Neurosurgery
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Emergent neurosurgery may be precipitated or complicated by previous or concomitant administration of anticoagulants, thrombolytic medications, or antiplatelet agents. Recommendations are presented to reverse or counteract the effects of those drugs before or during neurosurgical interventions. ⋯ Other clinical experience based on mechanisms of drug action within the coagulation process confirm that single or combined administration of platelet transfusions, fresh frozen plasma, cryoprecipitate, vitamin K, protamine, desmopressin, and recombinant activated factor VII can treat coagulopathies caused by warfarin, heparin, aspirin, adenosine diphosphate-receptor antagonist, glycoprotein IIb/IIIa receptor blocking agents, and thrombolysis. Specific interventions and recommended dosages are reviewed.
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The primary purpose of the study was to investigate the psychosocial effects of harboring a known but untreated unruptured intracranial aneurysm (UIA), information considered important to the decision of whether to treat or not treat an unruptured aneurysm. ⋯ A decrease in overall quality of life was found to be associated with harboring an identified but untreated UIA. Findings from the current study suggest that further investigation of psychosocial outcome in other groups of untreated UIA patients is warranted. Results also suggest that some untreated UIA patients might benefit from psychological intervention.
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Comparative Study
Homologous transplantation of neural stem cells to the injured spinal cord of mice.
Murine neural stem cells (NSCs) were homografted onto the injured spinal cord (SC) to assess their potential to improve motor behavior, to differentiate as neurons, and to establish synapse-like contacts with the descending axonal paths of the host. In addition, we investigated whether transduced NSCs over-expressing vascular endothelial growth factor might exert any angiogenetic effect in the injured SC. ⋯ In the traumatically injured mice SC, NSC grafting improves motor recovery. Although differentiation of engrafted NSCs is restricted exclusively toward the astrocytic phenotype, the NSC-derived astrocytes show features that are typical of the early phase after SC injury when the glial scar is still permissive to regenerating axons. The immature phenotype of the NSC-derived astrocytes suggests that these cells might support neurite outgrowth by the host neurons. Thus, modifying the glial scar with NSCs might enhance axonal regeneration in the injured area. The use of genetically engineered NSCs that express trophic factors appears to be an attractive tool in SC transplantation research.
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A case of chordoid meningioma originating in the right sylvian fissure is reported. Chordoid meningiomas are uncommon tumors. This is the first reported case of a chordoid meningioma without dural attachment arising in the sylvian fissure. ⋯ Meningiomas originate from arachnoid cap cells and can arise at locations remote from the pachymeninges. Although rare, meningiomas should be included on the differential diagnosis of sylvian fissure lesions.
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Comparative Study
Anticoagulation regimes and their influence on the occlusion rate of aneurysms: an experimental study in rabbits.
Our purpose was to determine whether anticoagulation has an influence on the occlusion rate and thromboembolic occurrence in saccular aneurysms treated with Guglielmi detachable coils. ⋯ Anticoagulation with heparin during the first days, followed by aspirin, appears unlikely to affect the occlusion rate in aneurysms. LMWH over a long period, however, could impair thrombus organization. Therefore, in regard to thrombus organization, an anticoagulation regime with aspirin seems to be superior to LMWH. This could play an important role in the prevention of thromboembolic events in humans treated with Guglielmi detachable coils.