Secondary Benefits of Microsurgical Intervention on the Vertebral Artery (V1 Segment) for Refractory Vertebrobasilar Insufficiency: Alleviation of Parkinsonism-Like Symptoms.

OBJECTIVE: The objective of this study was to investigate the outcomes of microneurosurgical interventions on V1 segment of the vertebral artery in patients with refractory vertebrobasilar insufficiency (VBI) due to dolicoarteriopathy and external compressions and to assess the secondary benefits of Parkinsonism-like symptoms. METHODS: Retrospective analysis encompassed 101 patients treated for vertebral artery dolicoarteriopathy or compression-related refractory VBI from 2016 to 2023. Of these, 16 patients exhibited drug-resistant Parkinsonism-like symptoms. The diagnostic evaluation included cerebral computed tomography/magnetic resonance angiography or digital subtraction angiography and brain computed tomography or magnetic resonance perfusion studies, corroborated by preoperative and 6- and 12-month postoperative Movement Disorder Society-Unified Parkinson's Disease Rating Scale Part 3 assessments. Data were analyzed through Turkey's "E-nabiz" system, employing Stata16 for statistical scrutiny. RESULTS: A significant reduction in Movement Disorder Society-Unified Parkinson's Disease Rating Scale scores was observed (preoperative: 26.75±10.91; 6 months: 23.09±9.24; 12 months: 22.5±8.73; P < 0.001). Postoperative follow-up denoted that 43.7% of patients ceased medication and 50% reduced antiparkinsonian drugs. The microneurosurgical approach resulted in complete remission of VBI-related symptoms in 84.6% of patients, with the rest showing partial or marked improvement. At 6 months postoperation, perfusion studies revealed posterior border zone or cerebellar perfusion enhancements in 81% (13 out of 16) of patients, with full symptom resolution, while the remaining 19% (3 out of 16) showed partial perfusion and clinical improvements, particularly in regions supplied by the posterior cerebellar artery or posterior inferior cerebellar artery. The absence of operative mortality and minimal transient morbidities underscored the procedure's safety. CONCLUSIONS: Microneurosurgery for vertebral artery anomalies in refractory VBI patients, particularly those with concomitant parkinsonian-like syndromes, has demonstrated potential in symptom remission and medication reduction.

Adventitia Layer-Focused Microsurgical Flow Reconstruction for Long-Segment Tubular Stenosis of the Cervical Segment (C1) Internal Carotid Artery: Clinical Valuable Experience in 20 Cases.

To evaluate the efficacy of perivascular sympathectomy in managing adventitia layer-related long-segment tubular stenosis of cervical segment (C1) internal carotid arteries (ICAs) in a cohort where conventional medical and endovascular interventions were not viable options, we retrospectively analyzed 20 patients (8 males, 12 females, aged 41-63 years) who underwent perivascular sympathectomy for long-segment (>5 cm) tubular cervical ICA stenosis (non-atherosclerotic, non-intima related, and nondolichoarteriopathic) between 2017 and 2023. The procedure aimed to alleviate symptoms such as hemiparesis, pulsatile tinnitus, and migraines associated with transient ischemic attacks (TIAs). Preoperative and postoperative symptoms were assessed, and patient follow-up was conducted by MR angiography and perfusion studies. Postoperatively, 10 out of 11 migraine sufferers (90.9%) reported complete cessation of symptoms, while one patient (9.09%) experienced reduction in frequency and intensity. In cases of tinnitus, six out of nine patients (66.6%) reported complete resolution, two (22.2%) had reduced symptoms, and one (11.1%) saw no change. Regarding motor function, all 12 patients (100%) with initial hemiparesis (30-40% loss of motor function) showed complete recovery postoperatively. There was no TIA attack among the patients after the procedure in the mean two-year follow-up. Perivascular sympathectomy has shown promising results in alleviating symptoms and preventing recurrent cerebrovascular events in long-segment tubular stenosis of cervical ICAs.

