Neurosurgery
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Clinical Trial
Peripheral stimulation for treatment of trigeminal postherpetic neuralgia and trigeminal posttraumatic neuropathic pain: a pilot study.
Trigeminal neuropathic pain (TNP) after facial trauma or herpes zoster infection is often refractory to treatment. Peripheral nerve stimulation has been used to treat occipital neuralgia; however, efficacy in controlling facial TNP or postherpetic neuralgia is unknown. A retrospective case series of patients who underwent subcutaneous placement of stimulating electrodes for treatment of V(1) or V(2) TNP secondary to herpetic infection or facial trauma is presented. ⋯ Peripheral nerve stimulation of the supraorbital or infraorbital branches of the trigeminal nerve is an effective method for relief of TNP after facial trauma or herpetic infection. A prospective trial using this novel approach to treat these disorders is thus warranted.
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Case Reports Clinical Trial
Intraoperative Doppler to measure cerebrovascular resistance as a guide to complete resection of arteriovenous malformations.
Intraoperative color Doppler ultrasound has been used to locate arteriovenous malformations (AVMs). We describe the use of spectral Doppler to measure flow resistance and resistive index (RI) of vessels around the nidus to distinguish feeding arteries from en passant and normal vessels. This is particularly helpful in small AVMs and aids in the identification of normal vessels and completeness of resection by ruling out persistent low RI flow. ⋯ Intraoperative duplex Doppler allowed more accurate localization of the AVM nidus. RI of the vessels around the AVM helped to distinguish vessels feeding the AVM from en passant vessels. Furthermore, comparison of pre-resection and postresection RI accurately indicated the completeness of resection.
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There are several lines of evidence suggesting that matrix metalloproteinases (MMPs), particularly MMP-9, are involved in the pathogenesis of intracranial aneurysms. Some studies have demonstrated that genetic variants in the promoter region of the MMP-9 gene are associated with aneurysms. We performed a case-control study to investigate whether single-nucleotide polymorphisms (SNPs) within the coding region of the MMP-9 gene might affect the development of intracranial aneurysms. ⋯ SNPs of the coding region and the 3' untranslated region of the MMP-9 gene are not associated with intracranial aneurysms in Caucasians.
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Acute occlusion of the proximal middle cerebral artery (MCA) can lead to rapid development of fatal brain swelling and ischemic strokes. Decompressive surgery, if performed early in this subpopulation of patients, can reduce mortality and result in a favorable outcome. In this article, we describe our surgical approach for treating malignant MCA syndrome and compare it with other management strategies. ⋯ Surgical decompression consisting of a large craniectomy, anterior temporal lobectomy, resection of infarcted tissue, and duraplasty is beneficial to a significant number of patients with massive MCA stroke and clinical signs of herniation.
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Professor Hirotaro Narabayashi (1922-2001) was the founder of stereotactic neurosurgery in Japan and one of the early great world pioneers in this field. He constructed his first stereotactic apparatus in 1949 and performed his first pallidotomy in 1951, unaware of the similar work of others outside postwar Japan. His neurological clinic, which opened in Tokyo in 1957, became an international center for stereotaxy for more than 40 years. This article describes his early career, with personal anecdotes and reminiscences from his interesting life.