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ABSTRACT: Abstract A unique case of a large intradiploic abscess involving posterior fossa osseous structures is reported. A 16-year-old boy presented with a hard mass in the calvarium of posterior fossa region, fever and confusion. Radiological examination revealed an intradiploic collection with compression to cerebellum, fourth ventricle and brain stem, resulting in syringomyelia in cervical and thoracic spinal cord. After drainage and resection of the abscess wall, closure of a round dural defect was performed. The medical history of the patient and the intraoperative observations support the contention that the abscess in the reported case was a result of chronic and subclinical process of an intraosseous infection. The features concerned with diagnosis, differential diagnosis and pathogenesis of this rare entity are discussed.
British Journal of Neurosurgery 01/2012; 26(5):763-6. · 0.88 Impact Factor
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ABSTRACT: nimodipine is the most widely preferred and administered calcium channel blocker in cerebral vasospasm prevention and treatment. There is no experimental or clinical study investigating the comparative effects of routine treatment modalities.
35 male New Zealand White rabbits were assigned randomly to one of seven groups: Control, only SAH, SAH/oral nimodipine, SAH/IV nimodipine, SAH/IT nimodipine, SAH/IA nimodipine, SAH/angiography.
basilar artery vessel diameters are measured by angiography. Basilar artery vessel diameters and luminal sectional areas are measured in pathology slides. Basilar artery thicknesses were significantly higher in group 2 and 7 than the others (p < 0.05). Luminal sectional areas in group 5 and 6 were significantly higher than other groups (p < 0.05). We found no significant difference in group 1, 5 and 6 (p > 0.05). Basilar section areas in group 3 and 4 were significantly higher than group 2 but lower than group 1.
this is the first study to show the most effective drug delivery route in CVS after SAH. Nimodipine treatment in cerebral vasospasm is useful. This study showed that selective IA nimodipine treatment and IT nimodipine treatment must be preferred to IV and oral treatments of chronic vasospasm following SAH.
Acta neurochirurgica. Supplement 01/2011; 110(Pt 2):23-8.
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ABSTRACT: intrathecal administration of calcium channel antagonists has been proposed to reduce cerebral vasospasm (CVS) in animal subarachnoid hemorrhage (SAH) models. Also, delayed CVS treatment model with oral administration of cilostazol can be seen in the literature.
in this study, 25 male New Zealand white rabbits were randomly assigned to five groups: control, SAH only, SAH/nimodipine, SAH/cilostazol, SAH/vehicle. The animals' basilar arteries were sectioned from four separate zones and four sections were obtained from each rabbit. Basilar artery luminal section areas were measured by using SPOT for windows Version 4.1 computer program.
basilar artery luminal section areas in SAH/ nimodipine and SAH/ cilostazol groups were significantly higher than SAH only group (P < 0.05).
phosphodiesterase 3 inhibitor cilostazol has vasodilatory effects without affecting cerebral blood flow. Nimodipine is a calcium channel blocker and is still used in vasospasm therapy either oral or intravenously. This study demonstrates that prophylactic bolus intrathecal administration of either cilostazol or nimodipine equally prevents SAH-associated CVS in an animal model. We therefore propose that cilostazol is a candidate for clinical trials in the treatment of delayed vasospasm.
Acta neurochirurgica. Supplement 01/2011; 110(Pt 2):43-8.
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ABSTRACT: cerebral vasospasm (CVS) is one of the most considerable complications of subarachnoid hemorrhage (SAH). The aim of this study was to assess and to compare the ability of intrathecal dotarizine and nimodipine to prevent and treat vasospasm in a rabbit model of subarachnoid hemorrhage.
thirty male New Zealand white rabbits weighing 2,500-3,000 g were allocated into five groups randomly. The treatment groups were as follows: Control, only SAH, SAH/Dotarizine, SAH/Nimodipine, SAH/Vehicle. Forty-eight hours after SAH injection, all animals underwent femoral artery catheterization procedure by open surgery under anesthesia and angiography performed for each animal in the fifth day just before sacrifice.
basilar artery vessel diameters are measured by angiography. Basilar artery vessel diameters and luminal sectional areas are measured in pathology slides. There was a statistically significant difference between the mean basilar artery cross-sectional areas and the mean arterial wall thickness measurements of the control and SAH-only groups (p < 0.05).
these findings demonstrate that calcium channel blocker dotarizine has marked vasodilatory effect in an experimental model of SAH in rabbits. Nimodipine is an effect-proven agent in CVS, but dotarizine may take place of it.
Acta neurochirurgica. Supplement 01/2011; 110(Pt 2):55-60.
