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Intracranial OR Aneurysm Neuro*

Sara Reis Teixeira, Fabrício Guimarães Gonçalves, Carolina A Servin, Kshitij Mankad, Giulio Zuccoli
Abusive head trauma (AHT) is a form of inflicted head injury. AHT is more frequent in 2-year-old or younger children. It is an important cause of neurological impairment and the major cause of death from head trauma in this age group. Brain magnetic resonance imaging allows the depiction of retinal hemorrhages, injured bridging veins, and identifying and localizing extra- and intra-axial bleeds, contusions, lacerations, and strokes. The diagnosis of AHT is a multidisciplinary team effort which includes a careful evaluation of social, clinical, laboratory, and radiological findings...
December 2018: Topics in Magnetic Resonance Imaging: TMRI
Breno Franco Silveira Fernandes, Paulo Caramelli
PURPOSE OF REVIEW: To address the important relationships between stroke and infection, focusing on the most frequent infections found in low-income and middle-income countries. RECENT FINDINGS: Stroke is one of the leading causes of mortality and disability worldwide, with a great proportion of the stroke burden occurring in low-income and middle-income countries. Infectious diseases are still a great health problem in developing countries and it is possible that the proportion of infection-related strokes is greater in these nations...
December 3, 2018: Current Opinion in Neurology
Leanne Stunkel, Nancy J Newman, Valérie Biousse
PURPOSE OF REVIEW: This review summarizes the recent literature on diagnostic error relevant to the practice of neuro-ophthalmology, and evaluates the potential of increased access to neuro-ophthalmology as a means to decrease rates of diagnostic error, thereby reducing medical harm and spending on unnecessary tests and treatments. RECENT FINDINGS: Despite medical advances, current research continues to show alarmingly high rates of diagnostic error. Research into diagnostic error shows that many of these errors can be traced to cognitive errors...
December 3, 2018: Current Opinion in Neurology
Susanne Muehlschlegel
PURPOSE OF REVIEW: This article reviews the epidemiology, clinical presentation, diagnosis, and management of patients with aneurysmal subarachnoid hemorrhage (SAH). SAH is a type of hemorrhagic stroke and is a neurologic emergency with substantial morbidity and mortality. This article reviews the most common and potentially life-threatening neurologic and medical complications to promote their early recognition and prevent secondary brain injury. RECENT FINDINGS: Over the past 30 years, the incidence of SAH has remained stable; yet, likely because of improved care in specialized neurocritical care units, discharge mortality has considerably decreased...
December 2018: Continuum: Lifelong Learning in Neurology
Matthew A Koenig
PURPOSE OF REVIEW: This article reviews the management of cerebral edema, elevated intracranial pressure (ICP), and cerebral herniation syndromes in neurocritical care. RECENT FINDINGS: While corticosteroids may be effective in reducing vasogenic edema around brain tumors, they are contraindicated in traumatic cerebral edema. Mannitol and hypertonic saline use should be tailored to patient characteristics including intravascular volume status. In patients with traumatic brain injury who are comatose, elevated ICP should be managed with an algorithmic, multitiered treatment protocol to maintain an ICP of 22 mm Hg or less...
December 2018: Continuum: Lifelong Learning in Neurology
Lukas Grassner, Franz Marhold, Yousif Miron, Andreas Grillhösl, Karl Ungersboeck, Joachim Schulz, Martin Strowitzki
BACKGROUND: Decompressive craniectomy is a commonly performed procedure. It reduces intracranial pressure, improves survival, and thus might have a positive impact on several neurosurgical diseases and emergencies. Sometimes primary skin closure is not possible due to cerebral herniation or extensive skin defects. In order to prevent further restriction of the underlying tissue, a temporary skin expansion might be necessary. METHODS AND MATERIAL: We retrospectively reviewed patients in need for a temporary skin substitute because skin closure was not possible after craniectomy without violating brain tissue underneath in a time period of 6 years (2011-2016)...
December 4, 2018: Acta Neurochirurgica
Ian R Macdonald, Jai J S Shankar
BACKGROUND: The efficacy of SILK flow diverters (SFD) in the management of cerebral aneurysms has been established. However, the risk of complications with parent artery occlusion (PAO) remains to be fully elucidated. The purpose of our study was to analyze intracranial aneurysms treated with SFDs and assess for occurrences and potential risk factors for PAO. MATERIALS AND METHODS: Between September 2010 and September 2017, 34 patients were treated for intracranial aneurysms using SFDs at a Canadian institution...
