Journal of neurosurgery
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Journal of neurosurgery · Apr 2011
Improvement in neurological outcome and abolition of cerebrovascular endothelin B and 5-hydroxytryptamine 1B receptor upregulation through mitogen-activated protein kinase kinase 1/2 inhibition after subarachnoid hemorrhage in rats.
Delayed cerebral ischemia after subarachnoid hemorrhage (SAH) remains a major cause of death and disability. It has been hypothesized that cerebrovascular upregulation of vasoconstrictor receptors is a key step in the development of delayed cerebral ischemia. Upregulation of endothelin-B (ET(B)) and 5-hydroxytryptamine 1B (5-HT(1B)) receptors has been demonstrated in cerebral artery smooth muscles in the delayed ischemic phase after experimental SAH, and intracellular signaling via the mitogen-activated protein kinase kinase (MEK)-extracellular signal-regulated kinase 1/2 pathway has been shown to be involved in this upregulation. The aim in the present study was to determine whether treatment with the MEK1/2 inhibitor U0126 can prevent cerebrovascular receptor upregulation and improve functional outcome after experimental SAH in rats. ⋯ The authors demonstrated that experimental SAH induces upregulation of ET(B) and 5-HT(1B) receptors in cerebrovascular smooth muscles and that treatment with the MEK1/2 inhibitor U0126 abolishes this receptor upregulation. They also demonstrated that experimental SAH results in sensorimotor deficits as assessed by a rotating pole test. These deficits were alleviated by U0126 treatment, suggesting that cerebrovascular receptor upregulation is critical for the functional outcome of delayed cerebral ischemia. The authors suggest that inhibition of MEK1/2 may be a promising new SAH treatment strategy.
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The object of this study was to describe the rapid closure technique in decompressive craniectomy without duraplasty and its use in a large cohort of consecutive patients. ⋯ The present analysis of the largest series reported to date reveals that the rapid closure technique is feasible and safe in decompressive craniectomy. The surgical time is significantly shorter without increased complication rates or additional complications. Cranioplasty after a RCDC procedure was also feasible, fast, safe and not impaired by the RCDC technique.
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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.