Aneurysm Arising at the Origin of a Duplicated Middle Cerebral Artery.

A duplicated middle cerebral artery (DMCA) is a common anomaly. However, aneurysms arising from the origin of a DMCA are extremely rare. A 22-year-old female was admitted to our hospital with a World Federation of Neurosurgical Societies grade 2 subarachnoid haemorrhage. Four-vessel angiography revealed a DMCA and an aneurysm arising from the origin of this artery. The aneurysm was successfully treated by embolization, and the patient was discharged 2 weeks later. Ruptured aneurysms arising from the origin of a DMCA can be successfully treated by embolization. These aneurysms are small and 3D-computed tomography reconstruction is mandatory to detect them. It is important to preserve the DMCA during the treatment procedure.

Fratura traumática da coluna torácica limitada entre T1 e T10 / Traumatic thoracic spine fractures limited between T1 and T10

Objetivo: Estudo retrospectivo de uma série de 79 pacientes com fratura traumática da coluna torácica,limitada entre T1 e T10,hospitalizados entre 1995 e 2004 no Serviço de Neurocirurgia do Centro Hospitalar Universitário(CHU), Norte de Marseille, França.Métodos:As fraturas foram classificadas de acordo com a classificação da AO(Arbeitsgemeinschaft für Osteosynthesefragen)e o quadro neurológico por meio da classificação de Frankel na hospitalização,aos seis meses e um ano.Resultados:A etiologia mais frequente das fraturas foram os acidentes automobilísticos(68,3 por cento), e o tipo de fratura, o B(54,4 por cento); 57 pacientes foram considerados politraumatizados e 82,3 por cento apresentavam lesão medular. O tratamento cirúrgico foi empregado em 96,2 por cento dos casos, sendo a via posterior a mais utilizada com objetivo de estabilização,descompressão medular, correção do alinhamento da coluna, diminuição da dor e mobilização precoce.Conclusão:As incidências, as causas, os tipos de fraturas e os manejos destas foram analisados e comparados com a literatura e os resultados confirmaram a gravidade das lesões neste segmento da coluna, o número elevado de lesões associadas, a raridade de recuperação neurológica, assim como o benefício do tratamento cirúrgico por via posterior.

Motor and sensory re-innervation of the lung and heart after re-anastomosis of the cervical vagus nerve in rats.

There is no study in the literature dealing with re-innervation of the cardiopulmonary vagus nerve after its transection followed by re-anastomosis. In the present study, we explored the bronchomotor, heart rate and respiratory responses in rats at 2, 3 and 6 months after re-anastomosis of one cervical vagus trunk. The conduction velocity of A, B and C waves was calculated in the compound vagal action potential. We searched for afferent vagal activities in phase with pulmonary inflation to assess the persistence of pulmonary stretch receptor (PSR) discharge in re-innervated lungs. In each animal, data from the stimulation or recording of one re-anastomosed vagus nerve were compared with those obtained in the contra-lateral intact one. Two and three months after surgery, the conduction velocities of A and B waves decreased, but recovery of conduction velocity was complete at 6 months. By contrast, the conduction velocity of the C wave did not change until 6 months, when it was doubled. The PSR activity was present in 50% of re-anastomosed vagus nerves at 2 and 3 months and in 75% at 6 months. Respiratory inhibition evoked by vagal stimulation was significantly weaker from the re-anastomosed than intact nerve at 2 but not 3 months. Vagal stimulation did not elicit cardiac slowing or bronchoconstriction 6 months after re-anastomosis. Our study demonstrates the capacity of pulmonary vagal sensory neurones to regenerate after axotomy followed by re-anastomosis, and the failure of the vagal efferents to re-innervate both the lungs and heart.

Análise da cirurgia do hematoma subdural crônico em cem pacientes idosos / Analysis of the surgical tratment of chronic subdural hematoma in 100 elderly patients

Objetivo: avaliar o tratamento cirúrgico do hematoma subdoral crônico em pacientes idosos, com idade a partir de 75 anos. Método: estudo retrospectivo de série consecutiva de 100 pacientes dessa faixa etária, com hematoma subdural, operados em um período de oito anos, no Service de Neurochirurgie-Professeur Bernard Alliez do Hôpital Nord, AP-HM, Centre Hospitalier Universitaire de Marseille, França. Resultados: os sintomas de alrme e o quadro clínico foram variados e enganadores, diferente do observado em pacientes mais jovens. Houve predominância masculina, a média etária foi de 82 anos; traumatismo craniano foi realtado em 42 casos; 96 pacientes foram operados, obtendo-se cura completa em 59 (61,4 por cento); 22(23 por cento) ficaram com sequelas neurológicas, e 15(15,6 por cento) faleceram. Conclusão: apesar da idade avançada dos pacientes, a resposta ao tratamento cirúrgico foi boa com mais de 60 por cento de cura completa. A idade avançada dos pacientes não deve ser considerada contra-indicação à cirurgia.

