Neurosurgery
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Giant-cell tumors of bone are rare, benign neoplasms that occur infrequently in the spine above the sacrum, and their presence in the cervical vertebrae is even more exceptional. Although complete en bloc surgical resection is difficult in the cervical spine, treatment with adjuvant radiotherapy has been considered controversial because of a small risk of malignant transformation. The authors report two cases of giant-cell tumors in the cervical vertebrae that were treated successfully with surgical excision and postoperative radiation as well as long-term follow-up. ⋯ Radical resection of giant-cell tumors is generally agreed to be the best treatment option. However, complete resection is often not a feasible option for tumors in the cervical spine because of involvement of critical neurovascular structures. In these cases, the benefits of radiotherapy to reduce the risk of local recurrence may well outweigh concerns about the treatment's theoretical risks.
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Although the chemotherapy drug hydroxyurea (HU) and the antiprogesterone mifepristone (RU486) have been used to treat meningiomas for which surgical and radiation therapies have failed, results have been disappointing. The addition of calcium channel antagonists (CCAs) to chemotherapeutic drugs enhances tumor growth inhibition in other tumor types, and the authors demonstrated that CCAs can block meningioma growth in vitro and in vivo. The purpose of this study was to test the effects of the addition of a CCA to HU or RU486 on meningioma growth. ⋯ The addition of diltiazem or verapamil to HU or RU486 augments meningioma growth inhibition in vitro by inducing apoptosis and G1 cell-cycle arrest. The combination of HU and diltiazem inhibited the growth of meningiomas in vivo by decreasing proliferation and microvascular density. These results suggest a possible role for these drugs as an additional adjuvant therapy for recurrent or unresectable meningiomas.
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Historical Article
History of endovascular surgery: personal accounts of the evolution.
Endovascular therapy has continuously evolved since it was first described in 1904. It was first used as a technique to inject particles to follow the flow into vascular lesions, and from the mid-seventies on, microballoons were developed to reach targets in the arterial vascular tree. Arteriovenous malformations were approached with catheters, the tip mounted by calibrated leak balloons. ⋯ The elegance of the endovascular approach was an important argument for this technology from its inception, but in early years, restricted endovascular efficacy limited the efficiency of embolizations. Increasing experience and exploding new technologies have made endovascular techniques not only safer but also as effective as microsurgery. The number of vascular pathologies where microsurgery is the only option is decreasing, and training in vascular neurosurgery may become the privilege of specialized centers in the future.
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Increasing systolic and pulse pressure with bradycardia and respiratory irregularity are signs of increased intracranial pressure, leading to cerebral herniation and fatal brainstem compression. This phenomenon, the vasopressor response, is generally known as the Cushing reflex based on Harvey Cushing's experimental work in Europe in 1901 and 1902. ⋯ Cushing initially failed to give credit to the work of these predecessors. Nonetheless, he studied the brain's reaction to compression more carefully than previous researchers and offered an improved explanation of the pathophysiology of the phenomenon named after him.