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Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular , Procedimientos Endovasculares/instrumentación , Encefalopatía Hepática/etiología , Hipertensión Portal/cirugía , Venas Mesentéricas/cirugía , Stents , Vena Cava Inferior/cirugía , Femenino , Encefalopatía Hepática/diagnóstico , Humanos , Hipertensión Portal/complicaciones , Hipertensión Portal/diagnóstico por imagen , Hipertensión Portal/fisiopatología , Circulación Hepática , Venas Mesentéricas/diagnóstico por imagen , Venas Mesentéricas/fisiopatología , Persona de Mediana Edad , Presión Portal , Diseño de Prótesis , Recurrencia , Resultado del Tratamiento , Vena Cava Inferior/diagnóstico por imagen , Vena Cava Inferior/fisiopatologíaRESUMEN
Pilomyxoid astrocytoma (PMA) is a recently classified WHO grade II astrocytoma that is histologically similar to pilocytic astrocytoma (PA). Both tumors typically present in childhood, but PMA is more aggressive with higher rates of recurrence and cerebrospinal fluid dissemination. Currently, there is no standardized treatment protocol for PMA although this will change with increased awareness of this disease entity within the neurosurgical community. We present a 22-year-old patient with a left frontal lobe PMA manifesting with atypical radiographic findings. This is the first reported case of PMA in an adult woman.
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Astrocitoma/diagnóstico por imagen , Neoplasias Encefálicas/diagnóstico por imagen , Astrocitoma/cirugía , Neoplasias Encefálicas/cirugía , Femenino , Humanos , Radiografía , Adulto JovenRESUMEN
The authors present a unique case of a patient with communicating hydrocephalus and repeated ventriculoperitoneal shunt obstructions resulting from mucin-secreting enterogenous cell deposits at the cervicomedullary junction. Pathological examinations revealed that these cellular deposits lacked characteristic cystic architecture and the patient had no history of previous cyst with dissemination. Because of the repeated shunt obstructions and inability to surgically resect the lesion in its entirety, the authors elected radiation therapy to the cervicomedullary junction, encompassing the radiological abnormality. As of this writing, the patient has remained at neurological baseline and has not required further shunt revisions for obstruction.
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Hidrocefalia/etiología , Defectos del Tubo Neural/complicaciones , Derivación Ventriculoperitoneal/efectos adversos , Células Endoteliales/patología , Falla de Equipo , Femenino , Humanos , Hidrocefalia/cirugía , Defectos del Tubo Neural/patología , Insuficiencia del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: : Several small studies have investigated the relationship among facial fractures, c-spine injuries, and head injuries with varying results. Determining this correlation at a national level would be the first step in updating the trauma imaging protocol. The purpose of this study was to review the incidence of facial fractures, c-spine injuries, and head injuries at trauma centers across the United States. METHODS: : The design was a retrospective chart review of International Classification of Disease, Ninth Revision, diagnosis and procedure codes from the National Trauma Data Bank between the years 2002 and 2006. This included data on more than 2.7 million reported traumas. RESULTS: : The incidence of facial fracture was 13.5% in patients with a c-spine injury, 21.7% in patients with a head injury, and 24.0% of patients with a combined c-spine and head trauma. Head injuries were found in 40.2% of patients with a c-spine injury, 67.9% of patients with a facial fracture, and 71.5% of patients with a combined c-spine injury and facial fracture. C-spine injuries were reported in 6.7% of facial fractures, 7.0% of head injuries, and 7.8% of patients with a combined facial fracture and head injury. CONCLUSIONS: : This is the largest review in history documenting these associations. Pending cost-benefit analysis, the current trauma imaging protocol may be challenged.
