Neurosurgery
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Case Reports
Aggressive cranial vault decompression for cranial hyperostosis: technical case report of two cases.
Camurati-Engelmann's disease, also known as progressive diaphysial dysplasia, is a disorder of the bone metabolism. Neurological manifestations of progressive diaphysial dysplasia include cranial nerve dysfunction, generalized weakness, cerebellar herniation, and increased intracranial pressure. In the past, surgical intervention has been of limited and temporary benefit. We present two patients with cranial hyperostosis secondary to Camurati-Engelmann's disease who were treated successfully with a single surgery involving a combination of multiple craniotomies for cranial vault decompression. ⋯ Effective surgical options are needed for clinically significant cranial hyperostosis. In an effort to further define operative management in these patients, we describe a single, aggressive surgical procedure that may be used for successful cranial decompression.
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Clinical Trial
Use of ultrasonic aspiration for dural opening in cranial reoperations: technical note.
Dural detachment from the brain in cranial reoperations has been accomplished previously by selective coagulation and the cutting of brain-dural adhesions. The results of ultrasonic aspiration during tumor surgery or brain cutting procedures led the authors to speculate that the detachment of the dura mater from brain tumors by applying the Cavitron ultrasonic surgical aspirator (Valleylab, Boulder, CO [formerly Cavitron, Inc., Stamford, CT]) to the brain-dura mater interface could be used to reduce bleeding and facilitate dural opening during cranial reoperations. ⋯ Incremental dural opening and brain visualization is achieved by careful application of ultrasonic aspiration directly into the brain-dura limit, producing immediate regional dural devascularization. Use of this technique reduces cortical and dural bleeding and enhances the ease and effectiveness of brain visualization.
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Clinical Trial
Microvascular retractor: a new concept of retracting and repositioning cerebral blood vessels.
In this technical note, we report our results with a newly designed retractor blade that can be directly applied for the retraction and repositioning of cerebral blood vessels and delicate neural structures. ⋯ The new retractor incorporates the existing advantages offered by flexible self-retaining retractor blades with those features that adapt to blood vessel retraction. Rather than concentrating force at one point as typical retractors do, the semicircular tip distributes the retraction force over multiple points along its circumference.
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To describe a new technique of suturing microvessels with persistent perfusion via a temporary intraluminal microshunt. ⋯ We have described a new technique for performing microvascular anastomoses over a temporary intraluminal microcatheter shunt.
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Adhesion and migration of leukocytes into the periadventitial space play a role in the pathophysiology of vasospasm after subarachnoid hemorrhage (SAH). Intercellular adhesion molecule-1 is a determinant cell adhesion molecule involved in this process. Ibuprofen has been shown to inhibit intercellular adhesion molecule-1 upregulation and prevent vasospasm in animal models of SAH. In this study, we report the toxicity and efficacy of locally delivered ibuprofen incorporated into controlled-release polymers to prevent vasospasm in a monkey model of SAH. ⋯ Ibuprofen polymers are safe and prevent angiographic vasospasm after SAH in the monkey model. These findings support the role of cell adhesion molecules and inflammation in the pathophysiology of vasospasm.