Neurosurgery
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Previous work has demonstrated the importance of protein kinase C in regulating glioma cell proliferation in vitro. Tamoxifen, a protein kinase C inhibitor when administered in high dosages, is currently being used as an adjuvant in the treatment of patients with malignant gliomas. The patient in the present study harbored a left frontal anaplastic astrocytoma adjacent to Broca's area and the paracentral region, which limited gross resection. ⋯ The subsequent in vitro testing of the tumor that was removed after the recurrence of tumor (22 months after the initiation of tamoxifen) revealed loss of sensitivity to tamoxifen. However, the recurrent tumor remained sensitive to growth inhibition by the potent protein kinase C inhibitor, hypericin, despite loss of sensitivity to tamoxifen in vitro, suggesting the potential clinical application of this agent. This close in vitro correlation with the clinical course of the patient in the present study suggests a potential role for such in vitro radiation and chemosensitivity testing in designing a rational individualized clinical course of treatment.
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This study proposes an anatomically based nomenclature for the internal carotid artery (ICA) that can be applied by all disciplines. In 1938, Fischer published a seminal paper describing five segments of the ICA that were designated C1 through C5. These segments were based on the angiographic course of the intracranial ICA rather than its arterial branches or anatomic compartments. ⋯ Histological sections in critical areas were examined. The authors' classification has the following seven segments: C1, cervical; C2, petrous; C3, lacerum; C4 cavernous; C5, clinoid; C6, ophthalmic; and C7, communicating. This classification is practical, accounts for new anatomic information and clinical interests, and clarifies all segments of the ICA.
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The morphological consequences of delayed posttraumatic brain hyperthermia (39 degrees C) after fluid percussion brain injury were assessed in rats. Sprague-Dawley rats anesthetized with 4% halothane and maintained on a 70:30 mixture of nitrous oxide:oxygen and 0.5% halothane underwent moderate (1.5-2.0 atm) traumatic brain injury with the injury screw positioned parasagittally over the right parieto-occipital cortex. At 24 hours after traumatic brain injury, the rats were reanesthetized and randomized into two groups in which either a 3-hour period of brain normothermia (36.5 degrees C, n = 18) or hyperthermia (39 degrees C, n = 18) was maintained. ⋯ For example, numbers of swollen axons within the sixth layer of the right somatosensory cortex, corpus callosum, and internal capsule were 7.3 +/- 1.3, 4.2 +/- 1.4, and 3.0 +/- 1.2 axons (mean +/- standard error of the mean) with normothermia, respectively, compared with 24.7 +/- 12.1, 33.1 +/- 4.2, and 27.3 +/- 3.1 axons with hyperthermia, respectively (P < 0.01). An ultrastructural examination of the swollen axons demonstrated a severely thinned myelin sheath containing axoplasm devoid of cytoskeletal components. These experimental results indicate that posttraumatic brain hyperthermia might increase morbidity and mortality in patients with head injury by aggravating axonal and microvascular damage.
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Comparative Study
Nonoperative management of Types II and III odontoid fractures: the Philadelphia collar versus the halo vest.
The nonoperative management of patients with Types II and III fractures of the odontoid process consists of a prolonged course of cervical immobilization. The need for rigid fixation, demonstrated by the routine use of the halo vest in many institutions, has never been rigorously substantiated. We retrospectively analyzed our results with the nonsurgical management of odontoid fractures to ascertain whether cranial fixation affected overall outcome. ⋯ In general, nonsurgical management of Type III odontoid fractures was recommended, accompanied by use of a cervical orthosis. The determination of operative versus nonoperative treatment for Type II fractures was made on the basis of fracture anatomy, patient age, other associated injuries, and patient preference. The lack of a significant difference in the need for late surgical procedures or late instability, improved patient comfort with the cervical orthosis, and elimination of the risk of halo-related complications favored the use of the rigid cervical orthosis in the majority of these cases.
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Case Reports Comparative Study
The role of computed tomographic angiography in the diagnosis of intracranial aneurysms and emergent aneurysm clipping.
Conventional cerebral angiography has always been regarded as the gold standard for intracranial aneurysm detection. However, conventional angiography has the disadvantages of being invasive and time consuming. We present here 30 patients who underwent computed tomographic angiography (CTA) with three-dimensional reconstruction for the detection of intracranial aneurysms. ⋯ Unfortunately, there was no surgical confirmation in this case because the family of the patient refused surgery. Our results have demonstrated that CTA is a quick, reliable, and relatively simple diagnostic tool for intracranial aneurysms. In an emergent situation, such as a deteriorating patient with a hematoma, it is superior to either empiric exploration or infusion computed tomographic scans because it delineates the orientation and configuration of the aneurysm and its associated vascular anatomy.