Abstract:
OBJECT:Grade 3 and 4 blunt vertebral artery (VA) injuries may carry a different natural course from that of lower-grade blunt VA injuries. Proper screening, management, and follow-up of these injuries remain controversial. Grade 3 and 4 blunt VA injuries were analyzed to define their natural history and establish a rational management plan based on lesion progression and cerebral infarction. METHODS:A retrospective review of a prospectively maintained database of all blunt traumatic carotid and vertebral artery injuries from August 2003 to April 2013 was performed, and Grade 3 and 4 blunt VA injuries were identified. Grade 3 injuries were defined as stenosis of the vessel greater than 50% or the development of a pseudoaneurysm, and Grade 4 injuries were defined as complete vessel occlusion. Demographic information, radiographic imaging findings, number of imaging sessions performed per individual, length of radiographic follow-up, radiographic outcome at end of follow-up, treatment(s) provided, and documentation of ischemic stroke or transient ischemic attack were recorded. RESULTS:A total of 79 high-grade (Grade 3 and 4) blunt VA injuries in 67 patients were identified. Fifty-nine patients with 66 high-grade blunt VA injuries were available for follow-up. There were 17 patients with 23 Grade 3 injuries and 42 patients with 43 Grade 4 injuries. The mean follow-up duration was 58 days for Grade 3 and 67 days for Grade 4 blunt VA injuries. Repeat imaging of Grade 3 blunt VA injuries showed that 39% of injuries were radiographically stable, 43% resolved, and 13% improved, while 1 injury radiographically worsened. Repeat imaging of the Grade 4 blunt VA injuries showed that 65% of injuries were radiographically stable (persistent occlusion), 30% improved (recanalization of the vessel), and in 2 cases (5%) the injury resolved. All Grade 3 injuries that were treated were managed with aspirin or clopidogrel alone, as were the majority of Grade 4 injuries. There were 3 cerebral infarctions thought to be related to Grade 4 blunt VA injuries, which were likely present on admission. All 3 of these patients died at a mean of 13.7 days after hospital admission. No cerebral infarctions directly related to Grade 3 blunt VA injuries were identified. CONCLUSIONS:The majority of high-grade blunt VA injuries remain stable or are improved at final follow-up. Despite a 4% rate of radiographic worsening in the Grade 3 blunt VA injury group and a 35% recanalization rate in the Grade 4 blunt VA injury group, there were no adverse clinical outcomes associated with these radiographic changes. No cerebral infarctions were noted in the Grade 3 group. A 7% stroke rate was identified in the Grade 4 blunt VA injury group; however, this was confined to the immediate postinjury period and was associated with 100% mortality. While these data suggest that these high-grade vertebral artery injuries may require less intensive radiographic follow-up, future prospective studies are needed to make conclusive changes related to treatment and management.
journal_name
J Neurosurgjournal_title
Journal of neurosurgeryauthors
Scott WW,Sharp S,Figueroa SA,Eastman AL,Hatchette CV,Madden CJ,Rickert KLdoi
10.3171/2014.9.JNS1461subject
Has Abstractpub_date
2015-05-01 00:00:00pages
1202-7issue
5eissn
0022-3085issn
1933-0693journal_volume
122pub_type
杂志文章abstract::In a series of 32 surgical cases of carotid-ophthalmic artery aneurysm, seven of the lesions were located in the "carotid cave." This special type of aneurysm is usually small and projects medially on the anteroposterior view of the angiogram. At surgery, it is located intradurally at the dural penetration of the inte...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1989.70.2.0216
更新日期:1989-02-01 00:00:00
abstract:OBJECT:Meningoencephaloceles are congenital malformations that have a high incidence in the population of Southeast Asia. Frontoethmoidal meningoencephaloceles, the most common variety, require surgical treatment. The authors combined neurosurgical and craniofacial approaches for the development of a simple technique t...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/ped.2006.104.5.326
更新日期:2006-05-01 00:00:00
abstract::Lumbar cerebrospinal fluid (CSF) pressure and ventricular size were determined in six patients with impairment of cerebral venous outflow caused by either sagittal sinus thrombosis or arteriovenous shunting into the sagittal sinus. None of the patients had enlargement of the ventricular system, but all six had elevate...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1980.53.5.0656
更新日期:1980-11-01 00:00:00
abstract::The authors report on a 17-year-old boy who suffered from slowly progressive and long-standing symptoms of ataxia, neck pain, and headache. Computerized tomography (CT) and magnetic resonance (MR) imaging revealed a tumor arising from the floor of the fourth ventricle that resulted in a moderate hydrocephalus. A parti...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1999.91.3.0506
更新日期:1999-09-01 00:00:00
abstract::OBJECTIVE The comparative effectiveness of the 2 treatment options-surgical clipping and endovascular coiling-for unruptured cerebral aneurysms remains an issue of debate and has not been studied in clinical trials. The authors investigated the association between treatment method for unruptured cerebral aneurysms and...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2016.1.JNS152028
