Neurosurgery
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Biography Historical Article
I and the Village, by Marc Chagall (1887-1985).
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The rationale and current evidence for using p53 gene replacement as a potential treatment for human gliomas are reviewed. The possible benefits of and obstacles to this approach are delineated. ⋯ Preclinical data strongly support the use of p53 gene transfer as a potential treatment for human gliomas.
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Randomized Controlled Trial Comparative Study Clinical Trial
Use of factor IX complex in warfarin-related intracranial hemorrhage.
Anticoagulation-treated patients presenting with intracranial hemorrhage, including subdural hematoma, epidural hematoma, subarachnoid hemorrhage, and intracerebral hemorrhage, require urgent correction of their coagulopathy to prevent worsening hemorrhage and to facilitate surgical intervention when necessary. In this study, we compared the use of fresh frozen plasma (FFP) with that of Factor IX complex concentrate (FIXCC) to achieve rapid correction of warfarin anticoagulation. ⋯ The use of FIXCC accelerated correction of warfarin-related anticoagulation in the presence of intracranial hemorrhage.
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Vertebrobasilar dissecting aneurysms are an uncommon but increasingly recognized cause of subarachnoid hemorrhage (SAH). We describe a patient with SAH caused by a dissecting aneurysm involving both vertebral arteries as well as the basilar trunk. The patient was treated successfully with proximal occlusion of the vertebral arteries using endovascular balloon occlusion in two stages. The importance of early follow-up angiography to document progression or resolution of untreated dissections is emphasized. This approach is suggested as definitive treatment for vertebrobasilar dissection in appropriate circumstances. ⋯ Bilateral vertebrobasilar dissecting aneurysms are an uncommon cause of SAH. If unilateral proximal vertebral artery occlusion is chosen as the initial treatment, it is essential to document the status of the contralateral vessel using follow-up angiography. Staged bilateral vertebral artery occlusion should be considered in the event of recurrent or progressive aneurysm enlargement. Endovascular balloon occlusion has advantages over proximal clipping of the parent vessel: cranial nerve manipulation is avoided, test occlusion in the awake patient can be performed at the site of permanent occlusion, and therapeutic levels of anticoagulation can be maintained throughout and after the procedure, thus diminishing the likelihood of thromboembolic complications.
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Associations among various factors and the occurrence of hydrocephalus after aneurysmal subarachnoid hemorrhage (SAH) were evaluated retrospectively in 897 patients enrolled in the North American study of tirilazad mesylate. ⋯ Hydrocephalus seems to have a multifactorial etiology. Knowledge of risk factors related to the occurrence of hydrocephalus may help guide neurosurgeons in the long-term care of patients who have experienced aneurysmal SAH.