Journal of neurosurgery
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Journal of neurosurgery · Jul 2005
Case ReportsEndoscopic options in the management of isolated fourth ventricles. Case report.
Isolation of the fourth ventricle is occasionally observed after shunt treatment of the lateral ventricles for obstructive panventricular hydrocephalus. Of the various surgical options currently available, placement of shunts in the fourth ventricle has remained as the mainstay of treatment. These shunts are difficult to place, however, and have been associated with higher complication rates. ⋯ Symptoms improved in all and the size of the fourth ventricle decreased as well, indicating a functioning stent. The ETV failed in two patients, however, and they required placement of a ventriculoperitoneal (VP) shunt. Aqueductal stenting with an ETV or a VP shunt is a promising option in the management of IFVs.
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Journal of neurosurgery · Jul 2005
Randomized Controlled Trial Multicenter Study Clinical TrialClazosentan (AXV-034343), a selective endothelin A receptor antagonist, in the prevention of cerebral vasospasm following severe aneurysmal subarachnoid hemorrhage: results of a randomized, double-blind, placebo-controlled, multicenter phase IIa study.
The goal of this study was to investigate the safety and tolerability of the novel endothelin A (ETA) receptor antagonist clazosentan in patients with subarachnoid hemorrhage (SAH) and its potential to reduce the incidence and severity of cerebral vasospasm following surgical clipping of the aneurysm. ⋯ This study indicates that clazosentan reduces the frequency and severity of cerebral vasospasm following severe aneurysmal SAH with the incidence and severity of adverse events comparable to that of placebo.
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Journal of neurosurgery · Jul 2005
Comparative StudySerum neuron-specific enolase, S100B, and myelin basic protein concentrations after inflicted and noninflicted traumatic brain injury in children.
Misdiagnosis of inflicted traumatic brain injury (iTBI) is common. Serum biomarkers may be able to assist in the detection of iTBIs that would otherwise be missed. The authors investigated whether serum concentrations of biomarkers were increased after noninflicted (n)TBI and iTBI in pediatric cases of varying severity. ⋯ Serum NSE, S100B, or myelin basic protein are increased in the majority of children with acute nTBI and iTBI, including well-appearing children with iTBI in whom the diagnosis might otherwise have been missed. Differences in the time course of NSE, S100B, and myelin basic protein after nTBI and iTBI may provide insight into the pathophysiology of iTBI. These serum markers should be prospectively evaluated in a target population of infants.
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Journal of neurosurgery · Jul 2005
Racial differences in demographics, acute complications, and outcomes in patients with subarachnoid hemorrhage: a large patient series.
Few studies have focused on the impact of racial differences in demographics, clinical characteristics, acute complications, and outcomes of patients with aneurysmal subarachnoid hemorrhage (SAH). The purpose of this study was to examine this issue. ⋯ Race was not found to be a prognostic factor for outcome after aneurysmal SAH. The higher SAH mortality rate previously observed in African-American patients is likely a result of a higher incidence of SAH in this group. These findings highlight the importance of primary prevention programs aimed at modifying risk factors for SAH.
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Journal of neurosurgery · Jul 2005
Clinical TrialEffect of normal saline bolus on cerebral blood flow in regions with low baseline flow in patients with vasospasm following subarachnoid hemorrhage.
Arterial vasospasm is the most common cause of delayed ischemic neurological deficits (DINDs) and one of the major causes of disability following subarachnoid hemorrhage (SAH). Current management of vasospasm involves intravascular volume expansion and hemodynamic augmentation with the goal of increasing cerebral blood flow (CBF). The purpose of this study was to examine the effects of volume expansion on regional (r)CBF in patients with DIND following SAH. ⋯ In euvolemic patients with vasospasm, intravascular volume expansion with a normal saline bolus raised CBF in regions of the brain most vulnerable to ischemia.