Neurosurgery
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Comparative Study
Human marrow stromal cell treatment provides long-lasting benefit after traumatic brain injury in rats.
This study was designed to investigate the effects of human bone marrow stromal cell (hMSC) administration in rats for 3 months after traumatic brain injury (TBI). ⋯ hMSCs injected in rats after TBI survive until 3 months and provide long-lasting functional benefit. Functional improvement may be attributed to stimulation of endogenous neurorestorative functions such as neurogenesis and synaptogenesis.
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Comparative Study
Expression of structural proteins and angiogenic factors in normal arterial and unruptured and ruptured aneurysm walls.
To identify differences in the expression of certain structural proteins and angiogenic growth factors in vessel tissues that represent different phases of the process of intracranial aneurysm formation and rupture: normal vessel wall, intact (unruptured) aneurysm wall, and ruptured vessel wall. ⋯ Normal vessel wall, unruptured aneurysm wall, and ruptured aneurysm wall exhibit different levels and patterns of expression for the structural proteins and regulator growth factors investigated. If one accepts the premise that immunohistochemical study has its inherent methodological problems, these results suggest that the biological mediators of aneurysm formation in a vessel wall differ from those of the biological mediators of aneurysm rupture. There was a novel finding related to fibronectin and laminin: the results indicated that a rise in the fibronectin-to-laminin ratio in an unruptured aneurysm wall may contribute to rupture. A drop in transforming growth factor-alpha expression in a vessel wall may also contribute to aneurysm formation.
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Review Comparative Study
Safety of heparinization for cerebral aneurysm coiling soon after external ventriculostomy drain placement.
Our practice has been to heparinize patients for cerebral aneurysm coiling even after recent external ventriculostomy drain (EVD) placement. The current medical literature cites a 12.5% symptomatic hemorrhage rate with heparinization after recent EVD placement. We reviewed our experience to determine our level of safety with this practice. ⋯ Heparinization for cerebral aneurysm coiling can be safely performed even after EVD placement within 24 hours, particularly if the activated prothrombin time is kept strictly controlled.
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Review Comparative Study
Presentation, natural history, and management of carotid cavernous aneurysms.
We present the largest reported cohort of carotid cavernous aneurysms (CCA), comparing the neuro-ophthalmic presentation, complications, and outcome with and without endovascular treatment. ⋯ Endovascular treatment of carotid cavernous aneurysms leads to a significantly higher rate of pain resolution compared with untreated patients, even after adjusting for initial pain severity. Diplopia may not resolve after treatment. The results of this study underscore our approach indicating treatment only in cases of debilitating pain, visual loss from compression, or diplopia in primary gaze or in patients with risk factors for major complications such as pre-existing coagulopathy or sphenoid sinus erosion.
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Radiosurgery offers patients with brain metastases an effective and minimally invasive treatment modality. Radiosurgery provides local tumor control and prolongs survival in select patients with brain metastases. ⋯ Treatment recommendations will be outlined in view of the available clinical data. Although surgery or radiosurgery with whole-brain radiotherapy remains an important option for patients with a solitary brain metastasis, radiosurgery with or without whole-brain radiotherapy should be considered in patients with a limited number of small tumors and a good prognosis.