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ABSTRACT: the aim of this study was to assess and to compare the ability of intrathecal flunarizine and nimodipine to prevent vasospasm in a rabbit model of subarachnoid hemorrhage (SAH).
forty male New Zealand white rabbits were allocated into 5 groups randomly. The treatment groups were as follows: (1) control (no SAH [n = 8]), (2) SAH only (n = 8), (3) SAH plus vehicle (n = 8), (4) SAH plus nimodipine (n = 8), and (5) SAH plus flunarizine (n = 8). Before sacrifice, all animals underwent femoral artery catheterization procedure by open surgery under anesthesia and angiography performed for each animal.
there was a statistically significant difference between the mean basilar artery cross-sectional areas and the mean arterial wall thickness measurements of the control and SAH-only groups (p < 0.05). Basilar artery vessel diameter and luminal section areas in group 4 were significantly higher than in group 2 (p < 0.05). Basilar artery vessel diameter and basilar artery luminal section areas in group 5 were significantly higher than in group 2 (p < 0.05).Basilar artery vessel diameter and basilar artery luminal section areas in group 5 were significantly higher than in group 4 (p < 0.05).
these findings demonstrate that flunarizine has marked vasodilatatory effect in an experimental model of SAH in rabbits.
Acta neurochirurgica. Supplement 01/2011; 110(Pt 2):69-73.
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ABSTRACT: the aim of this study was to assess and to compare the ability of intrathecal nicergoline and nimodipine in prevention of cerebral vasospasm in a rabbit model of subarachnoid hemorrhage (SAH).
twenty male New Zealand white rabbits were allocated into four groups randomly. Subarachnoid hemorrhage was induced by injecting autologous blood into the cisterna magna. The treatment groups were as follows: (1) control [no SAH (n = 5)], (2) SAH only (n = 5), (3) SAH plus nimodipine (n = 5), and (4) SAH plus nicergoline (n = 5).
there was a statistically significant difference between the mean basilar artery cross-sectional areas and the mean arterial wall thickness measurements of the control and SAH-only groups (p < 0.05). Basilar artery vessel diameter and luminal section areas in group 3 were significantly higher than in group 2 (p < 0.05). Basilar artery vessel diameter and basilar artery luminal section areas in group 4 were significantly higher than in group 2 (p < 0.05). There was no significant difference between basilar artery vessel diameter and basilar artery luminal section areas in group 3 and group 4.
these findings demonstrate that intrathecal nicergoline has a vasodilatatory effect in an experimental model of SAH in rabbits but not more than that of nimodipine.
Acta neurochirurgica. Supplement 01/2011; 110(Pt 2):81-5.
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ABSTRACT: Our aim in this study was to investigate the efficacy of intravenous administration of cilostazol and compare these effects with intravenous usage of nimodipine in subarachnoid hemorrhage model.
Twenty-five male New Zealand White rabbits were assigned randomly to 1 of 5 groups. Animals in group 1 (n=5) served as controls, group 2 (n=5) was the SAH-only group, group 3 (n=5) was treated with intravenous 10 mg/kg cilostazol, group 4 (n=5) was treated with 0.05 mg/kg intravenous nimodipine, and group 5 (n=5) served as the vehicle group and treated with a mixture of dimethyl sulfoxide and phosphate buffer solution. Basilar arteries were removed from the brain stems and analyzed. The vessels were measured using computer-assisted morphometry (SPOT for Windows Version 4.1). Statistical comparisons were performed using the Kruskall-Wallis and Mann-Whitney U tests.
Basilar artery wall thicknesses in group 3 and 4 were smaller than the group 2 and this was statistically significant at p < 0.05. The mean arterial cross-sectional areas in group 3 and 4 were higher than group 2 and this was also statistically significant at p < 0.05.
Our results demonstrate that intravenous administration of both cilostazol and nimodipine significantly attenuates cerebral vasospasm after SAH.
Turkish neurosurgery 10/2009; 19(4):374-9. · 0.62 Impact Factor
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Neurology India 59(1):136-7. · 0.96 Impact Factor
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ABSTRACT: The retrosigmoid approach is a common route to the cerebellopontine angle and lateral clivus. Patient's head positioning just before the operation is crucial to perform the procedure effectively and safely.
The aim of the study is to determine the positional angle of the head on preoperative axial sequences of the cranial magnetic resonance imaging (MRI).
The angle between the line drawn along the petrous bone ventral to the internal auditory canal and the line drawn parallel to the dorsal face of the clivus on the axial view of MRI sequences was measured.
This method of patient positioning has resulted in minimal cerebellar retraction, less time in the preoperative preparation period and less postoperative headache and neck pain.
This method can provide quick and better exposure of the cerebellopontine angle. Preoperative measurement of positional angle on axial MRI sequences is a very simple and sufficient way to determine the angle of the head that is turned to the contralateral side.
Neurology India 57(6):777-9. · 0.96 Impact Factor
