Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
-
A subset of brain arteriovenous malformations (AVM) cannot be treated using today's treatment paradigms. Novel therapies may be developed, however, as the underlying pathophysiology of these lesions becomes better understood. Endothelial cells (EC) are the subject of new biological therapies, such as radiosensitisation and vascular targeting. ⋯ Leucocyte and platelet adherence is increased for several days post-irradiation due to increased E-selectin and P-selectin and intercellular adhesion molecule-1 expression. ET-1 is highly expressed in irradiated AVM EC. Radiosurgery produces local radiation-induced changes in EC, which may allow these changes to be harnessed in conjunction with other techniques such as vascular targeting.
-
The trigeminocardiac reflex (TCR) is a common event during skull base surgery that can lead to intraoperative arterial hypotension and bradycardia. Arterial hypotension associated with TCR can be a negative prognostic factor for postoperative auditory function and ipsilateral tinnitus in patients undergoing surgery for vestibular schwannoma (VS). In this study, the contribution of TCR to postoperative auditory function in non-VS cerebellopontine angle (CPA) tumor surgery was investigated. ⋯ Of the 30 patients with preoperative functional hearing, 1/3 (33.3%) patients in the TCR group and 23/27 (85.2%) patients in the non-TCR group had functional hearing postoperatively. When patients with large tumors and functional, hearing were considered, only 33.3% of patients in the TCR group and 77.8% of patients in the non-TCR group remained within the same hearing classes following surgical treatment (p=0.1573). TCR may be a negative prognostic factor for postoperative auditory function in patients with large, non-VS CPA tumors.
-
We investigated the effects of cervical disc herniation on kinematics of adjacent segmental motion by evaluating 407 patients using kinetic MRI. For each patient, measurements for translational motion (mm), angular variation (degrees) and disc height (mm) were obtained at each segment from C2/C3 through C7/T1. The results show that the spinal levels above the disc herniation experienced, on average, a 7.2% decrease in translational motion per millimeter of disc herniation (p=0.0113), but no significant change in angular motion. ⋯ This study indicates that although disc height, translational motion and angular variation are significantly affected at the level of a disc herniation, no significant changes are apparent within the adjacent segments. Herniated discs have no effect on the range of motion at adjacent levels regardless of the degree of disc degeneration or the size of disc herniation. The natural progression of disc herniation and adjacent segment disease within the cervical spine appear to be separate, unrelated processes.
-
Thrombosis via Hunterian ligation, with or without high-flow bypass, is the definitive treatment for unclippable giant aneurysms; however, secondary deterioration may occur. We present a 67-year-old woman with an unclippable giant (33mm) carotid ophthalmic aneurysm. ⋯ Subsequent expansion of the thrombosed aneurysm created mass effect with hydrocephalus, leading to marked cognitive and visual decline. Aneurysmal decompression led to improved vision and near-normal neurological function.