The role of erythropoietin in aneurysmal subarachnoid haemorrhage: from bench to bedside.

Subarachnoid haemorrhage (SAH) caused by a ruptured aneurysm accounts for only 5 % of strokes, but occurs at a fairly young age and carries a poor prognosis. Delayed cerebral ischaemia (DCI) is an important cause of death and dependence after aneurysmal SAH. The current mainstay of preventing DCI is nimodipine and maintenance of normovolemia, but even with this strategy DCI occurs in a considerable proportion of patients.Several drugs have been developed that have the potential to limit cerebral vasospasm and delayed ischaemic neurologic deficit, thus improving outcome for patients. However, although numerous agents can prevent arterial narrowing and/or block the excitatory cascade of events leading to ischaemic neuronal death in experimental conditions, there is still no pharmacologic agent that has been shown conclusively to improve the outcome in clinical practice.Erythropoietin (EPO) is a well-known erythropoietic hormone recently found to exert neuroprotective properties and has been shown to reduce cerebral vasospasm and infarct volume after experimental SAH. In humans, although EPO treatment did not impact the overall incidence of vasospasm, it significantly reduced the incidence of severe vasospasm, the incidence of delayed ischaemic deficits with new cerebral infarcts, and the duration of impaired autoregulation. The current study provides new evidence for the potential benefit and relative safety of EPO for the treatment of SAH in humans. Future clinical trials will hopefully provide definite evidence whether EPO treatment is beneficial in SAH patients.

Anterior cervical discectomy and fusion with ROI-C peek cage: cervical alignment and patient outcomes.

OBJECTIVE: The intersomatic cage ROI-C one is a new promising system in anterior cervical discectomy with subsequent fusion. METHODS: Patients were studied prospectively. ROI-C cages were used in consecutive 32 patients. Intraoperative parameters, clinical features and dysphagia scores were recorded. Radiographs evaluated the height of intervertebral space, the cervical Cobb angle and implant positioning. Data were collected on the last day of hospital stay, at 6 weeks, at 3, 6, 12 and 24 months. RESULTS: A total of 32 cages were implanted. One patient had transient dysphagia. The intervertebral height and the cervical Cobb angle were significantly improved at 24 months follow-up (P < 0.05). Compared to pre-operatively, visual analog scale pain score and neck pain and disability scale were reduced at 1-month follow-up without change during subsequent follow-up. CONCLUSIONS: This is the first prospective study on ROI-C cages. Although this is a preliminary assessment, the ROI-C cage may represent an excellent alternative to other devices or simple bone graft.

Halogenated Anesthetics Determination in Urine by SPME/GC/MS and Urine Levels Relationship Evaluation with Surgical Theatres Contamination.

In this work, a new sensitive analytical method has been developed and evaluated for the determination of the most commonly used gaseous anesthetics, desflurane, sevoflurane, and this latter's hepatic metabolite hexafluoroisopropanol (HFIP) in the urine. In addition, an evaluation of anesthetics exposition on the urine levels of a small population of surgical operators has been performed and results are briefly discussed.

Hemostasis in brain tumor surgery using the Aquamantys system.

BACKGROUND: Adequate hemostasis in cranial and spinal tumor surgery is of paramount importance in neurosurgical practice. Generalized ooze bleeding from the surgical walls cavity, coming from neoplastic vessels or nervous tissue, may be problematic. Recent technical advances have dramatically reduced intraoperative complications related to blood loss. Several techniques are usually employed to control hemostasis in tumor surgery, including preoperative embolization, intraoperative hypotension, electrical coagulation, and local application of fibrin sealants or hemostatic matrix, which influence coagulation. MATERIAL AND METHODS: Our aim in this study was to evaluate the efficacy and the safety of the Aquamantys® system (Medtronic Advanced Energy, Portsmouth, NH, USA), a novel bipolar coagulation device that incorporates a new bipolar coagulation technique. This device has been used in 10 consecutive patients affected by cerebral tumor along with the standard microsurgical technique and well-known intraoperative tools. The technique is associated with simultaneous delivery of bipolar radio frequency energy and conductive fluid through its electrode tip. The volume of saline passing by the electrode tip prevents charring and maintains a clean tip. This cools the tissue as it raises the temperature sufficiently to shrink the collagen of veins and arteries. RESULTS: Effective hemostasis was achieved in all the cases. No complications or unwanted reactions associated with the device have been observed. CONCLUSIONS: Our findings suggest that the Aquamantys® system may be a highly effective adjuvant tool in minimizing blood loss in a patient with brain tumor, as well as reducing time of surgery.

