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  • 1
    Electronic Resource
    Electronic Resource
    Changes in serum cytokine concentrations after neurosurgical procedures (1996)
    Springer
    Acta neurochirurgica 138 (1996), S. 970-976 
    Details
    ISSN: 0942-0940
    Keywords: Cytokine ; interleukin-6, neurosurgery ; steroid
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Cytokine responses to surgical trauma have been studied in 70 patients undergoing various neurosurgical procedures. Serum concentrations of interleukin-1ß (IL-1ß), interleukin-6 (IL-6), interleukin-8, (IL-8), tumour necrosis factor-α (TNF-α), and interferon-γ (IFN-γ) were measured before and after surgery using enzyme-linked immunosorbent assays. The serum concentrations of IL-1ß, IL-8, TNF-α, and IFN-γ did not change significantly following neurosurgical operations. In contrast, serum IL-6 levels were significantly elevated following surgery, peaking at postoperative day 1 and then gradually decreasing. Maximum IL-6 concentrations were considerably higher in patients who underwent surgery for brain tumours or aneurysms as compared with patients who had a ventriculoperitoneal shunt, neurovascular decompression or transsphenoidal adenomectomy. Intra-operative use of methylprednisolone, which is known to block the production and action of cytokines, suppressed the increase in IL-6 levels after surgery. There was a statistically significant correlation between the IL-6 peak concentration and the length of surgery in patients not treated with steroids, but not in patients treated with steroids. Additionally patients who underwent supratentorial surgery had higher peak concentrations of IL-6 than those who underwent infratentorial surgery. These results suggest that IL-6 is an early marker of tissue damage and may be useful in assessing the extent of postoperative stress.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01411287
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  • 2
    Electronic Resource
    Electronic Resource
    Intra-Arterial Infusion of Fasudil Hydrochloride for Treating Vasospasm Following Subarachnoid Haemorrhage (1999)
    Springer
    Acta neurochirurgica 141 (1999), S. 13-19 
    Details
    ISSN: 0942-0940
    Keywords:  Keywords:Cerebral vasospasm; fasudil hydrochloride; intra-arterial infusion; subarachnoid haemorrhage.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary  In this pilot study we treated cerebral vasospasm in patients with subarachnoid haemorrhage to assess intra-arterial fasudil hydrochloride. We analysed effects of intra-arterial infusion on angiographically evident cerebral vasospasm in 10 patients including 3 with symptoms of vasospasm. Over 10 to 30 min 15 to 60 mg was administered via the proximal internal carotid artery or vertebral artery following standard angiography, without superselective techniques. A total of 24 arterial territories (21 internal carotid, 3 vertebral) were treated. Angiographic improvement of vasospasm was demonstrated in 16 arterial territories (local dilation in 2, diffuse dilation in 14) in 9 patients. In 2 symptomatic patients, intra-arterial fasudil hydrochloride was associated with resolution of symptoms without sequelae. In the third symptomatic patient the benefit of fasudil hydrochloride was only temporary, and a large cerebral infarction occurred. All asymptomatic patients showed no progression of angiographic to symptomatic vasospasm after treatment with intra-arterial fasudil hydrochloride. No adverse effect was encountered.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s007010050260
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  • 3
    Electronic Resource
    Electronic Resource
    The effects of an intracellular calcium antagonist HA 1077 on delayed cerebral vasospasm in dogs (1988)
    Springer
    Acta neurochirurgica 90 (1988), S. 53-59 
    Details
    ISSN: 0942-0940
    Keywords: Calcium antagonist ; chronic cerebral vasospasm ; HA 1077 ; subarachnoid haemorrhage
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The effectiveness of calcium antagonists on a chronic cerebral vasospasm after an SAH is still under debate. Calcium channel blockers such as nimodipine, nefedipine etc. can dilate spastic arteries by intrathecal administration, but not by systemic (iv or po) use. HA 1077 is a novel and potent calcium antagonist vasodilator which is considered to act by employing different mechanisms from the usual calcium channel blockers since it inhibits 1. calcium ionophore A 23187 induced contraction in arterial strips and 2. phenylephrine induced contraction in calcium free media, suggesting that its site of action is in the intracellular space. HA 1077 is water soluble and relatively stable in light. In the present study, the efficacy of HA 1077 was evaluated on dogs by using the spiral arterial strips in vitro and by angiography in vivo. In the arterial strips from the control dogs, a 50% relaxation of KCl (15 mM) induced contraction was obtained by a 10−6 M HA 1077 for the “intracranial” basilar and middle cerebral arteries, while a 10−5 M was needed to obtain the same effect for the “extracranial” common carotid and vertebral arteries, indicating that HA 1077 is more effective for the intracranial arteries. A vasospasm was produced by the “two haemorrhage” model of Varsoset al. The average angiographic diameter of the basilar artery was reduced to 60% of the control on SAH day 7. Intravenous infusion of HA 1077 (0.5–3 mg/kg/30 min) significantly dilated the spastic basilar artery (up to 20–30%), for over 2 hours. A fall in the systemic BP remained less than 20% during this time. Such spasmolytic effects by intravenous administration could not have been obtained with the usual calcium channel blockers. HA 1077 may be suitable for the treatment of a vasospasm in humans as well.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01541267
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  • 4
    Electronic Resource
    Electronic Resource
    Microclip haemostasis for surgical treatment of cerebral arteriovenous malformations (1995)
    Springer
    Acta neurochirurgica 136 (1995), S. 95-98 
    Details
    ISSN: 0942-0940
    Keywords: Arteriovenous malformation ; vascular clip ; microclip ; haemostasis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The authors describe newly designed microclips and their utility in obtaining haemostasis during the surgical resection of cerebral arteriovenous malformations. The microclips are particularly well-suited for controlling bleeding from small fragile vessels often encountered on the periphery of large arteriovenous malformations during the final stages of a surgical procedure. Histological examination of these vessels revealed very thin dilated walls without elastic layers, causing easy rupture. Hence, haemostasis using conventional means, such as bipolar coagulators, can be extremely difficult. We have used microclips on such vessels in 14 patients with arteriovenous malformations and controlled bleeding successfully.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01411443
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  • 5
    Electronic Resource
    Electronic Resource
    Interleukin-6 and Development of Vasospasm after Subarachnoid Haemorrhage (1998)
    Springer
    Acta neurochirurgica 140 (1998), S. 943-951 
    Details
    ISSN: 0942-0940
    Keywords: Keywords: Cerebral vasospasm; interleukin-6; interleukin-8; subarachnoid haemorrhage (SAH).