更新日期:2017-03-01 00:00:00
abstract::The diagnosis of CSF hypovolemia remains controversial. The primary diagnostic factor relies on confirmation of leakage of the CSF based on reduced spinal fluid pressure. Determining the specific leakage site is the most important issue for effective treatment but remains a difficult task. Although CT myelography, rad...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2015.2.JNS142746
更新日期:2016-02-01 00:00:00
abstract::The potential efficacy of early repeat transsphenoidal surgery for persistent Cushing's disease has not previously been examined. On 222 patients with no prior pituitary treatment and a preoperative diagnosis of Cushing's disease, 29 (13%) remained hypercortisolemic after an initial transsphenoidal pituitary explorati...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1994.80.1.0037
更新日期:1994-01-01 00:00:00
abstract::A method of lateral orbital rim advancement is described for periorbital deformities associated with coronal and metopic synostosis in infants. The technique offers the advantages of a smooth lateral rim contour and improvement in accompanying malar recession. In 13 patients with follow-up periods of up to 2 years fol...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1990.72.1.0022
更新日期:1990-01-01 00:00:00
abstract:OBJECT:Disturbance of calcium homeostasis contributes to evolving tissue damage and energetic impairment following traumatic brain injury (TBI). Calcium-mediated activation of calcineurin results in production of tissue-damaging nitric oxide and free oxygen radicals. Inhibition of calcineurin induced by the immunosuppr...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2001.94.5.0782
更新日期:2001-05-01 00:00:00
abstract:OBJECT:Inflammatory responses and oxygen free radicals have increasingly been implicated in the development of ischemic brain injury. In some cases, an attenuation of inflammation or free-radical injury can provide tissue protection. Diphosphoryl lipid A (DPL) is a detoxified derivative of a lipopolysaccharide (endotox...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2000.92.3.0435
更新日期:2000-03-01 00:00:00
abstract::OBJECTIVE Dysexecutive syndrome is common in patients with moyamoya disease (MMD), a chronic cerebrovascular disease that is characterized by stenosis of the bilateral internal carotid arteries and progressive collateral revascularization, and MMD can be classified as ischemic or hemorrhagic according to the disease p...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2015.7.JNS142666
更新日期:2016-08-01 00:00:00
abstract:OBJECT:The purpose of this study was to examine patterns of diagnosis and relative survival rates in individuals in whom a primary malignant brain tumor was diagnosed between 1973 and 1997; follow-up review of these patients continued through the end of 1999. METHODS:The study population was composed of 21,493 patient...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2003.99.3.0458
更新日期:2003-09-01 00:00:00
abstract::A patient with glioblastoma multiforme of the brain was treated with both intravenous and oral glycerol as well as intravenous mannitol in an attempt to reduce increased intracranial pressure. After an initial lowering of the cerebrospinal fluid (CSF) pressure to near normal values during continuous glycerol administr...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1975.42.2.0226
更新日期:1975-02-01 00:00:00
abstract:OBJECT:Cerebrospinal fluid leaks may occur as a result of trauma or following surgery, and occasionally may also be spontaneous. Leakage of CSF from the lateral sphenoid recess is rare and challenging to treat. The authors present their experience with repairs of 10 CSF leaks that were confined to the lateral sphenoid ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2009.7.JNS09306
更新日期:2010-02-01 00:00:00
abstract:OBJECT:Concussion is the signature American football injury of the 21st century. Modern varsity helmets, as compared with vintage leather helmets, or "leatherheads," are widely believed to universally improve protection by reducing head impact doses and head injury risk for the 3 million young football players in the U...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2011.9.JNS111059
更新日期:2012-01-01 00:00:00
abstract::The author describes a woman in whom an S1-2 fracture developed after L4-S1 decompression and fusion. Osteoporosis was not present, but the lesion failed to respond to conservative therapy, necessitating surgical extension of the spinal fusion. Although biomechanical complications of lumbosacral fusion are uncommon, p...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/spi.2003.99.3.0310
更新日期:2003-10-01 00:00:00
abstract::The authors report the case of an adult patient with irreducible fixed dystonia (inward rotation) of the right foot that arose after cardioembolic ischemia of the left putamen and globus pallidus externus. Given the resistance of such symptomatology to all of the attempted conservative treatments (including botulinum ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2009.4.JNS08785
更新日期:2009-12-01 00:00:00
