Neurosurgery
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Cerebral autoregulation maintains a relatively stable cerebral blood flow over a range of perfusion pressures. During exercise, regional cerebral blood flow may be elevated in particular areas of the brain. This case report presents the impact of aerobic exercise on intracranially measured pressure and brain tissue oxygenation in an adult human. ⋯ Our results suggest that cerebral autoregulation appears to maintain constant cerebral oxygen tension during exercise. Further, we note transient cerebral hyperoxygenation at the onset of exercise as autoregulation "turns on" and at the termination of exercise. We present a quantitative interpretation of the post-exercise hyperoxygenation phase based on Fick's principle. We are the first to demonstrate cortical hyperoxygenation in a human breathing natural air without oxygen supplementation.
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We introduce a technique that enables the use of catheter angiography during image-guided surgery for the resection of previously embolized arteriovenous malformations. ⋯ Catheter-based angiography can be used during image guidance to reduce the artifact from metal particles after embolization. Excellent accuracy was obtained in merging 3-dimensional angiography with computed tomographic angiography. Further studies are needed to evaluate catheter-based 3-dimensional angiography as a single method for navigation during neurovascular surgery.
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Multicenter Study
Little evidence of association between severity of trigonocephaly and cognitive development in infants with single-suture metopic synostosis.
To measure severity of trigonocephaly among infants with single-suture metopic craniosynostosis by using a novel shape descriptor, the trigonocephaly severity index (TSI), and to evaluate whether degree of trigonocephaly correlates with their neurodevelopmental test scores. ⋯ We observed little evidence of an association between the severity of trigonocephaly among metopic synostosis patients and their neurodevelopmental test scores. Detecting such a relationship with precision may require larger sample sizes or alternative phenotypic quantifiers. Until studies are conducted to explore these possibilities, it appears that although associated with the presence of metopic synostosis, the risk of developmental delays in young children is unrelated to further variation in trigonocephalic shape.
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Although most people who have headache pain do not present with an underlying mass lesion, a large number of patients with brain tumors do report headache (as many as 60% in our institution). The problem for clinicians is that the tumor-headache association is not universal, as evidenced by anecdotal reports of patients with large tumors and increased intracranial pressure, but a complete absence of headache pain. In this review, we examine more than 80 years of research on brain tumor headaches, delineating the link between tumor location, laterality, growth rate, and pain. ⋯ Nevertheless, some generalizations concerning brain tumor headaches can be drawn. The following sections review these generalizations, presenting caveats where appropriate. Lingering questions in the field are also addressed and presented together with promising future research avenues.