Clinical neurosurgery最新文献

{"title":"Enriched motor neuron populations derived from bacterial artificial chromosome-transgenic human embryonic stem cells.","authors":"D. Placantonakis, M. Tomishima, Fabien G. Lafaille, Sabrina C. Desbordes, Fan Jia, N. Socci, A. Viale, Hyojin Lee, Neil L Harrison, L. Studer, V. Tabar","doi":"10.1227/01.NEU.0000333455.99024.6F","DOIUrl":"https://doi.org/10.1227/01.NEU.0000333455.99024.6F","url":null,"abstract":"S OF OPEN PAPERS controls. Injection of Ad-GAD65 into the trigeminal ganglion also resulted in long-term analgesia following a chronic constriction injury of the infraorbital nerve, a model of orofacial neuropathic pain. Immunohistochemical analysis showed that adenovirus-mediated GAD65 was expressed mainly in the satellite glial cells that surround the perikarya of sensory neurons in the trigeminal ganglion, suggesting that the analgesic effects were mediated by an intraganglionic, paracrine release of GABA. CONCLUSION: Adenoviral vector-mediated expression of GAD65 is a suitable means to synthesize GABA in sensory ganglia and produce analgesia in different pain models. 884 Negative Exploration during Microvascular Decompression: Initial Experience with Intraoperative Glycerol Rhizotomy for Trigeminal Neuralgia Richard S. Zimmerman, M.D., Amy Theiler, PA-C, Naresh P. Patel, M.D. INTRODUCTION: Microvascular decompression (MVD) has been shown to be effective for trigeminal neuralgia (TN). Although patient selection criteria and outcome have been described in detail, there are few reports in the literature focusing on options when the exploration is negative for vascular compression of the trigeminal nerve. One option involves partial sectioning of the root with complications such as facial numbness and incomplete or no pain relief. We describe an alternative, namely open glycerol rhizotomy (OGR), carried out intraoperatively when no discreet vascular compression is observed. METHODS: A total of 101 consecutive MVD cases for TN were reviewed, 14 of which had no vascular compression identified by an experienced surgeon. Included in these 14 were patients who failed previous procedures (e.g., MVD, gamma knife). For the 14 negative explorations, a droplet of glycerol was placed 3 to 4 mm distal to the root entry zone of the sensory portion of the trigeminal root. These cases were retrospectively reviewed for follow-up and to evaluate outcomes. RESULTS: The procedure was tolerated well by all patients. Thirteen of the 14 experienced immediate complete facial pain relief; seven of the 14 experienced initial facial numbness described as mild, but all patients retained their ipsilateral corneal reflex. Reassessment at 6 weeks revealed that nine of 14 had no pain, two were improved, and three had the same pain as prior to surgery. Between 6 months and 2 years after surgery, two patients restarted medication and two had a percutaneous glycerol rhizotomy. There were no cases of anesthesia dolorosa. There were no other neurological deficits and no deaths. CONCLUSION: Intraoperative glycerol rhizotomy appears to be effective when no significant vascular compression is observed and is associated with outcomes comparable to other rhizotomy techniques. Additional follow-up is necessary to establish long-term results, but the initial results suggest the potential for an alternative method of rhizotomy. Transgenic method for combinatorial expression of fluorescent ","PeriodicalId":10381,"journal":{"name":"Clinical neurosurgery","volume":"13 1","pages":"125-32"},"PeriodicalIF":0.0,"publicationDate":"2008-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85244321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The combination of selective inhibition of the cannabinoid CB1 receptor and activation of the cannabinoid CB2 receptor yields improved attenuation of motor and autonomic deficits in a mouse model of spinal cord injury.","authors":"J. Heller, Darric E. Baty, Ming Zhang, Hongbo Li, M. Adler, D. Ganea, J. Gaughan, C. Loftus, J. Jallo, R. Tuma","doi":"10.1227/01.NEU.0000333487.18324.36","DOIUrl":"https://doi.org/10.1227/01.NEU.0000333487.18324.36","url":null,"abstract":"Spinal cord injury (SCI) is a tremendous public health problem in the United States and worldwide. The Centers for Disease Control and Prevention and the University of Alabama National Spinal Cord Injury Statistical Center estimate the annual incidence of SCI in the United States is between 11,000 and 12,000 injured per year.14,31 There are approximately 250,000 people in the United States living with disability related to an SCI.14,31 The cost of SCI to society is considerable, with a monetary estimate of more than $9,700,000,000 per year.14 Considering that more than half of individuals affected by SCI are young males between the ages of 15 and 29 years, the cost to society from loss of productivity may even be greater. Internationally, the incidence of SCI is increasing at an alarming rate, as motorization and in many regions violence increases. Although there have been advances in the care and rehabilitation of patients with SCI, currently there are unfortunately very few, if any, medical treatments for acute SCI that effect functional outcome.3,17,22 The current mainstay in medical therapy for acute injury is high-dose methylprednisolone.3,10–12,22,25 Many experts, however, believe that the risk of adverse events associated with high-dose steroids may outweigh the potential benefits gained through its use.22,25 According to Hurlbert, the continued use of steroids in acute SCI is “primarily out of peer pressure and fear of litigation.”22 Just as in traumatic brain injury, a complex array of secondary insults is responsible for ongoing neuronal damage after SCI.3,28 Neuroprotection is defined by Anderberg et al.3 as measures to “counteract secondary injury mechanisms and/or limit the extent of damage caused by self-destructive cellular and tissue processes.” Neuroprotective medications may be able to interrupt this destructive progression and theoretically have the potential to yield improved functional recovery.3 The search for neuroprotective agents that demonstrate efficacy in SCI is of paramount importance given the increasing incidence and devastating