Journal of neurosurgery
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Journal of neurosurgery · Apr 2011
Case ReportsRecipient targeting for revascularization using pulsed Doppler ultrasonography for the treatment of an intracranial giant aneurysm.
Aneurysmal occlusion after blood flow revascularization is a promising management strategy for the treatment of intracranial giant aneurysms. However, it is necessary to design robust revascularization for preventing postoperative flow-related infarctions caused by abrupt occlusion of the parent vessels. ⋯ In this paper, the authors' goal was to identify distal cortical recipient arteries on the brain surface, based on pulsed Doppler ultrasonography analysis of blood flow alteration after temporary closure of the efferent vessels. This method is used to visualize the area around the sacrificed vessels, omits intraoperative arteriography or the risk of a surgical trace of the vessels by dissecting the distal sulci, and could be advantageous for necessary and sufficient revascularization.
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Journal of neurosurgery · Apr 2011
The relevance of age and disease duration for intervention with subthalamic nucleus deep brain stimulation surgery in Parkinson disease.
The optimal age and disease duration for consideration of deep brain stimulation (DBS) surgery are not well characterized in patients with Parkinson disease. The aim of this study was to assess variation in motor response to surgery among subgroups stratified by age and disease duration. ⋯ The postoperative improvement in rigidity for younger patients with shorter disease duration may indicate that performing early surgery maximizes the benefit of DBS. However, older patients with primarily dyskinesia symptoms also appear to have significant clinical improvement, and DBS can offer relief from this common consequence of long-term levodopa use.
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Journal of neurosurgery · Apr 2011
Early surgery of multiple versus single aneurysms after subarachnoid hemorrhage: an increased risk for cerebral vasospasm?
As many as 33% of patients suffering from subarachnoid hemorrhage (SAH) present with multiple intracranial aneurysms (MIAs). It is believed that aneurysm surgery has the potential to increase the risk of cerebral vasospasm due to surgical manipulations of the parent vessels and brain tissue. Consequently, 1-stage surgery of MIAs, which usually takes longer and requires more manipulation, could even further increase the risk of vasospasm. The aim of this study is to define the correlation between vasospasm and the operative treatment of single intracranial aneurysms versus MIAs in a 1-stage operation. ⋯ Clipping of more than 1 aneurysm in a 1-stage operation within 72 hours after SAH can be performed without increasing the risk of cerebral (TCD) vasospasm and symptomatic vasospasm.
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Journal of neurosurgery · Apr 2011
Risk of ventriculostomy-related hemorrhage in patients with acutely ruptured aneurysms treated using stent-assisted coiling.
Intracranial stenting has improved the ability to treat wide-neck aneurysms via endovascular techniques. However, stent placement necessitates the use of antiplatelet agents, and the latter may complicate the treatment of patients with acutely ruptured aneurysms who demonstrate hydrocephalus and require ventriculostomy. Antiplatelet agents in this setting could increase the incidence of ventriculostomy-related hemorrhagic complications, but there are insufficient data in the medical literature to quantify this potential risk. The aim of this study was to directly quantify the risk of ventriculostomy-related hemorrhage in patients with acute aneurysmal subarachnoid hemorrhage treated with stent-assisted coiling. ⋯ The application of dual antiplatelet therapy in stent-assisted coiling of acutely ruptured aneurysms is associated with an increase in the risk of hemorrhagic complications following ventriculostomy or VP shunt placement, as compared with its use in a coiling procedure without a stent.
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Journal of neurosurgery · Apr 2011
Optimal cerebrospinal fluid magnesium ion concentration for vasodilatory effect and duration after intracisternal injection of magnesium sulfate solution in a canine subarachnoid hemorrhage model.
The optimal CSF Mg(++) concentration for vasodilation of spastic cerebral arteries after subarachnoid hemorrhage (SAH) and its duration are unknown. The temporal profile of the vasodilatory effect and optimal CSF Mg(++) concentration after the intracisternal injection of MgSO(4) solution were investigated in an SAH model in canines. ⋯ The reversible effect of an intracisternal injection of MgSO(4) solution on the spastic artery requires CSF Mg(++) concentrations > 3 mEq/L. The vasodilatory effect continues for 3-6 hours after injection. These results suggest that the continuous infusion or intermittent intracisternal injection of MgSO(4) is needed to maintain the optimal CSF Mg(++) concentration and constantly ameliorate cerebral vasospasm.