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Vértebras Cervicales/lesiones , Traumatismos Craneocerebrales/epidemiología , Huesos Faciales/lesiones , Fracturas Óseas/epidemiología , Traumatismos de la Médula Espinal/epidemiología , Traumatismos Vertebrales/epidemiología , Traumatismos Craneocerebrales/complicaciones , Traumatismos Craneocerebrales/diagnóstico , Bases de Datos Factuales , Fracturas Óseas/complicaciones , Fracturas Óseas/diagnóstico , Humanos , Incidencia , Clasificación Internacional de Enfermedades , Sistema de Registros , Estudios Retrospectivos , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/diagnóstico , Traumatismos Vertebrales/complicaciones , Traumatismos Vertebrales/diagnóstico , Centros TraumatológicosRESUMEN
We previously demonstrated that there is a significantly greater transfer of intravenously-injected Evan's blue dye into the forebrain of acyclic (reproductive senescent) females compared to young adult females, indicating that blood brain barrier permeability is compromised in the reproductive senescent forebrain. The present study examined brain IgG expression and microvessel tight junction proteins to assess ovarian age-related changes in microvascular permeability, and further compared young and senescent females with age-matched males to distinguish changes attributable to age and reproductive senescence. Blood brain barrier breakdown are often associated with increased extravasation of plasma proteins and high levels of immunoglobulin G (IgG) in brain. In the present study, IgG expression was dramatically increased in the hippocampus and thalamus, but not the hypothalamus of reproductive senescent females compared to young adult females. In males, IgG expression was increased in all these regions in middle-aged animals (aged-matched to senescent females) as compared to young males (age-matched to the young adult females). Furthermore, the proportion of hippocampal microvessels with perivascular IgG immunoreactivity was significantly greater in reproductive senescent females as compared to young adult females, while middle-aged males and young adult males did not differ. The tight junctions between adjacent microvascular endothelial cells regulated by transmembrane proteins such as claudin-5 and occludin play a critical role in maintaining the blood brain barrier integrity. Increased hippocampal IgG expression in senescent females was paralleled by poor junctional localization of the tight junction protein claudin-5 in hippocampal microvessels. However, there was no difference in hippocampal claudin-5 localization between young adult and middle-aged males, indicating that dysregulation of this junctional protein was associated with ovarian aging. Parallel studies in human brain microvessels also revealed age-dependent disruption in claudin-5 distribution in post-menopausal women compared to pre-menopausal women. Collectively, these data support the hypothesis that constitutive loss of barrier integrity in the forebrain during reproductive senescence may be due, in part, to the selective loss of tight junction proteins in endothelial junctions.
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Envejecimiento/metabolismo , Barrera Hematoencefálica/metabolismo , Claudinas/metabolismo , Inmunoglobulina G/metabolismo , Proteínas de la Membrana/metabolismo , Uniones Estrechas/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Animales , Femenino , Hipocampo/irrigación sanguínea , Humanos , Inmunoglobulina G/análisis , Masculino , Microvasos/metabolismo , Persona de Mediana Edad , Ocludina , Ovariectomía , Ratas , Ratas Sprague-Dawley , Tálamo/irrigación sanguíneaRESUMEN
OBJECTIVES: Computerized tomographic angiography (CTA) has emerged as a valuable diagnostic tool for the management of patients with cerebrovascular disease. The use of CTA in lieu of, or as an adjunct to, conventional cerebral angiography in the management of cerebral aneurysms awaits further experience. In this study, we evaluated the role of CTA specifically for the pre-operative assessment and planning of cerebral aneurysm surgery. PATIENTS AND METHODS: We reviewed the relevant neuroimaging of all patients treated at Dartmouth Hitchcock Medical Center between January, 2001 and December, 2004 with a diagnosis of cerebral aneurysm and diagnostic evaluation with both CTA and conventional digital subtraction angiography (DSA) using standard imaging protocols. 32 patients underwent both CTA and DSA during the study period for a total of 36 aneurysms. Images were independently re-assesed by two neurosurgeons for information valuable for pre-operative surgical planning. RESULTS: In 26 of 36 aneurysms (72%), the CTA was felt to provide the best image quality in defining the morphology of the aneurysm. In 14 aneurysms (39%), CTA provided clinically valuable anatomic detail not demonstrated on DSA, largely due to better visualization of parent and perforating vessel relationships at the aneurysm neck. There were no instances where a lesion was seen on DSA but missed on CTA. The DSA was of most clinical value in determining flow dynamics, such as the arterial supply of an anterior communicating artery aneurysm and distal anterior cerebral branches via the two A1 segments. CONCLUSION: CTA with three-dimensional reconstructions is a valuable adjunct to the preoperative evaluation of cerebral aneurysms. We advocate routine use of CTA in all patients in whom surgical aneurysm repair is planned, even when DSA has already been performed.
