Journal of neurosurgery
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Journal of neurosurgery · Oct 2002
The effect of brain temperature on hemoglobin extravasation after traumatic brain injury.
Although the benefits of posttraumatic hypothermia have been reported in experimental studies, the potential for therapeutic hypothermia to increase intracerebral hemorrhage remains a clinical concern. The purpose of this study was to quantify the amount of extravasated hemoglobin after traumatic brain injury (TBI) and to assess the changes in intracerebral hemoglobin concentrations under posttraumatic hypothermic and hyperthermic conditions. ⋯ Injury severity is an important determinant of the degree of hemoglobin extravasation after TBI. Posttraumatic hypothermia reduced hemoglobin extravasation, whereas hyperthermia increased hemoglobin levels compared with normothermia. These findings are consistent with previous data reporting that posttraumatic temperature manipulations alter the cerebrovascular and inflammatory consequences of TBI.
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Journal of neurosurgery · Oct 2002
Retrospective analysis of a 10-year experience of stereotactic radio surgery for arteriovenous malformations in children and adolescents.
To obtain information essential to the decision to perform radiosurgery for arteriovenous malformations (AVMs) in children and adolescents, the authors retrospectively analyzed their experience with gamma knife surgery for AVMs in 100 patients ranging in age from 4 to 19 years. ⋯ Radiosurgery is an acceptable treatment for small AVMs in children and adolescents in whom a higher obliteration rate can be achieved with lower risks of interval hemorrhage compared with the reported results in the general population. Careful follow-up observation seems to be required, however, even after angiographically verified obliteration.
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Journal of neurosurgery · Oct 2002
Fibrinolysis therapy achieved with tissue plasminogen activator and aspiration of the liquefied clot after experimental intracerebral hemorrhage: rapid reduction in hematoma volume but intensification of delayed edema formation.
Fibrinolysis therapy accomplished using tissue plasminogen activator (tPA) and aspiration is considered to be a viable alternative to microsurgery and medical therapy for the treatment of deep-seated spontaneous intracerebral hematomas (SICHs). Tissue plasminogen activator is a mediator of thrombin- and ischemia-related delayed edema. Because both thrombin release and ischemia occur after SICH, the authors planned to investigate the effect of fibrinolytic therapy on hematoma and delayed edema volume. ⋯ Despite a significantly accelerated reduction in hematoma volume, the development of delayed perifocal edema was intensified by fibrinolytic therapy, which is probably related to the function of tPA as a mediator of edema formation after thrombin release and ischemia. Further experimental and clinical investigations are required to establish the future role of fibrinolysis in the management of SICH.
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Journal of neurosurgery · Oct 2002
Hydroxyapatite laminar spacers and titanium miniplates in cervical laminoplasty.
The authors describe a new surgical technique for cervical laminoplasty that was performed in 25 patients. The posterior elements along with the various ligaments are removed en bloc and are stabilized in a lift-up position by placing hydroxyapatite (HA) laminar spacers and titanium miniplates and screws. The procedure and clinical results are discussed. ⋯ This technique enables rigid laminoplasty while maintaining anatomical and biomechanical integrity of posterior elements of cervical spine. Expansive and nonexpansive laminoplasty procedures are possible.
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Journal of neurosurgery · Oct 2002
Case ReportsA bone and cable girth-hitch technique for atlantoaxial fusion in pediatric patients. Technical note.
A new technique for performing a posterior rib and multistranded cable atlantoaxial fusion in children is described. The technique has been used successfully, in two patients 22 and 18 months of age, respectively. In both cases, fusion was used to augment C1-2 transarticular screw fixation, and solid arthrodesis was achieved without a halo orthosis.