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Slavin KV, Vannemreddy P. Cervical spinal cord stimulation for prevention and treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage: clinical and radiographic outcomes of a prospective single-center clinical pilot study. Acta Neurochir (Wien) 2022; 164:2927-2937. [PMID: 35920945 DOI: 10.1007/s00701-022-05325-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 07/21/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Cerebral vasospasm induced by aneurysmal subarachnoid hemorrhage (aSAH) is a major cause of high morbidity and mortality, for which there is no consistently effective treatment. Cervical spinal cord stimulation (cSCS) has been shown to induce vasodilatation and improve peripheral and cerebral blood flow in both animal and human studies. This pilot study was performed to assess the clinical effect and long-term results of cSCS treatment in aSAH patients. METHODS This was the first IRB- and US FDA-approved prospective non-randomized non-controlled study comprising of 12 aSAH patients (8 women, 4 men, age range 34-62 years) treated between May and November 2008. All patients underwent up to 2 weeks of cSCS with a single percutaneously implanted 8-contact electrode. Neurological outcomes at discharge and follow-up of up to 13 years and mortality/complications rates were analyzed. RESULTS All 12 aSAH patients underwent cSCS electrode implantation immediately after securing the aneurysm. Patients were stimulated for 10-14 consecutive days starting within 3 days of aneurysm rupture. Angiographic vasospasm occurred in six patients; two patients developed new vasospasm-related neurological symptoms; both recovered completely by discharge time. One patient died from unrelated multi-system failure; the rest were followed up clinically (average, 7.5 years; range, 12-151 months) and angiographically (average, 6.5 years; range, 36-125 months). No delayed ischemic neurological deficits/strokes and no cSCS-related adverse effects were observed. CONCLUSIONS Our short- and long-term data suggest that cSCS is feasible and safe for patients in the acute aSAH settings. Small size of the patient cohort and lack of control do not allow us to conclude whether cSCS is able to prevent cerebral vasospasm, decrease its severity, and improve clinical outcomes in aSAH patients. However, our findings support further clinical trials and development of cSCS as a new concept to prevent and treat cerebral vasospasm. TRIAL REGISTRATION CLINICALTRIALS gov NCT00766844, posted on 10/06/2008.
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Affiliation(s)
- Konstantin V Slavin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA. .,Neurology Service, Jesse Brown Veterans Administration Hospital, Chicago, IL, USA.
| | - Prasad Vannemreddy
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
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OLĞUN A, KARADAĞ MK, ZEYNAL M, ŞAHİN MH, DEMİRTAŞ R, TURAN Ç, AYDİN M. Denervation injury of scalp hair due to trigeminal ganglion ischemia: the first experimental study. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1109188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim: Scalp hairs are mainly innervated by sensitive fibers of trigeminal nerves. Ischemic neurodegeneration of trigeminal ganglion can cause denervation injury of scalp hairs. We investigated if there is a relationship between the degenerated neuron densities of trigeminal ganglion neuron densities and the numbers of degenerated hair follicles numbers following subarachnoid hemorrhage (SAH).
Material and Method: Five normal (n=5), five SHAM (n=5), and ten (n=10) male rabbits were chosen from formerly experimental SAH created by cisternal homologous blood injection (0.75cc) group, which followed for three weeks. Degenerated neuron numbers of trigeminal ganglion and atrophic hair follicles numbers in the frontal areas of the scalp were examined by stereological methods. Degenerated neuron densities of trigeminal ganglions and atrophic hair follicles numbers were analyzed by the Mann-Whitney U test.
Results: The mean degenerated neuron densities trigeminal ganglions (n/mm3) and atrophic hair follicles (n/mm2) were determined as 5±2/m3 and12±4/mm2 in control; 12±3/m3 and 41±8/mm2 in Sham and, 168±23/m3 and 79±14/mm2 in the study group (p>0.001). In the post-hoc analysis, all groups differed significantly from each other. A linear association was observed between the degenerated neuron densities of trigeminal ganglions and atrophic hair follicles (r: 0.343, p: 0.007).
