Surg Neurol
-
Case Reports
Migration of pump for intrathecal drug delivery into the peritoneal cavity. Case report.
We report on a patient in whom a subfascially implanted pump for the intrathecal delivery of baclofen spontaneously migrated into the peritoneal cavity. ⋯ When creating a pocket for subfascial implantation, a high subcostal incision should be used so that the lower extent of the pocket will still be above the level of the linea semilunaris, hence ensuring a strong fascial layer between the pump and the peritoneum.
-
Review Historical Article
The history of awake craniotomy for brain tumor and its spread into Asia.
In ancient times, awake craniotomy was used for trepanation to treat seizures and remove a variety of morbid conditions or even to permit the escape of evil air. In modern times, this technique was initially used for removal of epileptic foci with simultaneous application of brain mapping with electrical current. ⋯ It has been used in North America since the 1980s, then Europe, and recently has spread into Asia. Its spread to Asia could have significant impact based on the large population of patients and the low resource utilization associated with awake craniotomy.
-
Reduced cerebral blood flow and cerebrovascular reactivity to acetazolamide (type 3 ischemia) is believed as an independent predictor for subsequent ischemic stroke in patients with occlusive carotid artery diseases. However, recent studies have shown that type 3 patients can be divided into 2 pathophysiologically different subgroups as follows: those with elevated OEF and those with normal OEF. This study was aimed to clarify whether there is a difference in the prognosis between patients with type 3 and elevated OEF and those with type 3 but normal OEF. ⋯ Type 3 patients may be categorized into 2 subgroups as follows: those with elevated OEF and higher stroke risk and those with normal OEF and lower stroke risk, although larger number of subjects should be analyzed.
-
The major risk of CEA is perioperative stroke. NIRS can detect ischemic changes during CEA; however, possible watershed-type perfusion defects may not be detected by single-channel NIRS occurring at some distance from the light source. In the present case, we tested the usefulness of optical topography (ie, multichannel NIRS, OT) for this purpose. ⋯ OT could detect watershed-type posterior perfusion defects which the single-channel NIRS failed to detect. OT may represent a useful tool for intraoperative monitoring during CEA.
-
In the United States, TBI remains a major cause of morbidity and mortality in children and young adults. A total of 1.5 million Americans experience head trauma every year, and the yearly economic cost of this exceeds $56 billion. The magnitude of this problem has generated a great deal of interest in elucidating the complex molecular mechanism underlying cell death and dysfunction after TBI and in the development of neuroprotective agents that will reduce morbidity and mortality. ⋯ The literature and evidence for EPO as a potent inhibitor of apoptosis and promising therapeutic agent in a variety of neurological insults, including trauma, are mounting. With the recent interest in clinical trials of EPO in human stroke, it is both timely and prudent to consider the use of this pharmaceutical avenue in TBI in man.