Neurosurgery
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Brain arteriovenous malformations (AVM) have high matrix metalloproteinase-9, interleukin-6, and myeloperoxidase (MPO) expression, and polymorphic variations in inflammatory genes are associated with an increased risk of hemorrhage. In this study, we characterized the presence of inflammatory cells in AVM lesional tissue specimens. ⋯ Our study demonstrates that inflammatory cells are present in AVM tissue. Taken together with previous genetic and cytokine studies, these data are consistent with a novel view that inflammation is associated with AVM disease progression and rupture.
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Case Reports
Definitive reconstruction of circumferential, fusiform intracranial aneurysms with the pipeline embolization device.
The Pipeline embolization device (PED; Chestnut Medical, Menlo Park, CA) is a new endovascular construct designed to exclude aneurysms from the parent cerebrovasculature. We report the results of the first two human implantations of this device in North America. ⋯ The PED represents an important advance in the endovascular therapy of cerebral aneurysms, targeting primary parent vessel reconstruction rather than endosaccular occlusion as a means by which to achieve exclusion of the aneurysm and definitive anatomic reconstruction of the parent artery.
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This article aims to provide more insight into the presentation, diagnosis, and treatment of Bertolotti's syndrome, which is a rare spinal disorder that is very difficult to recognize and diagnose correctly. The syndrome was first described by Bertolotti in 1917 and affects approximately 4 to 8% of the population. It is characterized by an enlarged transverse process at the most caudal lumbar vertebra with a pseudoarticulation of the transverse process and the sacral ala. It tends to present with low back pain and may be confused with facet and sacroiliac joint disease. ⋯ As with conventional surgical approaches, a complete knowledge of anatomy is required for minimally invasive spine surgery. This case is an example of the expanding utility of minimally invasive approaches in treating spinal disorders.
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Comparative Study
Prognostic factors for radiosurgery treatment of trigeminal neuralgia.
Trigeminal neuralgia treatment results are thought to be highly dependent upon selection criteria. We retrospectively analyzed a series of patients to determine the likelihood of treatment success for patients treated with radiosurgery. ⋯ Anticonvulsant responsiveness is the single most important prognostic indicator of treatment success for patients presenting with facial pain. Other predictive factors generally failed to reach statistical significance. Linear accelerator radiosurgery for trigeminal neuralgia is a safe and effective treatment for well-selected patients, with results similar to those obtained with gamma unit radiosurgery.