Conclusion: Trigeminal ganglion neurodegeneration may be an essential factor in hair follicles atrophy after SAH, which has not been mentioned in the literature so far.
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Affiliation(s)
- Abdulkerim OLĞUN
- Atatürk Üniversitesi, Tıp Fakültesi, Plastik, Rekonstruktif ve Estetik Cerrahi Anabilim Dalı
| | | | - Mete ZEYNAL
- Atatürk Üniversitesi, Tıp Fakültesi, Nöroşirürji Anabilim Dalı
| | | | - Rabia DEMİRTAŞ
- Atatürk Üniversitesi, Tıp Fakültesi, Patoloji Anabilim Dalı
| | - Çağrı TURAN
- Afyonkarahisar Sağlık Bilimleri Üniversitesi, Tıp Fakültesi, Deri ve Zührevi Hastalıkları Anabilim Dalı
| | - Mehmet AYDİN
- Atatürk Üniversitesi, Tıp Fakültesi, Nöroşirürji Anabilim Dalı
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Schlaeppi JA, Affentranger L, Bervini D, Z’Graggen WJ, Raabe A, Pollo C. Electrical Stimulation for Cerebral Vasospasm After Subarachnoid Hemorrhage: A Systematic Review. Neuromodulation 2022; 25:1227-1239. [DOI: 10.1016/j.neurom.2022.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/13/2021] [Accepted: 01/04/2022] [Indexed: 10/18/2022]
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Powell K, White TG, Nash C, Rebeiz T, Woo HH, Narayan RK, Li C. The Potential Role of Neuromodulation in Subarachnoid Hemorrhage. Neuromodulation 2022; 25:1215-1226. [PMID: 35088724 DOI: 10.1016/j.neurom.2021.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Aneurysmal subarachnoid hemorrhage (SAH) continues to be a difficult cerebrovascular disease with limited pharmacologic treatment options. Cerebral vasospasm (CV) and delayed cerebral ischemia (DCI) are leading causes of morbidity and mortality after SAH. Despite the advances in the understanding of its pathophysiology and tremendous efforts to date, nimodipine is currently the sole Food and Drug Administration-approved treatment for patients with SAH, with benefits that are marginal at best. The neuromodulation therapies are promising, especially those that target CV and DCI to improve functional outcomes. The aim of this review is therefore to summarize the available evidence for each type of neuromodulation for CV and DCI, with a special focus on its pathophysiological mechanisms, in addition to their clinical utility and drawbacks, which we hope will lead to future translational therapy options after SAH. MATERIALS AND METHODS We conducted a comprehensive review of preclinical and clinical studies demonstrating the use of neuromodulation for SAH. The literature search was performed using PubMed, Embase, and ClinicalTrials.gov. A total of 21 articles published from 1992 to 2021 and eight clinical trials were chosen. RESULTS The studies reviewed provide a compelling demonstration that neuromodulation is a potentially useful strategy to target multiple mechanisms of DCI and thus to potentially improve functional outcomes from SAH. There are several types of neuromodulation that have been tested to treat CV and DCI, including the trigeminal/vagus/facial nerve stimulation, sphenopalatine ganglion and spinal cord stimulation, transcranial direct electrical stimulation, transcutaneous electrical neurostimulation, and electroacupuncture. Most of them are in the preclinical or early phases of clinical application; however, they show promising results. CONCLUSIONS DCI has a complex pathogenesis, making the unique anatomical distribution and pleiotropic capabilities of various types of neuromodulation a promising field of study. We may be at the cusp of a breakthrough in the use of these techniques for the treatment of this stubbornly difficult disease.
