Journal of neurosurgery
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Journal of neurosurgery · Mar 2007
Endoscopic, endonasal extended transsphenoidal, transplanum transtuberculum approach for resection of suprasellar lesions.
The extended transsphenoidal approach is a less invasive method for removing purely suprasellar lesions compared with traditional transcranial approaches. Most advocates have used a sublabial incision and a microscope and have reported a significant risk of cerebrospinal fluid (CSF) leakage. The authors report on a series of purely endoscopic endonasal surgeries for resection of suprasellar supradiaphragmatic lesions above a normal-sized sella turcica with a low risk of CSF leakage. ⋯ A purely endoscopic endonasal approach to suprasellar supradiaphragmatic lesions is a feasible minimally invasive alternative to craniotomy. With a multilayer closure, the risk of CSF leakage is low and lumbar drainage can be avoided. A larger series will be required to validate this approach.
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Journal of neurosurgery · Mar 2007
A retrospective analysis of reasons for reoperation following initially successful peripheral nerve stimulation.
The authors investigated the causes for surgical reexploration in patients with complex regional pain syndrome Type II who received initial relief of pain from implantation of a peripheral nerve stimulator (PNS). ⋯ Although infection is attributable to surgical technique, most complications requiring repeated surgery (nine [33%] of 27) are caused by equipment design. Changes in PNS design or in implantation technique might substantially reduce the need for reoperation after PNS implantation.
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Journal of neurosurgery · Mar 2007
Neural injury and recovery near cortical contusions: a clinical magnetic resonance spectroscopy study.
Proton magnetic resonance (MR) spectroscopy can detect neural metabolic alterations noninvasively after traumatic brain injury (TBI) even in areas that appear normal. Unlike metabolic depression in diffuse TBI, focal metabolic alterations near cortical contusions in humans have not been previously investigated in a longitudinal study. The object of this study was to identify these alterations and examine their course. ⋯ Metabolic depression reflecting neural injury was apparent in subjacent normal-appearing white matter at 1 week after cortical contusion; this had normalized substantially at 1 month.
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Journal of neurosurgery · Mar 2007
Attenuation of experimental subarachnoid hemorrhage-induced increases in circulating intercellular adhesion molecule-1 and cerebral vasospasm by the endothelin-converting enzyme inhibitor CGS 26303.
Adhesion molecules, including intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and E-selectin, are important mediators of inflammation, and their levels are elevated in the serum of patients following aneurysmal subarachnoid hemorrhage (SAH). The investigators previously found that CGS 26303 is effective in preventing and reversing arterial narrowing in a rabbit model of SAH. The purpose of the present study was to examine whether levels of adhesion molecules are altered after treatment with CGS 26303 in this animal model. ⋯ These results show that ICAM-1 may play a role in mediating SAH-induced vasospasm and that a reduction of ICAM-1 levels after SAH may partly contribute to the antispastic effect of CGS 26303.
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Journal of neurosurgery · Mar 2007
Inhibition of angiogenesis induced by cerebral arteriovenous malformations using gamma knife irradiation.
The authors studied the effect of Gamma Knife irradiation on angiogenesis induced by cerebral arteriovenous malformation (AVM) tissues implanted in the corneas of rats. ⋯ The results suggest that Gamma Knife irradiation inhibits angiogenesis induced by AVM tissue in the cornea angiogenesis model. The data are not directly related to understanding how Gamma Knife irradiation occludes existing AVM vasculature, but to understanding why properly treated AVMs do not recur and do not show neovascularization after Gamma Knife irradiation.