A case of symptomatic synchronous cervical and cerebellar metastasis after resection of thoracal metastasis from temporal glioblastoma multiforme without any local recurrence.

Glioblastoma multiforme (GBM) is the most common and the most malignant primary intracranial tumor in adults and it is usually occurs between the age of 40 and 60 years. It is local invasive and recurrent tumor and hence that has a poor prognosis. However, recent advances in tumor surgery, irradiation and chemotherapeutic agent permit long survival and metastasis which is symptomatic. Previously studies reported spinal metastasis, but we report a first case of synchronous symptomatic cerebellar and cervical spinal metastasis after resection of symptomatic thoracic spinal metastasis from temporal GBM without any recurrence of excision areas.

The Role of Fenestration of the Lamina Terminalis on Symptomatic Vasospasm After Aneurysmal Subarachnoid Hemorrhage: A Clinical Research.

AIM: To compare the beneficial effects of cisternal blood clot evacuation with or without microsurgical fenestration of the lamina terminalis (LT) on symptomatic vasospasm during the course of aneurysmal subarachnoid hemorrhage. MATERIAL AND METHODS: This was a clinical, retrospective study that included 72 patients with aneurysmal subarachnoid hemorrhage (aSAH). The patient group that underwent aneurysm clipping with only extensive cisternal drainage of the subarachnoid blood clot was defined as the non fenestrated lamina terminalis group (NonFLT group, n=39). The patient group that underwent aneurysm clipping with extensive cisternal drainage of the subarachnoid blood clot combined with microsurgical fenestration of LT was defined as the fenestrated lamina terminalis group (FLT group, n=33). All patients were operated by the same experienced neurovascular surgeon, the senior author of this article (MEU), and his colleagues. New cerebral infarct development was determined with computed tomography, Glasgow Outcome Score (GOS), clinical vasospasm rate and Hunt-Hess scale (H&H) grade before and after surgery and duration of hospital stay of the patients were assessed and compared. RESULTS: A favorable clinical outcome was obtained from 51.2% of the NonFLT group patients and 72.66% of the FLT group patients. And FLT group patients have better GOS and H&H grade. Clinical vasospasm rate and duration of hospital stay were also significantly reduced in FLT group patients. CONCLUSION: Wide fenestration of lamina terminalis as a cerebrospinal fluid diversion technique may be very beneficial in the surgical treatment of aneurysmal SAH.

Cerebral abscesses in Behcet's disease: a case report.

Behçet's disease is a multisystem relapsing inflammatory disorder of unknown cause. Neurological involvement is one of the most serious causes of long-term morbidity and mortality in Behçet's disease. Cerebral abscess is very rare in literature. A 45-yr-old man with Behçet's disease manifesting focal epileptic seizure and multiple cerebral abscesses is reported in the case. He was diagnosed with cerebral abscess and was treated with antibiotics but no improvement occurred. Excisional biopsy was performed and the lesions were consistent with abscess. The clinical state of the patient gradually improved. The patient had no further complications. The etiology, and clinical and magnetic resonance imaging findings are discussed.

The role of intravenous immunoglobulin in the treatment of cerebral vasospasm induced by subarachnoid haemorrhage: an experimental study.

OBJECTIVES: The aim of this study was to determine whether intravenous immunoglobulin (IVIG) prevents cerebral vasospasm in rabbits with induced subarachnoid haemorrhage (SAH). The effect of IVIG on apoptosis in the endothelial cells of the basilar artery was also evaluated. METHODS: Eighteen New Zealand white rabbits were allocated randomly into three groups. SAH was induced by injecting autologous blood into the cisterna magna. Group 1, the control group, was subjected to sham surgery (no induction of SAH). Group 2 had SAH alone and Group 3 had SAH plus IVIG. Three days after treatment, the animals were sacrificed. The basilar artery tissues were analysed histologically and the malondialdehyde levels in the brain stem tissues were evaluated biochemically. RESULTS: Differences in the histopathological luminal areas and full wall thicknesses in the SAH plus IVIG group and the SAH group were statically insignificant (p > 0.005). The malondialdehyde level was also found to be lower in the IVIG group than in the SAH group, although this difference was not significant (p > 0.005). CONCLUSION: Although the IVIG treatment was revealed to have no vasodilator effect on the SAH-induced spastic basilar artery, it was shown to have a beneficial effect on the apoptosis of endothelial cells, probably via anti-inflammatory mechanisms.

