Journal of neurosurgery
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Journal of neurosurgery · May 2010
Aquaporin-1-mediated cerebral edema following traumatic brain injury: effects of acidosis and corticosteroid administration.
Dysregulation of water homeostasis induces cerebral edema. Edema is a major cause of morbidity and mortality following traumatic brain injury (TBI). Aquaporin-1 (AQP-1), a water channel found in the brain, can function as a transporter for CO2 across the cellular membrane. Additionally, AQP-1's promoter contains a glucocorticoid response element. Thus, AQP-1 may be involved with edema-related brain injury and might be modulated by external conditions such as the pH and the presence of steroids. In this study, the authors investigated the hypotheses that: 1) AQP-1 participates in brain water homeostasis following TBI; 2) secondary injury (for example, acidosis) alters the expression of AQP-1 and exacerbates cerebral edema; and 3) corticosteroids augment brain AQP-1 expression and differentially affect cerebral edema under nonacidotic and acidotic conditions. ⋯ These findings implicate an important, modifiable role for AQP-1 in water homeostasis within the CNS following TBI.
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Journal of neurosurgery · Apr 2010
Clinical TrialUsefulness of composite methionine-positron emission tomography/3.0-tesla magnetic resonance imaging to detect the localization and extent of early-stage Cushing adenoma.
Fifty to eighty percent of Cushing disease is diagnosed by typical endocrine responses. Recently, the number of diagnoses of Cushing disease without typical Cushing syndrome has been increasing; therefore, improving ways to determine the localization of the adenoma and making an early diagnosis is important. This study was undertaken to determine the present diagnostic accuracy for Cushing microadenoma and to compare the differences in diagnostic accuracy between MR imaging and PET/MR imaging. ⋯ Composite MET-PET/3.0-T MR imaging is useful for the improvement of the delineation of Cushing microadenoma and offers high-quality detectability for early-stage Cushing adenoma.
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Journal of neurosurgery · Apr 2010
Clinical TrialOutcomes following single-treatment Gamma Knife surgery for trigeminal neuralgia with a minimum 3-year follow-up.
Gamma Knife surgery (GKS) has been shown to be effective in treating trigeminal neuralgia (TN). Existing studies have demonstrated success rates of 69.1-85% with median follow-up intervals of 19-60 months. However, series with uniform long-term follow-up data for all patients have been lacking. In the present study the authors examined outcomes in a series of patients with TN who underwent a single GKS treatment followed by a minimum follow-up of 36 months. They used a clinical scale that simplifies the reporting of outcome data for patients with TN. ⋯ Despite a time-dependent deterioration in the success rate of GKS for medically intractable TN, the authors' study showed that > 50% of patients can be expected to have a good outcome based on their scoring system, with approximately 33% having an ideal outcome (pain free with no need for medications). Long-term data, as those presented here, are important when counseling patients on their treatment options.
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Journal of neurosurgery · Apr 2010
A comprehensive analysis of hearing preservation after radiosurgery for vestibular schwannoma.
Gamma Knife surgery (GKS) has evolved into a practical alternative to open microsurgical resection in the treatment of patients with vestibular schwannoma (VS). Hearing preservation rates in GKS series suggest very favorable outcomes without the possible acute morbidity associated with open microsurgery. To mitigate institutional and practitioner bias, the authors performed an analytical review of the published literature on the GKS treatment of vestibular schwannoma patients. Their aim was to objectively characterize the prognostic factors that contribute to hearing preservation after GKS, as well as methodically summarize the reported literature describing hearing preservation after GKS for VS. ⋯ These data provide a methodical overview of the literature regarding hearing preservation with GKS for VS and a less biased assessment of outcomes than single-institution studies. This objective analysis provides insight into advising patients of hearing preservation rates for GKS treatment of VSs that have been reported, as aggregated in the published literature. Analysis of the data suggests that an overall hearing preservation rate of approximately 51% can be expected approaching 3-4 years after radiosurgical treatment, and the analysis reveals that patients treated with < or = 13 Gy were more likely to have preserved hearing than patients receiving larger doses of radiation. Furthermore, larger tumors and older patients do not appear to be at any increased risk for hearing loss after GKS for VS than younger patients or patients with smaller tumors.
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Journal of neurosurgery · Apr 2010
Long-term outcome following ilioinguinal neurectomy for chronic pain.
Ilioinguinal neuralgia is one cause of chronic groin pain following inguinal hernia repair, and it affects approximately 10% of patients. Selective ilioinguinal neurectomy is one proposed treatment option for carefully selected patients. The goal of this study was to determine the long-term outcome of patients who underwent selective ilioinguinal neurectomy for chronic post-hernia pain. ⋯ Ilioinguinal neurectomy is an effective and appropriate treatment for selected patients with iatrogenic ilioinguinal neuralgia following abdominal surgery. Although a high proportion of patients reported some long-term recurrence of pain, complete or partial pain relief was achieved in 66.7% of the patients observed.