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  • ISSN: 2373-9479
    Volume 2, Issue 6
    Mini Review
    Chang-Joon Lee and Yi Qian*
    Abstract: A sudden rupture of intracranial aneurysms leads to severe subarachnoid hemorrhage (SAH).Current clinical diagnosis of aneurysm rupture is primarily based on aneurysm morphology but there is uncertainty in this method that makes diagnosis difficult for clinicians. Image-based computational fluid dynamics (CFD) has been employed recently to identify objective predictive parameters of aneurysm rupture. Several studies have suggested a correlation between wall shear stress (WSS) and aneurysm rupture but these findings have also led to conflicting conclusions. In this short review, we have examined the ability of CFD to predict the probability of rupture. In particular, we focused on the WSS controversy and an alternative parameter based on energy loss (EL) concept, as well as application of a novel fluid-structure interaction (FSI) method for predicting aneurysm rupture. While these CFD-based studies have provided invaluable information on aneurysm hemodynamics and its relation to aneurysm rupture, they are limited without better understanding of aneurysm biology. Therefore, a multi-disciplinary approach involving molecular scientists, biomechanical engineers and clinicians is required in the future for more acceptable CFD-based diagnosis.
    Review Article
    Damien P. Kuffler*
    Abstract: Following peripheral nerve trauma, no technique induces axons to regenerate across a long nerve gaps and restore neurological function. The standard clinical "gold standard" technique for bridging nerve gaps is a graft of pure sensory nerve. However, sensory nerve grafts have many limitations because they only induce good axon regeneration across gaps <2 cm in length, for the nerves repaired <2-3 months post nerve trauma, or for patients <25 y/o. Although many different materials have been tested for their ability in induce axons to regenerate across nerve gaps, none is more effective than sensory nerve grafts. We clinically tested three novel techniques that induce axon regeneration across gaps up to 16 cm in length, for repairs performed >3 years post trauma, and for patients up to 58 years of age. This short review exams some of the techniques tested for their ability to induce axon regeneration and concludes with a brief discussion of the three novel nerve repair techniques.
    Research Article
    Christopher T. Loh, Mohammed A. Almekhlafi, Muneer Eesa, Parviz Dolati, and Alim P. Mitha*
    Abstract: Dural arteriovenous fistulas (dAVFs) are unusual vascular lesions that may form because of trauma or sinus thrombosis, but are idiopathic in most cases [1]. Connections between the dural artery and the cortical veins result in the veins being exposed to high pressures, leading to venous hypertension and subarachnoid hemorrhage [2]. Patients may present with pulsatile tinnitus (or pulse-synchronous cephalic bruit), non-specific headaches, vision loss or mental status change [3]. One or several major arteries can supply a dAVF, including the vertebral, basilar, and external (ECA) or internal carotid arteries (ICA) through their dural branches [2]. Given the high risk of bleeding in dAVFs with cortical venous hypertension, treatment of such lesions is indicated. This can be achieved via endovascular occlusion of the fistulous pouch or via open microsurgical disconnection.
    In this report, a case is presented in which a patient with a transient speech difficulty was found to have a left sided dAVF with a blind-ending venous sinus pouch and retrograde cortical venous drainage. A combined surgical/endovascular approach resulted in successful and complete embolization.
    Case Report
    Mohsin Khan*, Boleslaw Lach, Ahmed Al Jishi, and Naresh K. Murty
    Abstract: Superficial Siderosis (SS) is a rare neurological condition which results from hemosiderin deposition on the leptomeninges, subpial and ependymal surfaces of the central nervous system (CNS). Patients commonly present with the classic triad of hearing loss, cerebellar ataxia and pyramidal signs. We report clinical, radiological and pathological findings in a patient with SS due to chronic haemorrhages from a paraganglioma of cauda equina.
    Cheng-Che Hung, I-Han Hsiao, Chun-Chung Chen*, and Der-Yang Cho
    Abstract: Choroid plexus papilloma (CPP) is a rare tumor of the central nervous system, which is usually located in the ventricular system and can metastasize to cisterns along the cerebrospinal fluid circulation. CPP is only rarely located in the intraparenchymal. Here, we describe an unusual case of such a tumor in a 25-year- old man. He initially experienced a sudden, generalized tonic-clonic seizure; further investigation showed no electrolyte imbalance and ruled out the possibility that the seizure was induced by medication. A sharply circumscribed regular mass lesion was identified on a magnetic resonance image in the medial aspect of the left temporal lobe together with invasion of the cortex. The patient underwent stereotaxic biopsy for a pathological diagnosis, followed by craniotomy with total resection of the mass 1 week later. The histopathology showed that the lesion was a CPP. The pathophysiology, radiology, classification, and treatment strategy of this rare tumor are discussed in the report.
    Sebastian Lucke, Adrian Kinzel, Lutz Schreiber, and Athanasios K. Petridis*
    Abstract: The microsurgical anterior foraminotomy is a well-established treatment of cervical radiculopathy in cases of cervical disc herniation and spondylotic foraminal stenosis. The risk of injuring vertebral artery because of the proximity to the uncovertebral joint, which is resected with the drill is not insignificant.
    PIEZOsurgery is known to reduce the risk of soft tissue damage in fields of maxillo-facial / ENT surgery, because it selectively cuts mineralized structures. The use of PIEZOsurgery is widespread in paediatric neurosurgery, but until now there are only a few studies about dorsal spine procedures and none about anterior approaches to the cervical spine published.
    We report our experience of ventral approaches to the cervical spine with this innovative ultrasonic osteotomy tool. With selective cutting of mineralized structures and a good visualisation, dissection along the nerval and vascular structures could be performed without damage.
    In our opinion the use of the PIEZOsurgery osteotomy gives the surgeon a safe possibility to perform the uncoforaminotomy and to decompress the cervical root. The PIEZOsurgery tool will allow surgeons, to perform this surgery with lower risk of damage soft tissues or the vertebral artery.
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