20 research outputs found

    Eyebrow Keyhole Approach in Aneurysm Surgery

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    The concept of keyhole neurosurgery is not only to perform small incision and reduce the craniotomy size for the sake of a small opening as we called “keyhole,” but it is rather to make “minimum craniotomy” required to access deep intracranial lesions at the end of the route. Standard craniotomy forms a “funnel-shaped surgical corridor" to reach deeper area of the brain. In contrast, keyhole mini craniotomy forms a “reverse funnel-shaped surgical corridor” that provides adequate working space through small incision and bone window to reach the target. This concept of this approach is that the deep area of the brain can be accessed through smaller craniotomy since the superficial optical field is widened if the size of craniotomy is bigger

    Neuroangiography patterns of the middle cerebral artery: Study of 554 cerebral angiography results

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    The middle cerebral artery (MCA) is the largest and most complex of cerebral arteries because the cerebral neocortex is significantly developed in humans [1,2]. The MCA covers a large part of the cerebral hemispheres; therefore, it is exposed during surgical intervention in that area. Aspects of the cerebral branches tend to vary, and different branching patterns can be described. In the past, surgical interest in the MCA has been directed at avoiding damage to its branches during surgery performed within its territory. Microsurgical techniques have made reconstruction and bypass to the MCA, surgical approaches to MCA aneurysms and resection of arteriovenous malformations (AVMs) related to MCA branches common procedures in vascular neurosurgery. The vascular territory of the MCA includes some of the most eloquent cortical areas for motor and sensory functions. That territory encompasses the receptive and expressive components of language, abstract thought and other faculties of higher cognitive functioning. Moreover, the perforating branches of the proximal MCA supply the basal ganglia and important descending and corticospinal tracts. Anatomical variations of the MCA have to be recognised when planning interventions in order to avoid damage or occlusion of the perforating vessels that arise from the MCA and to assess their contribution to the perfusion of the deep MCA territory. Descriptions of the origins and possible common trunks of the MCA branches are still lacking in the literature. While bifurcation and trifurcation types of MCA branching are usually described, most studies fail to mention the different subtypes. Moreover, there is still some confusion about the criteria used to determine the different branching subtypes. Thus, the present study aimed to review the neuroangiography patterns of the MCA

    Clinical Outcomes of Repeated Intraventricular Transplantation of Autologous Bone Marrow Mesenchymal Stem Cells in Chronic Haemorrhagic Stroke. A One-Year Follow Up.

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    Object: Stroke, one of the most devastating diseases, is a leading cause of death and disability throughout the world and is also associated with emotional and economic problems. The main goal of this study was to investigate the clinical outcome of the intraventricular transplantation of bone marrow mesenchymal stem cells (BM-MSCs) in post-haemorrhagic stroke patients. Method: This study was done consisting of eight patients with supratentorial haemorrhagic stroke, who had undergone 24 weeks of standard treatment of stroke with stable neurological deficits. All of the patients received stem cell transplantation intraventricularly using autologous BM-MSCs. Six months and Twelve months after stem cells treatment, the clinical outcomes were measured using the National Institute of Health Stroke Scale (NIHSS) and adverse effect also observed. Result: The results of this study showed improvement of NIHSS score values before and after the treatment in five patients. No adverse effects or complications were detected during the 1-year observation. Conclusion: Intraventricular transplantation of BM-MSCs has shown benefits in improving the functional status of post-haemorrhagic stroke patients with no adverse effect

    Clinical Outcomes of Repeated Intraventricular Transplantation of Autologous Bone Marrow Mesenchymal Stem Cells in Chronic Haemorrhagic Stroke. A One-Year Follow Up

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    Objects Stroke, one of the most devastating diseases, is a leading cause of death and disability throughout the world and is also associated with emotional and economic problems. The main goal of this study was to investigate the clinical outcome of the intraventricular transplantation of bone marrow mesenchymal stem cells (BM-MSCs) in post-haemorrhagic stroke patients. Method This study was done consisting of eight patients with supratentorial haemorrhagic stroke, who had undergone 24 weeks of standard treatment of stroke with stable neurological deficits. All of the patients received stem cell transplantation intraventricularly using autologous BM-MSCs. Six months and Twelve months after stem cells treatment, the clinical outcomes were measured using the National Institute of Health Stroke Scale (NIHSS) and adverse effect also observed. Result The results of this study showed improvement of NIHSS score values before and after the treatment in five patients. No adverse effects or complications were detected during the 1-year observation. Conclusion Intraventricular transplantation of BM-MSCs has shown benefits in improving the functional status of post-haemorrhagic stroke patients with no adverse effect

    Comparison of the Administration Route of Stem Cell Therapy for Ischemic Stroke: A Systematic Review and Meta-Analysis of the Clinical Outcomes and Safety

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    Abstract Stem cell treatment is emerging as an appealing alternative for stroke patients, but there still needs to be an agreement on the protocols in place, including the route of administration. This systematic review aimed to assess the efficacy and safety of the administration routes of stem cell treatment for ischemic stroke. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A comprehensive literature search was undertaken using the PubMed, Scopus, and Cochrane databases. A total of 21 publications on stem cell therapy for ischemic stroke were included. Efficacy outcomes were measured using the National Institutes of Health Stroke Scale (NIHSS), the modified Rankin Scale (mRS), and the Barthel index (BI). Intracerebral administration showed a better outcome than other routes, but a greater number of adverse events followed due to its invasiveness. Adverse events were shown to be related to the natural history of stroke not to the treatment. However, further investigation is required, since studies have yet to compare the different administration methods directly

