Neurosurgery
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Elevated mean cerebral blood flow velocity (mCBFV) on transcranial Doppler predicts vasospasm of the large intracranial arteries after aneurysmal subarachnoid hemorrhage (aSAH). The pulsatility index (PI) is a measure of distal vascular resistance, which may be low when there is compensatory distal vasodilatation following hypoperfusion caused by large-vessel vasospasm. ⋯ Low PI on TCCD is an independent predictor of SLVVS after aSAH, whereas mCBFV is a better predictor of angiographic vasospasm.
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Endovascular embolization is a desirable treatment option for complex posterior circulation aneurysms, particularly recurrent aneurysms or those in difficult-to-access surgical locations. However, endovascular access is occasionally prohibited by proximal vertebral artery (VA) occlusion or vessel tortuosity. One strategy in such instances involves creation of an extracranial bypass conduit to the distal VA. ⋯ Extracranial carotid-VA bypass can be a valuable tool in the management of complex posterior circulation aneurysms. It is a safe and efficacious technique providing a conduit for repeated access to the posterior circulation in patients with otherwise prohibitive vertebral anatomy.
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Despite intraoperative technical improvements, the insula remains a challenging area for surgery because of its critical relationships with vascular and neurophysiological functional structures. ⋯ With intraoperative cortico-subcortical mapping and neurophysiological monitoring, a major resection is possible with an acceptable risk and a significant result in the follow-up.
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Clinical Trial
A new method for modulating traumatic brain injury with mechanical tissue resuscitation.
Traumatic brain injuries remain a treatment enigma with devastating late results. As terminally differentiated tissue, the brain retains little capacity to regenerate, making early attempts to preserve brain cells after brain injury essential. ⋯ Mechanical tissue resuscitation with controlled subatmospheric pressure can significantly modulate levels of excitatory amino acids and lactate in traumatic brain injury, decrease the water content and volume of injured brain, improve neuronal survival, and speed functional recovery.