Clinical information system services and capabilities desired for scalable, standards-based, service-oriented decision support: consensus assessment of the Health Level 7 clinical decision support Work Group.

A standards-based, service-oriented architecture for clinical decision support (CDS) has the potential to significantly enhance CDS scalability and robustness. To enable such a CDS architecture, the Health Level 7 CDS Work Group reviewed the literature, hosted multi-stakeholder discussions, and consulted domain experts to identify and prioritize the services and capabilities required from clinical information systems (CISs) to enable service-oriented CDS. In addition, relevant available standards were identified.

A novel method in predicting immediate postoperative facial nerve function post acoustic neuroma excision.

Unlabelled: To determine whether the percentage calculated by dividing the amplitude of postexcision direct facial nerve stimulus responses (at pontomedullary junction) by the amplitude of distal ipsilateral transcutaneous (stylomastoid region) maximal stimulus responses and response amplitude progression by increasing stimulus intensities have predictive value for determining normal or near-normal (House-Brackmann Grade 1 or 2) immediate postoperative facial nerve function.

Study Design: Intraoperative recordings of three muscle groups: 1) frontalis, 2) orbicularis oculi, and 3) orbicularis oris. Postexcision direct facial nerve stimulation at the pontomedullary junction and transcutaneous maximal facial nerve stimulation at the ipsilateral stylomastoid region and their associated response amplitudes were recorded.

Unilateral acoustic neuromas: long-term hearing results in patients managed with fractionated stereotactic radiotherapy, hearing preservation surgery, and expectantly.

Introduction: Hearing preservation is invariably a consideration when exploring treatment options for acoustic neuromas. We reviewed the long-term hearing results of patients who were treated using 1) hyperfractionated stereotactic radiotherapy (HSR), 2) hearing preservation tumor excision surgery (HPTES), and 3) expectantly (no treatment).

Methods And Materials: Single institution retrospective chart review of 42 patients managed with HSR (1993-2003), 113 patients in whom HPTES was carried out, and 86 patients who were untreated (1974-2003).

Comparison of monitoring techniques for intraoperative cerebral ischemia.

Objective: To prospectively compare somatosensory evoked potentials, electroencephalography (EEG) and transcranial Doppler ultrasound (TCD) for detection of cerebral ischemia during carotid endarterectomy (CEA).

Methods: Somatosensory evoked potentials and EEG recordings were attempted in 156 consecutive CEAs and TCD was also attempted in 91 of them. Recordings from all three modalities were obtained for at least 10 minutes before CEA, during CEA and for at least 15 minutes after CEA.

Acoustic neuroma surgery: the results of long-term hearing preservation.

Objective: To report the long-term outcome hearing results following acoustic neuroma surgery. To determine whether changes, if any, in the thresholds of the operated ear are mirrored in the contralateral unoperated side. In addition, to identify predictive factors, if any, that may predispose individuals to hearing loss in the operated ear in the late post-operative period.

Posttraumatic syringomyelia: predisposing factors.

Posttraumatic spinal cord cavitation (syrinx) and progressive myelopathy associated with a posttraumatic syrinx (PTS) have been recognized for many years. Predisposing factors for PTS have not been well defined. All symptomatic PTS patients (n = 58) treated at the University of Toronto neurosurgical units over 30 years were analysed retrospectively to discover risk factors for the development of PTS.

Cerebrospinal fluid leak after acoustic neuroma surgery: influence of tumor size and surgical approach on incidence and response to treatment.

Object: The aims of this study were to review the incidence of cerebrospinal fluid (CSF) leakage complicating the removal of acoustic neuroma and to identify factors that influence its occurrence and treatment.

Methods: Prospective information on consecutive patients who underwent operation for acoustic neuroma was supplemented by a retrospective review of the medical records in which patients with CSF leaks complicating tumor removal were identified. This paper represents a continuation of a previously published series and thus compiles the authors' continuous experience over the last 24 years of practice.

Primary spinal epidural mantle cell lymphoma: case report.

Objective And Importance: Mantle cell lymphoma is a distinct clinicopathological type of non-Hodgkin's lymphoma that often presents at an advanced stage, with systemic spread. Spinal involvement is uncommon and generally occurs as part of advanced disease or generalized relapses. Primary spinal epidural lymphoma is a rare initial manifestation of non-Hodgkin's lymphoma, and mantle cell lymphoma with initial presentation in the spinal epidural space is extremely rare, having been previously reported in only two cases.

A study of vestibular schwannomas using positron emission tomography and monoclonal antibody Ki-67.

Objective: This study aimed to evaluate the role of positron emission tomography (PET) as an in vivo determinant of tumor aggressiveness and growth.

Study Design: The study design was a prospective pilot study.

Setting: Positron emission tomography was performed at the Clarke Institute of Psychiatry.

Changing practice and costs of carotid endarterectomy in Toronto, Canada.

Background And Purpose: During our annual audits of carotid endarterectomy (CEA) in Toronto metropolitan hospitals, we have been aware of major changes in the practice of this operation in recent years. To evaluate the effect of changing practice on costs of carotid endarterectomy, we have therefore compared the effects of changes in length of stay, complication rates, and other variables on cost during the last 3 years for which we have complete data.

