Neurosurgery
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Association between peridural scar and recurrent radicular pain after lumbar discectomy: magnetic resonance evaluation. ADCON-L European Study Group.
The purpose of this study was to investigate the presence of any correlation between recurrent radicular pain during the first six months following first surgery for herniated lumbar intervertebral disc and the amount of lumbar peridural fibrosis as defined by MR imaging. 197 patients who underwent first-time single-level unilateral discectomy for lumbar disc herniation were evaluated in a randomized, double-blind, controlled multicenter clinical trial. Clinical assessments, performed by physicians blinded to patient treatment status, were conducted preoperatively and at one and six months postoperatively. The enhanced MR images of the operative site utilized in the analysis were obtained at six months postoperatively. ⋯ The results showed that the probability of recurrent pain increases when scar score increases. Patients having extensive peridural scar were 3.2 times more likely to experience recurrent radicular pain than those patients with less extensive peridural scarring. In conclusion, this prospective, controlled, randomized, blinded, multicenter study has demonstrated that there is a significant association between the presence of extensive peridural scar and the occurrence of recurrent radicular pain.
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To analyze the effect of stereotactic radiosurgery on the hemorrhage rate of arteriovenous malformations (AVMs), we reviewed the clinical and angiographic characteristics of 315 patients with AVMs before and after radiosurgery. One hundred ninety-six patients sustained 263 bleeds in 10,939 patient-years before radiosurgery, for an annual nonfatal hemorrhage rate of 2.4%. Clinical follow-up after radiosurgery was available in 312 patients (mean, 47 +/- 20 mo); follow-up > or = 24 months was obtained in 295 patients (94%). ⋯ Stereotactic radiosurgery was not associated with a significant change in the hemorrhage rate of AVMs during the latency interval before obliteration. No protective benefit was conferred on patients who had incomplete nidus obliteration in early (< 60 mo) follow-up after radiosurgery. AVM patients with unsecured proximal aneurysms should have aneurysms obliterated either before radiosurgery or at the time of surgical resection of their AVMs.
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Historical Article
A history of neurological surgery at the University of California, San Francisco.
Over a span of 80 years and four chairmanships, and now beginning the fifth chairmanship, the Department of Neurological Surgery at the University of California, San Francisco has held a position of renown among academic institutions serving neurological surgery. This article attributes this reputation to the qualities of the chairmen, an unforgettable group including Howard Naffziger, Edwin Boldrey, John Adams, and Charles Wilson. Some of their accomplishments are described.
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Histoanatomically invading astrocytoma cells appear to migrate along distinct structures within the brain. Astrocytoma invasion may occur along extracellular matrix (ECM) protein-containing structures, such as blood vessels, but most frequently occurs along tracts of myelinated fibers. This behavior most likely is a consequence of the use of constitutive extracellular ligands expressed along the pathways of preferred dissemination. ⋯ For both glioblastoma primary cell preparations, myelin and merosin were the most permissive substrates for attachment and migration. Other ECM proteins (collagen type IV, fibronectin, and vitronectin) were moderate or nonpermissive substrates. Our findings indicated that astrocytoma cells may be able to use oligodendrocyte membrane-associated ligands as well as ECM proteins of the basement membranes for invasion of normal brain.