Journal of neurosurgery
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Journal of neurosurgery · Sep 2003
Fluorescence-guided resection of glioblastoma multiforme by using high-dose fluorescein sodium. Technical note.
The authors have recently performed a fluorescence-guided tumor resection procedure by using high-dose fluorescein sodium without any special surgical microscopes for the intraoperative visualization of glioblastoma multiforme (GBM), and they report on the actual procedure and clinicopathological findings. Thirty-two patients with GBMs underwent tumor resection during which this fluorescence-guided procedure was used. Fluorescein sodium (20 mg/kg) was intravenously injected after dural opening at the craniotomy site. ⋯ Although the extent of surgery was revealed to be one of the significant and independent prognostic factors for GBM, the fluorescein sodium-guided resection procedure was not a significant or independent prognostic factor in this series. This surgical procedure does not require any special surgical microscopic equipment and is simple, safe, useful, readily accomplished, and universally available for resection of GBMs. Its efficacy simplifies the surgical procedure of navigating the stained lesion from the unstained area to achieve GTR of GBMs, which can be demonstrated on magnetic resonance images.
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Journal of neurosurgery · Sep 2003
Clinicopathological study of "snake-eye appearance" in compressive myelopathy of the cervical spinal cord.
The goal of this study was to elucidate the pathophysiological features and clinical significance of the magnetic resonance imaging-documented small intramedullary high signal intensity known as "snake-eye appearance" (SEA) in cases of compressive myelopathy such as cervical spondylosis or ossification of the posterior longitudinal ligament. ⋯ Snake-eye appearance was found to be a product of cystic necrosis resulting from mechanical compression and venous infarction. Destruction of the gray matter accompanying significant neuronal loss in the anterior horn suggested that SEA is an unfavorable prognostic factor for the recovery of upper-extremity motor weakness.
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Journal of neurosurgery · Sep 2003
Case ReportsTraumatic carotid-cavernous fistula treated by combined transarterial and transvenous coil embolization and associated cavernous internal carotid artery dissection treated with stent placement. Case report.
The authors report on a case in which a carotid-cavernous fistula and an associated cavernous-carotid dissection developed in a 48-year-old man following a motor vehicle accident. The fistula was treated with coil embolization via a combined transarterial-transvenous approach. The dissected carotid artery segment was treated with a balloon-expandable stent, which restored normal caliber and hemispheric flow. There was no recurrence of the fistula and the postoperative wide patency of the carotid artery indicates that stent placement is an effective method of treating traumatic intracranial artery dissections.
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Journal of neurosurgery · Sep 2003
Differential temporal expression of matrix metalloproteinases after spinal cord injury: relationship to revascularization and wound healing.
Matrix metalloproteinases (MMPs), particularly MMP-9/gelatinase B, promote early inflammation and barrier disruption after spinal cord injury (SCI). Early blockade of MMPs after injury provides neuroprotection and improves motor outcome. There is recent evidence, however, that MMP-9 and MMP-2/gelatinase A participate in later wound healing in the injured cord. The authors therefore examined the activity of these gelatinases during revascularization and glial scar formation in the contused murine spinal cord. ⋯ These findings suggest that although MMP-9 and -2 exhibit overlapping expression during revascularization, the former is associated with acute injury responses and the latter with formation of a glial scar.
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The authors retrospectively reviewed the presenting symptomatology and 6-month outcome in 241 consecutive patients who underwent C6-7 anterior cervical discectomy (ACD) from an overall series of 1008 patients in whom the senior author performed one-level procedures. ⋯ Approximately 15% of patients with a C-7 radiculopathy are likely to present with atypical symptoms that, if persisting after nonsurgical therapy, will often resolve after ACD and fusion.