December 4, 2018: Journal of Neurointerventional Surgery
Maxim Mokin, Muhammad Waqas, Swetadri Vasan Setlur Nagesh, Nitant Vivek Karkhanis, Elad I Levy, Ciprian N Ionita, Adnan H Siddiqui
BACKGROUND: The amount of force applied on a device is an important measure to evaluate the endovascular and surgical device manipulations. The measure has not been evaluated for neuroenodvascular procedures. PURPOSE: We aimed to study the use of force measure as a novel approach to test distal access catheter (DAC) performance during catheterization of cervical and intracranial vessels using patient specific 3-dimentional (3D) phantoms. METHODS: Using patient specific 3D phantoms of the cervical and intracranial circulation, we recorded measure of force required to deliver three types of DACs beyond the ophthalmic segment of the internal carotid artery...
December 4, 2018: Journal of Neurointerventional Surgery
Marielle Ernst, Levente Kriston, Uta Hanning, Andreas M Frölich, Jens Fiehler, Jan Hendrik Buhk
BACKGROUND AND PURPOSE: To evaluate factors influencing the confidence of management recommendation for unruptured intracranial aneurysms (UIAs) and to assess the ability of neurointerventionalists to predict procedure-related neurological complications compared with a 3-point risk score. MATERIALS AND METHODS: Twenty-eight neurointerventionalists were asked to evaluate digital subtraction angiographies examinations of patients with UIAs by determining the best management approach, their level of confidence in their management recommendation, and estimating the risk of procedure-related neurological complications...
December 4, 2018: Journal of Neurointerventional Surgery
Bruno Bartolini, Francesco Puccinelli, Pascal J Mosimann, Steven D Hajdu, Louis Veunac, Patrik Michel, Guillaume Saliou
INTRODUCTION: A new generation of carotid artery stents that use a dual micromesh layer to reduce embolic events during carotid artery stenting has recently been introduced. We aimed to analyze the effectiveness and safety of the new Casper-RX stent in patients experiencing acute ischemic stroke with large vessel intracranial occlusion associated with a tandem lesion (another carotid occlusion or severe stenosis). METHODS: We retrospectively analyzed all consecutive patients treated with carotid Casper-RX stents from our stroke registry...
December 4, 2018: Journal of Neurointerventional Surgery
Ilaria Alice Crippa, Carles Subirà, Jean-Louis Vincent, Rafael Fernandez Fernandez, Silvia Cano Hernandez, Federica Zama Cavicchi, Jacques Creteur, Fabio Silvio Taccone
BACKGROUND: Sepsis-associated brain dysfunction (SABD) is associated with high morbidity and mortality. The pathophysiology of SABD is multifactorial. One hypothesis is that impaired cerebral autoregulation (CAR) may result in brain hypoperfusion and neuronal damage leading to SABD. METHODS: We studied 100 adult patients with sepsis (July 2012-March 2017) (age = 62 [52-71] years; Acute Physiology and Chronic Health Evaluation II score on admission = 21 [15-26])...
December 4, 2018: Critical Care: the Official Journal of the Critical Care Forum
Anton Lund, Mette B Damholt, Jørgen Wiis, Jesper Kelsen, Ditte G Strange, Kirsten Møller
BACKGROUND: Because osmotic fluid shifts may occur over the blood-brain barrier, patients with acute brain injury are theoretically at risk of surges in intracranial pressure (ICP) during hemodialysis. However, this remains poorly investigated. We studied changes in ICP during hemodialysis in such patients. METHODS: We performed a retrospective study of patients with acute brain injury admitted to Rigshospitalet (Copenhagen, Denmark) from 2012 to 2016 who received intermittent hemodialysis (IHD) or continuous renal replacement therapy (CRRT) while undergoing ICP monitoring...
December 3, 2018: Acta Anaesthesiologica Scandinavica
Xiuyun Liu, Lara L Zimmermann, Nhi Ho, Paul Vespa, Xiaoling Liao, Xiao Hu
OBJECTIVES: Intracranial pressure (ICP) monitoring is a common practice when treating intracranial pathology with risk of elevated ICP. External ventricular drain (EVD) insertion is a standard approach for both monitoring ICP and draining cerebrospinal fluid (CSF). However, the conventional EVD cannot serve these two purposes simultaneously because it cannot accurately measure ICP and its pulsatile waveform while the EVD is open to CSF drainage. A new Integra® Camino® FLEX Ventricular Catheter (Integra Lifesciences, County Offaly, Ireland) with a double-lumen construction has been recently introduced into the market, and it can monitor ICP waveforms even during CSF drainage...
