Journal of neurological surgery. Part A, Central European neurosurgery
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J Neurol Surg A Cent Eur Neurosurg · Sep 2012
CSF fistulas after transsphenoidal pituitary surgery--a solved problem?
Transsphenoidal surgery has been the gold standard for intra- and suprasellar lesions as well as some extrasellar pathologies for more than 40 years. This approach, with proper surgical expertise, is very safe with a low morbidity and mortality rate. However, as with every surgical treatment, complications can occur and may result in serious consequences for the patient. The goal of this article is to focus on cerebrospinal fluid (CSF) fistulas after transsphenoidal surgery and discuss possible risk factors and treatment options, including less common procedures in persistent CSF fistulas. ⋯ CSF fistulas continue to present a problem after transsphenoidal surgery and require sophisticated technical measures to treat this complication. Failure after repair can occur and necessitates more intense treatment modalities. The usage of the transsphenoidal approach in other skull base lesions leads to higher rates of CSF fistulas and subsequently higher frequency of meningitis.
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J Neurol Surg A Cent Eur Neurosurg · Sep 2012
Effects of acute intracranial hypertension on extracerebral organs: a randomized experimental study in pigs.
The study was conducted to determine the effects of isolated acute intracranial hypertension (AICH) on extracerebral organs. ⋯ Isolated AICH induces injury to multiple extracerebral organs, even in the absence of hypoperfusion or hypoxemia.
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J Neurol Surg A Cent Eur Neurosurg · Aug 2012
Randomized Controlled TrialEarly survival of comatose patients after severe traumatic brain injury with the dual cannabinoid CB1/CB2 receptor agonist KN38-7271: a randomized, double-blind, placebo-controlled phase II trial.
BACKGROUND AND STUDY OBJECT: Despite many drug trials, no substance has yet been identified that improves the outcome of severe head injury. The dual cannabinoid CB1/CB2 receptor agonist KN38-7271 mediates potent neuroprotection in animal models. We describe here the first randomized, double-blind, prospective, placebo-controlled clinical phase IIa proof-of-concept trial to investigate the safety, pharmacokinetics, and potential efficacy of a cannabinoid receptor agonist in humans. ⋯ KN38-7271 appeared beneficial in the acute early phase of the comatose patient after a head injury. Its use was safe and well tolerated by patients. These results may provide the basis for further phase II/III trials in larger study populations.
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J Neurol Surg A Cent Eur Neurosurg · Aug 2012
Review Historical ArticleTraumatic brain injuries in the ancient Egypt: insights from the Edwin Smith Papyrus.
Traumatic brain injury (TBI) is probably as old as human beings. The Edwin Smith Papyrus is the first treatise describing the treatment of patients with TBI and allows insights into the medical examination and treatment of head-injured patients in ancient Egypt. ⋯ The Edwin Smith Papyrus reveals astonishing observation skill when considering the methods and limits of ancient times. These physicians were able to recognize many symptoms of TBI and assign them a prognostic value.
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J Neurol Surg A Cent Eur Neurosurg · May 2012
Case ReportsUncommon lesions in the internal auditory canal (IAC): review of the literature and case report.
Despite the relatively frequent occurrence of multiple primary tumors, namely, 10% of intracranial tumors, metastasis is a rare occurrence within the internal auditory canal (IAC) and cerebellopontine angle (CPA). Intracanalicular metastases of adenocarcinoma are documented, but a primary adenocarcinoma remains unreported. We provide a review of uncommon lesions in the IAC and describe to our knowledge the first instance of a primary adenocarcinoma. ⋯ The differentiation between benign and malign lesions in the CPA and IAC is important, as it requires diverse treatment protocols. For the physician this differentiation represents a clinical and radiological challenge. For the developmental research the left-right asymmetry might be a field of research.