Neurologia medico-chirurgica
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Neurol. Med. Chir. (Tokyo) · Jan 2013
Comparative StudyAcetyl salicylic acid locally enhances functional recovery after sciatic nerve transection in rat.
Local effect of acetyl salicylic acid (ASA) on peripheral nerve regeneration was studied using a rat sciatic nerve transection model. Forty-five male healthy White Wistar rats were divided into three experimental groups (n = 15), randomly: Sham-operation (SHAM), control (SIL), and ASA-treated (SIL/ASA) groups. In SHAM group after anesthesia left sciatic nerve was exposed through a gluteal muscle incision and after homeostasis the muscle was sutured. ⋯ Morphometric indices of regenerated fibers showed that the number and diameter of the myelinated fibers in SIL/ASA were significantly higher than in control group. In immuohistochemistry, location of reactions to S-100 in SIL/ASA was clearly more positive than in SIL group. Response to local treatment of ASA demonstrates that it influences and improves functional recovery of peripheral nerve regeneration.
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Neurol. Med. Chir. (Tokyo) · Jan 2013
Controlled Clinical TrialSimple solution for preventing cerebrospinal fluid loss and brain shift during multitrack deep brain stimulation surgery in the semisupine position: polyethylene glycol hydrogel dural sealant capping: rapid communication.
This study evaluated preliminary findings on the efficacy of polyethylene glycol (PEG) hydrogel dural sealant capping for the prevention of cerebrospinal fluid (CSF) leakage and pneumocephalus during deep brain stimulation (DBS) surgery in the semisupine position. Group A consisted of 5 patients who underwent bilateral subthalamic nucleus (STN)-DBS surgery without PEG hydrogel dural sealant capping. Group B consisted of 5 patients who underwent bilateral STN-DBS surgery with PEG hydrogel dural sealant capping. ⋯ No hemorrhage or venous air embolisms were observed in either group. The effect of brain shift was discriminated by STN recordings in Group B. These preliminary findings indicate that PEG hydrogel dural sealant capping may reduce adverse effects related to CSF leakage and brain shift during DBS surgery.
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Neurol. Med. Chir. (Tokyo) · Jan 2013
Comparative StudyDecompression only versus fusion surgery for lumbar stenosis in elderly patients over 75 years old: which is reasonable?
As the population ages, more elderly patients suffer from spinal stenosis requiring lumbar fusion. However, there are few and conflicting results regarding the clinical outcome of lumbar fusion. The purpose of this study is to evaluate the safety and efficiency of posterior lumbar interbody fusion (PLIF) in over 75-year-old patients and analyze the relative effectiveness of lumbar spinal fusion surgery compared with decompression surgery for spinal stenosis. ⋯ The decrease in back pain score after treatment was greater in the PLIF group compared to the DLF group (P < 0.01) with a statistically significant difference in the trend in the two groups over time (P < 0.01). Even in elderly patients, lumbar surgery appears to be a safe and justifiable treatment for spinal stenosis. Lumbar fusion surgery rather than decompressive surgery was recommended for those patients who mainly complained of back pain.
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Neurol. Med. Chir. (Tokyo) · Jan 2013
Case ReportsTraumatic cerebrovascular injury following severe head injury: proper diagnostic timetable and examination methods.
Traumatic cerebrovascular injury (TCVI) is a serious complication of severe head injury, with a high mortality rate. To establish a proper treatment strategy for TCVI, we investigated patients with a high risk of TCVI according to the Guidelines for the Management of Severe Head Injury (hereafter "the Guidelines") to elucidate the validity of the criteria for TCVI in the Guidelines and the appropriate screening timing and methods. Of those transported to our facility between December 2008 and June 2012, 67 individuals with a high risk of TCVI were evaluated to reveal the proper timing and methods of vascular evaluation. ⋯ In addition, according to the Glasgow Outcome Scale (GOS), outcomes were three deaths due to primary brain injury, six cases of persistent vegetative state, five cases of severe disability, three cases of moderate disability, and four cases of good recovery. Although 3DCTA is a simple and convenient diagnostic method, cerebral angiography is necessary to evaluate dissecting lesions. If patients have any signs or symptoms of TCVI, as described in the Guidelines, cerebral angiography or 3DCTA should be performed as an initial screening method within 72 hours of admission, followed by cerebral angiography on postadmission Day 14 ± 2 to prevent failed diagnosis.
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Stroke during pregnancy is rare, but after occurring, most patients develop serious neurological conditions. Hemorrhagic stroke, including intracerebral hemorrhage and subarachnoid hemorrhage, often requires emergency surgical intervention. ⋯ Whether the patients receive general or spinal and epidural anesthesia is another clinically significant issue. Finally neurosurgeons, anesthesiologists, and obstetricians should cooperate to manage pregnant women with stroke.