Neurosurgery
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Trigeminal neuralgia (TGN) is generally a disease of the elderly. Vascular compression, the causative agent in the majority of cases, is thought to result from atherosclerotic changes within the vessels of the posterior fossa. Rarely, the disease presents during childhood, before the onset of severe atherosclerotic changes. We therefore sought to explore the role of vascular compression in pediatric patients with medically refractory TGN. ⋯ MVD has been demonstrated to be a safe and efficacious treatment for TGN in the adult population. Patients whose symptoms begin in childhood do not enjoy the same therapeutic response to MVD as do patients with TGN onset in adulthood. An increased incidence of venous compression was noted in this population, as was a longer duration of symptoms before MVD. These factors may be responsible for the decreased efficacy of MVD in this patient population.
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Biography Historical Article
Library: historical perspective. Herbert Olivecrona (1891-1980)
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The infratemporal fossa (ITF) gives passage to most major cerebral vessels and cranial nerves. Dissection of the ITF is essential in many of the lateral cranial base approaches and in exposure of the high cervical internal carotid artery (ICA). We reviewed the surgical anatomy of this region. ⋯ The styloid diaphragm divides the ITF into prestyloid and retrostyloid regions and covers the high cervical ICA. Using landmarks for the exocranial portion of the lower cranial nerves is useful it identifying them and avoiding injury during approaches to the high cervical ICA, the upper cervical spine, and the ITF.
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Delayed cerebral vasospasm occurring after subarachnoid hemorrhage (SAH) is still responsible for a considerable percentage of the morbidity and mortality in patients with aneurysms. It has been suggested that the pathogenesis of delayed cerebral vasospasm is related to a number of pathological processes, including endothelial damage and smooth muscle cell contraction resulting from spasmogenic substances generated during lysis of subarachnoid blood clots, changes in vascular responsiveness, and inflammatory or immunological reactions of the vascular wall. It has been recognized that the endothelium plays an important role in the regulation of the cerebral vascular tone. In 1988, endothelin (ET)-1, a potent vasoconstrictor, was isolated from cultured porcine aortic endothelial cells. ⋯ The results of current clinical and experimental investigations support the hypothesis that ET-1 is a major cause of cerebral vasospasm after SAH. Other studies indicate that SAH causes complex changes in the ET system and increased ET-1 levels after SAH, which are not solely responsible for the development of vasospasm but may occur after cerebral ischemia. Further investigations are therefore needed to clarify these different hypotheses.
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Surgical management of traumatic internal carotid artery (ICA) dissection remains controversial. Therefore, the delayed outcomes and graft patency rates of patients who underwent bypass procedures for symptomatic traumatic ICA dissection were studied. ⋯ Revascularization for persistently symptomatic traumatic ICA dissection eliminated ischemia and was associated with excellent long-term outcomes and graft patency rates.