Surg Neurol
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Although congenital afibrinogenemia can commonly present with hemorrhage from the umbilical cord at birth, or with spontaneous mucosal or intracranial hemorrhage in the neonatal period, life-threatening intracerebral hemorrhage in adults is infrequent. ⋯ Spontaneous intracerebral hemorrhage must be included in the differential diagnosis in patients with known afibrinogenemia presenting with symptoms suggesting raised intracranial pressure. Immediately after surgery, intracranial pressure monitoring of patients is mandatory to pick up further intracranial bleeding early. Fibrinogen replacement therapy is recommended before surgery, but its use as a long-term prophylaxis against hemorrhage should be weighed against the risk of thrombosis.
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Microscope-integrated near-infrared indocyanine green videoangiography (ICG-VA) is a new method of intraoperative blood flow assessment. The objective of this study was to evaluate the reliability of this technique in the evaluation of neck residuals and patency of branches after microneurosurgical clipping of intracranial aneurysms (IAs). ⋯ Indocyanine green videoangiograph is a simple and fast method of blood flow assessment with acceptable reliability. Indocyanine green videoangiograph can provide real-time information to assess blood flow in vessels of different size as well as the occlusion of the aneurysm. Intraoperative assessment of blood flow in the perforating branches is one of the most important advantages. In selected cases such as giant, complex, and deep-sited aneurysms or when the quality of image in ICG-VA is not adequate, other methods of intraoperative blood flow assessment should be considered.
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In the United States, TBI remains a major cause of morbidity and mortality in children and young adults. A total of 1.5 million Americans experience head trauma every year, and the yearly economic cost of this exceeds $56 billion. The magnitude of this problem has generated a great deal of interest in elucidating the complex molecular mechanism underlying cell death and dysfunction after TBI and in the development of neuroprotective agents that will reduce morbidity and mortality. ⋯ The literature and evidence for EPO as a potent inhibitor of apoptosis and promising therapeutic agent in a variety of neurological insults, including trauma, are mounting. With the recent interest in clinical trials of EPO in human stroke, it is both timely and prudent to consider the use of this pharmaceutical avenue in TBI in man.
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Review Historical Article
The history of awake craniotomy for brain tumor and its spread into Asia.
In ancient times, awake craniotomy was used for trepanation to treat seizures and remove a variety of morbid conditions or even to permit the escape of evil air. In modern times, this technique was initially used for removal of epileptic foci with simultaneous application of brain mapping with electrical current. ⋯ It has been used in North America since the 1980s, then Europe, and recently has spread into Asia. Its spread to Asia could have significant impact based on the large population of patients and the low resource utilization associated with awake craniotomy.
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Reduced cerebral blood flow and cerebrovascular reactivity to acetazolamide (type 3 ischemia) is believed as an independent predictor for subsequent ischemic stroke in patients with occlusive carotid artery diseases. However, recent studies have shown that type 3 patients can be divided into 2 pathophysiologically different subgroups as follows: those with elevated OEF and those with normal OEF. This study was aimed to clarify whether there is a difference in the prognosis between patients with type 3 and elevated OEF and those with type 3 but normal OEF. ⋯ Type 3 patients may be categorized into 2 subgroups as follows: those with elevated OEF and higher stroke risk and those with normal OEF and lower stroke risk, although larger number of subjects should be analyzed.