Neurosurgery
-
Comparative Study
Secondary insults in subarachnoid hemorrhage: occurrence and impact on outcome and clinical deterioration.
To study the occurrence of secondary insults during neurointensive care of patients with subarachnoid hemorrhage using a computerized multimodality monitoring system and to study the impact of secondary insults on clinical deterioration and functional outcome. ⋯ Elevated ICP not responding to treatment is predictive of clinical deterioration, whereas high CPP decreases the risk of clinical deterioration. It may be beneficial to not lower spontaneous high CPP in patients with subarachnoid hemorrhage.
-
Comparative Study
Bottleneck factor and height-width ratio: association with ruptured aneurysms in patients with multiple cerebral aneurysms.
Determining factors predictive of the natural risk of rupture of cerebral aneurysms is difficult because of the need to control for confounding variables. We studied factors associated with rupture in a study model of patients with multiple cerebral aneurysms, one aneurysm that had ruptured and one or more that had not, in which each patient served as their own internal control. ⋯ In a case-control study of patients with multiple cerebral aneurysms, increased bottleneck factor and height-width ratio were consistently associated with rupture.
-
Comparative Study
Collagen scaffolds populated with human marrow stromal cells reduce lesion volume and improve functional outcome after traumatic brain injury.
Traumatic brain injury (TBI) causes extensive loss of cerebral parenchyma; however, no strategy for reconstruction has been clinically effective. Our group and others have used human marrow stromal cells (hMSCs) to treat rats subjected to TBI and found no significant changes in the lesion volume, although functional outcome was improved significantly. To identify new ways of delivering hMSCs into the injured brain and to maximize the therapeutic benefits of hMSC treatment, we investigated the use of collagen scaffolds implanted with hMSCs as a cell delivery system for treatment of TBI. ⋯ The data show that scaffolds populated by hMSCs improve spatial learning and sensorimotor function, reduce the lesion volume, and foster the migration of hMSCs into the lesion boundary zone after TBI in rats. hMSC-populated scaffolds may be a new way to reconstruct the injured brain and improve neurological function after TBI.
-
Review Case Reports
Preserve the nerve: microsurgical resection of peripheral nerve sheath tumors.
-
Comparative Study
Atlanto-occipital dislocation: part 1--normal occipital condyle-C1 interval in 89 children.
Although atlanto-occipital dislocation has long been recognized as an extremely unstable and often lethal injury, no single radiodiagnostic criterion published to date has achieved failure-proof status. This is because most existing diagnostic tests exploit bony landmarks remote from the injured condyle-C1 (OC1) joint so that patient positioning could inadvertently line up these landmarks and conceal actual disruption of the joint. Many of the landmarks used are wide apart and/or noncoplanar; their measurements are subject to errors related to x-ray angle, target-film distance, and superimposed bony outlines. We propose using the actual occipital condyle-C1 interval (CCI) obtained from high-resolution reconstructed computed tomographic scans as the indicator for OC1 joint disruption. We hypothesize that the normal CCI is very small and has great left-right symmetry and that atlanto-occipital dislocation is always manifested by an abnormal widening of the CCI and/or by left-right joint asymmetry irrespective of the shifting of other remote bony landmarks. Part I of this study establishes standard normal values for CCI in children. ⋯ The normal OC1 joint in children 0 to 18 years is tightly held together by ligaments with a mean CCI of 1.28 mm in the 89 subjects tested. There is great left-right joint symmetry in both CCI and conformational anatomy. CCI and left-right symmetry do not appear to change significantly with age. It is reasonable to set a maximum CCI as a discriminator between normal and disrupted OC1 joints to indicate atlanto-occipital dislocation.