Neurosurg Focus
-
The choices available in the management of metastatic spine disease are complex, and the role of surgical therapy is increasing. Recent studies have indicated that patients treated with direct surgical decompression and stabilization before radiation have better functional outcomes than those treated with radiation alone. The most common anterior surgical approach for direct spinal cord decompression and stabilization in the thoracic spine is open thoracotomy; however, thoracotomy for spinal access is associated with morbidity that can be avoided with minimally invasive techniques like thoracoscopy. ⋯ The minimally invasive thoracoscopic approach can be applied to the treatment of thoracic and thoracolumbar metastatic spine disease in an effort to reduce access morbidity. Preliminary results have indicated that adequate decompression, reconstruction, and stabilization can be achieved with this technique.
-
Case Reports
The superficial temporal artery trunk as a donor vessel in cerebral revascularization: benefits and pitfalls.
The superficial temporal artery (STA) is the mainstay of donor vessels for extracranial-intracranial bypass in cerebral revascularization. However, the typically used STA anterior or posterior branch is not always adequate in its flow-carrying capacity. In this report the authors describe the use of the STA trunk at the level of the zygoma as an alternative donor and highlight the benefits and pitfalls of this revascularization option. ⋯ The STA trunk is a valuable donor option for cerebral revascularization, but should be avoided in the setting of subarachnoid hemorrhage.
-
The microsurgical anatomy of the occipital artery (OA) was studied to describe the diameter, length, and course of this vessel as it pertains to revascularization procedures of the posterior cerebral circulation. ⋯ The length, diameter, and flow accomodated by the OA make it an ideal choice as a conduit for posterior circulation bypass. The bypass from the OA to the caudal loop of the PICA demonstrates the least difference in vessel diameter, and is therefore best suited for EC-IC bypass procedures in the posterior circulation.
-
Lamotrigine is an antiepileptic drug that inhibits presynaptic voltage-gated sodium channels and reduces the presynaptic release of glutamate in pathological states. Neuroprotective effects of this drug have already been demonstrated in cerebral ischemia models. The aim of the present study was to determine the effects of presynaptic glutamate release inhibition on experimental spinal cord injury (SCI). ⋯ Currently, no available agent has been identified, that can block all the glutamate receptors at the same time. To prevent excitotoxicity in SCI, inhibiting glutamate release from the presynaptic buttons instead of blocking the postsynaptic glutamate receptors seems to be a more rational approach. Further research, such as neurobehavioral assessment, is warranted to demonstrate the probable neuroprotective effects of presynaptic glutamate release inhibition in SCI.
-
Venous stasis and intrathecal hypertension are believed to play a significant role in the hypoperfusion present in the spinal cord following injury. Lowering the intrathecal pressure via cerebrospinal fluid (CSF) drainage has been effective in treating spinal cord ischemia during aorta surgery. The purpose of the present study was to determine whether CSF drainage increases spinal cord perfusion and improves outcome after spinal injury in an animal model. ⋯ Cerebrospinal fluid drainage effectively lowers intrathecal pressure and decreases the amount of tissue damage in an animal model of spinal cord injury. Further studies are needed to determine whether different draining regimens can improve motor or electrophysiological outcomes.