Purpose: The purpose of this study was to introduce a method of using three-dimensional (3D) curved-multiplanar reconstruction(MPR) images for sylvian dissection during microsurgical treatment of ...middle cerebral artery (MCA) aneurysms.
Materials and Methods: Forty-nine patients who had undergone surgery for MCA aneurysms were enrolled. We obtained the 3D curved-MPR images along the sphenoid ridge using OsiriX MDTM imaging software, compared sylvian dissection time according to several 3D MPR image factors, and investigated the correlations between these images and intraoperative findings.
Results: Utilizing preoperative information of the sylvian fissure (SF) and peri-aneurysmal space on 3D curved-MPR images, we could predict the feasibility of sylvian dissection for a safe surgery. 3D curved-MPR images showed several features: first, perpendicularimages to the sylvian surface in the same orientation as the surgeon’s view; second, simultaneous visualization of the brain cortex, vessels, and cisternal space; and third, more accurate measurement of various parameters, such as depth of the MCA from the sylvian surface and the location and width of the SFs.
Conclusion: In addition to conventional image studies, 3D curved-MPR images seem to provide useful information for Sylvian dissection in the microsurgical treatment of MCA aneurysms. KCI Citation Count: 0
Objective: Consensus about the sequence of cranioplasty and ventriculoperitonealshunt placement to reduce postoperative complications has not been established. Thismeta-analysis investigated and ...collated further evidence to determine whether stagedcranioplasty with ventriculoperitoneal shunt placement would signifcantly reduce the risk ofpostoperative surgical-site infection (SSI) and symptomatic intracranial hemorrhage.
Methods: Two independent reviewers identifed articles and extracted the data of patientswho underwent cranioplasty and ventriculoperitoneal shunt placement from PubMed,Embase, and Cochrane Central Register of Controlled Trials. A random effects model wasused to compare the complication rates using odd ratios (ORs) and 95% confdence intervals(CIs). A meta-regression analysis for traumatic brain injury (TBI) was additionally performed.
Results: Data from 7 studies with 391 patients were consecutively included. The metaanalysis revealed that staged surgery was signifcantly associated with lower rates of SSI aferdecompressive craniectomy (staged group vs. simultaneous group: 6.2% vs. 23.7%, OR:2.72, 95% CI: 1.46–5.06, I2=2.4%, p=0.407). Pooled analysis did not indicate a statisticallysignifcant difference between the 2 groups for symptomatic intracranial hemorrhage (stagedgroup vs. simultaneous group: 10.4% vs. 23.0%, OR: 1.66, 95% CI: 0.74–3.73, I2=0.0%,p=0.407). The meta-regression analysis did not indicate any modifying effect of TBI onpostoperative SSI development (p=0.987).
Conclusion: This meta-analysis indicated that staged surgery is signifcantly associatedwith a lower rate of postoperative SSI as compared with simultaneous surgery, but there isno difference in symptomatic intracranial hemorrhage. Additionally, there is no modifyingeffect of TBI on SSI. KCI Citation Count: 1
Recent toxicity studies of zinc oxide nanoparticles by oral administration showed relatively low toxicity, which may be resulted from low bioavailability. So, the intrinsic toxicity of zinc oxide ...nanoparticles needs to be evaluated in the target organs by intravenous injection for full systemic concentration of the administered dosage. Although the exposure chance of injection route is low compared to oral and/or inhalation route, it is important to see the toxicity with different exposure routes to get better risk management tool. In this study, the effects of zinc oxide nanoparticles on dams and fetuses were investigated in rats after intravenous injection (5, 10, and 20 mg/kg) from gestation day 6 to 20. Two of 20 dams in the 20 mg/kg treatment group died during the treatment period. Hematological examination and serum biochemistry showed dose-dependent toxicity in treated dams. Histopathological analysis of treated dams revealed multifocal mixed cell infiltration and thrombosis in lung, tubular dilation in kidneys, and extramedullary hemopoiesis in liver. Total dead fetuses (post-implantation loss) were increased and the body weight of fetus was decreased in the 20 mg/kg treatment group. Statistical differences in corpora lutea, resorption, placental weight, morphological alterations including external, visceral and skeletal malformations were not observed in treated groups. Based on the data, lowest observed adverse effect level of injection route was suggested to be 5 mg/kg in dams and no observed adverse effect level was suggested to be 10 mg/kg in fetal developmental toxicity.
Brain abscess commonly occurs secondary to an adjacent infection (mostly in the middle ear or paranasal sinuses) or due to hematogenous spread from a distant infection or trauma. Pulmonary ...arteriovenous fistulas (AVFs) are abnormal direct communications between the pulmonary artery and vein. We present two cases of brain abscess associated with asymptomatic pulmonary AVF. A 65-year-old woman was admitted with a headache and cognitive impairment that aggravated 10 days prior. An magnetic resonance (MR) imaging revealed a brain abscess with severe edema in the right frontal lobe. We performed a craniotomy and abscess removal. Bacteriological culture proved negative. Her chest computed tomography (CT) showed multiple AVFs. Therapeutic embolization of multiple pulmonary AVFs was performed and antibiotics were administered for 8 weeks. A 45-year-old woman presented with a 7-day history of progressive left hemiparesis. She had no remarkable past medical history or family history. On admission, blood examination showed a white blood cell count of 6290 cells/uL and a high sensitive C-reactive protein of 2.62 mg/L. CT and MR imaging with MR spectroscopy revealed an enhancing lesion involving the right motor and sensory cortex with marked perilesional edema that suggested a brain abscess. A chest CT revealed a pulmonary AVF in the right upper lung. The pulmonary AVF was obliterated with embolization. There needs to consider pulmonary AVF as an etiology of cerebral abscess when routine investigations fail to detect a source.
A 43-year-old man was admitted for head trauma after falling backward. The patient complained of diplopia. Unilateral internuclear ophthalmoplegia (INO) was diagnosed during the neurologic ...examination. Initially, no specific finding was shown on T2-weighted, T1-weighted, and fluid attenuated inversion recovery brain magnetic resonance image (MRI) or brain computed tomography (CT). However, susceptibility-weighted imaging (SWI) definitively demonstrated a tiny hemorrhage at the midline of the pontomesencephalic junction. The patient's symptom improved after 12 weeks. We discuss the clinical significance of SWI when traumatic INO due to a tiny hemorrhage is suspected.
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