World Neurosurg
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Comparative Study
Malignant Cerebral Venous Infarction; Decompressive Craniectomy versus Medical Treatment.
Cerebral venous thrombosis (CVT) is a common type of stroke in young adults and associated with 8% mortality. High intracranial pressure (ICP) and brain herniation are the most common causes of death in these patients. In contrast with malignant arterial middle cerebral infarction, there are few studies reporting the efficacy of decompressive craniectomy (DC) for treatment of high ICP in patients with CVT. In this study, we assess the clinical outcome of patients with CVT with impending brain herniation treated with DC versus medical management. ⋯ The results of our study confirmed that in contrast with DC, medical treatment could not prevent transtentorial herniation. DC is not only lifesaving for patients with CVT with impending brain herniation but also results in favorable outcome in most patients.
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Brainstem hemorrhage (BSH) is the most dangerous and devastating subtype of intracerebral hemorrhage and is associated with high morbidity and mortality. However, to date, no effective prevention methods or specific therapies have been available to improve its clinical outcomes. We preliminarily explored the efficacy of deferoxamine (DFO), a clinical chelator known for its iron-scavenging activities, in a rat model of BSH induced with collagenase infusion. ⋯ Administration of DFO had limited therapeutic effects on collagenase-induced brainstem hemorrhage in rats. Some potential explanations were proposed, and more preclinical work is required to clarify the controversial curative effect of DFO in ICH.
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Comparative Study
Embolization Of Very Small (≤3mm) Unruptured Intracranial Aneurysms - A Large Single Center Experience On Treatment Of Unruptured Versus Ruptured Cases.
In selected cases, embolization can be indicated for very small unruptured intracranial aneurysms. Previous studies reported high intraprocedural rupture rates. Recent improvements of endovascular devices and availability of small, soft platinum coils may lead to improved safety and efficacy profiles. ⋯ In the context of technical evolution of endovascular devices, we observed a procedural perforation rate lower than previously reported, low morbidity and no mortality. Further prospective studies are warranted to update our knowledge about safety of embolization for very small intracranial aneurysms.
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Posttraumatic cerebral venous sinus thrombosis (CVST) is a major complication after head injury. Impaired venous outflow caused by CVST leads to increased intracranial pressure (IICP) refractory to medications and surgical decompression and often results in devastating consequences. Currently, there is no consensus on the treatment strategy. ⋯ Acute cerebral sinus thrombosis caused by trauma may result in malignant IICP refractory to medications and surgical decompression. We have demonstrated that endovascular angioplasty and sinus stenting are effective in restoring venous outflow and reducing intracranial pressure. We have also demonstrated that appropriate and timely interventions are important to ensure quick and good recovery in patients with CVST.
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A case of high-flow cervical vertebro-vertebral arteriovenous fistula (VVAVF), which was occluded with detachable coils by the transarterial/transvenous double-catheter technique and balloon anchoring technique, is reported. ⋯ The double-catheter technique and balloon anchoring technique used in this case seem effective for transvenous embolization of VVAVF when preservation of the VA is desired.