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Regnier-Golanov AS, Gulinello M, Hernandez MS, Golanov EV, Britz GW. Subarachnoid Hemorrhage Induces Sub-acute and Early Chronic Impairment in Learning and Memory in Mice. Transl Stroke Res 2022; 13:625-640. [PMID: 35260988 DOI: 10.1007/s12975-022-00987-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 01/06/2022] [Accepted: 01/11/2022] [Indexed: 12/20/2022]
Abstract
Subarachnoid hemorrhage (SAH) leads to significant long-term cognitive deficits, so-called the post-SAH syndrome. Existing neurological scales used to assess outcomes of SAH are focused on sensory-motor functions. To better evaluate short-term and chronic consequences of SAH, we explored and validated a battery of neurobehavioral tests to gauge the functional outcomes in mice after the circle of Willis perforation-induced SAH. The 18-point Garcia scale, applied up to 4 days, detected impairment only at 24-h time point and showed no significant difference between the Sham and SAH group. A decrease in locomotion was detected at 4-days post-surgery in the open field test but recovered at 30 days in Sham and SAH groups. However, an anxiety-like behavior undetected at 4 days developed at 30 days in SAH mice. At 4-days post-surgery, Y-maze revealed an impairment in working spatial memory in SAH mice, and dyadic social interactions showed a decrease in the sociability in SAH mice, which spent less time interacting with the stimulus mouse. At 30 days after ictus, SAH mice displayed mild spatial learning and memory deficits in the Barnes maze as they committed significantly more errors and used more time to find the escape box but still were able to learn the task. We also observed cognitive dysfunction in the SAH mice in the novel object recognition test. Taken together, these data suggest dysfunction of the limbic system and hippocampus in particular. We suggest a battery of 5 basic behavioral tests allowing to detect neurocognitive deficits in a sub-acute and chronic phase following the SAH.
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Affiliation(s)
| | - M Gulinello
- Rodent Behavior Core, Department of Neuroscience, Albert Einstein University, Bronx, NY, 10461, USA
| | - M S Hernandez
- Department of Neurosurgery, Houston Methodist Hospital, Houston, USA
| | - E V Golanov
- Department of Neurosurgery, Houston Methodist Hospital, Houston, USA
| | - G W Britz
- Department of Neurosurgery, Houston Methodist Hospital, Houston, USA.
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Karmonik C, Anderson JR, Beilner J, Ge JJ, Partovi S, Klucznik RP, Diaz O, Zhang YJ, Britz GW, Grossman RG, Lv N, Huang Q. Relationships and redundancies of selected hemodynamic and structural parameters for characterizing virtual treatment of cerebral aneurysms with flow diverter devices. J Biomech 2015; 49:2112-2117. [PMID: 26654675 DOI: 10.1016/j.jbiomech.2015.11.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 11/13/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE To quantify the relationship and to demonstrate redundancies between hemodynamic and structural parameters before and after virtual treatment with a flow diverter device (FDD) in cerebral aneurysms. METHODS Steady computational fluid dynamics (CFD) simulations were performed for 10 cerebral aneurysms where FDD treatment with the SILK device was simulated by virtually reducing the porosity at the aneurysm ostium. Velocity and pressure values proximal and distal to and at the aneurysm ostium as well as inside the aneurysm were quantified. In addition, dome-to-neck ratios and size ratios were determined. Multiple correlation analysis (MCA) and hierarchical cluster analysis (HCA) were conducted to demonstrate dependencies between both structural and hemodynamic parameters. RESULTS Velocities in the aneurysm were reduced by 0.14m/s on average and correlated significantly (p<0.05) with velocity values in the parent artery (average correlation coefficient: 0.70). Pressure changes in the aneurysm correlated significantly with pressure values in the parent artery and aneurysm (average correlation coefficient: 0.87). MCA found statistically significant correlations between velocity values and between pressure values, respectively. HCA sorted velocity parameters, pressure parameters and structural parameters into different hierarchical clusters. HCA of aneurysms based on the parameter values yielded similar results by either including all (n=22) or only non-redundant parameters (n=2, 3 and 4). CONCLUSION Hemodynamic and structural parameters before and after virtual FDD treatment show strong inter-correlations. Redundancy of parameters was demonstrated with hierarchical cluster analysis.
