World Neurosurg
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Randomized Controlled Trial Multicenter Study
A prospective, multicenter, randomized study of the efficacy of eicosapentaenoic acid for cerebral vasospasm: the EVAS study.
The sphingosylphosphorylcholine-Rho-kinase pathway plays an important role in Ca(2+) sensitization of vascular smooth muscle contraction. Eicosapentaenoic acid (EPA) inhibits sphingosylphosphorylcholine -Rho-kinase-activated Ca(2+)-sensitization in vitro and in subarachnoid hemorrhage (SAH) models in vivo and has also been shown to inhibit the occurrence of cerebral vasospasm (CIV) after the onset of SAH in a prospective, nonrandomized study. The current prospective, multicenter, randomized study was performed to confirm the preventive effects of EPA on CIV in patients with SAH. ⋯ These results indicate that oral EPA reduces the frequency of SV and CIV after the onset of aneurysmal SAH.
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Case Reports Comparative Study
Comparative analysis of the transcranial "far lateral" and endoscopic endonasal "far medial" approaches: surgical anatomy and clinical illustration.
The main aim of our study was to analyze and compare the surgical anatomy pertinent to the dorsal transcranial transcondylar (far lateral approach) with that of the ventral endoscopic endonasal transcondylar (far medial approach) route. ⋯ The far medial approach offers a safe, wide exposure of the lower third of the clivus for lesions that expand ventromedial to the hypoglossal nerve. The far lateral approach is most suitable for lesions located dorsolateral to the lower cranial nerves. The vertebral artery and hypoglossal canal are the most important landmarks to guide surgical planning. A combined endonasal-transcranial approach should be considered for resection of extensive lesions involving both ventromedial and dorsolateral compartments. We strive to encourage skull base surgeons to integrate endoscopic and microscopic approaches to the posterior fossa.
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Myelomeningocele is a defect that typically is repaired surgically within the first few days of life in developed countries to minimize the risk of meningitis. If left unrepaired, these children may survive to have their meningocele sac epithelialize. The surgical reduction and closure of an epithelialized myelomeningocele represents a unique challenge for the neurosurgeon because it requires a modification of the typical closure technique. ⋯ Delayed closure of myelomeningoceles is facilitated by lessons learned from our surgical experience during a medical missions to Guatemala.