RESUMEN
Intraoperative angiography (IOA) has proven to be a safe and effective adjunct to surgical repair of cerebral aneurysms. Substantial practice variation exists regarding use of this modality in different centers, including use of IOA routinely, selectively, or rarely. In this editorial, we discuss our experience and review the existing literature to develop an argument for routine use of IOA during cerebral aneurysm surgery.
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Angiografía Cerebral/métodos , Aneurisma Intracraneal/cirugía , Monitoreo Intraoperatorio/métodos , Procedimientos Quirúrgicos Vasculares/métodos , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Reproducibilidad de los ResultadosRESUMEN
OBJECT: A review of the literature has revealed scant data related to neurosurgical treatment of gravid patients. The authors reviewed their experience with the neurosurgical treatment of pregnant women to better characterize the optimal management strategies for intracranial pathological entities in this population. METHODS: Between July 1969 and July 2005, 34 patients with documented pregnancy and concomitant intracranial pathological entities were treated at the authors' institution. The average age of the gravid patients at presentation was 27 +/- 6 years. Twelve patients harbored vascular and 14 patients harbored neoplastic lesions. Four gravid patients suffered from traumatic intracranial hemorrhage, 2 had primary intracerebral hemorrhage, and 2 had hydrocephalus. The medical records of these patients were reviewed to assess the outcome for the mothers and fetuses. RESULTS: Nineteen pregnant patients (56%) underwent a neurosurgical procedure after induction of general anesthesia. Of these, 14 (74%) underwent craniotomies for clipping/resection of their lesion, 2 (10%) underwent stereotactic biopsies, and 3 (16%) underwent CSF shunting procedures. Three patients (9%) delivered by cesarean section followed by their neurosurgical procedure, and 5 (15%) underwent therapeutic abortion preoperatively to allow for radiation therapy early in their pregnancy (4 of these patients underwent surgery prior to their therapeutic abortion). Eleven patients (32%) were treated nonoperatively while pregnant, and 3 of these received their treatment after delivery. There was no operative maternal mortality or permanent morbidity. The fetuses did not suffer from any complications related to the mother's neurosurgical procedure. CONCLUSIONS: Based on the authors' experience and a review of the literature, surgery for intracranial lesions in pregnant patients is generally well tolerated by both mother and fetus. Preoperative delivery by cesarean section of term or near-term babies is reasonable. Some patients treated conservatively may deteriorate and require an operation.
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Encéfalo/cirugía , Procedimientos Neuroquirúrgicos/métodos , Complicaciones del Embarazo/cirugía , Adolescente , Adulto , Encéfalo/patología , Neoplasias Encefálicas/patología , Neoplasias Encefálicas/cirugía , Trastornos Cerebrovasculares/cirugía , Femenino , Humanos , Hidrocefalia/cirugía , Hemorragias Intracraneales/cirugía , Imagen por Resonancia Magnética , Embarazo , Resultado del Tratamiento , Adulto JovenRESUMEN
Regeneration of endogenous axons through a Schwann cell (SC)-seeded scaffold implant has been demonstrated in the transected rat spinal cord. The formation of a cellular lining in the scaffold channel may limit the degree of axonal regeneration. Spinal cords of adult rats were transected and implanted with the SC-loaded polylactic co-glycollic acid (PLGA) scaffold implants containing seven parallel-aligned channels, either 450mum (n=19) or 660microm in diameter (n=14). Animals were sacrificed after 1, 2 and 3months. Immunohistochemistry for neurofilament expression was performed. The cross-sectional area of fibrous tissue and regenerative core was calculated. We found that the 450microm scaffolds had significantly greater axon fibers per channel at the 1month (186+/-37) and 3month (78+/-11) endpoints than the 660microm scaffolds (90+/-19 and 40+/-6, respectively) (p=0.0164 and 0.0149, respectively). The difference in the area of fibrous rim between the 450 and 660microm channels was most pronounced at the 1month endpoint, at 28,046+/-6551 and 58,633+/-7063microm(2), respectively (p=0.0105). Our study suggests that fabricating scaffolds with smaller diameter channels promotes greater regeneration over larger diameter channels. Axonal regeneration was reduced in the larger channels due to the generation of a large fibrous rim. Optimization of this scaffold environment establishes a platform for future studies of the effects of cell types, trophic factors or pharmacological agents on the regenerative capacity of the injured spinal cord.