Distal superficial temporal artery to proximal posterior cerebral artery bypass by posterior oblique transzygomatic subtemporal approach.

This article investigates the possibility for the distal superficial temporal artery (STA) to proximal posterior cerebral artery (PCA) direct bypass by subtemporal oblique posterior transzygomatic approach. Five adult cadaveric specimens were dissected. Cadeveric dissection protocol was approved by the Research Ethics Committee. A preauricular vertical skin incision was made, the trunk of STA was identified, and bifurcation, frontal, and parietal branches of the STA were followed distally. Posterior zygomatic arch osteotomy and microcraniotomy were then performed, and the dura was opened. The temporal lobe was retracted, interpeduncular and ambient cisterns were opened, and the P2 segment of the PCA was exposed. Parietal branch of STA and P2 segment of the PCA was anastomosed. The average length of the transected STA from the bifurcation and the zygomatic arch were 47.3 ± 2.1 mm and 71.4 ± 2.3 mm, respectively. The mean calibers of the parietal and frontal branch of the STA at this distance were 1.6 ± 0.1 and 1.4 ± 0.2, respectively. The mean diameter of the P2 was 2.1 ± 0.2 mm. Because of the calibers of the parietal branch of the STA and proximal PCA are over 1.5 mm and 2.0 mm, respectively, this direct end-to-side bypass technique may be a reasonable alternative in suitable cases.

Proximal STA to proximal PCA bypass using a radial artery graft by posterior oblique transzygomatic subtemporal approach.

The aim of the present study was to investigate the use of a radial artery graft (RAG) for bypass of the proximal superficial temporal artery (STA) to proximal posterior cerebral artery (PCA) by posterior oblique transzygomatic subtemporal approach as an alternative to the external carotid artery (ECA) to PCA anastomosis. We conducted an anatomical and technical study at a university hospital. Five adult cadaveric specimens were dissected. A preauricular vertical skin incision was used. The trunk of STA was identified. A 30 degrees oblique posterior zygomatic arch osteotomy and microcraniotomy was performed. The dura of the middle cranial fossa was then opened. The temporal lobe was retracted, the interpeduncular and ambient cisterns were opened, and the P2 segment of the PCA was exposed. The proximal side of the RAG was anastomosed with the proximal STA and the distal side was anastomosed with the P2 segment. The mean caliber of the proximal STA was 2.25 +/- 0.35 mm. The mean diameter of the P(2) was 2.2 +/- 0.2 mm. The average length of the RAG was 56 +/- 3.2 mm. The mean caliber of the proximal and the distal sides of the graft was 2.5 +/- 0.25 mm and 2.3 +/- 0.15 mm, respectively. Because the proximal STA to proximal PCA bypass uses a short RAG and their calibers are over 2 mm, this bypass technique can provide a sufficient blood flow and may be a reasonable alternative over ECA to PCA bypass using long grafts.

The efficacy of intratechal administration of a very low dose potirelin after acute spinal cord injury.

