Journal of neurosurgery
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Journal of neurosurgery · Sep 2014
Association of the NOS3 intron-4 VNTR polymorphism with aneurysmal subarachnoid hemorrhage.
The nitric oxide system has been linked to the pathogenesis of aneurysmal subarachnoid hemorrhage (SAH). The authors performed a case-control study to investigate the association between SAH and common genetic variants within the endothelial nitric oxide synthase gene (NOS3). ⋯ The authors' results suggest that the NOS3 27-bp-VNTR b/b genotype independent of other risk factors act in concert with male sex to substantially increase risk of SAH. This effect is not mediated by any single NOS3 haplotype.
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Journal of neurosurgery · Sep 2014
Case ReportsEmergent surgical embolectomy for middle cerebral artery occlusion due to carotid plaque rupture followed by elective carotid endarterectomy.
Embolic intracranial large artery occlusion with severe neurological deficit is associated with an extremely poor prognosis. The safest and most effective treatment strategy has not yet been determined when such emboli are associated with unstable proximal carotid plaque. The authors performed emergent surgical embolectomy for left middle cerebral artery (MCA) occlusion, and the patient experienced marked neurological recovery without focal deficit and regained premorbid activity. ⋯ Specimens from subsequent elective carotid endarterectomy (CEA) showed ruptured vulnerable plaque that was histologically consistent as a source of the intracranial embolic specimen. Surgical embolectomy for MCA occlusion due to carotid plaque rupture followed by CEA could be a safer and more effective alternative to endovascular treatment from the standpoint of obviating the risk of secondary embolism that could otherwise occur as a result of the manipulation of devices through an extremely unstable portion of plaque. Further, this strategy is associated with a high probability of complete recanalization with direct removal of hard and large, though fragile, emboli.
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Journal of neurosurgery · Sep 2014
Role of oxidized LDL and lectin-like oxidized LDL receptor-1 in cerebral vasospasm after subarachnoid hemorrhage.
Cerebral vasospasm after subarachnoid hemorrhage (SAH) is a serious complication. Free radicals derived from subarachnoid clotting are recognized to play an important role. Oxidized low-density lipoprotein (ox-LDL) and lectin-like oxidized LDL receptor-1 (LOX-1) have been shown to be related to the pathogenesis of atherosclerosis and may increase in cerebral arteries after SAH, due to the action of free radicals derived from a subarachnoid clot. These molecules may also affect the pathogenesis of vasospasm, generating intracellular reactive oxygen species and downregulating the expression of endothelial NO synthase (eNOS). If so, apple polyphenol might be effective in the prevention of vasospasm due to an abundant content of procyanidins, which exhibit strong radical scavenging effects, and the ability to suppress ox-LDL and LOX-1. The purposes of this study were to investigate changes in levels of ox-LDL and LOX-1 after SAH and whether administering apple polyphenol can modify cerebral vasospasm. ⋯ This is the first study suggesting that ox-LDL and LOX-1 increase due to SAH and that they may play a role in the pathogenesis of vasospasm. It is assumed that procyanidins in apple polyphenol may inhibit a vicious cycle of ox-LDL, LOX-1, and ROS in a dose-dependent manner. Apple polyphenol is a candidate for preventive treatment of cerebral vasospasm.
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Journal of neurosurgery · Sep 2014
Retrosigmoid removal of small acoustic neuroma: curative tumor removal with preservation of function.
Management of small acoustic neuromas (ANs) consists of 3 options: observation with imaging follow-up, radiosurgery, and/or tumor removal. The authors report the long-term outcomes and preservation of function after retrosigmoid tumor removal in 44 patients and clarify the management paradigm for small ANs. ⋯ As a result of a surgical technique that involved sharp dissection and internal auditory canal reconstruction with intraoperative auditory monitoring, retrosigmoid removal of small ANs can lead to successful curative tumor removal without long-term recurrence and with excellent functional outcome. Thus, the authors suggest that tumor removal should be the first-line management strategy for younger patients with small ANs and preserved hearing.
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Journal of neurosurgery · Sep 2014
Comparative StudyComparison of two algorithms for the application of real-time image mosaicking in neuroendoscopy.
Neuroendoscopy is used more and more frequently in neurosurgical procedures and has become an important tool in the neurosurgical armamentarium. However, the main restriction of neuroendoscopy is the limited field of view. A better overview of the area of interest would increase surgical safety and decrease procedure-related morbidity rates. In the present study, the authors aimed to improve this restriction by using and comparing two algorithms to create endoscopic panoramic images, which increase the field of view during neuroendoscopic procedures. ⋯ Results in the study showed that the creation of image mosaics is possible and reliable with the featured algorithms. Image mosaicking is an applicable device for neuroendoscopy and can increase the field of view during endoscopic procedures. Its use can increase the safety and the field of application of neuroendoscopy. However, faster frame rates will be required to create a smooth image for practical use during surgery.