Methods: We evaluated 757 consecutive patients, of whom 600 had CEA procedures in 3 teaching hospitals, and 190 procedures in 2 community hospitals in metropolitan Toronto.

Cervical myelopathy caused by hypoplasia of the atlas: two case reports and review of the literature.

Objective And Importance: Congenital anomalies of the posterior arch of the atlas (C1) are uncommon. They range from partial clefts to total agenesis of the posterior arch. Developmental cervical canal stenosis is a congenital anomaly that may cause cervical myelopathy.

Recurrent intracranial hemorrhage due to postpartum cerebral angiopathy: implications for management.

Background: Postpartum cerebral angiopathy as a cause of hemorrhagic stroke in young women is not well recognized. It is unknown whether this disorder represents a true inflammatory vasculitis or transient vasoconstriction related to the hormonal events of pregnancy and the postpartum period.

Case Description: A 39-year-old woman presented with postpartum intracranial hemorrhage and, 32 months later, with subarachnoid hemorrhage, following normal pregnancies.

Severe tension pneumocephalus complicating frontal sinus osteoma.

Background: Tension pneumocephalus, the accumulation of intracranial gas under pressure, is a rare but potentially life-threatening condition which can complicate craniofacial surgery, trauma, or cranial tumor. It presents as an acute or subacute expanding mass lesion.

Case Report: We present a case of a 40-year-old male who developed tension pneumocephalus as a consequence of a previously detected but untreated frontal sinus osteoma.

Prognostic factors in intraoperative facial nerve monitoring for acoustic neuroma.

Objectives: To determine the predictive value of intraoperative threshold stimulus for facial nerve outcome and the prevalence and prognostic value of persistent trains of activity and frequent spontaneous or mechanically induced contractions during acoustic neuroma surgery.

Study Design: Prospective recording and subsequent review of facial nerve activity.

Setting: Tertiary referral centre.

Primary intramedullary primitive neuroectodermal tumor of the spinal cord: case report and review of the literature.

Objective And Importance: Primary intraspinal primitive neuroectodermal tumors (PNETs) are rare. We report a case and review the literature.

Clinical Presentation: A 22-year-old woman presented with rapidly progressive paraparesis and neurogenic bladder.

Somatosensory evoked potential identification of sensorimotor cortex in removal of intracranial neoplasms.

Objective: To assess the ease and reliability of routine use of somatosensory evoked potentials (SSEPs) for identification of sensorimotor cortex in brain tumour removal and to document its influence on the performance and outcome of surgery.

Methods: SSEPs in response to contralateral median nerve stimulation were recorded from the cortical surface by means of a four lead electrode strip. Polarity reversal of short latency SSEP waves was used to identify the position of the central sulcus in 46 consecutive craniotomies for removal of metastases, gliomas, or meningiomas located in, near, or overlying sensorimotor cortex.

Hearing preservation in the removal of intracanalicular acoustic neuromas via the retrosigmoid approach.

In a series of 514 consecutive operations for complete excision of acoustic neuromas, 94 procedures were performed via a retrosigmoid approach to preserve the patient's hearing. Twenty-six of these procedures (5.1%) were performed in cases of intracanalicular tumor and 68 (13.

Cavernous malformation presenting as an extra-axial cerebellopontine angle mass: case report.

Objective And Importance: We describe a rare case of an extra-axial cavernoma of the cerebellopontine angle without internal auditory canal involvement and with an unusual appearance on preoperative magnetic resonance imaging (MRI). Only three cases of cerebellopontine angle cavernomas have been previously reported, and none of these reports included preoperative MRI.

Clinical Presentation: A young man presented with subacute left facial hypesthesia and chronic asymmetrical sensorineural hearing loss.

Hearing preservation in acoustic neuroma surgery: value of monitoring cochlear nerve action potentials.

This study reviews the hearing results in 80 consecutive patients who underwent complete removal of histologically proven acoustic neuromas by use of the suboccipital approach. Of these, 56 patients had successful monitoring of cochlear compound action potentials; 20 were not monitored because their surgery predated monitoring; and 4 had unsuccessful monitoring. A significant difference was found in hearing preservation rates between the group in whom compound action potential monitoring was performed and those in whom monitoring was either unavailable or failed (p = 0.

Iatrogenic false aneurysm following repair of intracranial aneurysm.

False aneurysm of the intracranial arteries occurs infrequently as a complication of head injury and rarely as a consequence of other pathology. A case of false aneurysm of the supraclinoid internal carotid artery following minor intraoperative injury during clipping of a basilar-superior cerebellar aneurysm by the pterional approach is described. False aneurysm is a potential cause of recurrent intracranial hemorrhage after successful aneurysm clipping.

Postoperative pain following excision of acoustic neuroma by the suboccipital approach: observations on possible cause and potential amelioration.

Incisional pain and headache have been reported following cerebellopontine angle surgery via the suboccipital approach. The high incidence and severity of pain determined in a retrospective study of acoustic tumor patients prompted the present prospective study. Various modifications of the suboccipital approach have been employed in an attempt to isolate a possible cause and potential method of minimizing this problem.