Neuromuscular rehabilitation by treadmill running or electrical stimulation after peripheral nerve injury and repair.

Numerous studies have been devoted to the regeneration of the motor pathway toward a denervated muscle after nerve injury. However, the regeneration of sensory muscle endings after repair by self-anastomosis are little studied. In previous electrophysiological studies, our laboratory showed that the functional characteristics of tibialis anterior muscle afferents are differentially affected after injury and repair of the peroneal nerve with and without chronic electrostimulation. The present study focuses on the axonal regeneration of mechano- (fibers I and II) and metabosensitive (fibers III and IV) muscle afferents by evaluating the recovery of their response to different test agents after nerve injury and repair by self-anastomosis during 10 wk of treadmill running (LSR). Data were compared with control animals (C), animals with nerve lesion and suture (LS), and animals with lesion, suture, and chronic muscle rehabilitation by electrostimulation (LSE) with a biphasic current modulated in pulse duration and frequency, eliciting a pattern mimicking the activity delivered by the nerve to the muscle. Compared with the C group, results indicated that 1) muscle weight was smaller in LS and LSR groups, 2) the fatigue index was greater in the LS group and smaller in the LSE group, 3) metabosensibility remained altered in the LS and LSE groups, and 4) mechanosensitivity presented a large increase of the activation pattern in the LS and LSE groups. Our data indicated that chronic muscle electrostimulation partially favors the recovery of muscle properties (i.e., muscle weight and twitch response were close to the C group) and that rehabilitation by treadmill running also efficiently induced a better functional muscle afferent recovery (i.e., the discharge pattern was similar to the C group). The effectiveness of the chronic electromyostimulation and the treadmill exercise on afferent recovery is discussed with regard to parameters listed above.

Decompressive craniectomy for severe traumatic brain injury: Evaluation of the effects at one year.

OBJECTIVE: To assess the effect on outcome (1 yr) of decompressive craniectomy performed within or after the first 24 hrs post-trauma in severely head-injured trauma patients with intractable cerebral hypertension. DESIGN: Retrospective cohort study. SETTINGS: Intensive care unit of a university hospital. PATIENTS: Among 816 patients with severe head trauma (Glasgow Coma Scale < or =8), 40 underwent decompressive craniectomy. After data collection, patients were divided into two groups: early and late decompressive craniectomy. An early decompressive craniectomy was performed within the first 24 hrs in patients according to the following criteria: a Glasgow Coma Scale score <6 and the existence of clinical signs of cerebral herniation (absence of pupillary reflexes), correlated with abnormalities in computed tomography scan including hematoma, appearance of diffuse or unilateral brain swelling, and/or cerebral herniation. The intracranial pressure in these patients was not measured before the decompressive craniectomy was performed. A late decompressive craniectomy (>24 hrs) was performed according to following criteria: an intractable intracranial hypertension with intracranial pressure >35 mm Hg, a unilateral or bilateral absence of pupillary reflexes, and the same abnormalities in computed tomography scan as previously described. INTERVENTION: Twenty-seven patients with signs of cerebral herniation required the procedure at the time of initial evacuation of a mass lesion. In 13 patients, decompressive craniectomy was performed because of elevated intracranial pressure refractory to medical treatment consisting of cerebrospinal fluid derivation, deep sedation, osmotherapy, hyperventilation, and nesdonal or propofol. MEASUREMENTS AND MAIN RESULTS: Five patients (19%) in whom an early decompressive craniectomy was performed had good recoveries (social rehabilitation), eight patients (30%) remained in a persistent vegetative state or with a severe disability, and 14 died (52%). On the other hand, the performance of late decompressive craniectomy in case of medical treatment failure was followed by social rehabilitation in five patients (38%) and death in three patients (23%). A persistent vegetative state or a severe disability was observed in five patients (38%). Meningitis or cerebral abscess occurred in six patients after decompressive craniectomy and were easily cured by antibiotic treatment. CONCLUSIONS: In 40 patients with intractable intracranial hypertension and at very high risk of brain death, decompressive craniectomy allowed 25% of patients to attain social rehabilitation at 1 yr.