Acta neurochirurgica. Supplement
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we focused on the recent management of aneurysmal subarachnoid hemorrhage (SAH) in patients over 70 years old (advanced age). ⋯ mean age and proportion of procedures in advanced age are increasing, but outcomes have improved. These results depend on radical surgery for aneurysm in the acute stage and aggressive prevention and treatment of vasospasm. Interventional treatment is necessary to improve the outcome in cases of advanced age.
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Acta Neurochir. Suppl. · Jan 2011
Application of pulsed radio frequency to the dorsal horn and dorsal roots.
In the world of neuromodulation for pain management, the new multifunctional electrode presented in this article, together with the associated procedure described, considerably extends the range of therapeutic options in the hands of pain physicians. Besides the definite therapeutic effect, the lower rate of complications and side effects, further factors also make this new procedure and device appear an attractive diagnostic and therapeutic modality.
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Acta Neurochir. Suppl. · Jan 2011
Randomized Controlled Trial Multicenter StudyClazosentan: prevention of cerebral vasospasm and the potential to overcome infarction.
Cerebral vasospasm is a common complication occurring after aneurysmal subarachnoid hemorrhage (SAH). It is recognized as a leading preventable cause of morbidity and mortality in this patient group, but its management is challenging, and new treatments are needed. Clazosentan is an endothelin receptor antagonist designed to prevent endothelin-mediated cerebral vasospasm. ⋯ Clazosentan reduced angiographic vasospasm dose-dependently relative to placebo with a maximum risk reduction of 65% with the highest dose. Despite this, there was no benefit of clazosentan on the secondary protocol-defined morbidity/mortality endpoint; however, additional post-hoc and modified endpoint analyses provided some evidence for a potential clinical benefit. Two additional large-scale studies (CONSCIOUS-2 and CONSCIOUS-3) are now underway to further investigate the potential of clazosentan to improve long-term clinical outcome.
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The extradural space is currently investigated through fluoroscopy and ultrasound for surgical approach, whereas magnetic resonance imaging has been used to provide detailed information. The aim of the present paper is to describe the radiologic anatomy of the sacral canal through a review of its appearance in the different radiologic techniques. CT is able to visualise also the sacrum and the content of the sacral canal, triangular in shape in the transverse images, being able to establish the measurement of the transverse area of the dural sac and of the canal diameter. ⋯ The band-like structure on top is the sacrococcygeal ligament. The band-like structure at the bottom is the dorsal surface of the sacrum. The sacral hiatus corresponds to the hypoechoic region observed between the two hyperechoic band-like structures.
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Acta Neurochir. Suppl. · Jan 2011
ReviewComparison of different preclinical models of intracerebral hemorrhage.
Intracerebral hemorrhage (ICH) is the most devastating type of stroke. It is characterized by spontaneous bleeding in brain parenchyma and is associated with a high rate of morbidity and mortality. Presently, there is neither an effective therapy to increase survival after intracerebral hemorrhage nor a treatment to improve the quality of life for survivors. ⋯ The "balloon" method has also been used to mimic ICH for study. In this summary, we intend to provide a comparative overview of the technical methods, aspects, and pathologic findings of these types of ICH models. We will also focus on the similarities and differences among these rodent models, achievements in technical aspects of the ICH model, and discuss important aspects in selecting relevant models for study.