Neurosurgery
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Review Case Reports
Complex intracranial aneurysms: combined operative and endovascular approaches.
Endovascular management of complex intracranial aneurysms is increasingly being considered as an alternative to standard surgical clipping. However, little attention has been paid to the complementary nature of surgery and endovascular therapy. ⋯ Several factors can contribute to the complexity of intracranial aneurysms. Management strategies that combine operative and endovascular techniques in a complementary way, for the best possible outcomes for these patients, can be designed accordingly.
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Case Reports
Odontoid process and C1-C2 corrective osteotomy through a posterior approach: technical case report.
To demonstrate a new posterior approach to the anterior elements of the atlas and the axis including the odontoid process. ⋯ It is possible to gain sufficient surgical access to the odontoid process via a posterior approach. The technique described is of benefit when the alternative anterior approaches to the upper cervical spine are technically difficult or impossible.
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We investigated the time course of inducible nitric oxide synthase (iNOS) enzymatic activity and immunocytochemical localization of iNOS expression after traumatic brain injury (TBI), as well as the possible role of iNOS in the pathogenesis of TBI. ⋯ These data indicate that iNOS is expressed after moderate parasagittal fluid-percussion brain injury, in a time-dependent manner, and that inhibition of iNOS synthesis improves histopathological outcomes. Thus, inhibition of iNOS activation may represent a potential therapeutic strategy for the treatment of TBI.
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Aggressive fibromatoses are proliferations of fibrous tissue that infiltrate surrounding tissues and tend to recur after surgical resection. We report a series of five children with aggressive fibromatosis involving the cranial base. ⋯ Fibromatoses of the cranial base are rare and seem to be most common in the pediatric age group. Gross total resection, preferably in the first attempt, should be the goal. Radiotherapy and hormonal therapy are useful adjunctive methods for the treatment of aggressive fibromatosis. Fibromatoses that involve the cranial base are most likely to require a multidisciplinary treatment approach.
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Randomized Controlled Trial Comparative Study Clinical Trial
Thiopental and desflurane treatment for brain protection.
Thiopental produces cerebral metabolic depression and cerebral vasoconstriction. However, the effect of thiopental on brain tissue oxygen pressure (PO2), carbon dioxide pressure, and pH is not known. In a prospective study, we measured brain tissue gases and pH during thiopental or desflurane treatment that was administered for brain protection during brain artery occlusion. ⋯ Thiopental has a metabolically neutral effect on brain tissue gases and pH, even though it is known to decrease cerebral oxygen consumption. The metabolic depressant and vasodilator effects of desflurane enhance tissue oxygenation and attenuate tissue PO2 reductions produced by artery occlusion. Both thiopental and desflurane inhibit ischemic lactic acidosis and decreases in pH.