Acta neurochirurgica
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Acta neurochirurgica · Aug 2011
Case ReportsBypass of the maxillary to proximal middle cerebral artery or proximal posterior cerebral artery with radial artery graft.
The authors report three cases of radial artery (RA) graft bypass from the maxillary artery (MA) to either the middle cerebral artery (MCA) or the posterior cerebral artery (PCA). The first two cases presented with the features of basal ganglion ischemia, and magnetic resonance imaging (MRI) revealed left and right basal ganglion ischemia respectively, whereas angiogram showed MCA occlusion. Computed tomography angiography (CTA) of the third case, who presented with headache and dysphasia, showed a giant basilar artery aneurysm with an absence of the left posterior communicating artery (PComA). ⋯ Postoperative angiogram disclosed patent RA graft and refilling of the ischemic segment. Follow-up at 7-9 months showed marked clinical improvement in all cases. To our knowledge, MA bypass has not been performed clinically till the date and this method may be a safe, effective and new surgical technique for the extracranial-intracranial (EC-IC) bypass surgery.
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Acta neurochirurgica · Aug 2011
Case ReportsImprovement of hand dexterity induced by stimulation of the peduncolopontine nucleus in a patient with advanced Parkinson's disease and previous long-lasting bilateral subthalamic DBS.
We report the case of a patient already submitted to bilateral deep-brain stimulation (DBS) of the subthalamic nucleus (STN) who started to develop gait impairment, postural imbalance and frequent falls in the course of the disease and who subsequently underwent DBS of the right pedunculopontine nucleus (PPN) at our institute. An immediate clinical benefit in hand dexterity was observed with acute external stimulation and maintained after the definitive implant of the internal pulse generator (IPG) at 6 months' follow-up. The benefit on hand dexterity seemed to be related to the interactions between the PPN low-frequency stimulation and the bilateral STN high-frequency stimulation.
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Acta neurochirurgica · Aug 2011
Computed tomography-guided γ knife stereotactic radiosurgery for trigeminal neuralgia.
Gamma knife stereotactic radiosurgery (GKSR) is an effective minimally invasive option for the treatment of medically refractory trigeminal neuralgia (TN). Optimal targeting of the retrogasserian trigeminal nerve target requires thin-slice, high-definition stereotactic magnetic resonance imaging (MRI). The purpose of this study was to evaluate management outcomes in TN patients ineligible for MRI and who instead underwent GKSR using computed tomography (CT). ⋯ CT-guided GKSR provides a similar rate of pain relief as MRI-guided radiosurgery. The posterior pins should be placed at least 1 cm away from the inion to reduce pin and frame-related artifacts on the targeting CT scan. This study indicates that GKSR using CT targeting is appropriate for patients with medically refractory TN who are unsuitable for MRI.
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Acta neurochirurgica · Aug 2011
The possible role of neuropeptide Y after spontaneous subarachnoid hemorrhage.
Neuropeptide Y (NPY), a highly potent vasoconstrictive neuropeptide, is widely expressed in the human brain, regulating vessel diameter and cerebral blood flow. Earlier studies focusing on the possible role of NPY in the context of aneurismal subarachnoid hemorrhage (SAH) and vasospasm have produced conflicting results. However, despite extensive research efforts, the pathophysiological mechanisms underlying the SAH-related vasospasm and delayed cerebral ischemia (DCI) have not been clarified. We, therefore, attempted to investigate the role of NPY in SAH-induced vasospasm in a larger, well documented patient population utilizing modern analytical tools. We focused on the release of the potent vasoconstrictor NPY in cerebrospinal fluid (CSF) and blood, and its correlation to vasospasm and stroke in the early clinical stage. ⋯ NPY is released excessively into blood and CSF following SAH. Patients with cerebral infarction caused by vasospasm had significantly higher levels of NPY. Our results indicate a certain role for NPY in the pathophysiology of vasospasm due to SAH and justify further studies in this area of research.