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Affiliation(s)
- Keren Powell
- Translational Brain Research Laboratory, The Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Timothy G White
- Translational Brain Research Laboratory, The Feinstein Institutes for Medical Research, Manhasset, NY, USA; Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Christine Nash
- Translational Brain Research Laboratory, The Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Tania Rebeiz
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Henry H Woo
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Raj K Narayan
- Translational Brain Research Laboratory, The Feinstein Institutes for Medical Research, Manhasset, NY, USA; Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Chunyan Li
- Translational Brain Research Laboratory, The Feinstein Institutes for Medical Research, Manhasset, NY, USA; Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
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Update on Mechanism and Therapeutic Implications of Spinal Cord Stimulation and Cerebral Hemodynamics: A Narrative Review. ACTA NEUROCHIRURGICA SUPPLEMENT 2017; 124:27-36. [DOI: 10.1007/978-3-319-39546-3_5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Tomycz ND. The proposed use of cervical spinal cord stimulation for the treatment and prevention of cognitive decline in dementias and neurodegenerative disorders. Med Hypotheses 2016; 96:83-86. [PMID: 27959284 DOI: 10.1016/j.mehy.2016.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 10/10/2016] [Indexed: 11/19/2022]
Abstract
Cervical spinal cord stimulation is a well-established treatment for intractable neuropathic upper extremity pain. More than 20years ago it was demonstrated that cervical spinal cord stimulation could engender an increase in cerebral blood flow. Cerebral blood flow has been shown to be decreased in many patients with dementia and in various neurodegenerative disorders such as Alzheimer's disease and Parkinson's disease. Furthermore, there is evidence that reduced cerebral blood flow worsens neurodegenerative disease and may also predict which patients progress from mild cognitive impairment to full blown Alzheimer's disease. Thus, the identification of decreased cerebral blood flow in patients with early cognitive problems may offer clinicians a window of opportunity to intervene and prevent further brain damage. Further evidence that supports augmenting cerebral blood flow as an effective strategy for preventing and treating cognitive brain dysfunction comes from experimental studies with omental transposition. The author proposes cervical spinal cord stimulation as a titratable, programmable extracranial neuromodulation technique to increase cerebral blood flow for the purposes of improving cognitive function and preventing cognitive deterioration in patients with dementias and neurodegenerative disorders.
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Affiliation(s)
- Nestor D Tomycz
- Allegheny General Hospital, Department of Neurological Surgery, United States.
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Backer-Grøndahl A, Lindal S, Lorentzen MA, Eldevik P, Vorren T, Kristiansen B, Vangberg T, Ytrebø LM. A new non-craniotomy model of subarachnoid hemorrhage in the pig: a pilot study. Lab Anim 2015; 50:379-89. [PMID: 26643281 DOI: 10.1177/0023677215619806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Subarachnoid hemorrhage (SAH) from rupture of an intracranial arterial aneurysm is a devastating disease affecting young people, with serious lifelong disability or death as a frequent outcome. Large animal models that exhibit all the cardinal clinical features of human SAH are highly warranted. In this pilot study we aimed to develop a non-craniotomy model of SAH in pigs suitable for acute intervention studies. Six Norwegian Landrace pigs received advanced invasive hemodynamic and intracranial pressure (ICP) monitoring. The subarachnoid space, confirmed by a clear cerebrospinal fluid (CSF) tap, was reached by advancing a needle below the ocular bulb through the superior orbital fissure and into the interpeduncular cistern. SAH was induced by injecting 15 mL of autologous arterial blood into the subarachnoid space. Macro- and microanatomical investigations of the pig brain showed a typical blood distribution consistent with human aneurysmal SAH (aSAH) autopsy data. Immediately after SAH induction ICP sharply increased with a concomitant reduction in cerebral perfusion pressure (CPP). ICP returned to near normal values after 30 min, but increased subsequently during the experimental period. Signs of brain edema were confirmed by light microscopy post-mortem. None of the animals died during the experimental period. This new transorbital injection model of SAH in the pig mimics human aSAH and may be suitable for acute intervention studies. However, the model is technically challenging and needs further validation.
