Impact of a new metal artefact reduction algorithm in the noninvasive follow-up of intracranial clips, coils, and stents with flat-panel angiographic CTA: initial results.

Introduction: Flat-panel angiographic CT after intravenous contrast agent application (ivACT) is increasingly used as a follow-up examination after coiling, clipping, or stenting. The purpose of this study was to evaluate the feasibility of a new metal artefact reduction algorithm (MARA) in patients treated for intracranial aneurysms and stenosis.

Methods: IvACT was performed on a flat-panel detector angiography system after intravenous application of 80 ml contrast media.

Indocyanine green angiography in endoscopic third ventriculostomy.

Background: Endoscopic third ventriculostomy (ETV) has become a well-established method for the treatment of noncommunicating hydrocephalus with a high success rate and a relatively low morbidity rate. However, vessel injury has been repeatedly reported, often with a fatal outcome. Vessel injury is considered to be the most threatening complication.

Cranioplasty after decompressive hemicraniectomy: underestimated surgery-associated complications?

Objective: Decompressive hemicraniectomy (DC) and duroplasty after malignant brain infarction or traumatic brain injury is a common surgical procedure. Usually, preserved bone flaps are being reimplanted after resolution of brain swelling. Alloplast cranioplasties are seldom directly implanted due to the risk of wound healing disorders.

Fluorescence-guided operation in recurrent glioblastoma multiforme treated with bevacizumab-fluorescence of the noncontrast enhancing tumor tissue?

The oral application of 5-aminolevulinic acid (ALA) leads to an accumulation of fluorescent porphyrins in malignant glioma tissue, which simplifies complete tumor resection. If pretreated with bevacizumab, a vascular endothelial growth factor (VEGF) antibody, these patients might not show a contrast enhancement on magnetic resonance imaging (MRI) despite tumor progression. As VEGF antibodies induce a normalization of the tumor vasculature, it is not known whether fluorescence-guided surgery is of any value in patients pretreated with this antibody.

Spinal cord cavernoma--operative strategy and results in 30 patients.

Background: Many case reports and small series addressing the surgical management of spinal cord cavernoma have been published. However, only few larger series that would allow identifying operative strategies exist. After having treated 30 patients, we feel encouraged to report our experiences.

The role of neuronavigation in intracranial endoscopic procedures.

In occlusive hydrocephalus, cysts and some ventricular tumours, neuroendoscopy has replaced shunt operations and microsurgery. There is an ongoing discussion if neuronavigation should routinely accompany neuroendoscopy or if its use should be limited to selected cases. In this prospective clinical series, the role of neuronavigation during intracranial endoscopic procedures was investigated.

Pituitary insufficiency after operation of supratentorial intra- and extraaxial tumors outside of the sellar-parasellar region?

Recent studies investigating pituitary function after non-sellar brain tumor surgery showed that up to 38.2% of patients have pituitary insufficiency (PI). It has been assumed that the operation causes the PI, but preoperative hormone testing, which would have been necessary to prove this assumption, was not performed.

Microsurgery can cure most intracranial dural arteriovenous fistulae of the sinus and non-sinus type.

There is consensus that intracranial dural arteriovenous fistulae (dAVF) with direct (non-sinus-type) or indirect (sinus-type) retrograde filling of a leptomeningeal vein should be treated due to the high risk of neurological deficits and hemorrhage. No consensus exists on treatment modality (surgery and/or embolization) and, if surgery is performed, on the best surgical strategy. This series aims to evaluate the role of surgery in the management of aggressive dAVFs.

Lower incidence of transcranial Doppler and symptomatic vasospasm after aneurysmal subarachnoid hemorrhage and aneurysm clipping in the elderly patient?

Background: Vasospasm is the major cause of morbidity and mortality after aneurysmal subarachnoid hemorrhage. It is well known that the vasoreactivity decreases with advancing age, but it is not well investigated in a large patient cohort whether, as a consequence, the incidence of vasospasm is lower in elderly patients.

Objective: To investigate whether transcranial Doppler vasospasm, delayed ischemic neurological deficits, and vasospasm-associated ischemic lesions are less frequent in older patients.

Early surgery of multiple versus single aneurysms after subarachnoid hemorrhage: an increased risk for cerebral vasospasm?

Object: As many as 33% of patients suffering from subarachnoid hemorrhage (SAH) present with multiple intracranial aneurysms (MIAs). It is believed that aneurysm surgery has the potential to increase the risk of cerebral vasospasm due to surgical manipulations of the parent vessels and brain tissue. Consequently, 1-stage surgery of MIAs, which usually takes longer and requires more manipulation, could even further increase the risk of vasospasm.

Transcranial direct current stimulation induces polarity-specific changes of cortical blood perfusion in the rat.

Objective: Transcranial direct current stimulation (tDCS) induces changes in cortical excitability and improves hand-motor function in chronic stroke. These effects depend on polarity, duration of stimulation and current intensity applied. Towards evaluating the therapeutic potential of tDCS in acute stroke, we investigated tDCS-effects on cerebral blood flow (CBF) in a tDCS rat model adapted for this purpose.

2-Octyl-cyanoacrylate for wound closure in cervical and lumbar spinal surgery.

It is claimed that wound closure with 2-octyl-cyanoacrylate has the advantages that band-aids are not needed in the postoperative period, that the wound can get in contact with water and that removal of stitches is not required. This would substantially enhance patient comfort, especially in times of reduced in-hospital stays. Postoperative wound infection is a well-known complication in spinal surgery.

Pituitary insufficiency after traumatic brain injury.

After traumatic brain injury (TBI), patients present with psychological disorders that may be explained by post-traumatic pituitary insufficiency (PI). The goal of this study was to determine the relationship between hypopituitarism, neuropsychological changes and findings on CT scans after TBI. Hospital charts of 55 TBI patients were screened for age, Glasgow Coma Scale (GSC) score, hypoxia or hypotension.

Arteriovenous differences of oxygen and transcranial Doppler sonography in the management of aneurysmatic subarachnoid hemorrhage.

After subarachnoid hemorrhage (SAH) the detection of hemodynamically significant vasospasm is frequently difficult, especially in comatose patients. Most clinicians use transcranial Doppler sonography (TCD) to detect increasing mean blood flow velocities in the basal arteries as markers of cerebral vasospasm, without accounting for the effects of sedation and variations in blood pressure or pCO(2). This study was conducted to test the hypothesis that the arteriovenous difference of oxygen (avDO(2); in terms of % volume) could also be useful for the evaluation of vasospasm.

Cerebral energy failure after subarachnoid hemorrhage: the role of relative hyperglycolysis.

After subarachnoid hemorrhage (SAH) cerebral metabolism is significantly impaired. Hyperglycolysis describes the reduction of oxidative metabolism followed by a relative increase of anaerobic glycolysis to maintain energy supply. This phenomenon is known in head injury but has not as yet been shown after SAH.