World Neurosurg
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Case Reports
Incidence and clinical features of symptomatic cerebral hyperperfusion syndrome after vascular reconstruction.
Vascular reconstructions are the established treatment for ischemic cerebrovascular disease. Cerebral hyperperfusion syndrome (CHS) is occasionally seen after vascular reconstruction and manifest clinical symptoms. The purpose of this study is to investigate the incidence and clinical features of CHS after vascular reconstruction. ⋯ The incidence of CHS is significantly higher in patients with MMD and results in vasogenic edema visible on magnetic resonance imaging.
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Current treatments for cerebral aneurysms are far from ideal. Platinum coils are prone to compaction, and currently used liquid embolics are delivered with angiotoxic agents. This work presents initial in vivo studies of a novel liquid-to-solid gelling polymer system (PPODA-QT), focusing on biocompatibility and effective delivery strategies. ⋯ This small-scale pilot study highlighted first-time in vivo use of PPODA-QT as an embolic agent for aneurysm treatment. Filling aneurysms to 80% to 90% capacity proved to be a safe and effective delivery strategy, and PPODA-QT showed excellent biocompatibility. This study indicates that future investigation of PPODA-QT for aneurysm embolization is warranted, as it may prove to be a viable alternative to current embolic materials.
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Randomized Controlled Trial Multicenter Study Comparative Study
A multicenter, single-blind, prospective randomized trial to evaluate the safety of a polyethylene glycol hydrogel (Duraseal Dural Sealant System) as a dural sealant in cranial surgery.
Incisional cerebrospinal fluid (CSF) leakage after cranial surgery is a significant cause of morbidity due to poor wound healing and infection, meningitis, and pseudomeningocele formation. Many common dural closure techniques, such as sutures, autologous grafts, gelatin or collagen sponges, and fibrin glues, are used to achieve watertight closure, although none are US Food and Drug Administration approved for this use. DuraSeal Dural Sealant System is a polyethylene glycol (PEG) hydrogel approved by the U.S. Food and Drug Administration for obtaining watertight dural closure when applied after standard dural suturing. This multicenter, prospective randomized study further evaluated the safety of a PEG hydrogel compared with common dural sealing techniques. ⋯ The PEG hydrogel dural sealant used in this study has a similar safety profile to commonly used dural sealing techniques when used as dural closure augmentation in cranial surgery. The PEG hydrogel dural sealant demonstrated faster preparation and application times than other commonly used dural sealing techniques.
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Review Case Reports
The innervation of the cranial dura mater: neurosurgical case correlates and a review of the literature.
Headache and postcraniotomy pain can be disabling. In addition, generation of pain on manipulation of dural membranes during an awake craniotomy can limit the mapping procedure and create significant discomfort for the patient. There is controversy regarding the distribution of innervation of the cranial dura mater. Our aim was to review the literature regarding the innervation of the cranial dura mater and provide surgical case illustrations to highlight the relevance of such innervation to the neurosurgeon. ⋯ Knowledge of the nerves that supply the dura mater of the skull and their pathways is important to the clinician who treats headache and to the neurosurgeon who operates in this region.
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At the turn of the twentieth century, the only computational device used in neurosurgical procedures was the brain of the surgeon. Today, most neurosurgical procedures rely at least in part on the use of a computer to help perform surgeries accurately and safely. The techniques that revolutionized neurosurgery were mostly developed after the 1950s. ⋯ Developments over the last 10 years in areas of sensors and robotics that promise to transform the practice of neurosurgery further are discussed. Potential impacts of advances in computers related to neurosurgery in developing countries and underserved regions are also discussed. As this article illustrates, the computer, with its underlying and related technologies, is central to advances in neurosurgery over the last half century.