Journal of neurosurgery
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Journal of neurosurgery · Jul 2019
Macrophage CD163 expression in cerebrospinal fluid: association with subarachnoid hemorrhage outcome.
Even though heme-induced cerebral inflammation contributes to many of the adverse sequelae seen in patients with subarachnoid hemorrhage (SAH), little is known about the mechanism; mouse models have shown a critical role for macrophages/microglia. Macrophage CD163 is a hemoglobin scavenger receptor involved in blood clearance after SAH. The authors hypothesized that the modified Fisher score is independently associated with cerebrospinal fluid (CSF) macrophage CD163 expression on postictal day 1, and that CSF macrophage CD163 expression is associated with 1-month neurological outcome. ⋯ This early study suggests that CSF macrophage CD163 expression, as measured by flow cytometry, may have some neuroprotective function given its inverse association with outcome and provides unique insights into the neuroinflammatory process after SAH.
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Journal of neurosurgery · Jul 2019
Daniel Ruge: the first neurosurgeon to serve as physician to the president.
The role of chief White House physician has traditionally been held by an individual with a background in a broad medical field, such as emergency medicine, family medicine, or internal medicine. Dr. Daniel Ruge, who served as the director of the Spinal Cord Injury Service for the Veterans Administration and was appointed during President Ronald Reagan's first term, was the first neurosurgeon to become the chief White House physician. ⋯ Dr. Ruge's actions after the assassination attempt on President Reagan resulted in the rapid, smooth recovery of the then-president. Daniel Ruge's background, his high-profile roles and heavy responsibilities, and his critical decision-making are characteristics that make his role in the history of medicine and of neurosurgery unique.
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Journal of neurosurgery · Jul 2019
Comparison of 3D intraoperative digital subtraction angiography and intraoperative indocyanine green video angiography during intracranial aneurysm surgery.
During the last decade, improvements in real-time, high-resolution imaging of surgically exposed cerebral vasculature have been realized with the successful introduction of intraoperative indocyanine green video angiography (ICGVA) and technical advances in intraoperative digital subtraction angiography (DSA). With the availability of 3D intraoperative DSA (3D-iDSA) in hybrid operating rooms, the present study offers a contemporary comparison for rates of accuracy and discordance. ⋯ A combination of vascular monitoring techniques most often achieved correct intraoperative interpretation of complete IA occlusion and parent artery integrity. Compared with 3D-iDSA imaging, ICGVA demonstrated high accuracy. Despite the relatively low discordance rate, iDSA was confirmed to be the gold standard. Improved imaging quality, including 3D-iDSA, supports its routine use in IA surgery, obviating the need for postoperative DSA.
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Journal of neurosurgery · Jul 2019
Association between metal hypersensitivity and implant failure in patients who underwent titanium cranioplasty.
Digitally designed titanium plates are commonly used for the reconstruction of craniofacial defects, although implant exposure (referred to as failure) is one of the major complications. Metal hypersensitivities have been suggested as possible causes of implant failure of orthopedic, intravascular, gynecological, and dental devices, yet there has been no consensus on the requirement for allergy screening before cranioplasty. ⋯ Based on their findings, the authors suggest that routine allergy screening be performed before titanium plate cranioplasty. For patients with hypersensitivities to more than 3 metals, alternative materials, such as polyetheretherketone, should be considered for cranioplasty.
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Journal of neurosurgery · Jul 2019
Bilateral coagulation of inferior hypophyseal artery and pituitary transposition during endoscopic endonasal interdural posterior clinoidectomy: do they affect pituitary function?
The endoscopic endonasal transcavernous approach with interdural pituitary transposition provides surgical access to the posterior clinoids and interpeduncular cistern. Prior to posterior clinoidectomy, selective coagulation and transection of the inferior hypophyseal artery (IHA) is recommended to prevent uncontrolled tearing of the artery and its avulsion from the wall of the cavernous carotid artery. The authors' preliminary experience has shown that unilateral sacrifice of the IHA caused no permanent endocrine dysfunction. In this study, they investigated the pituitary function in the setting of bilateral sacrifice of IHAs and pituitary transposition. ⋯ The endoscopic endonasal transcavernous approach to the interpeduncular cistern with pituitary transposition and bilateral sacrifice of the IHAs does not cause pituitary dysfunction in a majority of patients. When endocrine deficit occurs, it appears to be more likely to have been caused by surgical manipulation than loss of blood supply. This finding confirms clinically the crucial concept of interarterial anastomosis of pituitary vasculature proposed by anatomists.