Neurosurgery
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Stereotactic radiosurgery has been used for patients with high-risk cavernous malformations of the brain. We performed radiosurgery for patients with symptomatic, imaging-confirmed hemorrhages for which resection was believed to be associated with high risk. This study examines the long-term hemorrhage rate after radiosurgery. ⋯ Radiosurgery confers a reduction in the risk of hemorrhage for high-risk cavernous malformations. Risk reduction, although in evidence during initial follow-up, is most pronounced after 2 years. Given the difficulty of identifying high-risk patients, treatment after one major hemorrhage should be considered in selected younger patients. Such a strategy warrants further investigation.
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This article describes the professional lives of the founders of neurological surgery in Brazil as well as the Brazilian Society of Neurosurgery. The pioneers were Augusto Brandão Filho, the first general surgeon to perform brain surgery in Brazil, and José Ribe Portugal and Elyseu Paglioli, the founders of the first two neurosurgery schools in Brazil. The Brazilian Society of Neurosurgery was founded in Brussels, Belgium, on July 26, 1957, during the First International Congress of Neurological Surgery, at the initiative of José Ribe Portugal and José Geraldo Albernaz.
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Blood vessel (BV) compression of the trigeminal nerve (Cranial Nerve [CN] V) is a common cause of trigeminal neuralgia (TN). High-resolution magnetic resonance imaging scans obtained during gamma knife radiosurgery (GKRS) in patients with TN may be used to analyze the BV-CN V relationship. Follow-up data from a large series of patients treated with GKRS for TN were used to provide information regarding the BV-CN V relationship and pain relief. ⋯ In patients who have not undergone previous surgery for TN, BV-CN V contact revealed by high-resolution magnetic resonance imaging may indicate a particularly favorable response to GKRS.
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The interactions of CD44 with hyaluronan are thought to be crucial for tumor cell attachment to the extracellular matrix, migration, and invasion. For migration to occur, however, the interactions between hyaluronan and cell surface receptors need to be transient. Hyaluronidases may facilitate the degradation of hyaluronan bound to the cell surface and thus reduce the interactions of the cells with the matrix, whereas the overproduction of hyaluronan in the absence of hyaluronidase activity may prevent cells from proliferating or invading normal surrounding tissue. ⋯ The data suggest that an increased synthesis of hyaluronan by astrocytoma cells is only promoting tumor cell growth in vivo if the cells express hyaluronidases as well.
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The Thrombolysis in Myocardial Infarction (TIMI) grading scheme and other classification systems are limited because they do not account for occlusion location or collateral circulation. A new scheme for angiographic classification of arterial occlusion and recanalization response to intra-arterial thrombolysis in acute ischemic stroke was designed because of limitations in existing grading systems. ⋯ Application of the new classification scheme for assessing pretreatment occlusion and response to intra-arterial thrombolysis resulted in high interobserver agreement and correlated with 7-day outcomes. The six grades used in this scheme allowed precise angiographic evaluation of perfusion changes.