Neurosurgery
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Comparative Study
Impact of coil embolization on overall management and outcome of patients with aneurysmal subarachnoid hemorrhage.
We report on the consequences of introducing coil embolization for the total management of and outcome in patients with subarachnoid hemorrhage (SAH). ⋯ The increasing use of coil embolization for ruptured aneurysms in the anterior circulation did not have any significant impact on the overall incidence of SAH-related complications or outcome. The main determinant for outcome after SAH is still the severity of the SAH.
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Comparative Study Clinical Trial
Continuous intrathecal administration of 5-fluoro-2'-deoxyuridine for the treatment of neoplastic meningitis.
Previously, we reported a good clinical treatment effect of intrathecal chemotherapy by repeated bolus administration of 5-fluoro-2'-deoxyuridine (FdUrd) for neoplastic meningitis (NM). Moreover, we detected no side effects or neurotoxicity despite the long-term repetition of intrathecal administration. On the basis of these findings, continuous intrathecal chemotherapy (CIC) with FdUrd for patients with NM was attempted using a simple pump system. We evaluated the usefulness of CIC with FdUrd for the treatment of NM. ⋯ This therapy may be useful, especially as a maintenance therapy for NM.
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Comparative Study
Effect of brain surgery on auditory and motor cortex activation: a preliminary functional magnetic resonance imaging study.
The effect of glioma removal on blood oxygen level-dependent (BOLD) functional magnetic resonance imaging (fMRI) activation has not been widely documented. The aim of this preliminary study was to observe the effect of tumor resection on BOLD fMRI of the auditory and motor cortices. ⋯ The results of this study suggest that the resection of a glioma with preoperative edema affecting the auditory and/or motor cortex may cause a transient increase in the BOLD response ipsilateral to the tumor. It seems that when the tumor is resected, the pressure on the brain, specifically on the affected auditory and/or motor cortex, decreases and the functional cortex becomes more easily detectable in BOLD fMRI.
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Comparative Study
Heparin-induced thrombocytopenia Type II in subarachnoid hemorrhage patients: incidence and complications.
Heparin-induced thrombocytopenia Type II (HIT II) is the autoimmune-mediated severe form of the disease characterized by a significant reduction in platelets, and it carries a high risk of "paradoxical" serious thrombotic complications. Although HIT II has been studied in several different patient populations, the incidence of HIT II and the rate of thrombotic complications have never been reported in a neurosurgical patient population. Subarachnoid hemorrhage (SAH) patients, among neurosurgical patient populations, have a high exposure to heparin because they are in critical care units and have indwelling vascular catheters. In addition, the increase in neuroendovascular procedures with the associated use of heparinization will increase the exposure of SAH patients to heparin. ⋯ The incidence of HIT II in SAH patients at a single center was 15%. The SAH patients with HIT II had significantly higher rates of thrombotic complications, new hypodensities on head computed tomographic scans, more deaths, and significantly less favorable outcomes. This is the first report of the incidence of HIT II in a neurosurgical patient population.
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Comparative Study
A quantitative model of tumor-induced angiogenesis in the nude mouse.
Novel animal models allowing for the quantification of tumor-induced angiogenesis and cell migration may offer significant insight into the characterization and multidisciplinary treatment of brain tumors. In this study, we seek to establish such a model in tumor-bearing brain, allowing for a clear demarcation of primary and satellite tumor tissue in conjunction with precise quantification of cerebral microvasculature. ⋯ Because these highly infiltrative malignant brain tumors interdigitate with normal brain parenchyma through finger-like projections at the periphery of the solid tumor boundary, therapeutic options targeting tumor blood flow--combined with novel three-dimensional imaging to localize and track such interventions--may offer new hope for glioma management. To our knowledge, this system represents the first animal brain tumor model allowing for the precise colocalization and quantification of angiogenesis and tumor cell invasion, which may play an important role in the development of future therapy for brain tumors.