Plating for Anterior Cervical Fusion

Objective and Importance: To describe the clinical presentation and neuropathological findings of metastatic cerebral aneurysms of bronchogenic origin. Metastatic bronchogenic cerebral aneurysms are exceptionally rare and have only been reported in association with high grade hemorrhage. Clinical Presentation:One patient presenting with a history of headache, speech difficulty, left-sided numbness , left seventh nerve palsy and left hemiparesis was found to have intraparenchymal and subarachnoid hemorrhage with an aneurysm of the right distal Sylvian middle cerebral artery. Intervention: Pterional craniotomy with excision of mycotic segment. Surgical specimen sent to pathology for routine histology and immunohistochemistry. Conclusion: Patients with metastatic cerebral aneuryms ofbronchogenic origin usually present with subarachnoid hemorrhage, contrary to prior observations that hemorrhage from neoplasia-induced aneurysms is paradoxically rare. A tumor embolus should be considered in the differential diagnosis of a mycotic aneurysm

Understanding Neurosurgery Through Experimental and Computer Models

Endovascular neurosurgery is an evolving field, with the goal of treating neurological disease with minimal invasion of the body. The current approach is to deliver focused therapies via catheters traveling through the vascular tree. Refinement and advancement of these techniques requires not just new ideas, but new ideas that hold up when tested through the scientific method. Before clinical trials can begin, ethics and law demand that the ideas are tested first under experimental models. One benefit of these pre-clinical tests is the early identification of side effects. Another is the opportunity to practice and polish surgical technique in advance of human surgery. Historically, the best models of human systems have been similar systems in appropriate animals. Like human care, animal use is governed by strict laws and regulations. Violating these rules can not only result in criminal penalties, they can also make the research worthless: an animal poorly cared for may have physical symptoms that mask or confound the response to treatment. As computing power has increased, mathematical models have become more popular. The advantages of computational models include relative costs and relative speed. No animals, drugs or equipment have to be purchased, just a computer and software. The disadvantage is that the computational model can only represent those aspects of the modeled system that are understood and quantifiable. This article is an overview of how both animal and computational models have been used to approximate neurovascular conditions by researchers seeking to explore treatment options

Aneurysmal Rupture Without Subarachnoid Hemorrhage: A Case Report Abstract

Introduction: The present case study reports an intraparenchymal hemorrhage from a ruptured basilar tip aneurysm without subarachnoid hemorrhage. Case Report: A 57-year-old male presented with intraparenchymal hemorrhage from a ruptured basilar tip aneurysm without subarachnoid hemorrhage. The patient had successful endovascular embolization of his ruptured cerebral aneurysm 9 years previously. Discussion: Ruptured cerebral aneurysms without subarachnoid hemorrhage are extremely rare. Cerebral angiogram for atypical presentation of patients with intracranial hemorrhages should be considered. In patients with known cerebral aneurysms who present with an intracranial hemorrhage, rupture of that aneurysm or a de novo aneurysm must be ruled out

Dural Arteriovenous Malformations: A Review of the Literature and a Presentation of the JHN Series

Dural arteriovenous malformations (DAVMs), also known as dural arteriovenous fistulas, are arteriovenous shunts from a dural arterial supply to a dural venous channel, typically supplied by pachymeningeal arteries and located near a major venous sinus.1 The etiology of these lesions is not fully understood. DAVMs in the pediatric population are associated with structural venous abnormalities ,2 but the majority of DAVMs are thought to be acquired. Different etiologies have been implicated in this phenomenon, namely: sinus thrombosis, trauma or surgery.2–

A Metastatic Middle Cerebral Artery Aneurysm Caused by an Intraluminal Bronchogenic Tumor Embolus