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Affiliation(s)
- C Karmonik
- MRI Core, Houston Methodist Research Institute, Houston, TX, USA; Cerebrovascular Center, Neurosurgery, Houston Methodist, Houston, TX, USA.
| | - J R Anderson
- MRI Core, Houston Methodist Research Institute, Houston, TX, USA
| | | | - J J Ge
- Siemens AX, Shanghai, China
| | - S Partovi
- Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - R P Klucznik
- Cerebrovascular Center, Radiology, Houston Methodist, Houston, TX, USA
| | - O Diaz
- Cerebrovascular Center, Radiology, Houston Methodist, Houston, TX, USA
| | - Y J Zhang
- Cerebrovascular Center, Neurosurgery, Houston Methodist, Houston, TX, USA
| | - G W Britz
- Cerebrovascular Center, Neurosurgery, Houston Methodist, Houston, TX, USA
| | - R G Grossman
- Cerebrovascular Center, Neurosurgery, Houston Methodist, Houston, TX, USA
| | - N Lv
- Neurosurgery, The Affiliated Changhai Hospital of Second Military Medical University, Shanghai, China
| | - Q Huang
- Neurosurgery, The Affiliated Changhai Hospital of Second Military Medical University, Shanghai, China
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Khan SA, Agrawal A, Hailey CE, Smith TP, Gokhale S, Alexander MJ, Britz GW, Zomorodi AR, McDonagh DL, James ML. Effect of surgical clipping versus endovascular coiling on recovery from oculomotor nerve palsy in patients with posterior communicating artery aneurysms: A retrospective comparative study and meta-analysis. Asian J Neurosurg 2014; 8:117-24. [PMID: 24403953 PMCID: PMC3877497 DOI: 10.4103/1793-5482.121671] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background: Oculomotor nerve palsy (OMNP) is a well-recognized complication of posterior communicating artery (PCOM) aneurysms. Only a few comparative studies have assessed the effect of clipping versus coiling on recovery from OMNP in PCOM aneurysms. A retrospective review and meta-analysis was conducted to assess the relationship between PCOM aneurysm treatment and OMNP. Materials and Methods: Medical records of all patients presenting between January 2000 and February 2013 with intracranial aneurysm were searched. All patients with OMNP secondary to PCOM aneurysm were included for analysis. Patients undergoing surgical clipping or endovascular coiling were compared with respect to complete resolution of OMNP after aneurysm surgery (i.e., primary outcome). A meta-analysis of published studies of OMNP associated with PCOM aneurysm was performed after a MEDLINE search. Results: Seventeen patients with OMNP secondary to PCOM aneurysms met the inclusion criteria. Surgical clipping (seven of eight patients, or 87.5%) resulted in greater complete resolution of OMNP compared with endovascular coiling (four of nine patients, or 44.4%), P = 0.13. A meta-analysis of similar studies revealed that complete resolution of OMNP was more commonly associated with surgical clipping (36 of 43 patients, or 83.7%) than with endovascular coiling (29 of 55 patients, or 52.7%), yielding an adjusted odds ratio (OR) of 6.04 [confidence interval (CI) =1.88-19.45, P = 0.003]. Multivariate analysis found that the degree of pre-operative OMNP (OR = 0.07, CI = 0.02-0.28, P = 0.001) and surgical clipping (OR = 6.37, CI = 1.73-23.42, P = 0.005) were significant factors that affected the complete recovery of OMNP. Conclusion: Complete recovery of OMNP with PCOM aneurysms is more commonly associated with surgical clipping than with endovascular coiling. Also, the degree of pre-operative OMNP and the treatment modality are significant factors that affect the complete recovery of OMNP.
