Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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We investigated the neuroprotective effects of pre- and postconditioning on infarct volume in the transient middle cerebral artery occlusion (MCAo) model in rats. Thirty-two male rats were divided into occlusion, preconditioning, postconditioning and both pre- and postconditioning groups. MCAo (120 minutes) was monitored with continuous cerebral tissue oxygen (O2) pressure (PtiO2). ⋯ Comparison of infarct volumes showed a significant difference between the conditioned groups and occlusion group. Although there was better protection in the preconditioning group compared with the other two conditioned groups, the results did not reach statistically significant levels. The results suggest that preconditioning, postconditioning and pre/post conditioning have protective effects on cerebral ischemia.
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We aimed to investigate the use of advanced functional MRI (fMRI) techniques such as proton magnetic resonance spectroscopy ((1)H-MRS) and the apparent diffusion coefficient (ADC) value in diffusion weighted imaging (DWI), in the diagnosis of mild cognitive impairment (MCI). Multiple indicators were combined in order to improve the early diagnostic value of MRS and ADC. We administered MRS and DWI-ADC to 13 patients with Alzheimer's disease (AD), 9 patients with MCI, and 13 control patients. ⋯ The best correlation was obtained between ADC and MMSE, rather than between NAA or mI and MMSE. Thus, we found that changes in NAA/Cr, mI/Cr and ADC in the hippocampus and the temporoparietal regions were helpful in the clinical diagnosis of MCI. Furthermore, these changes showed potential in predicting the progression of MCI to AD if the multimarkers were combined.
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Clinical Trial
Outcomes and cost-effectiveness of gamma knife radiosurgery and whole brain radiotherapy for multiple metastatic brain tumors.
We aimed to analyze the outcomes and cost-effectiveness of gamma knife radiosurgery (GKRS) and whole brain radiotherapy (WBRT) for multiple metastatic brain tumors. Over a period of 5 years, 156 patients with multiple metastatic brain tumors were enrolled and freely assigned by the referring doctors to either gamma knife radiosurgery (GKRS, Group A, n=56), or to whole brain radiotherapy (WBRT, Group B, n=100). The follow-up time was set at 1200 days (3.3 years) post-treatment. ⋯ The cost-effectiveness per KPS score was also higher for the GKRS treatment (US$139/KPS score) than for WBRT (US$229/KPS score), p<0.01. Thus, the mortality rate for multiple metastatic brain tumors treated by GKRS is significantly better with a good initial KPS score and when the tumor number is 2-5. GKRS results in a better post-treatment KPS score, QALY, and higher cost-effectiveness than WBRT for treating multiple metastatic brain tumors.
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Clinical Trial
Clinicopathological considerations in patients with lumbosacral extraforaminal stenosis.
Lumbosacral extraforaminal stenosis is not uncommon among patients being treated for radicular symptoms. Patients who had lumbosacral extraforaminal stenosis were reviewed, and cadaver dissection was used to determine the anatomy of extraforaminal lesions. A total of 167 patients with lumbosacral spinal stenosis who underwent surgery from March 2004 to February 2006 were reviewed retrospectively. ⋯ No major complications or recurrences were observed during follow-up. Therefore, lumbosacral extraforaminal stenosis should be included in the differential diagnosis of lumbar radicular pain. A precise diagnosis using MRI is important, and complete decompression with an understanding of the extraforaminal anatomy is required.
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There is an increasing amount of published literature supporting the use of decompressive craniectomy in the management of raised intracranial pressure and it appears that this procedure will become established as a method by which intracranial hypertension can be treated. While technically fairly straightforward, a decompressive craniectomy is not without complications. A further complication is presented here, which has not been previously reported. ⋯ He suffered further cerebral injury and subsequently died. Following a detailed review of the case a number of recommendations were made and a specific post-decompressive craniectomy operational policy for the assessment and management of these patients was implemented. While we accept that these particular guidelines are specific to a particular institution, this case highlights the need to view these patients as a particularly high risk and recommend that institutions review or establish a specific policy regarding their management.