Neurosurgery
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Case Reports
Stenting and secondary coiling of intracranial internal carotid artery aneurysm: technical case report.
Endovascular stents have been successfully used in the treatment of fusiform and dissecting aneurysms of the peripheral circulation and extracranial carotid and vertebral arteries. Technical limitations related to the inability to navigate the stent and the delivery system through tortuous vascular segments has limited their application with intracranial lesions. Availability of new flexible and pliable stent systems might overcome these difficulties. ⋯ New flexible stents can be used to treat intracranial internal carotid artery aneurysms in difficult-to-access areas, such as the horizontal petrous segment. The stent may disrupt the aneurysm inflow tract, thereby inducing stasis and facilitating intra-aneurysmal thrombosis. In addition, the stent acts as an endoluminal scaffold to prevent coil herniation into the parent artery, which allows tight packing of even wide-necked and irregularly shaped aneurysms. The stent may also serve as a matrix for endothelial growth. We think this new generation of flexible stents and the use of this described technique will usher in the next era of endovascular management of intracranial aneurysms.
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Biography Historical Article
The beginnings of neurosurgery in California during the pre-Cushing era: 1850-1900.
The end of the present millennium marks the centennial of Harvey Cushing's European study year, after the completion of his surgical residency under William Stewart Halsted at the Johns Hopkins Hospital and just before beginning his surgical practice in Baltimore, Maryland. The year 2000 marks the sesquicentennial of California's admission to the Union as the 31st state. ⋯ This foundation would serve as a cornerstone for surgeons trained by Harvey Cushing (including Howard Naffziger, Carl Rand, and Edward Towne) who would arrive in California early in the 20th century and would define the specialty of neurosurgery. The legacy left by these physicians enhances the celebration of the closure of the millennium.
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This study was undertaken to examine the pathophysiological characteristics of trigeminal neuropathic pain. ⋯ This clinical study provides evidence that the pathophysiological mechanisms of trigeminal neuropathic pain after nerve injury involve impaired function of both small unmyelinated fibers and large myelinated fibers. An explanation for the finding of abnormal temporal summation of pain may involve hyperexcitability of central wide-dynamic range neurons. The results suggest that other mechanisms are involved in trigeminal neuropathic pain of spontaneous origin. Reduced heat and cold pain thresholds indicate heat and cold hyperalgesia, which possibly may be explained by sensitization of peripheral C nociceptors.
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Although an autogenous saphenous vein is frequently used as a bypass graft, an aneurysm of a venous graft is a rare complication, especially in the case of cerebrovascular revascularization. We report a case of a successfully treated aneurysmal change in a venous graft after short vein bypass grafting. ⋯ The aneurysm seemed to have developed in a curved segment because of hemodynamic stress.
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To examine whether traumatic subarachnoid hemorrhage (TSAH) caused by severe diffuse brain injury leads to delayed ischemic brain damage and secondary deterioration of outcome, as does aneurysmal subarachnoid hemorrhage (ASAH). ⋯ The findings suggest that the incidence of vasospasm is low in association with TSAH and that the cause is different compared with ASAH. There is no evidence that the presence of TSAH in cases of diffuse brain injury leads to delayed ischemic brain damage and secondary deterioration of outcome.