Journal of neurosurgery
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Journal of neurosurgery · Feb 1996
Microvascular anatomy of dural arteriovenous abnormalities of the spine: a microangiographic study.
Although most vascular abnormalities of the spinal cord are now ascribed to an abnormal communication between a dural artery and a medullary vein on the dura near a sensory nerve root, these lesions are too small for their anatomy to be demonstrated directly by spinal arteriography. Thus, it is unknown whether the site of dural arteriovenous shunting is an arteriovenous malformation (AVM), implying a congenital origin, or is a direct arteriovenous fistula (AVF), implying an acquired etiology. The authors treated six patients by en bloc resection of the involved dural root sleeve, proximal nerve root, and adjacent spinal dura. ⋯ Several medium-to-small collateral vessels arising from adjacent intercostal or lumbar arteries were commonly present in the dura and converged at the site of the AVF to join a single medullary vein. These results show that spinal dural AVMs are direct AVFs that link the dural branch of the radiculo-medullary-dural artery with the intradural medullary vein. They also provide an anatomical explanation for the presence of a multiple segmental arterial supply and a single draining medullary vein of spinal dural AVFs, and the propensity for reestablishment of flow through the arteriovenous shunt after embolic occlusion.
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Journal of neurosurgery · Feb 1996
Case ReportsPosttraumatic intradiploic meningoencephalocele. Case report.
A case of posttraumatic intradiploic meningoencephalocele is reported. The patient presented with a progressively enlarging lump in the left parietal area approximately 8 months after a blunt trauma. ⋯ These findings were confirmed at surgery. In addition, the cyst was found to have a lining of arachnoid membrane.
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Journal of neurosurgery · Feb 1996
Case ReportsMiddle cerebral artery dissecting aneurysm with persistent patent pseudolumen. Case report.
The extremely rare condition of an ischemic right middle cerebral artery dissecting aneurysm with persistent patent pseudolumen is described. In the majority of cases of dissecting aneurysms, the pseudolumen persists for a very short time, probably because reentry from the pseudolumen is minimal or nonexistent. In contrast, the present case was assumed to have sufficient reentry from the bypass flow in the pseudolumen. Endothelial formation both in the true lumen and the pseudolumen was suggested as the possible mechanism of the stabilized double lumen.
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Journal of neurosurgery · Jan 1996
Psychosocial functioning and quality of life in patients with primary brain tumors.
Perceived quality of life (QOL) was evaluated in a group of 50 patients with primary brain tumors. Participants completed two QOL measures and a demographic profile. Age was found not to be an important factor in differentiating QOL in these patients. ⋯ This study is one of the first to evaluate the multidimensional aspects of QOL in patients with primary brain tumors, an understudied group. A prospective study of QOL in this group, already underway at the authors' institution, is needed to evaluate comprehensively the effect of different treatments and interventions on the QOL functioning of primary brain tumor patients. Additionally, this study shows that the choice of QOL instruments is very important and needs to be driven by the research question.
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To determine the incidence of, and risk factors for, the occurrence of rebleeding between admission and early operation (ultra-early rebleeding) in patients with spontaneous subarachnoid hemorrhage (SAH), the authors reviewed the cases of 179 patients admitted within 24 hours after their last attack of SAH. Thirty-one (17.3%) of these patients had ultra-early rebleeding despite scheduling of early operation (within 24 hours after admission). The incidence of rebleeding significantly decreased as the time interval between the last attack and admission increased. ⋯ Multivariate analysis revealed that the following three factors were independently associated with ultra-early rebleeding: the level of enhancement of platelet sensitivity; the time interval between the last attack and admission; and the level of thrombin-antithrombin complex. On the basis of these findings, the authors suggest that many of the risk factors for ultra-early rebleeding are interrelated. A particularly high risk of ultra-early rebleeding was observed in those patients 1) who had platelet hypoaggregability; 2) who were admitted shortly after their last SAH; and 3) whose thrombin-antithrombin complex levels were extremely high and were thus in severe clinical condition.