Typical trigeminal neuralgia by an atypical compression: case report and review of the literature.

AIM: Trigeminal neuralgia is a disabling form of facial pain that causes a considerable discomfort and a marked reduction in the quality of life. Although neurovascular compression is often associated with trigeminal neuralgia, other intracranial pathologies can result in compression along the nerve. CASE DESCRIPTION: The authors report a case of a patient suffering from a typical left trigeminal neuralgia affecting both the second and the third branches. Neuroradiological examinations showed the presence of an arachnoid cyst located in the left temporal lobe, contiguous with the Meckel's cave, eroding the greater wing of the sphenoid bone. Following a meticulous decision-making process the patient underwent conservative treatment with success. A properly modulation of the drug dosage allowed pain relief to be achieved. CONCLUSION: This is a rare case reporting a typical trigeminal neuralgia by an arachnoid cyst of the Meckel's cave mimicking a neurovascular compression syndrome. Our findings, behind the review of the current literature, point out the importance of such a pathological condition when dealing with patients affected by cranial nerve dysfunction syndrome.

Unusual recurrence of trigeminal neuralgia after microvascular decompression by muscle interposal.

BACKGROUND: Patients with trigeminal neuralgia (TN) and persistent or recurrent facial pain after microvascular decompression (MVD) typically undergo less invasive procedures in the hope of providing pain relief. However, re-operation should be considered in selected patients. CASE REPORT: A 48-year-old woman presented with recurrent trigeminal neuralgia (TN) 3 years following microvascular decompression (MVD). The patient underwent brain magnetic resonance angiography (MRA), which did not reveal neurovascular compression; therefore surgical re-exploration was carried out. During the operation, the fifth cranial nerve was seen without impingement from any blood vessels; however, a very firm tissue was observed and identified as the muscle fragment from the previous MVD procedure. The fifth cranial nerve was carefully separated from the muscle. Thereafter, the right SCA was dissected out from the muscle and suspended by a periosteum tape sutured to the nearby dura. CONCLUSIONS: Our findings, along with similar cases reported in the literature, support the development of new inert materials and alternative surgical strategies that can limit TN recurrence.

Aneurysm clipping following endovascular coil embolization: a report of two cases.

BACKGROUND: Treatment of intracranial aneurysms by Guglielmi detachable coil (GDC) embolization is a useful therapeutic alternative to surgery. This procedure is attractive as a minimally invasive approach to treat cerebral aneurysms; however, is not devoid of complications or failure and retreatment, with either a surgical or endovascular technique, may often be required. CASE REPORTS: Two cases are presented in which surgery was required after coil embolization. In one case, surgical treatment was performed one month later because of regrowth and subsequent bleeding of the aneurysm. In the second case, surgical treatment was carried out six months later because of recanalization of the vascular malformation. Surgical treatment excluded both aneurysms from the cerebral circulation. CONCLUSIONS: In this paper the authors illustrate their experience and underline the difficulty of aneurysm surgery with coils in place.

The role of erythropoietin in neuroprotection: therapeutic perspectives.

Nervous system diseases are very complex conditions comprising a large variety of local and systemic responses. Several therapeutic agents interfering with all or in part the biochemical steps that ultimately cause neuronal death have been demonstrated to be neuroprotective in preclinical models. However, all the agents so far investigated have inexorably failed in the phase III trials carried out. A large body of evidence suggests that the hormone erythropoietin (EPO), besides its well-known hematopoietic action, exerts beneficial effects in the central nervous system. EPO's effect has been assessed in several experimental models of brain and spinal cord injury thus becoming a serious candidate for neuroprotection. The use of EPO as neuroprotectant raises several questions. Besides dosage and therapeutic time window, the safety of recombinant EPO administration in the setting of nervous system diseases takes priority over all other questions. Although recombinant EPO seems to be potentially safe at the neuroprotective proved doses, cardiovascular or cerebrovascular events can occur as a result of its bone marrow stimulating activities. The successful trial using EPO in patients with ischemic stroke and the large body of experimental evidence encourages intensive evaluation of this cytokine to support safe and larger clinical trials in the near future.