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Affiliation(s)
- S A Khan
- Department of Anaesthesiology, Duke University Medical Centre, Durham, USA ; Department of Anaesthesiology, Singapore General Hospital, Singapore
| | - A Agrawal
- Department of Surgery (Neurosurgery) & Radiology, Duke University Medical Centre, Durham, USA
| | - C E Hailey
- University of North Carolina Medical School, Chapel Hill, North Carolina, USA
| | - T P Smith
- Division of Vascular and Interventional Radiology, Duke University Medical Centre, Durham, USA
| | - S Gokhale
- Department of Neurology, Division of Neurocritical Care, Duke University Medical Centre, Durham, USA
| | | | - G W Britz
- Department of Neurosurgery, Methodist Neurological Institute, Houston, Texas, USA
| | - A R Zomorodi
- Department of Surgery (Neurosurgery) & Radiology, Duke University Medical Centre, Durham, USA
| | - D L McDonagh
- Department of Anaesthesiology, Duke University Medical Centre, Durham, USA
| | - M L James
- Department of Anaesthesiology, Duke University Medical Centre, Durham, USA
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Nimjee SM, Powers CJ, Kolls BJ, Smith T, Britz GW, Zomorodi AR. Endovascular treatment of venous sinus thrombosis: a case report and review of the literature. J Neurointerv Surg 2010; 3:30-3. [DOI: 10.1136/jnis.2010.002469] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Kim GS, Amato A, James ML, Britz GW, Zomorodi A, Graffagnino C, Zomorodi M, Olson DM. Continuous and Intermittent CSF Diversion after Subarachnoid Hemorrhage: a Pilot Study. Neurocrit Care 2010; 14:68-72. [DOI: 10.1007/s12028-010-9401-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Natarajan SK, Sekhar LN, Ghodke B, Britz GW, Bhagawati D, Temkin N. Outcomes of ruptured intracranial aneurysms treated by microsurgical clipping and endovascular coiling in a high-volume center. AJNR Am J Neuroradiol 2008; 29:753-9. [PMID: 18184845 DOI: 10.3174/ajnr.a0895] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to analyze the 3-month outcomes of patients with aneurysmal subarachnoid hemorrhage (SAH) treated from January 2005 to June 2006. This paper describes the outcomes after treatment of aneurysmal SAH and comparison between patients treated by clipping or coiling in a high volume center. MATERIALS AND METHODS A retrospective chart review was performed of records of 195 consecutive patients with SAH. The overall outcome and the pretreatment variables predicting outcomes and the difference between the clipping and coiling groups were analyzed by logistic regression analysis. RESULTS A total of 105 (55%) patients had microsurgical clipping and 87 (45%) had endovascular coiling. At 3 months, 69% of patients recovered with no or mild disability. The predictors of a 3-month modified Rankin Scale (mRS) were Hunt and Hess (HH) grade on admission and the presence of intracerebral hemorrhage (ICH). Patients in the coiling group had worse admission grades; they had worse 3-month mRS (2.28 vs 1.73), but this was not significant when the groups were matched (P = .38). Vasospasm rate was significantly higher in the clipping group (66% vs 52%). The immediate incomplete occlusion rate of aneurysms was higher (21.7% vs 7.6%) in the coiling group. CONCLUSION The overall results of treatment of aneurysmal SAH have improved. There is no significant difference in the outcomes between the patients in the clipping and coiling groups.