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary  The authors characterized the role of interleukins in the cerebrospinal fluid (CSF) in the development of vasospasm after subarachnoid haemorrhage (SAH), particularly interleukin-6 (IL-6).  Concentrations of interleukin-1β (IL-1 β), IL-6, and interleukin-8 (IL-8) were measured serially in CSF of 24 patients and in serum of 9 patients with SAH and correlated clinically. Additionally, the effects of the same cytokines on the cerebral arteries of dogs were analyzed on angiograms after intracisternal injection. Changes in levels of eicosanoids, angiogenic factors, and soluble cell adhesion molecules were investigated in the CSF of injected dogs.  CSF concentrations of IL-6 and IL-8 were elevated significantly above control levels from the acute stage of SAH until the chronic stage. Patients with symptomatic vasospasm had significantly higher levels of IL-6 as well as IL-8 in CSF on days 5 and 7. Intracisternal injection of IL-6 induced long-lasting vasoconstriction in five out of eight dogs, while IL-8 did not. The diameter of canine basilar artery after IL-6 was reduced 29±5% from pretreatment diameter at 8 hours. Prostaglandins E2 and I2 were elevated in CSF for the first 4.5 hour of this IL-6-induced vasospasm. Neither angioenic factors such as platelet-derived growth factor-AB and vascular endothelial growth factor nor soluble cell adhesion molecules were significantly elevated in CSF.  IL-6, which increases to very high concentrations in CSF after SAH, may be important in inducing vasospasm, as IL-6 produced long-lasting vasoconstriction in the canine cerebral artery, which may be partly related to activation of the prostaglandin cascade.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s007010050197
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  • 6
    Electronic Resource
    Electronic Resource
    Primary chronic intrasellar haematoma: A case report (1992)
    Springer
    Acta neurochirurgica 114 (1992), S. 147-150 
    Details
    ISSN: 0942-0940
    Keywords: Intrasellar haematoma ; transsphenoidal surgery ; hypopituitarism ; pituitary apoplexy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary This report describes a rare case of primary intrasellar haematoma in a 66 year-old man with hypopituitarism. Computerized tomography (CT) and magnetic resonance imaging (MRI) showed an intrasellar cystic lesion with small suprasellar extension. Transsphenoidal surgery revealed that the lesion was a chronic haematoma, without evidence of a tumour or vascular anomaly. Pathological diagnosis confirmed this. This is the first report of a chronic intrasellar haematoma, which is probably primary.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01400605
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  • 7
    Electronic Resource
    Electronic Resource
    Clinical Safety and Performance of Sugita Titanium Aneurysm Clips (2000)
    Springer
    Acta neurochirurgica 142 (2000), S. 159-163 
    Details
    ISSN: 0942-0940
    Keywords: Keywords: Aneurysm clips; intracranial aneurysm; subarachnoid haemorrhage; titanium.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary ¶ Background. In spite of advantages for neuro-imaging, titanium aneurysm clips are not yet chosen for routine use for clipping of intracranial aneurysms, probably because their reliability has not been demonstrated in large numbers of cases. We assess reliability and safety of Sugita titanium aneurysm clips for routine clinical use in a large number of operated cases.  Method. Intra-operative performance and safety of Sugita titanium aneurysm clips were evaluated in 347 patients in our institutions. Aneurysms in 261 patients had ruptured; 86 patients had unruptured aneurysms.  Results. A total of 441 clips of 52 different types were used. No early or delayed complications occurred in relation to the titianium clips, such as deformity or slippage of a clip. Patient outcome according to the Glasgow Outcome Scale was similar to that when conventional cobalt-based aneurysm clips were used.  Interpretation. Reliability and safety of Sugita aneurysm clips were demonstrated in a large number of patients. The clips are suitable for routine use in aneurysm surgery.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s007010050018
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  • 8
    Electronic Resource
    Electronic Resource
    Elevation of Nitric Oxide Metabolites in the Cerebrospinal Fluid of Patients with Moyamoya Disease (2000)
    Springer
    Acta neurochirurgica 142 (2000), S. 1275-1280 
    Details
    ISSN: 0942-0940
