Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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The intraoperative identification and resection of glioma is a significant and important challenge in neurosurgery. Complete resection of the enhancing tumour increases the median survival time in glioblastoma compared to partial glioma resection; however, it is achieved in fewer than half of eligible patients when conventional tumour identification methods are used. Increasing the incidence of complete resection, without causing excess morbidity, requires new methods to accurately identify neoplastic tissue intraoperatively, such as use of the drug 5-amino-levulinic acid (ALA). ⋯ ALA use led to a significant increase in the incidence of complete resection (65% compared to 36%), improved progression-free survival at 6 months (41% compared to 21%), fewer reinterventions, and delayed onset of neurological deterioration. This review provides a broad assessment of ALA-PpIX fluorescence-guided resection, with Part 1 focusing on its clinical efficacy, and correlations with imaging and histology. The theoretical, biochemical and practical aspects of ALA use are reviewed in Part 2.
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Comparative Study
A comparison of the hemodynamic effects of flow diverters on wide-necked and narrow-necked cerebral aneurysms.
Flow diverters (FD), a new generation of intracranial stents with a low porosity mesh, have been applied as an alternative treatment for intracranial aneurysms. However, their efficacy varies among aneurysms of different morphology. In this study, computational fluid dynamic simulations were performed to examine the influence of an FD on the hemodynamics of wide-necked and narrow-necked cerebral aneurysms. ⋯ By comparison, in the wide-necked aneurysm model, the results were 47% and 21%, respectively. This study demonstrates that the FD markedly altered the hemodynamic conditions inside intracranial aneurysms, depending on aneurysm morphology. Therefore, hemodynamic modifications should be individually designed for aneurysms with different morphology.
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We aimed to identify biomarkers in skin punch biopsies that could be used to monitor progression of diabetic peripheral neuropathy (DPN), and, in future studies, to assess the efficacy of agents that may reduce progression. Patients with DPN were studied with clinical assessments, skin biopsies, quantitative sensory testing (QST), histamine-induced skin flare, nerve conduction studies and contact heat-evoked potentials (CHEPS). Skin biopsies were performed on two visits with a 6 month interval (n=29 patients) to quantify intraepidermal (IENF) and subepidermal (SENF) nerve fibres immunoreactive for: protein gene product 9.5 (PGP9.5), a pan-neuronal marker; transient receptor potential cation channel vanilloid 1 (TRPV1), the heat and capsaicin receptor; and growth associated protein-43 (GAP-43), a marker of regenerating fibres. ⋯ The other tests did not show significant changes. Strongly positive GAP-43 nerve fibres were found in deep dermis in the patients with diabetes, even in those with an absence of IENF. We conclude that PGP9.5 and TRPV1 IENF and SENF in skin biopsies are useful markers of progression in DPN, whereas GAP-43 SENF could potentially help detect nerve regeneration in severe neuropathy.
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Aneurysms of the lenticulostriate artery have been associated with hypertension, vasculopathy, tumors, and arteriovenous malformations. Although several cases of microsurgical treatment of ruptured lenticulostriate artery aneurysms have been reported, to our knowledge there is no published case of microsurgical treatment of an unruptured lenticulostriate artery aneurysm. We report a 66-year-old woman with a history of moyamoya disease, previously treated with a right-sided middle cerebral artery-to-superficial temporal artery bypass who presented with an unruptured aneurysm of a lenticulostriate artery. We report successful microsurgical treatment of this rare lesion and discuss the rationale for our treatment strategy.
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Pituitary tumour apoplexy is a rare but life threatening condition. Cushing's disease usually presents with clinical features of Cushing's syndrome. ⋯ After a transsphenoidal surgery he developed pan-hypopituitarism with diabetes insipidus. We also review the relevant literature.