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Affiliation(s)
- S K Natarajan
- Department of Neurological Surgery, University of Washington, Seattle, WA 98104, USA
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Sviri GE, Britz GW, Lewis DH, Ghodke B, Mesiwala AH, Haynor DH, Newell DW. Brainstem hypoperfusion in severe symptomatic vasospasm following aneurysmal subarachnoid hemorrhage: role of basilar artery vasospasm. Acta Neurochir (Wien) 2006; 148:929-34; discussion 934-5. [PMID: 16826319 DOI: 10.1007/s00701-006-0802-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2005] [Accepted: 05/02/2006] [Indexed: 11/24/2022]
Abstract
BACKGROUND The hemodynamic effects of vertebrobasilar vasospasm are ill defined. The purpose of this study was to determine the effects of basilar artery (BA) vasospasm on brainstem (BS) perfusion. METHODS Forty-five patients with delayed ischemic neurological deficits (DIND) following aneurysmal subarachnoid hemorrhage (SAH) underwent cerebral angiography prior to decision-making concerning endovascular treatment. BA diameter was compared with baseline angiogram. Regional brainstem (BS) cerebral blood flow (CBF) was qualitatively estimated by (99m)Tc ethyl cysteinate dimer single photon emission computed tomography (ECD-SPECT). FINDINGS Delayed BS hypoperfusion was found in 22 (48.9%) of 45 patients and BA narrowing of more than 20% was found in 23 (51.1%). Seventeen of 23 (73.9%) patients with BA narrowing of more than 20% experienced BS hypoperfusion compared to 6 of 22 (27.3%) patients with minimal or no narrowing (p = 0.0072). Patients with severe and moderate BS hypoperfusion had higher degree of BA narrowing compared to patients with normal BS perfusion and mild BS hypoperfusion (p < 0.001). The three-month outcome of patients n-22) with BS hypoperfusion was significantly worse compared to patients (n-23) with unimpaired (p = 0.0377, odd ratio for poor outcome 4, 1.15-13.9 95% confidence interval). INTERPRETATION These findings suggest that the incidence of BA vasospasm in patients with severe symptomatic vasospasm is high and patients with significant BA vasospasm are at higher risk to experience BS ischemia. Further studies should be done to evaluate the effects of endovascular therapy on BS perfusion and the impact of BS ischemia on morbidity and mortality of patients with severe symptomatic vasospasm.
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Affiliation(s)
- G E Sviri
- Department of Neurosurgery, Rambam (Maimonides Medical Center), Haifa, Israel.
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Edwards RJ, Britz GW, Critchley GR. Spontaneous resolution of an acute subdural haematoma. Br J Neurosurg 2002; 16:609-10. [PMID: 12617248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
- R J Edwards
- Department of Neurosurgery, Atkinson Morley's Hospital, London, UK.
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Abstract
Pseudotumour of the craniovertebral junction is an uncommon cause of high cervical myelopathy in the elderly. The anterior transoral approach is the preferred means of accessing these lesions. An "odontoid sparing" transoral approach, in which there is only minimal bone removal, is thought to preserve stability of the craniovertebral junction, obviating the need for posterior stabilisation. This report is of an 82 year old man who developed fatal atlanto-axial instability following an odontoid sparing transoral resection of a pseudotumour. This complication has not previously been described and its occurrence has important implications for the surgical management of this condition.
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Affiliation(s)
- R J Edwards
- Department of Neurosurgery, Frenchay Hospital, Bristol, UK.
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Srinivasan J, Ellenbogen RG, Britz GW, Newell DW. Techniques for cerebral bypass: practical laboratory for microvascular anastomosis. Neurosurg Clin N Am 2001; 12:509-17, viii. [PMID: 11390311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
The techniques used for microvascular anastomosis are best mastered in the laboratory setting. A variety of techniques for end-to-end and end-to-side anastomoses are described and illustrated. An understanding of these different modalities allows the surgeon to choose the appropriate technique for each clinical setting.
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Affiliation(s)
- J Srinivasan
- Department of Neurological Surgery, Northwestern University Medical School, Chicago, Illinois 60611, USA
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Srinivasan J, Britz GW, Newell DW. Cerebral revascularization for moyamoya disease in adults. Neurosurg Clin N Am 2001; 12:585-94, ix. [PMID: 11390316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Moyamoya disease is a rare entity that results in progressive occlusion of the arteries of the circle of Willis. In adults, this most commonly leads to intraventricular hemorrhage and less frequently to symptoms of ischemia. Without treatment, there is progressive deterioration of neurologic function and re-hemorrhage. Direct superficial temporal artery to middle cerebral artery bypass is considered the treatment of choice, although it's efficacy, particularly for hemorrhagic disease, remains uncertain.