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Affiliation(s)
- Anders Backer-Grøndahl
- Department of Anesthesiology, University Hospital of North Norway, Tromsø, Norway Institute of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Sigurd Lindal
- Institute of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway Department of Pathology, University Hospital of North Norway, Tromsø, Norway
| | | | - Petter Eldevik
- Institute of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - Torgrim Vorren
- Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - Bente Kristiansen
- Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - Torgil Vangberg
- Institute of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - Lars Marius Ytrebø
- Department of Anesthesiology, University Hospital of North Norway, Tromsø, Norway Institute of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
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8
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Yin D, Slavin K. A hypothesis on possible neurochemical mechanisms of action of cervical spinal cord stimulation in prevention and treatment of cerebral arterial vasospasm after aneurysmal subarachnoid hemorrhage. Med Hypotheses 2015; 85:355-8. [DOI: 10.1016/j.mehy.2015.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 06/17/2015] [Indexed: 10/23/2022]
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9
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Kayaci S, Kanat A, Aydin MD, Musluman AM, Eseoglu M, Karalar M, Gundogdu C. Role of neuron density of the stellate ganglion on regulation of the basilar artery volume in subarachnoid hemorrhage: An experimental study. Auton Neurosci 2011; 165:163-7. [DOI: 10.1016/j.autneu.2011.06.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 06/17/2011] [Accepted: 06/22/2011] [Indexed: 11/27/2022]
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10
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Visocchi M, Della Pepa GM, Esposito G, Tufo T, Zhang W, Li S, Zhong J. Spinal Cord Stimulation and Cerebral Hemodynamics: Updated Mechanism and Therapeutic Implications. Stereotact Funct Neurosurg 2011; 89:263-74. [DOI: 10.1159/000329357] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2010] [Accepted: 05/02/2011] [Indexed: 11/19/2022]
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Hoshimaru M. Neuropsychological improvement in patients with cervical spondylotic myelopathy after posterior decompression surgery. Neurol Med Chir (Tokyo) 2010; 50:554-9. [PMID: 20671380 DOI: 10.2176/nmc.50.554] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Patients with cervical spondylotic myelopathy sometimes complain of cognitive dysfunction, which may be coincidence. However, cognitive dysfunction may be related to disorders of the cervical spine and/or spinal cord. This study investigated cognitive dysfunction in patients with cervical spinal disorders. A total of 79 patients with cervical spondylotic myelopathy (40 women and 39 men, mean age 61.2 years) underwent cervical laminoplasty between January 2006 and July 2007. Ten of these 79 patients (7 women and 3 men, mean age 65.2 years) complained of moderate to severe memory disturbances. These 10 patients underwent neuroimaging studies and a battery of neuropsychological tests consisting of the mini-mental state examination, Kohs Block Design Test, Miyake Memory Test, Benton Visual Retention Test (BVRT), and "kana-hiroi" test before and 3 months after surgery. Brain magnetic resonance imaging showed no organic brain lesions in the 10 patients, but single photon emission computed tomography demonstrated reduced regional cerebral blood flow in the posterior cortical areas in eight patients before surgery. Neuropsychological test scores showed statistically significant improvement after surgery in the Kohs Block Design Test and the BVRT, which measure visuospatial perception and reflect the function of the parietal and/or occipital lobes (p < 0.05). The practice effect may have contributed to the neuropsychological improvements, but this study suggests that cervical spinal disorders may affect cognitive functions and that surgical treatment can ameliorate such effects.
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Affiliation(s)
- Minoru Hoshimaru
- Department of Neurosurgery, Ohtsu Municipal Hospital, Ohtsu, Shiga, Japan.
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12
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Goellner E, Slavin KV. Cervical spinal cord stimulation may prevent cerebral vasospasm by modulating sympathetic activity of the superior cervical ganglion at lower cervical spinal level. Med Hypotheses 2009; 73:410-3. [DOI: 10.1016/j.mehy.2009.01.055] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Revised: 01/15/2009] [Accepted: 01/18/2009] [Indexed: 10/20/2022]
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Lee JY, Huang DL, Keep R, Sagher O. Effect of electrical stimulation of the cervical spinal cord on blood flow following subarachnoid hemorrhage. J Neurosurg 2008; 109:1148-54. [DOI: 10.3171/jns.2008.109.12.1148] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Cervical spinal cord stimulation (SCS) increases global cerebral blood flow (CBF) and ameliorates cerebral ischemia according to a number of experimental models as well as some anecdotal reports in humans. Nonetheless, such stimulation has not been systematically applied for use in cerebral vasospasm. In the present study the authors examined the effect of cervical SCS on cerebral vasoconstriction in a double-hemorrhage model in rats.