December 3, 2018: Neurocritical Care
Erin D Bigler, Marc Skiles, Benjamin S C Wade, Tracy J Abildskov, Nick J Tustison, Randall S Scheibel, Mary R Newsome, Andrew R Mayer, James R Stone, Brian A Taylor, David F Tate, William C Walker, Harvey S Levin, Elisabeth A Wilde
Automated neuroimaging methods like FreeSurfer ( ) have revolutionized quantitative neuroimaging analyses. Such analyses provide a variety of metrics used for image quantification, including magnetic resonance imaging (MRI) volumetrics. With the release of FreeSurfer version 6.0, it is important to assess its comparability to the widely-used previous version 5.3. The current study used data from the initial 249 participants in the ongoing Chronic Effects of Neurotrauma Consortium (CENC) multicenter observational study to compare the volumetric output of versions 5...
December 4, 2018: Brain Imaging and Behavior
Erin P McCormack, Justin M Cappuzzo, Zachary Litvack, M Isabel Almira-Suarez, Jonathan S Sherman
Epidermoid cysts account for a small fraction of intracranial brain tumors, most commonly found in the cerebellopontine angle and parasellar cisterns. Here we present a rare case of an epidermoid cyst located in the suprasellar region, specifically originating from the infundibulum. Only one additional case with an epidermoid cyst originating within the pituitary stalk has been previously reported in the literature. The patient in this case presented with headaches, diplopia and blurred vision without any endocrinopathy...
August 29, 2018: Curēus
Eros Bruzzone, Ilaria Melloni, Salvina Barra, Giulio Fraternali Orcioni, Leonardo Cocito
We describe a rare case of intracranial malignant triton tumor (MTT) arising in the middle cranial fossa in a 74-year-old female patient who had previously been exposed to radiation in the Chernobyl disaster. The patient underwent a surgical subtotal removal of the mass and radiation therapy, but the progression-free survival was only 2.5 months and death occurred four months after the onset of symptoms. MTTs are rare aggressive tumors arising from the nerve sheath showing rhabdomyosarcomatous differentiation and associated with a poor prognosis...
2018: Folia Neuropathologica
Steve S Cho, Sung-Eun Kim, Heung Cheol Kim, Won Jin Kim, Jin Pyeong Jeon
OBJECT: Clazosentan, an endothelin-receptor-antagonist, reduced vasospasm and delayed-ischemic-neurological-deficit (DIND) but did not improve outcome following subarachnoid hemorrhage (SAH) in clinical trials. However, a lack of dose-dependent analysis and potential overestimation of clazosentan's effect are concerning. We employ stratified analysis and trial-sequential-analysis (TSA) of existing data to investigate the effects of clazosentan on SAH outcome. METHODS: Studies from PubMed, EMBASE, and Cochrane were reviewed for eligibility...
November 30, 2018: World Neurosurgery
Yasuo Murai, Shun Sato, Kanako Yui, Daijiro Morimoto, Tomohiro Ozeki, Masahiro Yamaguchi, Kojiro Tateyama, Toshiki Nozaki, Shigeyuki Tahara, Fumio Yamaguchi, Akio Morita
BACKGROUND: The exoscope has been reported as a novel neurosurgical instrumentation in clinical practice. OBJECTIVE: To investigate the possibility that ORBEYE (OE), a novel instrument that excludes eyepiece lenses and allows for microsurgery by observation of the 4K3D monitor, could replace microscopes. METHODS: We report 22 clinical cases by 5 experienced neurosurgeons and the comparative results of training 10 residents. An observation study with questionnaire survey was conducted on usability...
December 3, 2018: Operative Neurosurgery (Hagerstown, Md.)
John P Andrews, Abhijeet Gummadavelli, Pue Farooque, Jennifer Bonito, Christopher Arencibia, Hal Blumenfeld, Dennis D Spencer
Importance: Seizures recur in as many as half of patients who undergo surgery for drug-resistant temporal lobe epilepsy (TLE). Understanding why TLE is resistant to surgery in some patients may reveal insights into epileptogenic networks and direct new therapies to improve outcomes. Objective: To characterize features of surgically refractory TLE. Design, Setting, and Participants: Medical records from a comprehensive epilepsy center were retrospectively reviewed for 131 patients who received a standard anteromedial temporal resection by a single surgeon from January 1, 2000, to December 31, 2015...
December 3, 2018: JAMA Neurology
Revadi Govindaraju, Ing Ping Tang, Narayanan Prepageran
PURPOSE OF REVIEW: Sphenoid sinus lateral recess encephalocoeles (SSLRE) are rare occurrences and pose unique challenges due to limited surgical access for endoscopic endonasal repair and also the lack of consensus on optimal perioperative managements specifically in the spontaneous cases, which are also believed to be a variant of idiopathic intracranial hypertension (IIH). Endoscopic endonasal approaches have largely replaced the transcranial route and the techniques are continuously being refined to reduce the neurovascular morbidity and improve outcome...
November 16, 2018: Current Opinion in Otolaryngology & Head and Neck Surgery
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