World Neurosurg
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Randomized Controlled Trial
Clinical and Radiological Outcome of Intra-Cranial Aneurysm Clipping aided by Transit Time Flowmetry.
Since the International Subarachnoid Aneurysm Trial, coiling has been favored over clipping for intracranial aneurysms, resulting in selection of increasingly complex aneurysm configurations for clipping. We present the outcomes of clipping of aneurysms not suitable for coiling, with transit time flowmetry technology to aid monitoring of intraoperative flow. ⋯ In this study of clinical and radiological outcomes of surgically treated cerebral aneurysms not suitable for unassisted coiling, we showed positive results for these challenging aneurysms, aided by transit time flowmetry as a valuable tool, providingquantitative measurements of arterial blood flow to help achieve optimal clip placement and minimizing aneurysm residuals that may be sites of rebleeding. Adequate flow, defined as ≥50% of baseline, greatly reduces the risk of unfavorable outcome.
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Case Reports
Laser interstitial thermotherapy for treatment of symptomatic peritumoral edema after radiosurgery for meningioma.
Symptomatic peritumoral edema (PTE) is a known complication after radiosurgical treatment of meningiomas. Although the edema in most patients can be successfully managed conservatively with corticosteroid therapy or bevacizumab, some medically refractory cases may require surgical resection of the underlying lesion when feasible. Laser interstitial thermotherapy (LITT) continues to gain traction as an effective therapeutic modality for the treatment of radiation necrosis where its biggest impact is through the control of peritumoral edema. ⋯ This case demonstrates that LITT may be a viable alternative treatment for patients with meningioma with symptomatic PTE who have failed medical therapy and require surgical intervention.
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Microvascular decompression (MVD) has been the most effective long-term surgical treatment of trigeminal neuralgia (TN). However, the risk factors for poor pain control after MVD are not fully understood. ⋯ Younger patients with TN had worse long-term pain outcomes after MVD. The additional factors associated with postoperative recurrence included poor preoperative pain control (Barrow Neurological Institute score >IV) and multivessel compression. Furthermore, combined compression of the superior cerebellar artery and petrosal vein was associated with worse outcomes.
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The present study was performed to elucidate the role of nitric oxide (NO) and connexin 40 (Cx40) in the induction of cerebral vasospasm after subarachnoid hemorrhage (SAH) in vivo. ⋯ The NO-cGMP-PKG pathway alleviated cerebral vasospasm via Cx40 upregulation.
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Carotid endarterectomy (CEA) for high cervical internal carotid artery stenosis is considered to be technically demanding because of the difficulty in dissecting the distal end. We report the surgical technique and outcome analysis of CEA for high cervical lesions. ⋯ The surgical outcomes for high cervical lesions are equivalent to that of non-high cervical lesions. Excessive blood pressure management from the early postoperative days is a risk of PRCI.