Acta neurochirurgica
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Acta neurochirurgica · Sep 2009
Case ReportsSymptomatic enlargement of an occluded giant carotido-ophthalmic aneurysm after endovascular treatment: the vasa vasorum theory.
We describe a patient with a symptomatic left giant carotido-ophthalmic aneurysm who initially underwent coil embolization with subtotal obliteration. The patient's symptoms were initially stable, but 1 year later, she presented with a rapidly progressive contralateral visual deficit. Although angiogram showed a stable neck remnant, MR confirmed aneurysm growth and showed a new peripheral hematoma in the wall of the thrombosed aneurysm. ⋯ The patient's recent visual deficit markedly improved, and the angiogram did not reveal any residue. Giant aneurysms may continue to grow due to a hypertrophic vasa vasorum and subadventitial hemorrhages. Surgery should be considered if complete thrombosis of the aneurysm does not alleviate patient's symptoms.
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Acta neurochirurgica · Sep 2009
Management of brachial plexus region tumours and tumour-like conditions: relevant diagnostic and surgical features in a consecutive series of eighteen patients.
Tumours of the brachial plexus region are rare and most publications are case reports or studies with a small series of patients. The aim of this study is to present our experience in managing these lesions. ⋯ The majority of tumours were benign and most of them could be excised with a low incidence of additional deficits. Some of the malignant tumours could be controlled by surgery plus adjuvant therapy, but this category is still associated with high morbidity and mortality rates.
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Acta neurochirurgica · Sep 2009
Navigated resection of giant intracranial meningiomas based on intraoperative 3D ultrasound.
Surgical resection of giant meningiomas may pose different challenges. Normal brain tissue is often compressed to the limit and is vulnerable to further traction. In addition, severe intraoperative bleeding may be a problem as many giant meningiomas are vascularised with deep feeding vessels entering from the skull base. Neuronavigation based on preoperative imaging can be of limited use as there may be extensive brain shifts during surgery. ⋯ We present a method of ultrasound-guided resection of giant meningiomas. The method enables image-guided resection through narrow approaches that minimise traction. Power Doppler angiography allows the identification of feeding vessels that may be coagulated to limit bleeding. Likewise, normal arteries can be avoided during surgery. The tumour capsule is often surprisingly easy to remove from the arachnoid membrane after gross intracapsular tumour reduction.
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Acta neurochirurgica · Sep 2009
Tentorial meningiomas: operative nuances and perioperative management dilemmas.
Tentorial meningiomas, comprising approximately 3-6% of all intracranial meningiomas, are complex entities with an intricate relationship to surrounding structures and require multiple surgical approaches. In the present study, the rationale for deciding the approaches for TMs and the perioperative management dilemmas were evaluated. ⋯ Classifying TM into medial and lateral, supra and infratentorial groups helps in deciding an appropriate and safe approach. Meticulously preserving venous sinuses is important since the risk of venous infarction cannot be predicted even with radiological good venous collaterization and apparent venous sinus blockade by tumor. Laterally situated tumors carry a better prognosis when compared to the medially situated ones. Leaving a small residual tumor in an effort to preserve important neurovascular structures does not obviate the expectation of a good long-term prognosis with minimal morbidity and low recurrence rates.
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It has been recently shown that A6 cells exposed to hyponatraemic stress respond with increased sodium uptake via activation of benzamil-sensitive sodium channels. This study was performed, therefore, to explore the possible involvement of benzamil-sensitive sodium channels and cellular sodium influx in brain oedema formation in hyponatraemic rats. ⋯ Early in the course of hyponatraemia, brain sodium channels may be activated, and the subsequent cellular sodium uptake may generate osmotic gradient to allow passive water flow into the cells. The simultaneous reduction of osmotic water conductivity of brain-specific aquaporin-4 by hyponatraemia, however, may limit water accumulation.