    Clinical Outcomes of Repeated Intraventricular Transplantation of Autologous Bone Marrow Mesenchymal Stem Cells in Chronic Haemorrhagic Stroke. A One-Year Follow Up

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    Stroke, one of the most devastating diseases, is a leading cause of death and disability throughout the world and is also associated with emotional and economic problems. The main goal of this study was to investigate the clinical outcome of the intraventricular transplantation of bone marrow mesenchymal stem cells (BM-MSCs) in post-haemorrhagic stroke patients. This study was done consisting of eight patients with supratentorial haemorrhagic stroke, who had undergone 24 weeks of standard treatment of stroke with stable neurological deficits. All of the patients received stem cell transplantation intraventricularly using autologous BM-MSCs. Six months and Twelve months after stem cells treatment, the clinical outcomes were measured using the National Institute of Health Stroke Scale (NIHSS) and adverse effect also observed. The results of this study showed improvement of NIHSS score values before and after the treatment in five patients. No adverse effects or complications were detected during the 1-year observation. Intraventricular transplantation of BM-MSCs has shown benefits in improving the functional status of post-haemorrhagic stroke patients with no adverse effect

    Spinal Dural Arteriovenous Fistula: Diagnosis and Treatment

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    Spinal dural arteriovenous (AV) fistulas are the most commonly encountered vascular malformation of the spinal cord and a treatable cause for progressive paraplegia or tetraplegia. They most commonly affected are elderly men and are classically found in the thoracolumbar region.Symptoms gradually progress or decline in a stepwise manner and are commonly associated with pain and sphincter disturbances. Surgical or endovascular disconnection of the fistula has a high success rate with a low rate of morbidity. Motor symptoms are most likely to improve after treatment, followed by sensory disturbances, and lastly sphincter disturbances. 

    Neuroangiography patterns and anomalies of middle cerebral artery: A systematic review

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    Background: As the largest and most complex cerebral artery, the middle cerebral artery (MCA) patterns and anomalies are not fully reported. At present, there is confusion about the criteria for the different subtypes. The study of MCA patterns and anomalies is important because variants such as accessories or duplicates represent a high risk of failure during endovascular embolization or navigation during treatment for ischemic stroke. This study conducted a systematic review of studies on the neuroangiography patterns and anomalies of MCA. Methods: We conducted a systematic review of four articles online databases and included English articles from PubMed, the Cochrane Library, Directory of Open Access Journals, and EBSCOhost. Results: The proportion of the MCA branching pattern was 1.9% (range from 0% to 6.3%) for monofurcation, 1.0% (range from 0% to 1.4%) for tetrafurcation, 69.9% (range from 58.1% to 92.7%) for bifurcation, and 27% (ranging from 7.3% to 40.4%) for trifurcation. The proportion of MCA anomalies for accessory is 0.03% (range from 0% to 1%), duplication is 0.17% (range from 0% to 3%), and fenestration is 0.15% (range from 0% to 2%). Conclusion: The proportions of the branching pattern and anomalies of MCA based on the systematic review are described in this study. This study is the first to systematically review the neuroangiography pattern of MCA and neuroangiography variations/anomalies of MCA in the literature

    Biocompatibility evaluation of electrospun Poly-L lactic Acid-chitosan immobilized with heparin as scaffold for vascular tissue repair

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    Stroke is the second leading cause of death worldwide, disability, high morbidity, and mortality. One of the leading causes of infarct stroke is carotid stenosis. The postoperative narrowing of the carotid artery diameter is a common complication after primary arterial closure in carotid endarterectomy surgery. A biomaterial design that combines synthetic and natural polymers is a promising strategy for patching arterial closure. In this paper, the electrospinning process was employed and Poly-L Lactic Acid (PLLA) was used as a base material. Chitosan and heparin were added to increase the biocompatibility of the biomaterial. The electrospun PLLA-chitosan immobilized with heparin (C sample) had better characteristics than the pure electrospun PLLA. The fiber diameter decreased to a micrometer scale and the pore size fell and became narrower, resulting in a smoother surface. Fiber diameter results for each sample were 1312.66 nm, 486.29 nm and 387.87 nm. Thereby potentially reducing the activation of blood coagulation and inflammation. The ultimate tensile strength test result for each sample were 2.28 MPa, 3.61 MPa and 3.25 MPa, for elongation results were 12.05%, 17.39%, and 18.14%, aligned with those of the human carotid artery and indicating potential use in patch angioplasty applications. This scaffold nanofiber was declared non-haemolytic for the C sample was 1.13% and non-cytotoxic. Percent viability for each sample was 89.35%, 83.81% and 78.92%. The in vivo host tissue response was shown to decrease pro-inflammatory cytokine expressions. This research shows that the proposed PLLA-chitosan-heparin biomaterial has strong physical properties and can modify the inflammatory response. However, it requires additional biofunctional alterations to optimize its tissue engineering capabilities
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