damage to the human post-geniculate visual pathway retrograde trans-synaptic degeneration of the optic nerve fibres occurs. It has been known for some time from investigations carried out in primates that a decline in the number of retinal ganglion cells follows occipital lobectomy. However, this is not detectable in all species studied and whether this occurs in humans was controversial until recent studies that have shown that following lesions of the occipital lobe, the retinal nerve fibre layer thickness measured by optical coherence tomography is reduced and corresponding shrinkage of the optic tract can be demonstrated by magnetic resonance imaging. The time course of the degeneration in humans is, however, unknown. In the present study, we have used optical coherence tomography to demonstrate for the first time progressive thinning of the retinal nerve fibre layer following occipital lobe/optic radiation damage due to stroke. First, in a group of 38 patients the measurement was taken on a single occasion at a known time interval since the stroke, ranging from 6 days to 67 years. Here, a negative straight line relationship (linear regression r?=?0.54, P?<?0.001) was found between nerve fibre layer thickness and elapsed time since injury in log years, giving a rate of decline of 9.08?µm per log year after adjusting for age. This indicates a decelerating rate of loss that differs from the rate of decline found with chronological age in this same group, which shows a steady rate of thinning by 0.4?µm per year (P?=?0.006) after adjusting for duration of the disease. In a second study serial measurements were taken following the acute event in a group of seven patients with homonymous hemianopia; here a negative straight line relationship was found between time and nerve fibre layer thickness in micrometres over a period of data collection beginning at a mean of 36.9 days post-stroke (range 5-112) and ending at a mean of 426.6 days post-stroke (range 170-917). Evidence from clinical observation (funduscopy) suggested that retrograde trans-synaptic degeneration occurred in humans only where the damage to the post-geniculate pathway occurred prenatally. The results reported herein add weight to the previous demonstration that this type of degeneration does indeed occur in the human visual system by showing that it can be monitored over time and hence may provide a model for trans-synaptic degeneration in the human central nervous system.

PMID: 22300877 [PubMed - as supplied by publisher]

Pictures as a neurological tool: lessons from enhanced and emergent artistry in brain disease.

Brain. 2012 Feb 1;

Authors: Schott GD

Abstract
Pictures created spontaneously by patients with brain disease often display impaired or diminished artistry, reflecting the patient's cerebral damage. This article explores the opposite: those pictures created in the face of brain disease that show enhanced or enduring artistry, and those that emerge for the first time in artistically naïve patients. After comments on background issues relating to the patient and the viewer, the paintings and drawings are considered in relation to the heterogeneous conditions in which this artistic creativity is seen. These conditions include various dementias-most notably frontotemporal lobar dementia, stroke, Parkinson's disease, autism and related disorders and psychiatric disease, epilepsy, migraine and trauma. In the discussion, it is argued that evidence of underlying brain dysfunction revealed by these pictures often rests on the abnormal context in which the pictures are created, or on changes in artistry demonstrated by a sequence of pictures. In the former, the compulsive element and sensory and emotional accompaniments are often important features; in the latter, evolving changes are evident, and have included depiction of increasing menace in portrayal of faces. The occurrence of synaesthesia, and its relation to creativity, are briefly discussed in respect of two unusual patients, followed by considering the role of the anterior and frontal lobes, mesolimbic connections and the right hemisphere. In at least some patients, impaired inhibition leading to paradoxical functional facilitation, with compensatory changes particularly in the right posterior hemisphere, is likely to be pivotal in enabling unusual artistry to emerge; preservation of language, however, is not a prerequisite. Many patients studied have been artists, and it appears possible that some of those with an artistic predisposition may be more likely to experience pathologically obsessive creativity. The discussion concludes that occasionally pictures created by these rare individuals unexpectedly prove to be an invaluable but little studied tool for investigating the dysfunctioning brain.

PMID: 22300875 [PubMed - as supplied by publisher]

Chordoma: current concepts, management, and future directions.

Lancet Oncol. 2012 Feb;13(2):e69-76

Authors: Walcott BP, Nahed BV, Mohyeldin A, Coumans JV, Kahle KT, Ferreira MJ

Abstract
Chordoma is a rare bone cancer that is aggressive, locally invasive, and has a poor prognosis. Chordomas are thought to arise from transformed remnants of notochord and have a predilection for the axial skeleton, with the most common sites being the sacrum, skull base, and spine. The gold standard treatment for chordomas of the mobile spine and sacrum is en-bloc excision with wide margins and postoperative external-beam radiation therapy. Treatment of clival chordomas is unique from other locations with an enhanced emphasis on preservation of neurological function, typified by a general paradigm of maximally safe cytoreductive surgery and advanced radiation delivery techniques. In this Review, we highlight current standards in diagnosis, clinical management, and molecular characterisation of chordomas, and discuss current research.

PMID: 22300861 [PubMed - in process]

A rare brainstem hemorrhage during transvenous embolization of a cavernous dural arteriovenous fistula.