Methods
Subarachnoid hemorrhage (SAH) was induced with 2 blood injections through an indwelling catheter in the cisterna magna. Spinal cord stimulation was applied 90 minutes after induction of the second SAH (Day 0) or on Day 5 post-SAH. Measurements of the basilar artery (BA) diameter and cross-sectional area and regional CBF (using laser Doppler flowmetry and 14C-radiolabeled N-isopropyl-p-iodoamphetamine hydrochloride) were obtained and compared between SAH and sham-operated control rats that did not receive SCS.
Results
At Day 0 after SAH, there were slight nonsignificant decreases in BA diameter and cross-sectional area (89 ± 3% and 81 ± 4%, respectively, of that in controls) in no-SCS rats. At this time point, BA diameter and crosssectional area were slightly increased (116 ± 6% and 132 ± 9%, respectively, compared with controls, p < 0.001) in SCS-treated rats. On Day 5 after SAH, no-SCS rats had marked decreases in BA diameter and cross-sectional area (64 ± 3% and 39 ± 4%, respectively, compared with controls, p < 0.001) and corrugation of the vessel wall. These changes were reversed in rats that had received SCS (diameter, 110 ± 9% of controls; area, 106 ± 4% of controls; p < 0.001). Subarachnoid hemorrhage reduced CBF at Days 0 and 5 post-SAH, and SCS increased flows at both time points, particularly in regions supplied by the middle cerebral artery.
Conclusions
Data in this study showed that SCS can reverse BA constriction and improve global CBF in this SAH model. Spinal cord stimulation may represent a useful adjunct in the treatment of vasospasm.
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Affiliation(s)
- Jin-Yul Lee
- 1Crosby Neurosurgical Laboratories, Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan; and
- 2Department of Neurosurgery, University of Cologne, Germany
| | - Dah-Luen Huang
- 1Crosby Neurosurgical Laboratories, Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan; and
| | - Richard Keep
- 1Crosby Neurosurgical Laboratories, Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan; and
| | - Oren Sagher
- 1Crosby Neurosurgical Laboratories, Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan; and
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Yang X, Farber JP, Wu M, Foreman RD, Qin C. Roles of dorsal column pathway and transient receptor potential vanilloid type 1 in augmentation of cerebral blood flow by upper cervical spinal cord stimulation in rats. Neuroscience 2008; 152:950-8. [PMID: 18321652 PMCID: PMC2396529 DOI: 10.1016/j.neuroscience.2008.01.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2007] [Revised: 01/04/2008] [Accepted: 01/10/2008] [Indexed: 11/20/2022]
Abstract
Clinical and basic studies have indicated that upper cervical spinal cord stimulation (cSCS) significantly increases cerebral blood flow (CBF), but the mechanisms are incompletely understood. This investigation was conducted to differentiate between stimulation of dorsal column fibers and upper cervical spinal cord cell bodies in cSCS-induced increases in CBF and decreases in cerebrovascular resistance (CVR). cSCS (50 Hz, 0.2 ms, 1 min) was applied on the left C1-C2 dorsal column of pentobarbital anesthetized, ventilated and paralyzed male rats. Laser Doppler flowmetry probes were placed bilaterally over the parietal cortex, and arterial pressure was monitored. cSCS at 30%, 60%, and 90% of motor threshold (MT) produced vasodilation bilaterally in cerebral cortices. Subsequently, cSCS was applied at 90% MT, and ipsilateral responses were recorded. Ibotenic acid (0.3 mg/ml, 0.1 ml) placed on dorsal surface of C1-C2 (n=7) to suppress cell body activity, did not affect cSCS-induced %DeltaCBF (42.5+/-8.1% vs. 36.8+/-7.1%, P>0.05) and %DeltaCVR (-19.4+/-4.2% vs. -15.2+/-5.6%, P>0.05). However, bilateral transection of the dorsal column at rostral C1 (n=8) abolished cSCS-induced changes in CBF and CVR. Also, rostral C1 transection (n=7) abolished cSCS-induced changes in CBF and CVR. Resinferatoxin (RTX), an ultrapotent transient receptor potential vanilloid type 1 (TRPV1) agonist, was used to inactivate TRPV1 containing nerve fibers/cell bodies. RTX (2 microg/ml, 0.1 ml) placed on the C1-C2 spinal cord (n=7) did not affect cSCS-induced %DeltaCBF (60.2+/-8.1% vs. 46.3+/-7.7%, P>0.05) and %DeltaCVR (-25.5+/-3.5% vs. -21.4+/-8.9%, P>0.05). However, i.v. RTX (2 microg/kg, n=9) decreased cSCS-induced %DeltaCBF from 65.0+/-9.5% to 27.4+/-7.2% (P<0.05) and %DeltaCVR from -28.0+/-7.6% to -14.8+/-4.2% (P<0.05). These results indicated that cSCS-increases in CBF and decreases in CVR occurred via rostral spinal dorsal column fibers and did not depend upon C1-C2 cell bodies. Also, our results suggested that cerebral but not spinal TRPV1 was involved in cSCS-induced cerebral vasodilation.