nature of the disease. Recently there has been an explosion of interest in the use of cannabinoids in treatment of central nervous system (CNS) diseases.2,4,8,13,15,18,20,32,34,36–38 Croxford15 identified multiple sclerosis, Parkinson’s disease, neuroprotection, analgesia, emesis, and anorexia and obesity all as areas with potential for the clinical application of cannabinoids. Our group has been exploring the role of cannabinoid receptor modulation in murine models of several CNS disorders such as stroke, multiple sclerosis, traumatic brain injury, and SCI.30,37,38 The term cannabinoid refers to any natural or synthetic compounds that resemble in structure and/or function those found naturally in the plant Cannabis sativa. Two types of cannabinoid receptors in the mammalian endocannabinoid system have been identified to date. The CB1 and CB2 receptors both work through Gi protein–coupled me","PeriodicalId":10381,"journal":{"name":"Clinical neurosurgery","volume":"41 1","pages":"84-92"},"PeriodicalIF":0.0,"publicationDate":"2008-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82212047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fiducials: Achilles' heel of image-guided neurosurgery: an attempt at indigenization and improvement.","authors":"D. Agrawal, P. Steinbok","doi":"10.1227/01.NEU.0000333456.37142.12","DOIUrl":"https://doi.org/10.1227/01.NEU.0000333456.37142.12","url":null,"abstract":"Image-guided surgery or neuronavigation has become an important part of the neurosurgical armamentarium in most centers around the world, primarily because it helps to improve patient safety and consistency of surgical results.1–5,8 However, these advantages come at the cost of increased health care and patient expenses. The disposable products used in image-guided surgery are often very costly. In developing countries such as India, hospitals may find money for large capital purchases, but often fail to budget for the price of consumables over the lifetime of the product. The lack of availability of the consumables may lead to underuse of the equipment. At the All India Institute for Medical Sciences, the Medtronic StealthStation (Medtronic Sofamor Danek, Inc., Memphis, TN) is used for neuronavigation, and the disposable fiducials cost INR4200 (US$100) for every procedure in which the StealthStation is used. As the average cost of consumables in major cranial surgery at our center is INR15000 (US$350), using neuronavigation can increase these costs by 25% simply because of the cost of fiducials. We therefore attempted to find less expensive available indigenous alternatives to replace the proprietary fiducials used with the StealthStation in image-guided neurosurgery.","PeriodicalId":10381,"journal":{"name":"Clinical neurosurgery","volume":"32 1","pages":"80-3"},"PeriodicalIF":0.0,"publicationDate":"2008-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86768279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of tregs in human glioma patients and their inhibition with a novel STAT-3 inhibitor.","authors":"A. Heimberger, L. Kong, Mohamed K. Abou-Ghazal, Chantal Reina-Ortiz, David S. Yang, Jun Wei, W. Qiao, R. Schmittling, G. Archer, J. Sampson, N. Hiraoka, W. Priebe, G. Fuller, R. Sawaya","doi":"10.1227/01.NEU.0000333524.54656.42","DOIUrl":"https://doi.org/10.1227/01.NEU.0000333524.54656.42","url":null,"abstract":"Several recent clinical trials for high-grade gliomas have demonstrated promising results. Nonetheless, despite improvement in survival, these patients ultimately die of tumor progression. Malignant glioma patients are profoundly immunosuppressed, and a fundamental understanding of which types of glioma have immune resistance mediated by Tregs is required for developing and initiating specific immunotherapeutic approaches that may target these cells.","PeriodicalId":10381,"journal":{"name":"Clinical neurosurgery","volume":"10 1","pages":"98-106"},"PeriodicalIF":0.0,"publicationDate":"2008-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74207093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping the horizon: techniques to optimize tumor resection before and during surgery.","authors":"Nader Sanai, Mitchel S Berger","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":10381,"journal":{"name":"Clinical neurosurgery","volume":"55 ","pages":"14-9"},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28012624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SPORT: what neurosurgeons need to know.","authors":"Peter D Angevine, Paul C McCormick","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":10381,"journal":{"name":"Clinical neurosurgery","volume":"55 ","pages":"72-5"},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28012630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lessons of the first era of psychosurgery.","authors":"Jack El-Hai","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":10381,"journal":{"name":"Clinical neurosurgery","volume":"55 ","pages":"138-9"},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28012639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fluorescence-guided resection of malignant gliomas using 5-aminolevulinic acid: practical use, risks, and pitfalls.","authors":"Jörg-Christian Tonn, Walter Stummer","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":10381,"journal":{"name":"Clinical neurosurgery","volume":"55 ","pages":"20-6"},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28012625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Epilepsy surgery\" versus lesionectomy in patients with seizures secondary to cavernous malformations.","authors":"Ricardo J Komotar, Charles B Mikell, Guy M McKhann","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":10381,"journal":{"name":"Clinical neurosurgery","volume":"55 ","pages":"101-7"},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28012634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tort reform: alternative models.","authors":"Alan M Scarrow","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":10381,"journal":{"name":"Clinical neurosurgery","volume":"55 ","pages":"121-5"},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28012636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}