Objective and Importance: To describe the clinical presentation and neuropathological findings of metastatic cerebral aneurysms of bronchogenic origin. Metastatic bronchogenic cerebral aneurysms are exceptionally rare and have only been reported in association with high grade hemorrhage. Clinical Presentation: One patient presenting with a history of headache, speech difficulty, left-sided “numbness”, left seventh nerve palsy and left hemiparesis was found to have intraparenchymal and subarachnoid hemorrhage with an aneurysm of the right distal Sylvian middle cerebral artery. Intervention: Pterional craniotomy with excision of mycotic segment. Surgical specimen sent to pathology for routine histology and immunohistochemistry. Conclusion: Patients with metastatic cerebral aneuryms of bronchogenic origin usually present with subarachnoid hemorrhage, contrary to prior observations that “hemorrhage from neoplasia-induced aneurysms is paradoxically rare.” A tumor embolus should be considered in the differential diagnosis of a mycotic aneurysm

Redefining Onyx HD 500 in the Flow Diversion Era

We report the largest US case series results using Onyx HD-500 (EV3), a new liquid embolic agent, in the successful treatment of 21 patients with wide-neck intracranial aneurysms (mean size 4.5 mm), which are at increased risk of incomplete occlusion or recanalization with standard endovascular intervention utilizing detachable platinum coils. All aneurysms were located in the anterior circulation, and three aneurysms presented as acute subarachnoid hemorrhages. Complete aneurysm occlusion was present in 19 of 21 patients (90%). On six-month followup, one patient with an initially small residual neck progressed to total occlusion. Aneurysm recanalization was not detected in any patients on mean follow up of 8.9 months in 11 patients. Four patients experienced transient neurologic deficits in the immediate postoperative period and one in a delayed fashion. Embolization with the liquid embolic agent Onyx appears to be a safe and effective endovascular modality of treatment for wide-neck aneurysms or recurrent aneurysms that had previously failed treatment with detachable coils

Effect of Salt Concentration and Extremely Halophilic Archaea on the Safety and Quality Characteristics of Traditional Salted Anchovies

Extremely halophilic archaea (EHA) might play an important role in salted fish production. So far, limited information has been available on the effect of EHA and salt concentration on the safety and quality characteristics of salted anchovies. Eight Halobacterium salinarum strains were isolated from different sea salt samples and subjected to phenotypic and genotypic characterization. The strains were then inoculated into fresh salt before addition to anchovies. A total of 18 experimental productions were performed. The inoculated trials showed the lowest counts of undesired microorganisms. In particular, salted anchovies produced with Hbt. salinarum H11 showed the lowest histamine concentration as well as the highest sensory scores. Differences in terms of volatile organic compounds (VOCs) were estimated among trials. Furthermore, multivariate analysis showed that experimental production performed with a reduced amount of salt (175 g of sea salt per kg of anchovies) did not affect the final quality of salted anchovies. The strain Hbt. salinarum H11 produced salted anchovies with well-appreciated organoleptic features. Thus, the addition of EHA and the use of a lower amount of sea salt might represent a valuable alternative to the traditional method for production of salted anchovies

Treatment of Posterior Circulation Aneurysms With the Pipeline Embolization Device

Abstract BACKGROUND: Treatment of complex intracranial aneurysms with the pipeline embolization device (PED) has become common practice in neurovascular centers. Very few studies have assessed the safety and efficacy of PED treatment for posterior circulation aneurysms. OBJECTIVE: To retrospectively present our experience with use of the PED in the posterior circulation. METHODS: A total of 7 patients harboring 7 posterior circulation aneurysms were treated with the PED at our institution between November 2011 and July 2012. RESULTS: Aneurysm size was 14.1 mm on average. All patients had unruptured aneurysms. Three aneurysms arose from the vertebral artery, 2 from the basilar artery, and 2 from the vertebrobasilar junction. A single stent was used in 4 patients, 2 stents in 2 patients, and 3 stents in 1 patient. Treatment was successful in all 7 patients. No procedural complications or perforator infarcts were noted in the series. No patient experienced new neurological symptoms related to PED treatment during the follow-up period. Angiographic follow-up was available for 6 patients at a mean time point of 5.5 months. Follow-up angiography showed 100% aneurysm occlusion in 3 patients, marked decrease in aneurysm size in 2 patients, and no change in 1 patient. CONCLUSION: In our initial experience, it appears that PED treatment in select patients with vertebrobasilar aneurysms may have a reasonable safety-efficacy profile. Larger studies are needed to confirm our findings