Neurosurgery
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Perforating arteries are commonly involved during the surgical dissection and clipping of intracranial aneurysms. Occlusion of perforating arteries is responsible for ischemic infarction and poor outcome. The goal of this study is to describe the usefulness of near-infrared indocyanine green videoangiography (ICGA) for the intraoperative assessment of blood flow in perforating arteries that are visible in the surgical field during clipping of intracranial aneurysms. In addition, we analyzed the incidence of perforating vessels involved during the aneurysm surgery and the incidence of ischemic infarct caused by compromised small arteries. ⋯ The involvement of perforating arteries during clip application for aneurysm occlusion is a usual finding. Intraoperative ICGA may provide visual information with regard to the patency of these small vessels.
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Comparative Study
Surgical treatment of high-risk intracranial dural arteriovenous fistulae: clinical outcomes and avoidance of complications.
An increasing number of intracranial dural arteriovenous fistulae (DAVFs) are amenable to endovascular treatment. However, a subset of patients with high-risk lesions requires surgical intervention for complete obliteration. We reviewed our experience with the surgical management of high-risk intracranial DAVFs and offer recommendations to minimize complications based on fistula location and type. ⋯ Despite fulminant presenting symptoms, high-risk intracranial DAVFs can be successfully managed with good outcomes. When anatomic features prevent endovascular access, or embolization fails to obliterate the lesion, urgent surgical treatment is indicated. Patients with residual filling of the DAVF should be considered for adjuvant therapy, including further embolization or radiosurgery.
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Comparative Study
Collagen scaffolds populated with human marrow stromal cells reduce lesion volume and improve functional outcome after traumatic brain injury.
Traumatic brain injury (TBI) causes extensive loss of cerebral parenchyma; however, no strategy for reconstruction has been clinically effective. Our group and others have used human marrow stromal cells (hMSCs) to treat rats subjected to TBI and found no significant changes in the lesion volume, although functional outcome was improved significantly. To identify new ways of delivering hMSCs into the injured brain and to maximize the therapeutic benefits of hMSC treatment, we investigated the use of collagen scaffolds implanted with hMSCs as a cell delivery system for treatment of TBI. ⋯ The data show that scaffolds populated by hMSCs improve spatial learning and sensorimotor function, reduce the lesion volume, and foster the migration of hMSCs into the lesion boundary zone after TBI in rats. hMSC-populated scaffolds may be a new way to reconstruct the injured brain and improve neurological function after TBI.
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With the recent interest in superficial temporal artery-middle cerebral artery (MCA) bypass for hemodynamic related ischemia, we performed an anatomic study to find the best possible craniotomy site that will allow finding a suitable recipient cortical artery without compromising the use of the best branch and/or segment of the donor's superficial temporal artery branches. ⋯ This study provides an anatomic and patient-independent mathematical measurement as a way to predictably find an adequate recipient temporal M4 branch for superficial temporal artery-MCA bypass in the majority of patients.