Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2013
ReviewAngiographic vasospasm versus cerebral infarction as outcome measures after aneurysmal subarachnoid hemorrhage.
Despite a significant reduction of angiographic vasospasm, the reduction of poor functional outcome in clinical trials on aneurysmal subarachnoid hemorrhage (SAH) remains challenging. While there is general consensus that vasospasm is associated with delayed cerebral ischemia (DCI), cerebral infarction, poor functional outcome, and mortality after SAH, causal relationships are subject to discussion. Therefore, it was the aim of our study to investigate the relationship between various outcome measures and poor functional outcome in clinical trials on pharmaceutical treatment of SAH. ⋯ Future clinical trials may use cerebral infarction and functional outcome as main outcome measures to -investigate the true impact of an intervention, assuming that the intervention targets cerebral infarction and hereby improves outcome.
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Acta Neurochir. Suppl. · Jan 2013
ReviewMagnesium sulphate for aneurysmal subarachnoid hemorrhage: why, how, and current controversy.
The neuroprotective effect of magnesium sulphate infusion has been confirmed in experimental models. Pilot clinical trials using magnesium sulphate in patients with acute aneurysmal subarachnoid hemorrhage (SAH) have reported a trend toward a reduction in clinical deterioration due to delayed cerebral ischemia (DCI) and an improvement in clinical outcomes. ⋯ In post hoc analysis, data also did not support that a higher dose of magnesium sulphate infusion might improve clinical outcome. We here review the current literature, highlight these discrepancies, and explore alternatives.
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Acta Neurochir. Suppl. · Jan 2013
Intra-operative transdural electric stimulation in awake patient: target refining for motor cortex stimulation.
Most authors perform the implantation of epidural electrodes for motor cortex stimulation (MCS) under general anesthesia, using navigation merely based on anatomic landmarks or in combination with intra-operative sensory evoked potentials (SEP) for functional localization. However, intra-operative SEP can only provide the localization of central sulcus in patients who present sensory pathways which are at least partially preserved. Conversely, there are massive deafferentation pain syndromes (e.g., brachial plexus avulsion or amputation) in which the peripheral sensory pathways are severely or totally injured, precluding the use of intra-operative SEP. Objective. The authors present a simple technique for functional localization and intra-operative mapping of motor cortex by the implementation of transdural electrical stimulation of cerebral cortex for target refining of motor cortex during cortical electrode implantation procedures. ⋯ The proposed technique was useful for target refining in implantation of epidural electrode for motor cortex stimulation. Further studies are required to investigate if target refining by intra-operative mapping will significantly improve the results in the treatment of refractory pain.
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Acta Neurochir. Suppl. · Jan 2013
ReviewSpreading ischemia after aneurysmal subarachnoid hemorrhage.
Spreading depolarization (SD) is a wave of mass neuronal and glial depolarization associated with net influx of cations and water. Prolonged SDs facilitate neuronal death. SD induces tone alterations in cerebral resistance arterioles, leading to either transient hyperperfusion (physiological neurovascular coupling) in healthy tissue or hypoperfusion (inverse neurovascular coupling = spreading ischemia) in tissue at risk for progressive damage. ⋯ In animals, spreading ischemia produced widespread cortical necrosis. In patients, spreading ischemia occurred in temporal correlation with ischemic lesion development early and late after aSAH. We briefly review important features of SD and spreading ischemia following aSAH.
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Acta Neurochir. Suppl. · Jan 2013
Multicenter StudyClinical, transcranial Doppler ultrasound, radiological features and, prognostic significance of delayed cerebral ischemia.
We aimed to investigate the profiles and prognostic values of delayed cerebral ischemia (DCI) and delayed cerebral infarction. ⋯ Delayed cerebral ischemia and delayed cerebral infarction carried different prognostic values in aneurysmal subarachnoid hemorrhage.