BACKGROUND AND OBJECT: The objective of this study was to determine the effect of a very low dose protirelin in cerebrospinal fluid (CSF) glucose, magnesium and lactate levels after spinal cord trauma (SCT) in rabbits. We also aimed to evaluate whether this very low dose might induce analeptic effect. MATERIAL AND METHODS: Twenty rabbits were divided equally into two groups: group I (n=10) was the control group, suffered from SCT but received only saline after SCT. Group II (n=10) (treatment group), received a very low dose of 0.05 mg/kg thyrotropin releasing hormone (TRH), analogue protirelin intratechally after SCT. The basal CSF glucose, magnesium and lactate levels were recorded in both groups. CSF lactate, glucose and magnesium contents were recorded at the same time (an hour before and after) SCT. Serum thyroid stimulating hormone (TSH), freetriiodothyronine (FT3) and freethyroxine (FT4) were measured in all rabbits before and after SCT. RESULTS: Before spinal cord trauma, there were not any significant differences in glucose, lactate and magnesium levels between group I and II whereas, after spinal cord trauma in group II, the significant suppression in elevation of lactate and glucose depletion (p<0.05) were observed while no significant suppression was observed in magnesium level (p>0.05) as compared with group I (Table 3). In respect of serum TSH levels, there were not any significant differences between two groups before and after SCT. CONCLUSIONS: This study showed that intratechal TRH has no analeptic effect on serum TSH, FT3 and FT4 levels but can attenuate the increase of lactate levels following spinal cord trauma. No significant decrease in magnesium level and also suppression of glucose decline in group II, may be related to the neuroprotective effects of TRH.

A new reversible ischemic neurologic deficit model in dogs.

BACKGROUND: The aim of this study was to produce an internal carotid artery (ICA) occlusion model in dogs that can be used for studying the effects of surgical revascularization procedures. MATERIAL/METHODS: After left frontoparietal craniectomy, the ICA and arterial circle of the brain were coagulated and transected, letting the middle cerebral artery be perfused by the contralateral ICA by way of the rostral cerebral artery in five mongrel dogs. Magnetic resonance imaging (MRI) and brain single-photon emission computed tomography (SPECT) were performed during the first 24 to 48 hours and 7 to 10 days after the operation. Paired t and Wilcoxon matched pair tests were used for statistics (p<0.05). RESULTS: All the dogs had postoperative hemiparesis that returned to normal after 7 to 10 days. Early MRI showed cerebral ischemia in the left parietal cortical area extending to the subcortical white matter, sparing the basal ganglion and the internal capsule. Early brain SPECT demonstrated hypoperfusion corresponding to the same area. This area became significantly restricted to a small cortical area in late MRI and SPECT images (p<0.05). CONCLUSIONS: It is concluded that, as symptoms resolved spontaneously, this model can be used as a "reversible ischemic neurological deficit" model for diagnostic imaging and pharmacological studies.

An anatomic study for a modified technique for bypass of the external carotid artery to the proximal middle cerebral artery.

We aimed to evaluate whether bypass of the external carotid artery (ECA) to the middle cerebral artery (MCA) can be established by a short saphenous vein graft in order to increase the anastomosis patency. The method was performed to ten adult cadaver sides. We described a modified technique for bypass of the ECA to the M2 segment of MCA. The diameters of the vessels and graft length were measured by using an electronic micrometer. The mean diameter of the superior, middle, and inferior trunks of the MCA with trifurcation were 1.7 +/- 0.15, 2.2 +/- 0.25, and 2.0 +/- 0.2 mm, respectively, whereas the mean diameter of the superior and inferior trunks of the MCA with bifurcation were 2.1 +/- 0.2 and 2.3 +/- 0.3 mm, respectively. The mean diameter of the ECA was 3.75 +/- 0.4 mm. The mean length of the saphenous vein graft was 71.5 +/- 3.9 mm. The high-flow ECA to proximal MCA bypass using a short venous graft can supply enough blood flow to establish cerebral revascularization with a straighter route.

Lactate contents from cerebrospinal fluid in experimental subarachnoid hemorrhage, well correlate with vasospasm: ongoing and neurologic status.