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Axones/patología , Axones/fisiología , Regeneración Tisular Dirigida/instrumentación , Regeneración Nerviosa/fisiología , Células de Schwann/trasplante , Traumatismos de la Médula Espinal/patología , Traumatismos de la Médula Espinal/cirugía , Animales , Recuento de Células , Proliferación Celular , Células Cultivadas , Análisis de Falla de Equipo , Regeneración Tisular Dirigida/métodos , Prótesis e Implantes , Diseño de Prótesis , Ratas , Ratas Sprague-Dawley , Células de Schwann/patología , Resultado del TratamientoAsunto(s)
Angiografía Cerebral/métodos , Aneurisma Intracraneal/cirugía , Arteria Carótida Interna/patología , Arteria Carótida Interna/cirugía , Arterias Cerebrales/patología , Arterias Cerebrales/cirugía , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Trombosis Intracraneal/diagnóstico , Trombosis Intracraneal/diagnóstico por imagen , Angiografía por Resonancia Magnética/métodos , Monitoreo Intraoperatorio/métodos , Tomografía Computarizada por Rayos X/métodosRESUMEN
BACKGROUND: Spinal surgery is increasingly being done in the outpatient setting. We reviewed our experience with inpatient and outpatient single-level anterior cervical discectomy and fusion with plating (ACDF+P). METHODS: All patients undergoing single-level anterior cervical discectomy and fusion with plating between August 2005 and May 2007 by two surgeons (RPB or JAF) were retrospectively reviewed. All patients underwent anterior cervical microdiscectomy, arthrodesis using structural allograft, and titanium plating. A planned change from doing ACDF+P on an inpatient basis to doing ACDF+P on an outpatient basis was instituted at the midpoint of the study. There were no other changes in technique, patient selection, instrumentation, facility, or other factors. All procedures were done in full-service hospitals accommodating outpatient and inpatient care. RESULTS: 64 patients underwent ACDF+P as inpatients, while 45 underwent ACDF+P as outpatients. When outpatient surgery was planned, 17 patients were treated as inpatients due to medical comorbidities (14), older age (1), and patient preference (2). At a mean follow-up of 62.4 days, 90 patients had an excellent outcome, 19 patients had a good outcome, and no patients had a fair or poor outcome. There was no significant difference in outcome between inpatients and outpatients. There were 4 complications, all occurring in inpatients: a hematoma one week post-operatively requiring drainage, a cerebrospinal fluid leak treated with lumbar drainage, syncope of unknown etiology, and moderate dysphagia. CONCLUSION: In this series, outpatient ACDF+P was safe and was not associated with a significant difference in outcome compared with inpatient ACDF+P.