    Keywords: Keywords: Collateral circulation; intracranial-extracranial bypass surgery; moyamoya disease; nitric oxide.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary  Background. To investigate whether nitric oxide (NO) contributes to formation of abnormal collateral circulation in patients with moyamoya disease.  Methods. Cerebrospinal fluid (CSF) samples were obtained from the subarachnoid space of the Sylvian fissure during combined bypass surgery for moyamoya disease and kept frozen until NO metabolites, nitrate and nitrite, were measured using a Griess method.  Results. Compared with control CSF obtained from 18 patients with hemifacial spasm, unruptured aneurysm, etc., concentrations of NO metabolites in 26 CSF samples of 18 patients with moyamoya disease were significantly higher (mean±SE; 17.6±1.2 vs. 10.5±1.0 μM, p〈0.01). In eight patients, the CSF samples from both the first and second operation could be obtained. NO metabolite concentrations (20.5±2.3 μM) in CSF obtained from the first surgery decreased to 15.7±1.8 μM (p〈0.01) in CSF obtained from the second, contralateral procedure. The cases of moyamoya disease with greater development of moyamoya vessels at angiographic stage 3 and 4 tended to show higher concentrations of NO metabolites than cases at earlier or later stages with a few moyamoya vessels.  Interpretation. Nitric oxide concentrations in CSF are chronically elevated in moyamoya disease, probably reflecting development of abnormal collateral circulation. i.e. moyamoya vessels. Vascular bypass surgery can reduce abnormal collateral circulation with reduced production of nitric oxide.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s007010070025
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  • 9
    Electronic Resource
    Electronic Resource
    Vasodilation by intrathecal lipopolysaccharide of the cerebral arteries after subarachnoid haemorrhage in dogs (1996)
    Springer
    Acta neurochirurgica 138 (1996), S. 330-337 
    Details
    ISSN: 0942-0940
    Keywords: Angiography ; dog ; inducible nitric oxide synthase ; lipopolysaccharide ; subarachnoid haemorrhage ; tumour necrosis factor-α
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary To investigate the influence of inducible nitric oxide synthase on cerebral arteries after subarachnoid haemorrhage (SAH) in vivo, lipopolysaccharide (LPS), a major inducer of inducible nitric oxide synthase, was injected intracisternally into control and SAH model dogs. Intracisternal injection of LPS (0.5 mg) produced a long-lasting, submaximal vasodilation of the basilar artery of control dogs on angiography. This effect became significant at 4 hours after LPS injection and plateaued after 6 hours. This vasodilation was reduced by NG-monomethyl-L-arginine. Vasopressin slightly suppressed the vasodilation, while bradykinin increased it. The concentration of L-arginine in CSF decreased after LPS injection, while that of L-citrulline increased. In cytokines, the concentration of tumour necrosis factor-α (TNF-α) in CSF increased transiently at 4 hours after LPS injection, while interleukin-1β, interleukin-6, interferon-γ did not change. These data suggest that vasodilation by LPS is mainly due to nitric oxide predominantly synthesized by an inducible nitric oxide synthase, proximally induced by TNF-α. Our data make it unlikely that SAH itself induces the inducible nitric oxide synthase in vascular tissue, since isolated endotheliumdenuded basilar artery from SAH model dogs did not respond to L-arginine. In SAH model dogs, the degree of vasodilation by LPS differed with the severity of vasospasm. Vasodilation was much greater in mild than in severe vasospasm in dogs, and was increased by superoxide dismutase. These findings suggest that the induction of inducible nitric oxide synthase or its activity may be less effective in severe vasospasm.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01411745
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  • 10
    Electronic Resource
    Electronic Resource
    A new table-fixed soft tissue retractor for the anterior cervical spinal surgery (1997)
    Springer
    Acta neurochirurgica 139 (1997), S. 235-237 
    Details
    ISSN: 0942-0940
    Keywords: Anterior cervical fusion ; instrumentation ; retractor ; spinal surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Since surgeons sometimes encounter difficulty in keeping self-retaining soft tissue retractors in the proper position for anterior cervical spinal surgery, we have developed a new, simple soft tissue retractor system, which is fixed to the side rails of the operating table via retractor stands. All three joints of the retractor can be tightened simultaneously with a single handle. Each of two retractor blades can keep its position independent of the other thereby maintaining a well-exposed operative field for a long period of time. Fine adjustments of the blade position, after fixation of the retractors, is possible by sliding the head of the blade assembly along the axis of a ratchet mechanism. We have used these retractors in 43 surgical exposures, including 35 for anterior cervical fusion, 2 for posterior thoraco-lumbar decompression, and 6 for carotid endarterectomy. There have been no complications related to tissue damage.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01844757
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