The role of lactate composition of cerebrospinal fluid (CSF) with vasospasm severity and rabbit neurologic status in subarachnoid hemorrhage was determined. The neurologic status of 20 New Zealand rabbits were graded initially and then, anesthetized and basal angiograms were performed. Then 1.0 mL of CSF was withdrawn through cisterna magna and then 1 mL autologous arterial blood was injected in all rabbits over 1 minute. After 5 days, neurologic severity score (NSS) and vertebrobasilar angiograms of all rabbits were repeated. Rabbits without radiologic vasospasm or spasm under 50% (n=7) were termed as group 1. Rabbits whose cerebral vasospasm were 50% or over 50% (n=7) and NSS is lesser than 3 were termed as groups 2, and rabbits whose cerebral vasospasm were 50% or above 50% (n=7) and NSS is greater than 3 were termed groups 3. On day 7, the CSF lactate values of each group were significantly different (P<0.05) with each other. But when compared with only CSF baseline lactate values groups 2 and 3 were significantly different (P<0.05). However, the NSSs were similar in groups 1 and 2, but group 3 significantly differed from groups 1 and 2 (P<0.05). All groups significantly differed from baseline NSSs (P<0.05). The data showed clearly that the degree of vasospasm correlates not only with neurologic status but also with CSF lactate levels. We suggest that CSF lactate level may be useful as a surrogate marker of cerebral vasospasm degree after subarachnoid hemorrhage in clinics where invasive cerebral angiography could not be assessed for whatever reasons.

Transzygomatic-Subtemporal Approach for Middle Meningeal-to-P2 Segment of the Posterior Cerebral Artery Bypass: An Anatomical and Technical Study.

We evaluated the use of a bypass between the middle meningeal artery (MMA) and P2 segment of the posterior cerebral artery (PCA) as an alternative to an external carotid artery (ECA-to-PCA) anastomosis. Five adult cadaveric heads (10 sides) were used. After a temporal craniotomy and zygomatic arch osteotomy were performed, the dura of the floor of the middle cranial fossa was separated and elevated. The MMA was dissected away from the dura until the foramen spinosum was reached. Intradurally, the carotid and sylvian cisterns were opened. After the temporal lobe was retracted, the interpeduncular and ambient cisterns were opened and the P2 segment of the PCA was exposed. The MMA trunk was transsected just before the bifurcation of its anterior and posterior branches where it passes inside the dura and over the foramen spinosum. It was anastomosed end to side with the P2 segment of the PCA. The mean caliber of the MMA trunk before its bifurcation was 2.1 +/- 0.25 mm, and the mean caliber of the P2 was 2.2 +/- 0.2 mm. The mean length of the MMA used to perform the bypass was 32 +/- 4.1 mm, and the mean length of the MMA trunk was 39.5 +/- 4.4 mm. This bypass procedure is simpler to perform than an ECA-to-P2 revascularization using long grafts. The caliber and length of the MMA trunk are suitable to provide sufficient blood flow. Furthermore, the course of the bypass is straight.

Superficial temporal artery graft for bypass of the maxillary to proximal middle cerebral artery using a transantral approach: an anatomical and technical study.

CONCLUSION: Using a transantral approach, we examined a new bypass of the maxillary artery (MA) to proximal middle cerebral artery (MCA). The caliber of the MA was suitable to provide sufficient blood flow. The length of the graft was shorter and it had a straighter course in the new technique than in previously described techniques. OBJECTIVE: To examine a new bypass of the MA to proximal MCA using a transantral approach as an alternative to other forms of anterior circulation bypass surgery. MATERIAL AND METHODS: The method was applied to five adult cadavers bilaterally. The MA and its branches were easily found after removal of the posterior sinus wall using a transantral approach. Then, a hole was created in the sphenoid bone 5-6 mm lateral to the posteroinferior edge of the superior orbital fissure extradurally. After the carotid and sylvian cisternae had been opened, the M2 segment of the MCA was exposed. The MA was transected just before the origin of the descending palatine artery branch. After opening the dura over the hole, the MA was passed through the hole to reach the intracranial cavity. The proximal side of the superficial temporal artery graft was anastomosed end-to-end with the MA and the distal side was anastomosed end-to-side with the M2 segment of the MCA. RESULTS: The mean caliber of the MA was 2.4+/-0.3 mm before the origin of the descending palatine artery branch. The mean caliber of the largest trunk of the M2 segment of the MCA was 2.3+/-0.3 mm. The average length of the graft was 24+/-3 mm.