J Clin Neurosci. 2012 Jan 31;

Authors: Nakagawa I, Wada T, Nakagawa H, Hironaka Y, Kichikawa K, Nakase H

Abstract
Intravascular treatment of cavernous dural arteriovenous fistula (dAVF) is usually safe and effective. However, we describe a patient with a rare brainstem hemorrhage during transvenous embolization (TVE). A 79-year-old woman suffered from left chemosis and diplopia. Cerebral angiography revealed a left cavernous dAVF with cortical venous drainage. The patient underwent TVE of the cavernous sinus (CS) via the left inferior petrosal sinus. Superior petrosal sinus (SPS) outflow occlusion was performed to avoid venous congestion, followed by superficial middle cerebral vein outflow occlusion, selective shunt occlusion of the middle meningeal artery, and superior orbital vein outflow occlusion. The patient's condition suddenly deteriorated during CS packing. A CT scan revealed a massive brainstem hemorrhage. Cerebral angiography did not show SPS reopening or redistributed drainage to the posterior fossa. Thus, TVE for cavernous dAVF can result in life-threatening vascular complications. Well-planned treatment strategies could avert this rare complication.

PMID: 22300793 [PubMed - as supplied by publisher]

Downregulation of PCDH9 predicts prognosis for patients with glioma.

J Clin Neurosci. 2012 Jan 31;

Authors: Wang C, Yu G, Liu J, Wang J, Zhang Y, Zhang X, Zhou Z, Huang Z

Abstract
Recent evidence has indicated that biological markers may be useful in estimating the prognosis of patients with glioma. The aim of this study was to determine the expression and clinical significance of a novel tumor suppressor, PCDH9 (protocadherin 9) in glioma using tissue microarrays and immunohistochemistry. Normal brain tissue showed strong positive immunostaining for PCDH9, but this was downregulated in the primary cerebral glial tumor samples (51.7%). Loss of PCDH9 expression was associated significantly with a higher histological grade. Survival analysis demonstrated that patients with PCDH9-negative tumors had significantly shorter survival times than those with PCDH9-positive tumors and that PCDH9 was an independent prognostic factor. Our results suggest that PCDH9 might function as a tumor suppressor during cancer development and progression and could be a useful biomarker for predicting the prognosis of patients with cerebral glial tumors.

PMID: 22300792 [PubMed - as supplied by publisher]

The effect of ischemic post-conditioning on hippocampal cell apoptosis following global brain ischemia in rats.

J Clin Neurosci. 2012 Jan 31;

Authors: Zhang W, Wang B, Zhou S, Qiu Y

Abstract
We evaluated the effect of brain ischemic post-conditioning on cell apoptosis in the hippocampus following global brain ischemia in rats. Adult male Sprague-Dawley rats were randomly divided into three groups (n=15/group): sham operation, ischemia/reperfusion (I/R) and ischemic post-conditioning (I PostC). Global brain ischemia was induced by four-vessel occlusion. Ischemic post-conditioning consisted of six cycles of 10s/10s reperfusion/reocclusion at the onset of reperfusion. All rats were sacrificed 24hours or 72hours after reperfusion. The hippocampal CA1 regions were analysed using the terminal deoxynucleotidyl transferase-mediated biotinylated deoxyuridine triphosphate nick end-labelling (Tunel) staining technique for determining cell apoptosis. Levels of caspase-3 and Bcl-2 were measured by Western blotting. After 72hours, fewer Tunel-positive brain cells were observed in rats from the I PostC group than in rats from the I/R group (10.3±2.7% versus 40.8±6.2%, p<0.01). After reperfusion at 24hours and 72hours, expression of caspase-3 in the I PostC group was significantly decreased (p<0.01) and expression of Bcl-2 in the I PostC group was significantly increased (p<0.01) compared with the I/R group. We conclude that down-regulation of caspase-3 and up-regulation of Bcl-2 by ischemic post-conditioning may underlie the protective effects of post-conditioning.

PMID: 22300791 [PubMed - as supplied by publisher]

Surgical results of arachnoid-preserving posterior fossa decompression for Chiari I malformation with associated syringomyelia.

J Clin Neurosci. 2012 Jan 31;

Authors: Lee HS, Lee SH, Kim ES, Kim JS, Lee JI, Shin HJ, Eoh W

Abstract
We analyzed the outcome of posterior fossa decompression accompanied by widening of the cisterna magna, without disturbing the arachnoid, in patients with Chiari I malformation (CMI) associated with syringomyelia. Twenty-five adult patients with CMI and syringomyelia, who underwent surgery between October 2000 and December 2008, were enrolled in this study. All patients underwent foramen magnum decompression with C1 decompression, with or without C2 decompression. Three surgeons performed a dura opening with duraplasty in 20 patients, and another surgeon excised the outer layer of the dura without duraplasty in five patients. Clinical and radiological assessments were performed preoperatively and during the follow-up period. After surgery, 20 (80%) patients achieved a significant improvement in their clinical symptoms. However, four patients (16%) achieved only a stable state, and one patient's symptoms worsened. Radiological analysis showed that 17 patients (68%) had a favorable result; that is, a total collapse, or a marked reduction, of the syrinx. Seven patients (28%) were stable in terms of syrinx size. However, the syrinx enlarged in one patient who had undergone excision of the outer dura. Twenty-four patients achieved a widened cisterna magna with ascent of the cerebellar tonsils into the posterior fossa and acquisition of a more rounded shape. Postoperative complications included a transient headache and vomiting in three patients and transient motor weakness in one patient. Two patients developed a superficial wound infection. This study shows that arachnoid-preserving posterior fossa decompression is a safe and effective treatment for patients with CMI with associated syringomyelia.

PMID: 22300790 [PubMed - as supplied by publisher]

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