RESUMEN
During recent decades extra-intracranial and intra-intracranial bypasses have deserved high interest among neurosurgeon, especially in management of giant cerebral aneurysms. Development of microsurgery and neuroanesthesiological techniques, advances in neuroradiology and neurophysiology prerequisite improvement of revascularization surgery. Evolution of competitive endovascular methods pushes the surgeons to improve microneurosurgical technique of revascularization and elaboration of new approaches to management of intracranial aneurysms. In this review we discuss principles of surgery of cerebrovascular bypasses in management of giant aneurysms applied in our clinic.
Asunto(s)
Revascularización Cerebral/métodos , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/cirugía , Femenino , Humanos , Masculino , RadiografíaRESUMEN
Dural arteriovenous fistulas (DAVFs) are complex disorders, some of them with aggressive clinical behaviour. During past decades their treatment strategy has changed due to increased knowledge of their pathophysiology and natural history, and advances in treatment modalities. In asymptomatic cases or cases with mild symptoms in the absence of cortical venous drainage (CVD) no treatment is necessarily required, whereas aggressive DAVFs should be treated promptly by endovascular or microsurgical means.In our series of 323 patients with 333 fistulas, treated in two neurosurgical units in Finland since 1944, there were 265 true DAVFs and 68 Barrow type A caroticocavernous fistulas. Among the DAVFs there was a slight female predominance, 140 women (55%) and 115 men (45%), and the majority of the cases were located in the area of transverse and sigmoid sinuses. Mode of treatment in the early series was proximal ligation of feeding artery, and later craniotomy, endovascular treatment and radiosurgery, or combination of these treatments, with total occlusion rate being 53%.
Asunto(s)
Malformaciones Vasculares del Sistema Nervioso Central , Microcirugia/métodos , Procedimientos Neuroquirúrgicos/métodos , Malformaciones Vasculares del Sistema Nervioso Central/diagnóstico , Malformaciones Vasculares del Sistema Nervioso Central/cirugía , Angiografía Cerebral , Femenino , Finlandia , Humanos , Masculino , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Resultado del TratamientoAsunto(s)
Aneurisma Intracraneal/cirugía , Procedimientos Neuroquirúrgicos , Arteria Vertebral/cirugía , Adolescente , Adulto , Anciano , Aneurisma Roto/cirugía , Cerebelo/irrigación sanguínea , Angiografía Cerebral , Revascularización Cerebral , Femenino , Humanos , Aneurisma Intracraneal/patología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Resultado del Tratamiento , Arteria Vertebral/patologíaAsunto(s)
Aneurisma Intracraneal/cirugía , Microcirugia/métodos , Procedimientos Neuroquirúrgicos/métodos , Atención Perioperativa/métodos , Ensayos Clínicos como Asunto , Finlandia , Humanos , Cooperación Internacional , Microcirugia/tendencias , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/tendencias , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina , Estudios Retrospectivos , Instrumentos Quirúrgicos , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/métodos , Procedimientos Quirúrgicos Vasculares/tendenciasRESUMEN
Activation of peripheral mixed and cutaneous nerves activates a distributed cortical network including the second somatosensory cortex (SII) in the parietal operculum. SII activation has not been previously reported in the stimulation of the dorsal penile nerve (DPN). We recorded somatosensory evoked fields (SEFs) to DPN stimulation from 7 healthy adults with a 122-channel whole-scalp neuromagnetometer. Electrical pulses were applied once every 0.5 or 1.5 sec to the left and right DPN. For comparison, left and right median and tibial nerves were stimulated alternatingly at 1.5-sec intervals. DPN stimuli elicited weak, early responses in the vicinity of responses to tibial nerve stimulation in the primary somatosensory cortex. Strong later responses, peaking at 107-126 msec were evoked in the SII cortices of both hemispheres, with left-hemisphere dominance. In addition to tactile processing, SII could also contribute to mediating emotional effects of DPN stimuli.