Neurosurgical review
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Neurosurgical review · Oct 2007
Case ReportsPersistent primitive hypoglossal artery with retrograde flow from the vertebrobasilar system: a case report.
The persistent primitive hypoglossal artery (PPHA) is one of the pairs of arterial connections that exist in the human embryo between the developing anterior and posterior circulation. Normally the PPHA arises from the cervical internal carotid artery (ICA) and passes through the hypoglossal canal to join the caudal basilar artery (BA). In most cases the vertebral arteries (VA) are either hypoplastic or aplastic and the posterior communicating arteries (PComA) are absent; thus, the main supply to the posterior circulation comes from the internal carotid via the PPHA in an antegrade fashion. ⋯ The postoperative angiogram showed resolution of the right ICA stenosis and persistence of the PHA. To our knowledge this is the first case report of a PPHA exhibiting reversal of blood flow from the posterior into the anterior circulation. Awareness of this embryological anomaly and its interaction with acquired atherosclerotic disease will minimize misinterpretation of vascular diagnostic studies.
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Neurosurgical review · Jul 2007
ReviewThe implications of ISAT and ISUIA for the management of cerebral aneurysms during pregnancy.
Both the International Subarachnoid Aneurysm Trial (ISAT) and the International Study on Unruptured Intracranial Aneurysms (ISUIA) have been widely extrapolated to influence the management of actual or anticipated aneurysmal subarachnoid hemorrhage (SAH). However, it remains possible that sub-groups exist for which such extrapolation might subsequently prove premature. In this review, we discuss the implications that such extrapolation may potentially have for one such SAH sub-group: the clinically rare scenario of SAH in pregnancy.
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Neurosurgical review · Jul 2007
Case ReportsAnterior subtemporal approach for posteriorly projecting posterior communicating artery aneurysms.
We report our experience with the anterior subtemporal approach for the posterior communicating artery aneurysm protruding posteriorly. Between 2000 and 2005, seven patients with posterior communicating artery aneurysm were operated on through the anterior subtemporal approach. ⋯ This approach seems to be suitable for posteriorly projecting posterior communicating artery aneurysms. The advantages of the anterior subtemporal approach are as follows: (1) It provides a short and a direct trajectory to the aneurysm. (2) Aneurysmal neck and surrounding structures can be easily identified and secured compared with the pterional approach. (3) A previously placed clip for a middle cerebral artery or internal carotid artery aneurysm through the pterional route does not interfere with the clipping surgery for regrown or de novo posterior communicating artery aneurysms.
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Different disorders may produce irreducible atlanto-axial dislocation with compression of the ventral spinal cord. Among the surgical approaches available for a such condition, the transoral resection of the odontoid process is the most often used. The aim of this anatomical study is to demonstrate the possibility of an anterior cervico-medullary decompression through an endoscopic endonasal approach. ⋯ The choana is entered and the mucosa of the rhinopharynx is dissected and transposed in the oral cavity in order to expose the cranio-vertebral junction and to obtain a mucosal flap useful for the closure. The anterior arch of the atlas and the odontoid process of C2 are removed, thus exposing the dura mater. The endoscopic endonasal approach could be a valid alternative to the transoral approach for anterior odontoidectomy.
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Neurosurgical review · Jul 2007
BDNF contributes to animal model neuropathic pain after peripheral nerve transection.
The outcome of peripheral nerve injury is often impaired by neuropathic pain, which is resistant to most analgesics and presents a serious clinical problem. The mechanisms underlying post-traumatic neuropathic pain remain unclear, but they are likely associated with the regeneration processes. Brain-derived neurotrophic factor (BDNF) is known to enhance peripheral nerve regeneration and is also considered to be an endogenous modulator of nociceptive responses following spinal cord lesion. ⋯ Seven weeks after the operation, the number of surviving and regenerating neurons in dorsal root ganglia was counted and the neuroma incidence was examined. We found that local inactivation of BDNF decreased the incidence as well as severity of autotomy and neuroma formation, but did not influence neuron regeneration into the chambers. These results indicate that BDNF plays a locally crucial role in neuropathic pain development after peripheral nerve injury.