Journal of neurosurgery
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Journal of neurosurgery · Oct 2014
Case ReportsCell-mediated allergy to cerebral aneurysm clip causing extensive cerebral edema.
The authors report the first case of vasogenic cerebral edema due to a cell-mediated hypersensitivity reaction to a nickel-containing aneurysm clip. The patient initially presented for elective clipping of a right middle cerebral artery aneurysm, and on long-term follow-up she demonstrated relapsing-remitting cerebral edema. Four years post-aneurysm clipping, she underwent an exploratory craniotomy given unsuccessful conservative management of her headaches and imaging evidence of cerebral edema with mass effect. ⋯ Histopathology was consistent with a cell-mediated (Type IV) hypersensitivity reaction. Concerns regarding nickel allergy are often reported in the cardiac literature. This case highlights the possibility of nickel hypersensitivity when using nickel-containing aneurysm clips, especially in patients with known nickel allergies.
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Journal of neurosurgery · Oct 2014
Clinical TrialResidual tumor volume and patient survival following reoperation for recurrent glioblastoma.
Maximal safe tumor resection is part of the standard of care for patients with newly diagnosed glioblastoma. The role of reoperation in the care of patients with recurrent glioblastoma is less clear, and less than a quarter of patients undergo a second surgery. Previous studies have identified preoperative variables associated with the improved survival of patients following reoperation, and guidelines for the selection of patients for reoperation have been devised and validated. In this study, the authors analyzed the relative survival benefit of maximal safe tumor removal in a series of patients with recurrent glioblastoma who all underwent reoperation. ⋯ The overall survival of patients with recurrent glioblastoma who underwent reoperations increased with decreasing postoperative residual tumor volumes. For patients meeting prognostic criteria for reoperation, the surgical goal should be to minimize residual tumor volume to maximize overall survival. Clinical trial registration no.: NCT00060541 ( ClinicalTrials.gov ).
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Journal of neurosurgery · Oct 2014
Comparative StudyComparison of techniques for ventriculoperitoneal shunting in 523 patients with subarachnoid hemorrhage.
It is common practice to use a new contralateral bur hole for ventriculoperitoneal shunt (VPS) placement in subarachnoid hemorrhage (SAH) patients with an existing ventriculostomy. At Thomas Jefferson University and Jefferson Hospital for Neuroscience, the authors have primarily used the ventriculostomy site for the VPS. The purpose of this study was to compare the safety of the 2 techniques in patients with SAH. ⋯ The results of this study suggest that the use of the ventriculostomy site for VPS placement may be feasible and safe and may not add morbidity (infection or need for revision) compared with the use of a fresh contralateral site. This rapid and simple technique also was associated with a lower risk of shunt-related hemorrhage. While both techniques appear to be feasible and safe, a definitive answer to the question of which technique is superior awaits a higher level of medical evidence.
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Journal of neurosurgery · Oct 2014
Case ReportsMicrovascular decompression of a C-2 segmental-type vertebral artery producing trigeminal hypesthesia.
The authors report a case of trigeminal hypesthesia caused by compression of the spinal cord by a C-2 segmental-type vertebral artery (VA) that was successfully treated with microvascular decompression. Aberrant intradural VA loops have been reported as causes of cervical myelopathy, some of which improved with microvascular decompression. ⋯ The patient underwent left C-1 and C-2 hemilaminectomies followed by microvascular decompression of an aberrant VA loop compressing the spinal cord. The patient subsequently reported complete resolution of symptoms.
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Journal of neurosurgery · Oct 2014
Intracranial pressure following complete removal of a small demarcated brain tumor: a model for normal intracranial pressure in humans.
Current published normal values for intracranial pressure (ICP) are extrapolated from lumbar CSF pressure measurements and ICP measurements in patients treated for CSF pressure disorders. There is an emerging agreement that true normal ICP values are needed for diagnostic and therapeutic purposes. This study documents normal ICP in humans. ⋯ This study provides a preliminary reference range for normal ICP in humans. It is the first study to show that ICP in the healthy human brain decreases to negative values when assuming the upright position. If these results are later confirmed in a larger series, they might provide reference values for diagnosis and treatment in patients with CSF-related disorders. New normal values also have implications for future shunt design and the ICP target range in hydrocephalus treatment.