Journal of neurosurgery
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Journal of neurosurgery · Jul 2012
Case ReportsAnnual rupture risk of growing unruptured cerebral aneurysms detected by magnetic resonance angiography.
In this paper, the authors' goals were to clarify the characteristics of growing unruptured cerebral aneurysms detected by serial MR angiography and to establish the recommended follow-up interval. ⋯ Despite the relatively short period, the annual rupture risk of growing unruptured cerebral aneurysms detected by MR angiography was not as low as previously reported. Surgical or endovascular treatment can be considered if aneurysm growth is detected during the follow-up period.
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Journal of neurosurgery · Jul 2012
Case ReportsA new strategic neurosurgical planning tool for brainstem cavernous malformations using interactive computer graphics with multimodal fusion images.
In this study, the authors used preoperative simulation employing 3D computer graphics (interactive computer graphics) to fuse all imaging data for brainstem cavernous malformations. The authors evaluated whether interactive computer graphics or 2D imaging correlated better with the actual operative field, particularly in identifying a developmental venous anomaly (DVA). ⋯ The authors report a new method for automatic registration of preoperative imaging data from CT, MRI, and 3D rotational angiography for reconstruction into 1 computer graphic. The diagnostic rate of DVA associated with brainstem cavernous malformation was significantly better using interactive computer graphics than with 2D images. Interactive computer graphics was also useful in helping to plan the surgical access corridor.
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Journal of neurosurgery · Jul 2012
Utility of VasoCT in the treatment of intracranial aneurysm with flow-diverter stents.
The small size and tortuous anatomy of intracranial arteries require that flow-diverter stents in the intracranial vasculature have a low profile, high flexibility, and excellent trackability. However, these features limit the degree of radiopacity that can be incorporated into the stents. Visualization of these stents and the degree of stent deployment using conventional radiographic techniques is suboptimal. To overcome this drawback, the authors used a new combined angiography/CT suite that uses flat-panel detector technology for higher resolution angiography. ⋯ The authors found that VasoCT provides clear visualization of flow-diverter stents. The images obtained both intraarterially and intravenously are very promising. The initial results provide a high confidence and reproducibility rate for further utilization of this new technique.
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Journal of neurosurgery · Jul 2012
Preliminary observations on the vasomotor responses to electrical stimulation of the ventrolateral surface of the human medulla.
Pulsatile arterial compression (AC) of the ventrolateral medulla (VLM) is hypothesized to produce the hypertension in a subset of patients with essential hypertension. In animals, a network of subpial neuronal aggregates in the VLM has been shown to control cardiovascular functions. Although histochemically similar, neurons have been identified in the retro-olivary sulcus (ROS) of the human VLM, but their function is unclear. ⋯ This stimulation technique for vasomotor mapping of the human VLM was safe and reproducible. Neuronal aggregates near the surface of the human ROS may be important in cardiovascular regulation. This method of vasomotor mapping with measures of responses in sympathetic tone (microneurography) should yield additional data for understanding the neuronal network that controls cardiovascular functions in the human VLM. Further studies in which a concentric bipolar electrode is used to generate this type of vasomotor map should also increase understanding of the pathophysiological mechanisms of neurogenically mediated hypertension, and assist in the design of studies to prove the hypothesis that it is caused by pulsatile AC of the VLM.
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Journal of neurosurgery · Jul 2012
Long-term benefits in quality of life after unilateral thalamic deep brain stimulation for essential tremor.
The goal of this study was to evaluate short- and long-term benefits in quality of life (QOL) after unilateral deep brain stimulation (DBS) for essential tremor (ET). ⋯ Unilateral thalamic stimulation significantly reduces ET and improves ADL scores for up to 12 years after surgery, as measured by the TRS. The PDQ-39 total score and the domains of ADL, emotional well-being, and stigma were significantly improved up to 7 years. Although scores were improved compared with presurgery, other than stigma, these benefits did not remain significant at the longest (up to 12 years) follow-up, probably related in part to changes due to aging and comorbidities.