Acta neurochirurgica
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Acta neurochirurgica · May 2010
Usefulness of multislice computerized tomographic angiography in the postoperative evaluation of patients with clipped aneurysms.
The aim of our study was to evaluate the diagnostic efficacy of multislice computed tomographic angiography (MSCTA) regarding exclusion quality after aneurysm clipping. ⋯ In the postoperative period, MSCTA was considered a useful tool to evaluate the large remnants as well as a non-invasive ulterior examination for suspected bifurcation. Nevertheless, 3D DSA is still required for an accurate evaluation of aneurysms treated by more than three clips.
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Acta neurochirurgica · May 2010
6-Mercaptopurine attenuates adhesive molecules in experimental vasospasm.
Adhesion molecules, including intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and E-selectin, are important inflammatory mediators which are elevated in the serum of patients following aneurysmal subarachnoid hemorrhage (SAH). The authors previously found that 6-mercaptopurine (6-mp) was effective in preventing and reversing arterial narrowing in a rodent SAH model. The present study was to examine whether levels of adhesion molecules were altered after treatment with 6-mp in this animal model. ⋯ These results show that ICAM-1 and E-selectin may play a role in mediating SAH-induced vasospasm and that a reduction of both adhesive molecules after SAH may partly contribute to the antispastic effect of 6-mp.
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Acta neurochirurgica · Apr 2010
Increasing hematocrit above 28% during early resuscitative phase is not associated with decreased mortality following severe traumatic brain injury.
To prevent iatrogenic damage, transfusions of red blood cells should be avoided. For this, specific and reliable transfusion triggers must be defined. To date, the optimal hematocrit during the initial operating room (OR) phase is still unclear in patients with severe traumatic brain injury (TBI). We hypothesized that hematocrit values exceeding 28%, the local hematocrit target reached by the end of the initial OR phase, resulted in more complications, increased mortality, and impaired recovery compared to patients in whom hematocrit levels did not exceed 28%. ⋯ Based on this retrospective observational analysis, increasing hematocrit above 28% during the initial OR phase following severe TBI was not associated with improved or worsened outcome. This questions the need for aggressive transfusion management. Prospective analysis is required to determine the lowest acceptable hematocrit value during the OR phase which neither increases mortality nor impairs recovery. For this, a larger caseload and early monitoring of cerebral metabolism and oxygenation are indispensable.
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Acta neurochirurgica · Apr 2010
Case ReportsMultiple lytic lesions of the spine: a rare diagnosis of eosinophilic granuloma in an adult: a case report.
Eosinophilic granuloma (EG) is a rare benign osteolytic lesion observed rarely in adults, with only some 18 cases of spinal location reported in the literature. We present an unusual variant of EG in a 23-year-old man with radiological features of multiple spinal lytic lesions which was evocated of metastatic processes. ⋯ The clinical and radiological findings of EG present dilemmas of both diagnosis and treatment. The etiology is unclear and the therapeutic approach is still controversial.
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Acta neurochirurgica · Apr 2010
Minimally invasive approach to far lateral lumbar disc herniation: technique and clinical results.
To describe our minimally invasive technique for the surgical treatment of far lateral lumbar disc herniation (FLLDH) using MetRx tissue dilators system and a surgical microscope; and to report our experience with this method. ⋯ Our results suggest that this minimally invasive technique is safe and efficacious for the management of FLLDH and might be an alternative to open microsurgical approaches.