Journal of neurosurgery
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Journal of neurosurgery · Jul 2005
Racial differences in demographics, acute complications, and outcomes in patients with subarachnoid hemorrhage: a large patient series.
Few studies have focused on the impact of racial differences in demographics, clinical characteristics, acute complications, and outcomes of patients with aneurysmal subarachnoid hemorrhage (SAH). The purpose of this study was to examine this issue. ⋯ Race was not found to be a prognostic factor for outcome after aneurysmal SAH. The higher SAH mortality rate previously observed in African-American patients is likely a result of a higher incidence of SAH in this group. These findings highlight the importance of primary prevention programs aimed at modifying risk factors for SAH.
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Journal of neurosurgery · Jul 2005
Clinical TrialEffect of normal saline bolus on cerebral blood flow in regions with low baseline flow in patients with vasospasm following subarachnoid hemorrhage.
Arterial vasospasm is the most common cause of delayed ischemic neurological deficits (DINDs) and one of the major causes of disability following subarachnoid hemorrhage (SAH). Current management of vasospasm involves intravascular volume expansion and hemodynamic augmentation with the goal of increasing cerebral blood flow (CBF). The purpose of this study was to examine the effects of volume expansion on regional (r)CBF in patients with DIND following SAH. ⋯ In euvolemic patients with vasospasm, intravascular volume expansion with a normal saline bolus raised CBF in regions of the brain most vulnerable to ischemia.
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Journal of neurosurgery · Jul 2005
Hydrocephalus in children with posterior fossa tumors: role of endoscopic third ventriculostomy.
Controversy exists regarding the indication for endoscopic third ventriculostomy (ETV) in children with hydrocephalus caused by posterior fossa tumors. The authors present their treatment modalities and discuss the role of ETV in the management of hydrocephalus. ⋯ For children with posterior fossa tumors, ETV is not indicated as a standard operation either prior to or following tumor removal. Only six of 52 children presenting with hydrocephalus required a permanent CSF draining procedure. Endoscopic third ventriculostomy may be suitable for patients with fourth ventricle outflow obstruction and persisting or progressive hydrocephalus following tumor removal.
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Journal of neurosurgery · Jul 2005
Lack of an association between the angiotensin-converting enzyme insertion/deletion polymorphism and intracranial aneurysms in a Caucasian population in the United States.
The identification of polymorphisms associated with an increase in the risk of developing disease is integral to the development of genetic biomarkers to identify individuals at risk. Based on reports indicating a role for angiotensin-converting enzyme (ACE) in the pathogenesis of intracranial aneurysms (IAs) as well as hypertension, an independent risk factor for IAs, the authors investigated the association between an insertion/deletion (I/D) polymorphism in the ACE gene and IAs in a Caucasian population in the US. ⋯ Contrary to findings in two European Caucasian populations (one British and one Polish), this polymorphism did not contribute to the risk of developing IAs in a Caucasian population in the US.
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Journal of neurosurgery · Jul 2005
Magnetic resonance imaging-based measurements of cerebrospinal fluid and blood flow as indicators of intracranial compliance in patients with Chiari malformation.
The diagnosis of Chiari malformation (CM) is based on the degree of tonsilar herniation, although this finding does not necessarily correlate with the presence or absence of symptoms. Intracranial compliance (ICC) and local craniocervical hydrodynamic parameters derived using magnetic resonance (MR) imaging flow measurements were assessed in symptomatic patients and control volunteers to evaluate the role of these factors in the associated pathophysiology. ⋯ Previous investigators have focused on CSF flow velocities and cord displacement to explain the pathogenesis of CM. Analysis of results have indicated that ICC is more sensitive than local hydrodynamic parameters to changes in the craniospinal biomechanical properties in symptomatic patients. The authors concluded that decreased ICC better explains CM pathophysiology than local hydrodynamic parameters such as cervical CSF velocities and cord displacement. Low ICC also better explains the onset of symptoms in adulthood given the decline in ICC with aging.