Neurosurgery
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Case Reports
Intravascular ultrasound for intracranial angioplasty and stent placement: technical case report.
Intravascular ultrasound (IVUS) imaging has been used extensively in coronary artery interventions and has provided invaluable information for the understanding and treatment of coronary arterial disease. We present here the first description, to our knowledge, of IVUS-guided intracranial arterial interventions in the clinical setting. ⋯ IVUS of the intracranial circulation may assist the performance of intracranial angioplasty and stenting. It provides useful information that can affect clinical decisions. It may prove to be a valuable tool in clinical use and enhance our understanding of vascular disease of the intracranial circulation, as it has in the coronary circulation.
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Review Biography Historical Article
Surgery of the mind and mood: a mosaic of issues in time and evolution.
The prevalence and economic burden of neuropsychiatric disease are enormous. The surgical treatment of these psychiatric disorders, although potentially valuable, remains one of the most controversial subjects in medicine, as its concept and potential reality raises thorny issues of moral, ethical, and socioeconomic consequence. This article traces the roots of concept and surgical efforts in this turbulent area from prehistory to the 21st century. ⋯ These refinements, characterized by progressive minimalism and founded on a better comprehension of underlying pathways of normal function and disease states, have been further explored with recent advances in imaging, which have allowed the emergence of less invasive and technology driven non-ablative surgical directives toward these problematical disorders of mind and mood. The application of therapies based on imaging comprehension of pathway and relay abnormalities, along with explorations of the notion of surgical minimalism, promise to serve as an impetus for revival of an active surgical effort in this key global health and socioeconomic problem. Eventual coupling of cellular and molecular biology and nanotechnology with surgical enterprise is on the horizon.
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Randomized Controlled Trial
Intra-arterial reteplase and intravenous abciximab in patients with acute ischemic stroke: an open-label, dose-ranging, phase I study.
New approaches are focusing on using a combination of medication that lyse fibrin and prevent aggregation of platelets to achieve higher rates of recanalization and improved clinical outcomes. ⋯ In this study, a combination of intra-arterial reteplase and intravenous abciximab was safely administered to patients with ischemic stroke presenting between 3 and 6 hours after symptom onset.
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We investigated predictors of survival and the neurological outcomes of neurosurgical patients who experienced cardiac arrest and received cardiopulmonary resuscitation after being admitted to the neurosurgical intensive care unit. ⋯ Even after initially successful resuscitation, survival and neurological recovery is quite dismal in patients with cerebral lesions. Prognostic factors for neurosurgical patients should be assessed on an individual basis to determine medical futility in the early post-resuscitation period.
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The optic strut (OS) is a candidate landmark in computed tomographic (CT) angiographic scans for the discrimination of intradural and extradural/intracavernous aneurysms involving the paraclinoid segment of the internal carotid artery. The goal of this study is to examine and confirm the qualifications of the OS as a landmark in CT angiographic scans for the preoperative evaluation of aneurysms in this region. ⋯ On CT angiographic scans, the OS is a precise identification of the proximal dural ring that forms the superior border of the cavernous sinus. The aneurysms whose necks arise obviously distal to the OS on CT angiographic scans are able to be clipped without dissection of the proximal dural ring.