Neurosurgery
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Comparative Study
Endovascular treatment for poorest-grade subarachnoid hemorrhage in the acute stage: has the outcome been improved?
Patients with poor-grade subarachnoid hemorrhage (SAH) have been considered good candidates for endovascular treatment. The results of treatment of Grade V SAH, the poorest grade, however, have not been fully elucidated. ⋯ Endovascular treatment of the 22 World Federation of Neurosurgical Societies Grade V SAH patients improved their survival rate but not their favorable outcome rate in comparison with conservative treatment. Further accumulation of clinical data is essential to determine whether endovascular treatment can improve the functional outcome of those with GCS scores of 6 and whether there is no role for endovascular treatment in those with GCS scores of 4 or 5.
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A prospective observational study was conducted to investigate whether episodes of ischemia are detected by continuous cerebral monitoring and whether such episodes are related to clinical outcome. ⋯ Intraparenchymal oximetry and microdialysis can detect but fail to predict the development of delayed cerebral ischemia. There were associations between episodes of low brain oxygen, abnormal microdialysis, and unfavorable outcome, but these associations were weak.
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Neurosurgery at the Catholic University in Rome was initiated by Gian Franco Rossi in 1969 and has gradually expanded since then. From the beginning, research has been regarded as an essential part of training and daily activities in the university's neurosurgery programs. The professional and research education of all faculty members includes at least 1 year abroad in a reputable neurosurgical center. ⋯ In 1999, Giulio Maira succeeded Dr. Rossi in directing the Institute of Neurosurgery and the Division of General Neurosurgery. In addition to the history of neurosurgery at the Catholic University in Rome, this article describes present challenges and plans for the future in neurosurgery at the university.
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Case Reports
Dissecting aneurysms of the bilateral vertebral arteries with subarachnoid hemorrhage: report of three cases.
Treatment of one side in cases of dissecting aneurysms of the bilateral vertebral arteries (VAs) with subarachnoid hemorrhage may result in dissection or rupture on the contralateral side. ⋯ Surgical intervention to treat dissecting aneurysms of the bilateral VAs on one side carries the risk of rupture of the contralateral lesion. Increased hemodynamic stress may be important in the development and rupture of dissections in the contralateral VA.
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Endoscopes have been commonly used in transsphenoidal surgery to treat pituitary tumors, to compensate for the narrow surgical field. Although many navigation systems have been introduced for neurosurgical procedures, there have been few reports of navigation systems for endoscopic operations. This report presents our recently developed, endoscopic, augmented reality (AR) navigation system. ⋯ The endoscopic AR navigation system allows surgeons to perform accurate, safe, endoscope-assisted operations to treat pituitary tumors; it is particularly useful for reoperations, in which midline landmarks may be absent. We consider the AR navigation system to be a promising tool for safe, minimally invasive, endonasal, transsphenoidal surgery to treat pituitary tumors.