Journal of neurosurgery
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Journal of neurosurgery · Sep 2013
Safety and pharmacokinetics of sodium nitrite in patients with subarachnoid hemorrhage: a phase IIa study.
Intravenous sodium nitrite has been shown to prevent and reverse cerebral vasospasm in a primate model of subarachnoid hemorrhage (SAH). The present Phase IIA dose-escalation study of sodium nitrite was conducted to determine the compound's safety in humans with aneurysmal SAH and to establish its pharmacokinetics during a 14-day infusion. Methods In 18 patients (3 cohorts of 6 patients each) with SAH from a ruptured cerebral aneurysm, nitrite (3 patients) or saline (3 patients) was infused. Sodium nitrite and saline were delivered intravenously for 14 days, and a dose-escalation scheme was used for the nitrite, with a maximum dose of 64 nmol/kg/min. Sodium nitrite blood levels were frequently sampled and measured using mass spectroscopy, and blood methemoglobin levels were continuously monitored using a pulse oximeter. ⋯ Previous preclinical investigations of sodium nitrite for the prevention and reversal of vasospasm in a primate model of SAH were effective using doses similar to the highest dose examined in the current study (64 nmol/kg/min). Results of the current study suggest that safe and potentially therapeutic levels of nitrite can be achieved and sustained in critically ill patients after SAH from a ruptured cerebral aneurysm.
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Journal of neurosurgery · Sep 2013
Controlled Clinical TrialTransplantation of Schwann cells in a collagen tube for the repair of large, segmental peripheral nerve defects in rats.
Segmental nerve defects pose a daunting clinical challenge, as peripheral nerve injury studies have established that there is a critical nerve gap length for which the distance cannot be successfully bridged with current techniques. Construction of a neural prosthesis filled with Schwann cells (SCs) could provide an alternative treatment to successfully repair these long segmental gaps in the peripheral nervous system. The object of this study was to evaluate the ability of autologous SCs to increase the length at which segmental nerve defects can be bridged using a collagen tube. ⋯ The technique of adding SCs to a guidance channel significantly enhanced the gap distance that can be repaired after peripheral nerve injury with long segmental defects and holds promise in humans. Most importantly, this study represents some of the first essential steps in bringing autologous SC-based therapies to the domain of peripheral nerve injuries with long segmental defects.
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Surgical exposure of a peripheral nerve can be technically challenging, making the operation more extensive and time consuming, particularly in the treatment of small nerves with an anatomically variable position. This study describes the application of ultrasound to facilitate surgical access and localization of targeted peripheral nerves. ⋯ Preoperative ultrasound-guided nerve mapping may be useful in facilitating surgical access to a targeted nerve and thereby minimizing tissue dissection and operating time.
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Journal of neurosurgery · Sep 2013
Combination of hypoglossal-facial nerve surgical reconstruction and neurotrophin-3 gene therapy for facial palsy.
Facial nerve injury results in facial palsy that has great impact on the psychosocial conditions of affected patients. Reconstruction of the facial nerve to restore facial symmetry and expression is still a significant surgical challenge. In this study, the authors assessed a hypoglossal-facial nerve anastomosis method combined with neurotrophic factor gene therapy to treat facial palsy in adult rats after facial nerve injury. ⋯ Results demonstrated that hypoglossal-facial nerve anastomosis facilitates innervation of paralyzed facial muscle via hypoglossal motoneurons without sacrificing ipsilateral hemitongue function. Neurotrophin-3 treatment through gene therapy could effectively improve such innervation, even after delayed reconstruction. These findings suggest that the combination of surgical reconstruction and NT-3 gene therapy is promising for its potential application in treating facial palsy in humans.
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Journal of neurosurgery · Sep 2013
Case ReportsIntrapelvic sciatic notch schwannoma: microsurgical excision using the infragluteal approach.
Benign neurogenic tumors at the sciatic notch that are purely intrapelvic have rarely been reported. Because of this tumor's particular position, a transabdominal or combined transabdominal-gluteal approach is usually used to achieve total resection. ⋯ The postoperative course was uneventful. The infragluteal approach can be safely used for the effective resection of intrapelvic benign neurogenic tumors at the sciatic notch that are extrinsic to the sciatic nerve, avoiding the more invasive and risky transabdominal approach.