Neurosurgery
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Watertight dural repairs are difficult to achieve, and cerebrospinal fluid leakage causes complications and extends hospital stays. Therefore, a novel synthetic hydrogel film was evaluated as an adjunct to dural closure in a canine model. ⋯ The hydrogel-treated animals exhibited normal progression of dural healing, no dural adhesions, and no underlying effects on the brain. Although dural healing progressed normally, the control animals displayed marked peridural adhesions. The results of this in vivo study suggest that hydrogels, such as that used here, may significantly decrease cerebrospinal fluid leakage, thereby increasing the safety and effectiveness of dural closure in patients and facilitating surgical reexploration.
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In a rat model, we studied the time courses of vascular endothelial growth factor (VEGF) expression and angiogenesis induced by chronic cerebral hypoperfusion in the brain, and we investigated the histological basis of normal-perfusion pressure breakthrough. ⋯ These results demonstrated that chronic cerebral hypoperfusion could induce sustained up-regulation of VEGF mRNA and protein expression in rat brain, which was correlated with angiogenesis. An absence of corresponding astrocytic reactivity during angiogenesis may be an important factor accounting for structural deficits of the blood-brain barrier and the occurrence of normal-perfusion pressure breakthrough.
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Paragangliomas of the thoracic spine are rare. Previously described cases involved nonfunctioning tumors. This report documents the diagnosis and surgical treatment for a patient who presented with a functioning thoracic paraganglioma. ⋯ Functioning paragangliomas of the thoracic spine are rare lesions that are difficult to treat. Successful treatment requires careful surgical planning and expert pharmacological manipulation.
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Review Case Reports
Transvenous treatment of carotid cavernous and dural arteriovenous fistulae: results for 31 patients and review of the literature.
To evaluate findings for patients with carotid cavernous fistulae or dural arteriovenous fistulae (AVFs) who underwent transvenous embolization via different transvenous approaches. ⋯ Transvenous treatment of CS and transverse/sigmoid sinus AVFs can be effective if all transvenous approaches, including combined surgical/endovascular approaches, are considered.
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Case Reports
Acute cervical cord injury associated with ossification of the posterior longitudinal ligament.
Patients with ossification of the posterior longitudinal ligament (OPLL) sometimes present with acute spinal cord injury caused by only minor trauma. In the present study, we reviewed our experience of acute cervical cord injury associated with OPLL to understand the pathomechanisms and to provide clinical information for management of this disorder. ⋯ The present study demonstrates the preexisting factors and pathomechanisms of acute spinal cord injury associated with cervical OPLL. Magnetic resonance imaging is useful to understand the level and mechanism of injury. Further investigation will be needed to elucidate the role of surgical decompression.