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Procedimientos Quirúrgicos Ambulatorios , Vértebras Cervicales , Discectomía , Hospitalización , Fusión Vertebral , Humanos , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
INTRODUCTION: The reported intracerebral hemorrhage rate due to ventriculostomy placement varies widely. As studies emerge regarding alternative techniques of ventriculostomy placement, and placement by non-neurosurgeons, further definition of the true intracerebral hemorrhage rate associated with ventriculostomy is warranted. We performed a meta-analysis of the existing literature to further elucidate the incidence of intracerebral hemorrhage due to ventriculostomy. METHODS: We performed an extensive literature search using Ovid MEDLINE and PubMed for relevant studies published after 1970. Only studies with more than 25 ventriculostomy procedures were included. Data were extracted regarding number of hemorrhages, clinically significant hemorrhages, and the use of routine post-ventriculostomy CT scanning. We performed subgroup analyses based on the use of routine post-ventriculostomy CT scanning. Chi-squared test was used to determine statistical significance. RESULTS: Overall, 102 hemorrhagic complications from 1,790 ventriculostomies were reported, a hemorrhage rate of 5.7%. Of the 102 hemorrhages, 11 were clinically significant (clinically significant hemorrhage rate = 0.61%). In studies that used routine post-placement CT scans, the hemorrhage rate was 10.06%, compared to a hemorrhage rate of 1.53% in studies in which routine CT scans were not performed (P < 0.001). Eight clinically significant hemorrhages (0.91%) were identified in the studies utilizing routine post-procedural CT scanning, compared to three clinically significant hemorrhages (0.33%) in studies without routine CT scans (P = 0.113). CONCLUSION: The overall hemorrhage risk associated with ventriculostomy placement based on the existing literature is 5.7%. Clinically significant hemorrhage due to ventriculostomy is less than 1%. Modifications of technique that might reduce hemorrhage risk, and the utility of routine post-procedural CT scanning, merit further investigation.
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Hemorragia Cerebral/epidemiología , Hidrocefalia/epidemiología , Hidrocefalia/cirugía , Ventriculostomía/efectos adversos , Ventriculostomía/estadística & datos numéricos , Humanos , Factores de RiesgoRESUMEN
CT angiography (CTA) is increasingly being utilized in the initial diagnosis of subarachnoid hemorrhage. While active bleeding from an intracranial aneurysm has been demonstrated on conventional angiography, CT angiogram findings of active aneurysmal hemorrhage are not well described. We present a case of an actively bleeding anterior communicating artery aneurysm demonstrated by CT angiography. The initial CTA demonstrated the extravasation of contrast from the anterior communicating artery. A second CT scan less than 1h later confirmed the ongoing hemorrhage, with extension of hemorrhage into the subarachnoid cisterns and the ventricular system. Recognition of active aneurismal hemorrhage by CTA may modify plan of treatment and follow-up imaging.
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Angiografía Cerebral/métodos , Aneurisma Intracraneal/diagnóstico por imagen , Hemorragia Subaracnoidea/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Anciano , Aneurisma Roto/complicaciones , Aneurisma Roto/diagnóstico por imagen , Arteria Cerebral Anterior/diagnóstico por imagen , Arteria Cerebral Anterior/patología , Humanos , Aneurisma Intracraneal/complicaciones , Masculino , Hemorragia Subaracnoidea/etiologíaRESUMEN
STUDY DESIGN: Experimental dog model of acute spinal cord injury. OBJECTIVE: To compare the relative value of methylprednisolone, surgical decompression, or both for the treatment of traumatic spinal cord injury. SUMMARY OF BACKGROUND DATA: Acute spinal cord injury results from both primary damage to the spinal cord at the time of the initial injury as well as a deleterious secondary cascade of events, which leads to further damage. Surgical decompression is known to improve clinical outcomes, but the timing of surgical decompression remains controversial. METHODS: A nylon tie was used to constrict the spinal cord in 18 adult male beagle dogs. The animals were then prospectively randomized to 3 groups: 1) surgical decompression at 6 hours and intravenous methylprednisolone; 2) surgical decompression at 6 hours and intravenous saline; and 3) intravenous methylprednisolone without surgical decompression. Each animal was evaluated by somatosensory-evoked potentials, daily neurologic assessment, and histologic examination at 2 weeks following injury. RESULTS: Immediately following spinal cord constriction, all animals were paraplegic, incontinent, and the somatosensory-evoked potentials were abolished. Surgical decompression 6 hours after injury, with or without methylprednisolone, led to significantly better neurologic function at 2 weeks than methylprednisolone alone. CONCLUSION: In the setting of acute and persistent spinal cord compression in beagle dogs, surgical decompression 6 hours after injury, with or without methylprednisolone, is more effective for improving neurologic recovery than methylprednisolone alone.
