Neurosurgery
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In human somatic cells, telomeres shorten with successive cell divisions, resulting in progressive genomic instability, altered gene expression, and cell death. Recently, telomere-specific deoxyribonucleic acid-binding proteins, such as telomeric repeat binding factor-1 (TRF1), have been proposed as candidates for the role of molecules regulating telomerase activity, and they have been suggested to play key roles in the maintenance of telomere function. The present study was designed to assess TRF1 expression in human astroglial brain tumors and to speculate on the clinical implications of its expression. ⋯ Our findings suggest that the loss of TRF1 expression capability, as a result of down-regulation of TRF1 expression in malignant gliomas cells, may play a role in the malignant progression of astroglial brain tumors.
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Large or malignant middle cerebral artery infarction is associated with a high mortality rate. Hemicraniectomy reduces intracranial pressure and has been demonstrated to increase survival. Questions remain regarding selection of patients for surgery and functional outcomes. ⋯ Hemicraniectomy is life-saving treatment for large middle cerebral artery infarction. Good functional outcomes can be obtained but are less likely in older patients. Younger patients with large-volume strokes may benefit from multiple decompressions, if necessary.
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To describe the effects of ventralis oralis anterior (VOA) and posterior (VOP), as well as ventralis intermedius (VIM), deep brain stimulation (two ipsilateral thalamic leads implanted) on posttraumatic Holmes tremor. Results of both thalamic lesioning and thalamic deep brain stimulation for Holmes tremor and tremors due to posttraumatic lesions in the region of the midbrain have been disappointing. In 2001, the use of two electrodes implanted in parallel for severe essential tremor was reported. We propose the use of a similar technique for posttraumatic Holmes tremor. One rationalization for the placement of two leads was to affect both the cerebellar receiving area (VIM) and the pallidal receiving area (VOA/VOP). A second rationalization was that the placement of a second electrode may affect somatotopy, and may, therefore, be beneficial for the treatment of more difficult to control tremor subtypes. ⋯ The patient experienced tremor rebound with VIM-VOP monotherapy. However, when the second lead (VOA/VOP) was activated, he experienced sustained improvement in tremor and tremor disability at a 12-month follow-up examination. This case elucidates a potential new approach for the treatment of patients with posttraumatic Holmes tremor. Additional study and longer follow-up periods will be needed to further evaluate this promising therapy.
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Traumatic subarachnoid hemorrhage (tSAH) is a frequent finding after closed-head injuries, and its presence is a powerful factor associated with poor outcome. The exact mechanism linking tSAH and an adverse outcome is poorly understood. The aim of this study was to identify the factors that may predict outcomes and changes in the computed tomographic (CT) scans of lesions in a selected population of tSAH patients. ⋯ The outcome of patients with tSAH at admission is related in a logistic regression analysis to the admission Glasgow Coma Scale score and to the amount of subarachnoid blood. These patients also have a significant risk of CT progression. The amount of subarachnoid blood and the presence of associated parenchymal damage are powerful independent factors associated with CT progression, thus linking poor outcomes and CT changes.
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To demonstrate the role of intraoperative multichannel electromyographic (EMG) monitoring to reduce postoperative deterioration and achieve full untethering of complex occult dysraphisms. ⋯ Intraoperative multichannel EMG monitoring can be carried out and requires only minimal changes to anesthetic procedures. With this method, it is possible to better identify the neural structures of complex malformations, reducing the risks of surgical damage and incomplete detethering.