Journal of neurosurgery
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Journal of neurosurgery · Jul 2003
Matrix metalloproteinase-9 concentration after spontaneous intracerebral hemorrhage.
Matrix metalloproteinases (MMPs) are overexpressed in the presence of some neurological diseases in which blood-brain barrier disruption exists. The authors investigated the MMP-9 concentration in patients after acute intracerebral hemorrhage (ICH) and its relation to perihematomal edema (PHE). ⋯ Expression of MMP-9 is raised after acute spontaneous ICH. Among patients with deep ICH this increase is associated with PHE and the development of neurological worsening within the acute stage.
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Journal of neurosurgery · Jul 2003
Treatment of anterior communicating artery aneurysms: complementary aspects of microsurgical and endovascular procedures.
Endovascular and surgical treatment must be clearly defined in the management of anterior communicating artery (ACoA) aneurysms. In this study the authors report their recent experience in using a combined surgical and endovascular team approach for ACoA aneurysms, and compare these results with those obtained during an earlier period in which surgical treatment was used alone. Morbidity and mortality rates, causes of unfavorable outcomes, and morphological results were also assessed. ⋯ The direction in which the fundus projects was chosen as the morphological criterion between endovascular and surgical methods. The authors propose that microsurgical clip application should be the preferred option in the treatment of ACoA aneurysms with anteriorly directed fundi and that endovascular packing be selected for those lesions with posteriorly directed fundi, depending on morphological criteria.
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Journal of neurosurgery · Jul 2003
Comparative StudyAnthropomorphic simulations of falls, shakes, and inflicted impacts in infants.
Rotational loading conditions have been shown to produce subdural hemorrhage and diffuse axonal injury. No experimental data are available with which to compare the rotational response of the head of an infant during accidental and inflicted head injuries. The authors sought to compare rotational deceleration sustained by the head among free falls, from different heights onto different surfaces, with those sustained during shaking and inflicted impact. ⋯ Vigorous shakes of this infant model produced rotational responses similar to those resulting from minor falls, but inflicted impacts produced responses that were significantly higher than even a 1.5-m fall onto concrete. Because larger accelerations are associated with an increasing likelihood of injury, the findings indicate that inflicted impacts against hard surfaces are more likely to be associated with inertial brain injuries than falls from a height less than 1.5 m or from shaking.
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Journal of neurosurgery · Jul 2003
Case Reports Comparative StudyFocal fractionated radiotherapy for intramedullary spinal arteriovenous malformations: 10-year experience.
Radiosurgical treatment of spinal arteriovenous malformations (AVMs) is becoming a practical therapeutic option as methodology improves, but no comparative study has yet been published on focal fractionated radiotherapy. The authors report their experience with conventional and hypofractionated radiotherapy for spinal AVM. ⋯ Because no patient experienced adverse effects, the maximum tolerable radiation dose for the spinal cord associated with an AVM could not be identified, although it presumably is higher than those administered. The lack of rebleeding in patients in whom complete angiographic occlusion was absent suggests that the natural history of spinal AVMs may be less aggressive than previously reported.
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Journal of neurosurgery · Jul 2003
Comparative StudyAnterior cervical plate fixation: biomechanical effectiveness as a function of posterior element injury.
The primary goal of this study was to determine if the stabilization provided to the spine by anterior cervical fixation with plating (ACFP) was dependent on the degree of posterior element injury. The secondary goal was to evaluate the effectiveness of additional posterior screw/rod stabilization in these injuries. ⋯ Capsular ligaments and articular facets are important structures in limiting three-dimensional vertebral motion in the presence of an anterior plate. Supplementary posterior fixation does reduce motion for all injury conditions.