Acta neurochirurgica
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Acta neurochirurgica · Jan 2007
Randomized Controlled Trial Multicenter StudyEffects of the selective endothelin A (ET(A)) receptor antagonist Clazosentan on cerebral perfusion and cerebral oxygenation following severe subarachnoid hemorrhage - preliminary results from a randomized clinical series.
To study the effects of clazosentan, a new selective endothelin receptor subtype A antagonist, on cerebral perfusion and cerebral oxygenation following severe aneurysmal subarachnoid haemorrhage (aSAH). ⋯ These preliminary data suggest that clazosentan reduces the extent of vasospasm-associated impairment of cerebral perfusion following aSAH. Furthermore, clazosentan may exert beneficial actions on overt vasospasm-associated hypoperfusion.
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Acta neurochirurgica · Jan 2007
Review Case ReportsDural arteriovenous malformation: an unusual cause of trigeminal neuralgia.
Trigeminal neuralgia has been rarely reported in association with dural arteriovenous malformations (DAVMs). We describe a case of trigeminal neuralgia resulting from compression of the trigeminal nerve at its root entry zone by a large tentorial DAVM. Surgical interruption of the draining vein at its exit from the tentorium resulted in complete angiographic obliteration of the fistula with immediate resolution of the facial pain. We review the literature relevant to this topic and discuss the aetiology and pathophysiology of trigeminal neuralgia as well as the management of tentorial DAVMs.
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Acta neurochirurgica · Jan 2007
ReviewIschaemic preconditioning of the brain, mechanisms and applications.
The concept of ischaemic preconditioning was introduced in the late 1980s. The concept emerged that a brief subcritical ischaemic challenge could mobilize intrinsic protective mechanisms that increased tolerance against subsequent critical ischaemia. Tissues with a high sensitivity against ischaemia, i.e. myocardium and central nervous system, present the most promising targets for therapeutic application of ischaemic preconditioning. During the last years the mechanisms of neuronal preconditioning were systematically studied and a number of molecular regulation pathways were discovered to participate in preconditioning. The purpose of the present review is to survey the actual knowledge on cerebral preconditioning, and to define the practical impact for neurosurgery. ⋯ Possible cumulative neuroprotection by preconditioning and pharmacological protection during critical ischaemia should be studied systematically. Easy to apply methods of preconditioning, such as the application of volatile anaesthetics or erythropoietin some hours or days prior to planned temporary ischaemia, should be introduced into the practice of operative neurosurgery.
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Acta neurochirurgica · Jan 2007
Objective criteria for successful transsphenoidal removal of suprasellar nonfunctioning pituitary adenomas. A prospective study.
Despite ample experience with transsphenoidal surgery, objective data on which suprasellar tumour expansion and growth pattern allows for radical adenoma resection are still sparse. Hence, we have performed a prospective study to establish the predictive value of tumour dimension and shape for the intra-operative descent of the diaphragma, the completeness of tumour resection and the outcome of patients harbouring pituitary adenomas with suprasellar extension. ⋯ One-stage transsphenoidal surgery allows total or near-total resection of most suprasellar pituitary adenomas with low surgical morbidity. Quantitative assessment of tumour dimension and configuration contributes to establishing guidelines for the selection of the appropriate approach and prediction of surgical outcome.
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Acta neurochirurgica · Jan 2007
Case ReportsEpidermoid cysts of the cerebellopontine angle with extension into the middle and anterior cranial fossae: surgical strategy and review of the literature.
Epidermoid cysts are tumours, which contain keratin, cellular debris and cholesterol, and lined with stratified squamous epithelium. Clinically, epidermoid cysts behave like benign, slow-growing lesions. ⋯ Radical surgical removal of epidermoid cysts should be attempted, but a less aggressive surgical strategy should be considered if there is strong adherence to the surrounding brain tissue, particularly in eloquent areas. In this case, complete tumour removal was achieved via a suboccipital retrosigmoid approach.