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Descompresión Quirúrgica , Modelos Animales de Enfermedad , Metilprednisolona/uso terapéutico , Traumatismos de la Médula Espinal/tratamiento farmacológico , Traumatismos de la Médula Espinal/cirugía , Enfermedad Aguda , Animales , Terapia Combinada/métodos , Descompresión Quirúrgica/métodos , Perros , Masculino , Estudios Prospectivos , Traumatismos de la Médula Espinal/patología , Factores de Tiempo , Resultado del TratamientoRESUMEN
INTRODUCTION: While catheter angiography has traditionally been used to assess the caliber and course of the superficial temporal artery prior to its use as a conduit for external carotid artery to internal carotid artery (EC-IC) bypass, computed tomographic angiography (CTA) has become increasingly used in the diagnostic assessment of cerebral vasculature. We demonstrate the application of CTA for evaluation of the superficial temporal artery as a vascular conduit for EC-IC bypass. CASE PRESENTATION: A female in the fourth decade of life presented with the chief complaint of headache. CTA of the Circle of Willis revealed an unruptured fusiform aneurysm of the M1 segment of the right middle cerebral artery (MCA). We performed CTA for the preoperative assessment of the STA for a putative EC-IC bypass procedure, and correlated this to conventional external carotid angiography. Reformatted CTA provided excellent surface visualization of the STA and its course in relationship to the cranial and zygomatic surfaces, and correlated well with findings on the conventional angiogram. CONCLUSION: CTA may eventually prove sufficient for use in assessing the STA in preparation for EC-IC bypass.
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INTRODUCTION: Over-the-counter herbal and alternative medicines are classified as dietary supplements and, unlike drugs, are not rigorously regulated by the United States Food and Drug Administration. Their potential adverse effects are often poorly characterized. METHOD: Red clover, dong quai, and Siberian ginseng are herbal compounds used for treatment of perimenopausal symptoms such as hot flashes. These compounds are known to contain coumarins, and thus carry the potential for hemorrhagic complications; however, no cases of intracranial hemorrhage have been reported. DISCUSSION: We report a 53-year-old woman with spontaneous subarachnoid hemorrhage due to the use of an herbal supplement containing red clover, dong quai, and Siberian ginseng.
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Medicamentos Herbarios Chinos/efectos adversos , Eleutherococcus/efectos adversos , Fitoterapia/efectos adversos , Hemorragia Subaracnoidea/inducido químicamente , Trifolium/efectos adversos , Angelica sinensis , Femenino , Sofocos/tratamiento farmacológico , Humanos , Persona de Mediana Edad , Recurrencia , Hemorragia Subaracnoidea/diagnóstico , Hemorragia Subaracnoidea/terapiaRESUMEN
The combination of induced hypertension, hypervolemia, and hemodilution (triple-H therapy) is often utilized to prevent and treat cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH). Although this paradigm has gained widespread acceptance over the past 20 years, the efficacy of triple-H therapy and its precise role in the management of the acute phase of SAH remains uncertain. In addition, triple-H therapy may carry significant medical morbidity, including pulmonary edema, myocardial ischemia, hyponatremia, renal medullary washout, indwelling catheter-related complications, cerebral hemorrhage, and cerebral edema. This review examines the evidence underlying the implementation of triple-H therapy, and makes practical recommendations for the use of this therapy in patients with aneurysmal SAH.
