World Neurosurg
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Comparative Study
Rapid Warfarin reversal in the setting of intracranial hemorrhage: a comparison of plasma, recombinant activated factor VII, and prothrombin complex concentrate.
To compare the safety and effectiveness of three methods of reversing coagulopathic effects of warfarin in patients with potentially life-threatening intracranial hemorrhage. ⋯ As an adjunct to Vit K for rapid warfarin reversal, FVIIa and PCC appear more effective than FFP. Either FVIIa or PCC are reasonable options for reversal, but FVIIa is considerably more expensive and may have greater risk of INR rebound.
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Transsphenoid surgery is the treatment of choice for growth hormone (GH)-producing pituitary adenomas. The measures that may predict postoperative remission need to be elucidated. ⋯ The results of our study show that transsphenoid surgery is an optimal treatment modality for GH-secreting pituitary adenoma. Suprasellar or sellar floor invasion, and preoperative GH or IGF-I do not necessarily predict poor outcomes. Large tumor size and cavernous sinus extension contribute to greater recurrence rates.
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Epilepsy is a significant but potentially preventable complication of traumatic brain injury (TBI). Previous research in animal models of acquired epilepsy has implicated the calcium-sensitive phosphatase, calcineurin. In addition, our lab recently found that calcineurin activity in the rat hippocampus increases acutely after lateral TBI. ⋯ Non-convulsive seizures in the brain injured rats, however, were four-times more frequent and two-times longer lasting than in their uninjured littermates. Interestingly, rats administered Tacrolimus acutely after TBI showed significantly fewer non-convulsive seizures than untreated rats, but a similar degree of cortical atrophy. The data thus indicate that administration of Tacrolimus acutely after TBI suppressed non-convulsive seizures months later.
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Meningiomas with growth onto or into the major venous sinuses, that is, venous meningiomas, provide management problems regarding their radical removal and preservation of venous drainage. The relationship to venous structures often precludes radical surgery; the risk of recurrence and aggressive histology is greater for parasagittal meningiomas than in other locations. Older series reflect the conflict between radical surgery and subtotal removal followed by the "wait-and-scan" approach for the residual. This review summarizes our experience of a more contemporary series of venous meningiomas, after to the introduction of gamma-knife radiosurgery, for residual tumors and a long follow-up of 10 years. ⋯ Surgical microscopic radicality was unexpectedly difficult to achieve. Gamma-knife radiosurgery was a useful adjunct but only in patients with tumors of low proliferative index. It should probably be used as part of the initial surgical management. As expected, treatment results for these patients seem to have improved during the last decades but recurrence and malignancy remained a problem, which is not always solved by repeated radiosurgery.