A modified technique to bypass the maxillary artery to supraclinoid internal carotid artery by using radial artery graft: an anatomical study.

OBJECTIVE: This study aims to examine the use of a radial artery graft for bypass of the maxillary artery (MA) to the supraclinoid internal carotid artery (ICA) in treating ICA occlusions. STUDY DESIGN AND SETTING: This method was carried out on five adult cadaver sides. The MA was reached 1-2 cm inferior to the crista infratemporalis, following a frontotemporal craniotomy and a zygomatic arch osteotomy. Extradurally 2-3 cm lateral to the foramen rotundum, a hole was drilled in the sphenoid bone with a 4 mm tipped drill. A radial artery graft was passed through the hole to the inside of the dura. Before giving the infraorbital artery branch, the MA was dissected from the surrounding tissue and transected. The proximal end of the graft was anastomosed end-to-end with the MA and the distal end of the graft end-to-side with the supraclinoid ICA. RESULTS: The mean calibre of the MA was 2.6 +/- 0.3 mm. The mean calibre of the proximal end of the radial artery graft was 2.5 +/- 0.25 mm and the distal end was 2.35 +/- 0.2 mm. The mean length of the radial artery graft was 4.0 +/- 0.5cm. CONCLUSION: This study suggested that the cases with ICA occlusion, which require high blood flow, may be treated as an alternative to current bypass methods requiring long vein grafts.

Arterial spasm following perimesencephalic nonaneurysmal subarachnoid hemorrhage in a pediatric patient.

Perimesencephalic nonaneurysmal hemorrhage is a benign form of subarachnoid hemorrhages. This entity is well recognized as a distinct type of subarachnoid hemorrhage in adults. However, perimesencephalic nonaneurysmal subarachnoid hemorrhage in pediatric patients is not well recognized. Angiographic changes such as vasospasm are uncommon in patients, especially in pediatric patients suffering from this type of hemorrhage. This case study reports a 12-year-old male who suffered from perimesencephalic nonaneurysmal subarachnoid hemorrhage. Cerebral carotid angiography performed on the tenth day of the posthemorrhagic period revealed severe vasospasm affecting the basilar artery. The patient, treated symptomatically, was discharged after improvement. One year later, magnetic resonance angiography revealed completely normal features.

Acute thrombosis of inferior vena cava in a pregnant woman presenting with sciatica: a case report.

A 20-year-old pregnant woman was admitted to our department with symptoms of deep venous thrombosis in the left lower extremity and excessive lumbar pain. Low-molecular-weight heparin was administered. She recovered with this treatment, however, severe lumbar pain continued. A lumbar magnetic resonance image showed dilated epidural veins compressing the roots and acute thrombosis of the inferior vena cava extending to renal veins. During the same period she had acute deep venous thrombosis in her right leg. An urgent venous thrombectomy was performed. Sciatica and deep venous thrombosis resolved after the operation. Low-molecular-weight heparin was administered until the end of her pregnancy.

Radial artery graft for bypass of the maxillary to proximal posterior cerebral artery: an anatomical and technical study.

