What is the restorative effect of VEGF inhibitor bevacuzimab against subarachnoid hemorrhage in an experimental model?

BACKGROUND: This study investigated the effect of vascular endothelial growth factor (VEGF) inhibitor bevacuzimab (BVZ) on the rabbit basilar artery using an experimental subarachnoid hemorrhage (SAH) model. METHODS: Eighteen adult male New-Zealand white rabbits were randomly divided into three groups: a control group (n = 6), SAH group (n = 6), and SAH+BVZ group (n = 6). Experimental SAH was created by injecting autologous arterial blood into the cisterna magna. In the treatment group, the subjects were administered a daily dose of 10 mg/kg, intravenous BVZ for 2 days after the SAH. Basilar artery diameters were measured with magnetic resonance angiography (MRA) 72 h after the SAH in all groups. After 72 h, whole brains, including the upper cervical region, were obtained from all the animals after perfusion and fixation of the animal. The wall thickness, luminal area, and the apoptosis at the basilar arteries were evaluated in all groups. RESULTS: BVZ significantly prevented SAH-induced vasospasm confirmed in vivo with MRA imaging with additional suppression of apoptosis on basilar artery wall. DISCUSSION: VEGF inhibition with BVZ has shown to have a vasospasm and apoptosis attenuating effect on basilar artery in a SAH model.

Delayed intracerebellar hemorrhage secondary to lumboperitoneal shunt insertion.

Aim of this paper is to present and discuss a case of a delayed cerebellar parenchymal hemorrhage developing after L/P shunt placement with a NPH patient. A hypertensive patient admitted to our clinic with a diagnosis of NPH. The patient was placed a pressure adjustable L/P shunt without any surgical complication. He was discharged with an uneventful period. The patient was admitted to the emergency clinic of our hospital with a 1.5 × 1.5 cm diameter hematoma at the left cerebellar hemisphere on 2 days after his discharge. CSF drainage by an L/P shunt can generate intracerebellar hemorrhages especially in hypertensive patients.

Coexistence of cervico-thoracic extradural en-plaque meningioma with multiple intracranial meningiomas.

Meningioma is one of the most common tumors in the spinal cord. Extradural and en-plaque variety of meningioma occur less frequently. A 47-year-old woman is presented with radiculopathy signs. Magnetic resonance imaging revealed a lesion from C6 through T3 vertebral levels compressing the cord both anteriorly and posteriorly. Subtotally excision was performed and histopathologic signs showed transitional type of meningioma (WHO Grade 1). Post operatively, she had good neurological recovery. Intraoperative findings point out that the en-plaque meningioma was pure extradural. Twelve cases of pure extradural en-plaque meningioma have been reported in the literature. Besides, to the best our knowledge coexistence of "en plaque" spinal epidural meningioma with meningiomas in cranial cavity has not been reported. Complete resection is mandatory to prevent recurrence. Moreover, it is considerably difficult to remove the parts of tumor over anterior of the dura without complication.

Freehand C1 lateral mass screw fixation technique: our experience.

BACKGROUND: Although C1 lateral mass fixation technique is frequently performed in upper cervical instabilities, it requires the guidance of fluoroscopic imaging. The fluoroscopy guidance is time-consuming and has the risks of accumulative radiation. Biplane fluoroscopy is also difficult in upper cervical pathologic conditions because of the use of cranial fixations. This study aimed to demonstrate that unicortical C1 lateral mass screws could be placed safely and rapidly without fluoroscopy guidance. METHODS: Between 2002 and 2008, 32 C1 lateral mass screws were inserted in 17 consecutive patients with various pathologic conditions involving either atlantoaxial or occipitocervical instability. RESULTS: C1 screw lengths ranged from 18 to 32 mm. The atlantoaxial fixation was performed in 13 patients, and C1 lateral mass screws were added to the occipitocervical construct in 3 patients, to the posterior cervical construct in 2 patients, and to the cervicothoracic construct in 1 patient. In 2 patients, because C1 lateral mass screws could not be inserted unilaterally, C1 pedicle screw analogs were inserted. There were no screw malpositions or neurovascular complications related to screw insertion. Operation time and intraoperative bleeding of the isolated atlantoaxial fixations were retrospectively evaluated. The mean follow-up was 32.3 months (range, 7-59 months). No screw loosening or construct failure was observed within this period. Postoperatively, 4 patients complained of hypoesthesia, whereas one patient had superficial wound infection. CONCLUSION: C1 lateral mass screws may be used safely and rapidly in upper cervical instabilities without intraoperative fluoroscopy guidance and the use of the spinal navigation systems. Preoperative planning and determining the ideal screw insertion point, the ideal trajections, and the lengths of the screws are the most important points.

Intraparenchymal haematoma related to true middle meningeal artery aneurysm: a case report.

Non-traumatic middle meningeal artery aneurysm and rupture resulting in intracranial haemorrhage is rare. In the present case, a 73-year-old man was admitted to hospital with a history of a minor head trauma. A CT scan of the head revealed a 2×2 cm intraparenchymal haematoma without significant mass effect in the left temporal lobe. The cerebral angiogram revealed a middle meningeal artery aneurysm. Intracerebral haematoma due to extracranial aneurysm is extremely rare, but should be considered when the history is suspicious and cranial CT is non-contributory.