Journal of neurosurgery
-
Journal of neurosurgery · Jul 2011
Gain-of-function polymorphisms of cystathionine β-synthase and delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage.
Cystathionine β-synthase (CBS) is an enzyme that metabolizes homocysteine to form H(2)S in the brain. Hydrogen sulfide functions as a vasodilator as well as a regulator of neuronal ion channels and multiple intracellular signaling pathways. Given the myriad effects of H(2)S, the authors hypothesized that patients possessing gain-of-function polymorphisms of the CBS gene will experience a decreased incidence of delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage (aSAH). ⋯ Polymorphisms of the CBS gene that impart gain-of-function may be associated with a reduced risk of DCI after aSAH, independent of serum homocysteine. Signaling through H(2)S may mediate protection from DCI following aSAH through a mechanism that does not involve macrovascular vasodilation.
-
Journal of neurosurgery · Jul 2011
Comparative StudyComparison of clinical characteristics and MR angiography appearance in patients with spontaneous intradural vertebral artery dissection with or without subarachnoid hemorrhage.
It is well known that spontaneous intradural vertebral artery dissection (siVAD) is an important cause of nontraumatic subarachnoid hemorrhage (SAH). The factors that influence whether SAH develops, however, remain unclear. The aim of this study was to investigate whether clinical characteristics and imaging findings are different in patients with siVAD with SAH compared to those with siVAD without SAH. ⋯ A larger VUBA of the dominant VA, the presence of unruptured supratentorial nondissecting saccular aneurysms, and current smoking may be factors that predict which patients with siVAD will develop SAH by dominant VAD.
-
Journal of neurosurgery · Jul 2011
Endovascular stent therapy for extracranial and intracranial carotid artery dissection: single-center experience.
The objective of this study was to evaluate endovascular stent therapy for carotid artery dissections (CADs). ⋯ Endovascular stent-assisted repair of extra- and intracranial CAD was safe and effective in this experience and can be recommended for selected patients. In particular, patients with symptomatic CADs that are not responsive to medical therapy should be considered for interventional treatment.
-
Journal of neurosurgery · Jul 2011
Relation between brain interstitial and systemic glucose concentrations after subarachnoid hemorrhage.
The aim in the present investigation was to study the relation between brain interstitial and systemic blood glucose concentrations during the acute phase after subarachnoid hemorrhage (SAH). The authors also evaluated the effects of insulin administration on local brain energy metabolism. ⋯ After SAH, there was a positive correlation between plasma and MD glucose concentrations with a high degree of individual variation. A gradual decline in MD glucose and the MD/plasma glucose ratio and an increase in MD pyruvate and MD lactate concentrations during the 1st week after SAH suggest a transition to a hyperglycolytic state with increased cerebral glucose consumption. The administration of insulin was related to a lowering of MD glucose and MD pyruvate, often to low levels even though plasma glucose values remained above 6 mmol/L. After SAH, the administration of insulin could impede the glucose supply of the brain.
-
Journal of neurosurgery · Jul 2011
Venous sacrifice in neurosurgery: new insights from venous indocyanine green videoangiography.
The purpose of this paper is to evaluate whether venous indocyanine green (ICG) videoangiography has any potential for predicting the presence of a safe collateral circulation for veins that are at risk for intentional or unintentional damage during surgery. ⋯ Venous ICG videoangiography is able to reveal substantial variability in the venous flow dynamics. "Slow veins," when they are tributaries of bridging veins, might hide a potential for anastomotic circulation that deserve further investigation.