Neurosurgery
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Classic surgical exposures of the infratemporal fossa region, including the adjacent intracranial space, temporal bone, and sinonasal region, require the extensive exposure associated with the transcranial, transfacial, and transmandibular approaches with their inherent neurological and cosmetic morbidities. In this study, we evaluated the feasibility and exposure afforded by combining 2 endoscopic transmaxillary approaches, endonasal and Caldwell-Luc supplement, to the infratemporal fossa. ⋯ Endoscopic exposure of the infratemporal fossa is feasible. Using the combination of the endonasal and Caldwell-Luc approaches for direct transmaxillary access significantly extended exposure, allowing safe and effective resection of infratemporal fossa lesions.
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To review our experience of managing idiopathic normal pressure hydrocephalus (iNPH) during the 6-year period from 2002 to 2007, when intracranial pressure (ICP) monitoring was part of the diagnostic workup. ⋯ Surgical results in iNPH were good with almost 80% of patients improving after treatment. The data indicate that improvement after surgery can be anticipated in 9 of 10 iNPH patients with abnormal ICP pulsatility, but in only 1 of 10 with normal ICP pulsatility. Diagnostic ICP monitoring had a low complication rate.
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Clinical Trial
Deep bypasses to the distal posterior circulation: anatomical and clinical comparison of pretemporal and subtemporal approaches.
The subtemporal approach for a superficial temporal artery-to-superior cerebellar artery bypass requires significant superior retraction that can injure the temporal lobe, compromise veins, and cause edema postoperatively. In contrast, the pretemporal approach requires posterolateral retraction that seems to be less injurious to the temporal lobe and better tolerated clinically. We hypothesized that the pretemporal approach provides ample exposure, more gentle retraction, and better clinical results than the subtemporal approach. ⋯ Pretemporal exposure of the PCA is equivalent to subtemporal exposure of the SCA, but the pretemporal approach is facilitated by a larger recipient artery. Posterolateral temporal lobe retraction associated with the pretemporal approach is gentler than superior retraction with the subtemporal approach. These results validate our preference for the pretemporal approach over the subtemporal approach when performing deep bypasses to the posterior circulation.
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Clinical Trial
Clinical response to hypertensive hypervolemic therapy and outcome after subarachnoid hemorrhage.
Hypertensive hypervolemic therapy is widely used to treat symptomatic vasospasm after subarachnoid hemorrhage. Few data exist to support a relationship between early clinical response and mortality or functional outcome. ⋯ Subarachnoid hemorrhage patients with symptomatic vasospasm who fail to demonstrate early clinical improvement in response to volume or pressor therapy are at high risk for death or disability. Urgent endovascular intervention in this high-risk patient cohort may be justified.
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Activated protein C (APC) is neuroprotective in stroke models and promotes postischemic neovascularization and neurogenesis. We used a controlled cortical impact (CCI) in mice to determine the effects of APC on neuroprotection and angiogenesis and neurogenesis after traumatic brain injury (TBI). ⋯ Activated protein C improves functional outcome and is neuroprotective after TBI. It also promotes angiogenesis and survival and migration of neuroblasts from the SVZ to the perilesional area, but the exact role of these brain repair mechanisms remains to be determined. The present findings suggest that APC therapy may hold a significant therapeutic potential for TBI.