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Volumen Sanguíneo , Hemodilución , Hipertensión , Hemorragia Subaracnoidea/terapia , Vasoespasmo Intracraneal/prevención & control , Circulación Cerebrovascular/fisiología , Humanos , Hemorragia Subaracnoidea/complicaciones , Hemorragia Subaracnoidea/fisiopatología , Vasoespasmo Intracraneal/etiología , Vasoespasmo Intracraneal/fisiopatologíaRESUMEN
As molecular, cellular, and tissue-level treatments for spinal cord injury are discovered, it is likely that combinations of such treatments will be necessary to elicit functional recovery in animal models or patients. We describe multiple-channel, biodegradable scaffolds that serve as the basis for a model to investigate simultaneously the effects on axon regeneration of scaffold architecture, transplanted cells, and locally delivered molecular agents. Poly(lactic-co-glycolic acid) (PLGA) with copolymer ratio 85:15 was used for these initial experiments. Injection molding with rapid solvent evaporation resulted in scaffolds with a plurality of distinct channels running parallel along the length of the scaffolds. The feasibility of creating scaffolds with various channel sizes and geometries was demonstrated. Walls separating open channels were found to possess void fractions as high as 89%, with accessible void fractions as high as 90% through connections 220 microm or larger. Scaffolds degraded in vitro over a period of 30 weeks, over which time-sustained delivery of a surrogate drug was observed for 12 weeks. Primary neonatal Schwann cells were distributed in the channels of the scaffold and remained viable in tissue culture for at least 48 h. Schwann-cell containing scaffolds implanted into transected adult rat spinal cords contained regenerating axons at one month post-operation. Axon regeneration was demonstrated by three-dimensional reconstruction of serial histological sections.
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Axones/fisiología , Regeneración Tisular Dirigida/métodos , Regeneración Nerviosa , Médula Espinal/fisiología , Implantes Absorbibles , Animales , Animales Modificados Genéticamente , Preparaciones de Acción Retardada/química , Dextranos/química , Femenino , Fluoresceína-5-Isotiocianato/análogos & derivados , Fluoresceína-5-Isotiocianato/química , Proteínas Fluorescentes Verdes/genética , Implantes Experimentales , Ácido Láctico/química , Masculino , Cloruro de Metileno/química , Ácido Poliglicólico/química , Copolímero de Ácido Poliláctico-Ácido Poliglicólico , Polímeros/química , Porosidad , Ratas , Ratas Sprague-Dawley , Células de Schwann/citología , Células de Schwann/trasplante , Médula Espinal/citología , Traumatismos de la Médula Espinal/terapia , Ingeniería de Tejidos/métodos , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: Survival of cardiac arrest (CA) after aneurysmal subarachnoid hemorrhage (SAH) is poorly characterized. We analyzed the clinical course and outcome of patients who survived resuscitation for CA after aneurysmal SAH. METHODS: Medical records of all patients with acute SAH treated at Mayo Clinic between 1990 and 1997 were reviewed. Three hundred five consecutive patients with angiographically proven aneurysmal SAH presenting within 7 days of ictus were analyzed. CA was defined as a pulseless state, documented by medical personnel, for which resuscitation was performed. Outcome was measured with the Glasgow Outcome Scale score at longest follow-up (mean, 16 mo). RESULTS: Data from 11 patients (3.6%) who had 14 episodes of CA were analyzed. Six patients had CA before reaching the hospital and were successfully resuscitated. Nine of 14 CA episodes occurred at hemorrhage or rehemorrhage. No patient with in-hospital CA failed to be resuscitated. Overall mortality in patients who had CA (46%) was higher than that of patients without CA (15%; P = 0.019). Outcome for all patients who had CA (mean Glasgow Outcome Scale score, 2.5) was worse than for patients without CA (mean Glasgow Outcome Scale score, 3.9; P = 0.005). However, half of the survivors of CA after SAH were living independently with limited deficit at longest follow-up. CONCLUSION: Most cases of CA occur at the time of initial or recurrent SAH. Resuscitation for in-hospital CA is likely to be successful. Although CA after aneurysmal SAH is associated with significantly higher mortality, the outcome of survivors of CA is not worse than that for other patients after aneurysmal SAH.