Journal of neurosurgery
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Journal of neurosurgery · Apr 2011
Case ReportsTheta-gamma dysrhythmia and auditory phantom perception.
Tinnitus is considered an auditory phantom percept analogous to phantom pain. Thalamocortical dysrhythmia has been proposed as a possible pathophysiological mechanism for both tinnitus and pain. Thalamocortical dysrhythmia refers to a persistent pathological resting state theta-gamma coupling that is spatially localized at an area where normally alpha oscillations predominate. ⋯ Maximal tinnitus suppression was obtained by current delivery exactly at the blood oxygen level-dependent activation hotspot, which colocalizes with increased gamma and theta activity, in contrast to the other electrode poles, which demonstrated a normal alpha peak. These spectral changes normalized when stimulation induced tinnitus suppression, both on electrode and source-localized electroencephalography recordings. These data suggest that thetagamma coupling as proposed by the thalamocortical dysrhythmia model might be causally related to a conscious auditory phantom percept.
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Journal of neurosurgery · Apr 2011
Reconstructive endovascular treatment of intracranial aneurysms with the Willis covered stent: medium-term clinical and angiographic follow-up.
Placement of covered stents has emerged as a promising therapeutic option for cerebrovascular diseases. However, the medium- and long-term efficacy and safety of covered stents in the treatment of these diseases remain unclear. The purpose of this study was to evaluate the medium-term clinical and angiographic outcomes of covered stent placement for the treatment of intracranial aneurysms. ⋯ Endovascular reconstruction with the Willis covered stent represents a safe, durable, and curative treatment option for selected intracranial aneurysms, yielding an excellent medium-term patency of the parent artery and excellent clinical outcomes.
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Journal of neurosurgery · Apr 2011
Case ReportsIndocyanine green videoangiography to detect aneurysm and related vascular structures buried in subarachnoid clots.
This 44-year-old woman presented with a ruptured anterior communicating artery aneurysm. Intraoperative indocyanine green (ICG) videoangiography demonstrated the aneurysm neck and dome, which were buried in subarachnoid clots. Dissection and aspiration of the clots around the neck were safely performed without touching the ruptured points. ⋯ The patient's postoperative course was excellent. This case illustrates the use of intraoperative ICG videoangiography to provide information about the anatomical location of the aneurysm neck and dome despite their being completely obscured by subarachnoid clots. Intraoperative ICG videoangiography allowed safer dissection of the ruptured aneurysm from the blood clots.
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Journal of neurosurgery · Apr 2011
The azygos anterior cerebral artery bypass: double reimplantation technique for giant anterior communicating artery aneurysms.
The authors introduce the azygos anterior cerebral artery (ACA) bypass as an option for revascularizing distal ACA territories, as part of a strategy to trap giant anterior communicating artery (ACoA) aneurysms. In this procedure, the aneurysm is exposed with an orbitozygomatic-pterional craniotomy and distal ACA vessels are exposed with a bifrontal craniotomy. The uninvolved contralateral A(2) segment of the ACA serves as a donor vessel for a short radial artery graft. ⋯ Retrograde flow from the CmaA supplies the ipsilateral recurrent artery of Heubner, and the aneurysm lumen thromboses. The azygos bypass was successfully performed to treat a 47-year-old woman with a giant, thrombotic ACoA aneurysm supplied by the A(1) segment of the left ACA, with left PcaA and CmaA originating from the aneurysm base. The authors conclude that the azygos ACA bypass is a novel option for revascularizing PcaA and CmaA, as part of the overall treatment of giant ACoA aneurysms.