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Affiliation(s)
- X Yang
- Department of Pain Management, Xi'an Jiaotong University First Hospital, Xi'an, Shaanxi 710061, PR China.
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Wu M, Linderoth B, Foreman RD. Putative mechanisms behind effects of spinal cord stimulation on vascular diseases: a review of experimental studies. Auton Neurosci 2008; 138:9-23. [PMID: 18083639 PMCID: PMC2291393 DOI: 10.1016/j.autneu.2007.11.001] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Revised: 10/29/2007] [Accepted: 11/01/2007] [Indexed: 12/16/2022]
Abstract
Spinal cord stimulation (SCS) is a widely used clinical technique to treat ischemic pain in peripheral, cardiac and cerebral vascular diseases. The use of this treatment advanced rapidly during the late 80's and 90's, particularly in Europe. Although the clinical benefits of SCS are clear and the success rate remains high, the mechanisms are not yet completely understood. SCS at lumbar spinal segments (L2-L3) produces vasodilation in the lower limbs and feet which is mediated by antidromic activation of sensory fibers and decreased sympathetic outflow. SCS at thoracic spinal segments (T1-T2) induces several benefits including pain relief, reduction in both frequency and severity of angina attacks, and reduced short-acting nitrate intake. The benefits to the heart are not likely due to an increase, or redistribution of local blood flow, rather, they are associated with SCS-induced myocardial protection and normalization of the intrinsic cardiac nervous system. At somewhat lower cervical levels (C3-C6), SCS induces increased blood flow in the upper extremities. SCS at the upper cervical spinal segments (C1-C2) increased cerebral blood flow, which is associated with a decrease in sympathetic activity, an increase in vasomotor center activity and a release of neurohumoral factors. This review will summarize the basic science studies that have contributed to our understanding about mechanisms through which SCS produces beneficial effects when used in the treatment of vascular diseases. Furthermore, this review will particularly focus on the antidromic mechanisms of SCS-induced vasodilation in the lower limbs and feet.
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Affiliation(s)
- Mingyuan Wu
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73190, United States.
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Robaina F, Clavo B. Spinal cord stimulation in the treatment of post-stroke patients: current state and future directions. ACTA NEUROCHIRURGICA. SUPPLEMENT 2007; 97:277-82. [PMID: 17691387 DOI: 10.1007/978-3-211-33079-1_37] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
A decrease in cerebral blood flow (CBF) and brain metabolic activity are well-known complications of stroke. Spinal cord stimulation (SCS) is successfully being used for the treatment of several low-perfusion syndromes. The aim of this chapter is to describe the data that support the effect of SCS on CBF and the use of SCS in the treatment of stroke and cerebral low perfusion syndromes. In addition, we present our relevant studies. Since April 1995, we have assessed 49 non-stroke patients. The following parameters were measured pre- and post-stroke: (1) CBF in healthy contralateral tissue by single photon emission computed tomography (SPECT), (2) systolic and diastolic velocity in the middle cerebral artery (MCA) by transcranial Doppler, (3) blood flow quantification in the common carotid artery (CCA) by color Doppler, and (4) glucose metabolism in healthy contralateral tissue by positron emission tomography (PET). Our results showed that during cervical SCS there was a significant (p < 0.001) increase in systolic (> or =21%) and diastolic (>26%) velocity in the MCA, and CCA blood flow (> or =51%) as well as glucose metabolism (44%). We concluded that cervical SCS (cSCS) can modify CBF and brain metabolism. Its potential role in the management of stroke and low-perfusion syndromes is further investigated by experimental studies and reports describing clinical experience. Appropriate clinical trials are warranted.