abstract::A case of cerebral metastasis of chorioepithelioma with an occlusion of the angular artery is presented. The occlusion was verified angiographically, surgically, and microscopically. ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1979.51.2.0247
更新日期:1979-08-01 00:00:00
abstract::A 48-year-old laborer presented with a 1-year history of low-back pain radiating into the posterior aspects of both thighs. Two weeks before admission, acute exacerbation resulted in signs and symptoms of compressive radiculopathy at L-5. Myelography revealed concentric constriction of the lower thecal sac due to abun...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1982.57.4.0559
更新日期:1982-10-01 00:00:00
abstract:OBJECTIVE:The brainstem is a compact, delicate structure. The surgeon must have good anatomical knowledge of the safe entry points to safely resect intrinsic lesions. Lesions located at the lateral midbrain surface are better approached through the lateral mesencephalic sulcus (LMS). The goal of this study was to compa...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2019.1.JNS182036
更新日期:2019-04-12 00:00:00
abstract::Mannitol is widely considered the hyperosmolar therapy of choice in routine neurosurgical practice for the reduction of intracranial pressure (ICP). The authors present a unique case of a patient with a large meningioma treated with mannitol, in which mannitol accumulation within the tumor and its surrounding parenchy...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/JNS/2008/108/5/1010
更新日期:2008-05-01 00:00:00
abstract:OBJECT:Oxygen delivered in supraphysiological amounts is currently under investigation as a therapy for severe traumatic brain injury (TBI). Hyperoxia can be delivered to the brain under normobaric as well as hyperbaric conditions. In this study the authors directly compare hyperbaric oxygen (HBO2) and normobaric hyper...
journal_title:Journal of neurosurgery
pub_type: 杂志文章,随机对照试验
doi:10.3171/2009.7.JNS09363
更新日期:2010-05-01 00:00:00
abstract:OBJECTIVE:The object of this study was to define caudate nucleus locations responsive to intraoperative direct electrical stimulation for tinnitus loudness modulation and relate those locations to functional connectivity maps between caudate nucleus subdivisions and auditory cortex. METHODS:Six awake study participant...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2018.10.JNS181659
更新日期:2019-02-08 00:00:00
abstract::The authors describe two patients in whom tumor swelling and brain swelling (and possible tumor swelling), respectively, developed after undergoing gamma knife surgery. One had a skull defect with a palpable parasagittal tumor. One had neurofibromatosis Type 2 with multiple tumors, one of which was parasagittal. ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2005.102.s_supplement.0001
更新日期:2005-01-01 00:00:00
abstract:OBJECT:Unlike their malignant counterparts, low-grade gliomas are associated with prolonged survival. However, these tumors have a propensity to progress after resection and ultimately undergo malignant degeneration. The factors associated with recurrence and malignant degeneration remain relatively unknown. The author...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2008.10.JNS08608
更新日期:2010-01-01 00:00:00
abstract::A new experimental model of chronic subdural hematoma in mice is described. A single intraperitoneal injection of 6-aminonicotinamide (25 mg/kg body weight) on the 5th postnatal day induced hydrocephalus in mice with almost 100% success. Approximately 60% of the mice spontaneously developed intracranial hemorrhage 20 ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1987.67.5.0710
更新日期:1987-11-01 00:00:00
abstract::Gadolinium-diethylenetriaminepenta-acetic acid (Gd-DTPA) is a chelated paramagnetic contrast agent under clinical trial for use in magnetic resonance (MR) imaging. The increased signal intensity following the intravenous infusion of contrast medium may improve the ability of MR imaging to delineate tumors. The use of ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1989.71.1.0049
更新日期:1989-07-01 00:00:00
abstract:OBJECTIVE:Hypoperfusion during carotid artery cross-clamping (CC) for carotid endarterectomy (CEA) may result in the major complication of perioperative stroke. Median nerve somatosensory evoked potential (MNSSEP) monitoring, which is an established method for the prediction of cerebral ischemia, has low sensitivity in...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2018.4.JNS171784
更新日期:2018-09-07 00:00:00
abstract:OBJECT:Functional neurosurgical interventions such as deep brain stimulation (DBS) are traditionally performed with the aid of a stereotactic frame. Although frameless techniques have been perceived as less accurate, data from a recent phantom study of a modified frameless approach demonstrated a laboratory accuracy ex...
journal_title:Journal of neurosurgery
pub_type: 临床试验,杂志文章
doi:10.3171/jns.2005.103.3.0404
更新日期:2005-09-01 00:00:00
abstract:OBJECT:Mild traumatic brain injury (mTBI), as defined by Glasgow Coma Scale (GCS) score of 13 or higher, is a common problem in the United States and worldwide, estimated to affect more than 1 million patients yearly. When associated with intracranial hemorrhage, it is a common reason for neurosurgical consultation and...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2014.10.JNS132713
更新日期:2015-09-01 00:00:00