Incorporating a parenchymal thermal diffusion cerebral blood flow probe in bedside assessment of cerebral autoregulation and vasoreactivity in patients with severe traumatic brain injury.

Object: Cerebral autoregulation may be altered after traumatic brain injury (TBI). Recent evidence suggests that patients' autoregulatory status following severe TBI may influence cerebral perfusion pressure management. The authors evaluated the utility of incorporating a recently upgraded parenchymal thermal diffusion probe for the measurement of cerebral blood flow (CBF) in the neurointensive care unit for assessing cerebral autoregulation and vasoreactivity at bedside.

Phospholipase A2 and arachidonic acid in Alzheimer's disease.

Essential fatty acids (EFA) play a critical role in the brain and regulate many of the processes altered in Alzheimer's disease (AD). Technical advances are allowing for the dissection of complex lipid pathways in normal and diseased states. Arachidonic acid (AA) and specific isoforms of phospholipase A(2) (PLA(2)) appear to be critical mediators in amyloid-beta (Abeta)-induced pathogenesis, leading to learning, memory, and behavioral impairments in mouse models of AD.

Radiosurgery facilitates resection of brain arteriovenous malformations and reduces surgical morbidity.

Objective: Stereotactic radiosurgery makes brain arteriovenous malformations (AVM) more manageable during their microsurgical resection. To better characterize these effects, we compared results of microsurgical resection of radiated (RS) and nonradiated (RS) AVMs to demonstrate that previous radiosurgery facilitates surgery and decreases operative morbidity.

Methods: From our series of 344 patients who underwent AVM resections at the University of California, San Francisco (1997-2007), 21 RS patients were matched with 21 RS patients based on pretreatment clinical and AVM characteristics.

Phospholipase A2 reduction ameliorates cognitive deficits in a mouse model of Alzheimer's disease.

Neuronal expression of familial Alzheimer's disease-mutant human amyloid precursor protein (hAPP) and hAPP-derived amyloid-beta (Abeta) peptides causes synaptic dysfunction, inflammation and abnormal cerebrovascular tone in transgenic mice. Fatty acids may be involved in these processes, but their contribution to Alzheimer's disease pathogenesis is uncertain. We used a lipidomics approach to generate a broad profile of fatty acids in brain tissues of hAPP-expressing mice and found an increase in arachidonic acid and its metabolites, suggesting increased activity of the group IV isoform of phospholipase A(2) (GIVA-PLA(2)).

Tentorial dural arteriovenous fistulae: operative strategies and microsurgical results for six types.

Objective: Tentorial dural arteriovenous fistulae (DAVF) are rare, have a high risk of hemorrhage, often cannot be obliterated endovascularly, and frequently require microsurgical interruption of the draining vein. We differentiated these fistulae into six types and developed specific operative strategies on the basis of these types.

Methods: During a 9-year period, 31 patients underwent microsurgical treatment for tentorial fistulae: seven galenic DAVF, eight straight sinus DAVF, three torcular DAVF, three tentorial sinus DAVF, eight superior petrosal sinus DAVF, and two incisural DAVF.

Distal aneurysms of basilar perforating and circumferential arteries. Report of three cases.

Distal aneurysms of basilar perforating and circumferential arteries are exceedingly rare. The authors encountered one patient with a distal basilar perforating artery aneurysm and two with aneurysms arising from circumferential branches of the basilar artery (BA). The diagnostic features, microsurgical treatment, and outcomes in these three patients are described.

Intracranial dermoid cyst mimicking hemorrhage. Case report and review of the literature.

Intracranial dermoid cysts are rare congenital lesions that result from abnormal sequestration of ectodermal cells during neural tube formation. Dermoid cysts are typically hypodense on computed tomography, but when hyperdense may mimic a hemorrhage. The authors report the case of a 16-year-old boy who presented with a history of chronic progressive headaches.

Successful treatment of cervical myelopathy with minimal morbidity by circumferential decompression and fusion.

Circumferential cervical decompression and fusion (CCDF) is an important technique for treating patients with severe cervical myelopathy. While circumferential cervical decompression and fusion may provide improved spinal cord decompression and stability compared to unilateral techniques, it is commonly associated with increased morbidity and mortality. We performed a retrospective analysis of patients undergoing CCDF at the University of California, San Francisco (UCSF) between January 2003 and December 2004.

Superior outcomes in children compared with adults after microsurgical resection of brain arteriovenous malformations.

Object: Young age is considered an important factor in determining outcomes after microsurgical resection of arteriovenous malformations (AVMs), but better results in children have not been adequately explained. A consecutive series of pediatric and adult patients was reviewed to determine whether differences in outcomes between these two groups were due to differences in AVM anatomy, rupture rates, neurological condition at presentation, treatment techniques, or other causes.

Methods: As assessed using the modified Rankin Scale (mRS), patient characteristics, clinical presentation, AVM anatomy, treatment techniques, and outcomes were compared between age groups.

Sacral epithelioid angiosarcoma associated with a bleeding diathesis and spinal epidural hematoma: case report.

Epithelioid angiosarcoma of bone is a rare, high-grade lesion that is highly vascular and can be associated with a bleeding diathesis. An association has been reported in angiosarcomas in other locations with coagulopathy from tumor-related disseminated intravascular coagulopathy and fibrinolysis. The authors report the case of a rare occurrence of a primary sacral epithelioid angiosarcoma associated with a large epidural hematoma and a severe bleeding diathesis.

Management of medically refractory trigeminal neuralgia in patients with multiple sclerosis.

Object: Trigeminal neuralgia (TN) is a painful disorder that frequently causes lancinating, electrical shock-like pain in the trigeminal distribution. Common surgical treatments include microvascular decompression (MVD), radiosurgery, and radiofrequency ablation, and complete pain relief is generally achieved with a single treatment in 70 to 85% of cases for all modalities. In a subset of patients with multiple sclerosis (MS), however, the rates of surgical treatment failure and the need for additional procedures are significantly increased compared with those in patients without MS.

Recurrent or refractory trigeminal neuralgia after microvascular decompression, radiofrequency ablation, or radiosurgery.

Object: Trigeminal neuralgia (TN) is characterized by paroxysmal lancinating pain in the trigeminal nerve distribution. When TN is refractory to medical management, patients are referred for microvascular decompression (MVD), radiofrequency ablation, or radiosurgery. After the initial treatment, patients may have refractory or recurrent symptoms requiring retreatment.

Management of a sporadic malignant subfrontal peripheral nerve sheath tumor.

Malignant subfrontal (olfactory) peripheral nerve sheath tumors (MPNSTs) are exceedingly rare. Although meningiomas are the most common subfrontal extra-axial lesions, it is important to recognize that MPNSTs, which are radiographically similar to meningiomas, can also be present in this location. MPNSTs require more aggressive surgical and postoperative management than meningiomas.