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Affiliation(s)
- F Robaina
- Stereotactic and Functional Neurosurgery and Chronic Pain Unit & Research Unit, Las Palmas de Gran Canaria, Canary Islands, Spain.
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Upadhyaya CD, Sagher O. Cervical spinal cord stimulation in cerebral ischemia. ACTA NEUROCHIRURGICA. SUPPLEMENT 2007; 97:267-75. [PMID: 17691386 DOI: 10.1007/978-3-211-33079-1_36] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Spinal cord stimulation (SCS) is a well established therapy in the treatment for chronic pain. SCS has also been shown to increase peripheral blood flow and is now an accepted treatment in the management of ischemic limb pain and angina. There is a growing body of evidence that cervical spinal cord stimulation also increases cerebral blood flow (CBF) in both animal and human models. SCS could potentially impact on the treatment of cerebral vasospasm and stroke by an increase in CBEF The utility of SCS is also being explored in novel applications such as adjunctive tumor therapy, where resistance to therapy conferred by tissue hypoxia may be ameliorated by CBF augmentation.
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Affiliation(s)
- C D Upadhyaya
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
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Gurelik M, Kayabas M, Karadag O, Goksel HM, Akyuz A, Topaktas S. Cervical spinal cord stimulation improves neurological dysfunction induced by cerebral vasospasm. Neuroscience 2005; 134:827-32. [PMID: 16009502 DOI: 10.1016/j.neuroscience.2005.04.062] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2004] [Revised: 04/20/2005] [Accepted: 04/23/2005] [Indexed: 11/29/2022]
Abstract
The effect of cervical spinal cord stimulation on the cerebral blood flow has been investigated both experimentally and clinically since 1986. Although the effect of the spinal cord stimulation on cerebral ischemia induced by cerebral vasospasm after subarachnoid hemorrhage has been investigated widely, neurological dysfunction induced by cerebral vasospasm and the effect of the spinal cord stimulation on neurological dysfunction have not been investigated so far. The aim of this study is to investigate the neurological dysfunction induced by cerebral vasospasm after subarachnoid hemorrhage and whether the spinal cord stimulation improves this neurological dysfunction or not in New Zealand albino rabbits. The animals were divided into sham and experiment groups: Sham group. Motor evoked potentials were recorded before experimental procedure was performed in this group. Just after, intracisternal saline was injected and 3 days later a stimulation electrode was placed in the cervical epidural space. Motor evoked potentials were recorded but electrical stimulation was not applied. Experiment group. Firstly, motor evoked potentials had been recorded before experimental procedure was performed in also this group. After then a stimulation electrode was placed in the cervical epidural space of the animals in which subarachnoid hemorrhage procedure was performed 3 days ago. Motor evoked potentials were recorded both before and after spinal cord stimulation. Motor evoked potential latencies and amplitudes did not change in the sham operation group. But, motor evoked potential latencies extended and the amplitudes decreased in the experiment group before spinal cord stimulation. Spinal cord stimulation improved the changes occurring in latencies and amplitudes in the experiment group. Spinal cord stimulation improves the neurological dysfunction induced by cerebral vasospasm and motor evoked potentials recording is a reliable electrophysiological method to detect cerebral vasospasm and to assess the effects of different treatments in cerebral vasospasm.
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Affiliation(s)
- M Gurelik
- Department of Neurosurgery, Cumhuriyet University, Faculty of Medicine, 58140 Sivas, Turkey.
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