OBJECTIVE: To examine the use of a radial artery graft for bypass of the maxillary artery (MA) to proximal posterior cerebral artery (PCA) as an alternative to the external carotid artery (ECA) to PCA anastomosis used in posterior circulation bypass surgery. MATERIALS AND METHODS: The method was applied to five adult cadaver sides bilaterally. The MA was easily found 1-2 cm beneath the infratemporal crest after a frontotemporal craniotomy and a zygomatic arch osteotomy. Extradurally, 2-3 cm posterolateral to the foramen rotundum, a hole was drilled in the sphenoid bone with a 4-mm tipped drill. After sylvian fissure, the interpedincular and ambient cisternae were opened and the P2 segment of the PCA appeared. The graft was passed through the hole and dura to reach the P2 segment. Proximal to the infraorbital artery branch, the MA was freed from the surrounding tissue and transected. The proximal side of the radial artery graft was anastomosed end-to-end with the MA and the distal side was anastomosed end-to-side with the P2 segment of the PCA. RESULTS: The average diameter of the MA proximal to the infraorbital artery branch was 2.6+/-0.3 mm. The average diameter of the P2 was 2.2+/-0.2 mm. The average length of the graft was 47+/-5.2 mm. CONCLUSION: As MA to proximal PCA bypass uses a short radial graft and as the calibers of the MA and PCA are >2 mm such a bypass may provide sufficient blood flow and represents a reasonable alternative to "ECA to PCA" bypass.

Congenital morphological abnormalities of the distal vertebral arteries (CMADVA) and their relationship with vertigo and dizziness.

BACKGROUND: The aim of our study was to identify congenital morphological abnormalities of distal vertebral arteries (CMADVA) and their association with cerebral hypoperfusion leading to vertigo, and the role of MR and MRA in the diagnosis of vertebrobasilar (VB) abnormalities. MATERIAL/METHODS: 768 patients who complained of dizziness and/or vertigo were included in the study and evaluated by MR and MRA. CMADVAs were determined in 88 of the cases with no other explanation for vertigo and dizziness. 150 patients without dizziness or vertigo were used as a control group. The 3D TOF (Time- of- flight) MR angiographic technique was used. RESULTS: CMADVAs were detected in 88 of 768 patients (11.5%) with vertigo and/or dizziness. We also detected CMADVAs in 4 (2.7%) of 150 persons in the control group. The patients with abnormal vertebral artery findings were classified into ten categories. Lacunar infarcts in the brain stem were found in 8 patients after long-duration vertigo attacks. There was significant correlation between the control and vertigo groups in terms of CMADVA (p=0.0001). After excluding the control group, there was a significant relationship between CMADVA and vertigo and/or dizziness symptoms (p=0.0001). CONCLUSIONS: We believe that vertigo and dizziness associated with CMADVA is a real entity that deserves greater attention. For this reason, the vertebrobasilar system in these patients should be examined for CMADVA with MRA. This would enable us to take preventive measures against brainstem ischemia or at least elucidate the etiology of vertigo in these patients.

Effect of gamma-hydroxybutyric acid on lipid peroxidation and tissue lactate level in experimental head trauma.

BACKGROUND: This study was designed to determine the effects of gamma-hydroxybutyric acid (GHB) on tissue lactate and malondialdehyde (MDA) levels in rabbit brain after experimental head trauma. METHODS: Thirty New Zealand rabbits were divided equally into three groups: group S was the sham-operated group, group C, and group GHB received head trauma, where group C was the untreated and group GHB was the treated group. Head trauma was delivered by performing a craniectomy over the right hemisphere and dropping a weight of 10 g from a height of 80 cm. GHB was administered 400 mg/kg intravenously for 10 minutes after the head trauma to group GHB. The nontraumatized side was named "1" and the traumatized side was named "2." One hour after trauma, brain cortices were resected from both sides and the concentrations of lactate and MDA were determined. RESULTS: There were significant differences between lactate and MDA levels of group S and all other groups (C1, C2, GHB1, and GHB2) except between lactate levels of group S and group GHB1, the nontraumatized and traumatized sides of groups C and group GHB, group C2 versus group GHB2, and group C1 versus group GHB1 (p < 0.05). Rectal temperature after the administration of GHB in group GHB was found lower than in groups S and C (p < 0.05). CONCLUSION: These results demonstrate that head trauma leads to an increase in brain tissue lactate and MDA levels, and GHB effectively suppresses the increase of lactate and MDA.