Journal of neurosurgery
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Journal of neurosurgery · Jul 2014
Neuroprotective effects of erythropoietin pretreatment in a rodent model of transient middle cerebral artery occlusion.
OBJECT.: There is an unmet clinical need to develop neuroprotective agents for neurosurgical and endovascular procedures that require transient cerebral artery occlusion. The aim in this study was to explore the effects of a single dose of recombinant human erythropoietin (rhEPO) before middle cerebral artery (MCA) occlusion in a focal cerebral ischemia/reperfusion model. ⋯ Administration of rhEPO before the onset of 60-minute transient MCA ischemia protected the brain from this insult. It is unlikely that rhEPO pretreatment leads to direct neuronal antiapoptotic effects, as supported by the lack of Akt activation, and its benefits are most probably related to an indirect effect on brain edema as a consequence of blood-brain barrier preservation. Although research on EPO derivatives is increasing, rhEPO acts through distinct neuroprotective pathways and its clinical safety profile is well known. Clinically available rhEPO is a potential therapy for prevention of neuronal injury induced by transitory artery occlusion during neurovascular procedures.
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Journal of neurosurgery · Jul 2014
Endoscopic endonasal transcavernous posterior clinoidectomy with interdural pituitary transposition.
OBJECT.: The object of this paper was to describe the surgical anatomy and technical nuances of the endonasal transcavernous posterior clinoidectomy approach with interdural pituitary transposition and to report the clinical outcome of this technical modification. ⋯ The authors introduce a surgical variant of the endoscopic endonasal posterior clinoidectomy approach that does not require intradural pituitary transposition and is more effective than the purely extradural approach. The endoscopic endonasal transcavernous approach facilitates the removal of prominent posterior clinoids increasing the working space at the lateral recess of the interpeduncular cistern, while preserving the pituitary function.
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Journal of neurosurgery · Jul 2014
ReviewTwist-drill craniostomy with hollow screws for evacuation of chronic subdural hematoma.
OBJECT.: The incidence of chronic subdural hematoma (CSDH) is expected to increase substantially over the next 25 years. Continuing refinement of techniques for surgical evacuation is essential for optimizing patient outcomes. A novel technique involving a hollow screw, which is threaded through a twist-drill hole in the cranium and then connected to a closed drainage system, has been increasing in popularity. The aim of this systematic review is to collate and analyze the published experience with this novel technique and to evaluate its efficacy in comparison with the other surgical treatment methods. ⋯ This systematic review adds further evidence to the pool of data assessing the safety and efficacy of the use of this novel, minimally invasive technique for the treatment for CSDH. Overall, twist-drill craniostomy with hollow screws appears to be safe and effective. Class I evidence is necessary to optimize the surgical management of patients with CSDH.