Neurosurgery
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Cerebral vasospasm is a potentially fatal consequence of aneurysmal subarachnoid hemorrhage and influences the prognosis of the patient. The purpose of this study was to evaluate the status of thin (actin) and thick (myosin) filament regulation of smooth muscle contraction in the double-subarachnoid hemorrhage canine model of cerebral vasospasm and to determine the effects of a kinase inhibitor reported to be effective in vasospasm, HA1077, on thin and thick filament regulation. ⋯ These data suggest that degradation of the thin filament-associated protein calponin plays a role in cerebral vasospasm and that the antivasospastic action of HA1077 is, at least in part, due to prevention of calponin degradation.
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Review Case Reports Multicenter Study
Ischemic events associated with unruptured intracranial aneurysms: multicenter clinical study and review of the literature.
To determine the prevalence, clinical characteristics, and long-term outcomes in cases involving transient ischemic attacks (TIAs) or ischemic strokes secondary to embolization from unruptured intracranial aneurysms. ⋯ Ischemic events can occur distal to both small and large unruptured intracranial aneurysms (predominantly in the anterior circulation). The long-term risk of recurrent ischemic events, particularly major or disabling strokes, seems to be low with either surgical or conservative treatment.
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Lesions situated posterolaterally along the mesencephalon present neurosurgeons with a special challenge. The midline and paramedian variations of the supracerebellar infratentorial approaches do not adequately expose this region. The subtemporal approach risks injury to the vein of Labbé. An extreme lateral supracerebellar infratentorial approach with more radical resection of bone superiorly and laterally, and skeletonization of the sigmoid and transverse sinuses, was used to approach lesions at this location in eight ⋯ The extreme lateral supracerebellar infratentorial approach differs from the midline and paramedian supracerebellar infratentorial variants in the area of exposure, patient positioning, and location of the craniotomy. The technique is effective for approaching the posterolateral mesencephalon.
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The purpose of this study was to compare the long-term effectiveness of spinal cord stimulation using laminectomy-style electrodes versus that using percutaneously implanted electrodes. ⋯ Spinal cord stimulation is an effective treatment for chronic pain in the lower back and lower extremities that is refractory to conservative therapy. Electrodes placed via laminectomy in the thoracic region appear to be associated with significantly better long-term effectiveness than are electrodes placed percutaneously.
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Traumatic brain injury is associated with a stress response that includes hyperglycemia, which has been shown to worsen neurological outcome during cerebral ischemia and hypoxia. To better examine the relationship between hyperglycemia and outcome after head injury, we studied the clinical course of 267 head-injured patients who were admitted for treatment in the neurosurgical department of Asclepeion Hospital of Athens between January 1993 and November 1997. ⋯ Early hyperglycemia is a frequent component of the stress response to head injury, a significant indicator of its severity, and a reliable predictor of outcome.