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Affiliation(s)
- J Srinivasan
- Department of Neurological Surgery, Northwestern University Medical School, Chicago, Illinois 60611, USA
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McCall TD, Grant GA, Britz GW, Goodkin R, Kliot M. Treatment of recurrent peripheral nerve entrapment problems: role of scar formation and its possible treatment. Neurosurg Clin N Am 2001; 12:329-39. [PMID: 11525211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Surgical management of peripheral nerve entrapment syndromes is usually successful, but the recurrence of symptoms after initial improvement can and does occur. Extraneural fibrosis is one possible cause of recurrent peripheral nerve problems as a result of nerve compression or tethering. Several approaches to prevent extraneural scarring after surgery have been studied, including wrapping the involved nerve with a graft, the application of various chemical compounds, and radiation. ADCON-T/N, an antiscar bioabsorbable gel device was evaluated in a retrospective clinical review. Sixty-seven percent of patients treated with ADCON-T/N after reoperation of a peripheral nerve experienced prolonged clinical improvement compared with 50% of patients who did not receive ADCON-T/N. These preliminary results suggest that ADCON-T/N may prove to be clinically useful in the surgical treatment of peripheral nerve problems. Additional more rigorous clinical studies are necessary, however.
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Affiliation(s)
- T D McCall
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, USA
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Avellino AM, Britz GW, McDowell JR, Shaw DW, Ellenbogen RG, Roberts TS. Spontaneous resolution of a cervicothoracic syrinx in a child. Case report and review of the literature. Pediatr Neurosurg 1999; 30:43-6. [PMID: 10202308 DOI: 10.1159/000028760] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A child with near complete spontaneous resolution of a cervicothoracic syrinx and improvement in a Chiari type I malformation without surgical intervention is presented. The child was followed clinically with serial magnetic resonance (MR) imaging and has remained neurologically stable over an 11-year period. To our knowledge, only 3 pediatric cases of spontaneous resolution of a spinal cord syrinx as documented by MR imaging without surgical intervention have been reported. This case contributes to the literature on the natural history of syringes.
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Affiliation(s)
- A M Avellino
- Department of Neurological Surgery, University of Washington School of Medicine and Children's Hospital and Medical Center, Seattle, Wash. 98105, USA
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Abstract
BACKGROUND Traumatic leptomeningeal cyst as a complication of skull fractures was initially thought to occur primarily in the pediatric population. The occurrence of a traumatic leptomeningeal cyst in the adult population is rare. CASE DESCRIPTION A lump in the right parietal region of this 53-year-old man prompted a computed tomography (CT) scan. The patient denied any symptoms and was in good health. Examination confirmed a firm, nontender, nonpulsatile mass in the right parietal region of the skull. The CT scan demonstrated a 4 x 3 cm area of irregular bone destruction involving both the inner and outer table of the skull. At operation a distinctly raised paper-thin outer table was noted, and underneath was a soft, tan-colored mass, which measured approximately 2 x 2 cm and was connected to the underlying brain through a 1 cm dural defect. The extradural portion of the mass was amputated, the dura repaired with a pericranium patch, the skull defect was repaired with a split thickness bone graft, and the final pathology was congruent with gliotic brain. CONCLUSION Although rare, this case demonstrates a traumatic leptomeningeal cyst in an adult.
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Affiliation(s)
- G W Britz
- Department of Neurological Surgery, University of Washington Medical Center, Seattle 98195, USA
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Abstract
The percutaneous placement of ventriculoatrial (VA) shunts has been previously described, usually in adults. We report a series of 7 pediatric cases ranging from 6 to 17 years. Five patients were female and 2 were male. All patients had prior ventriculoperitoneal (VP) shunts for hydrocephalus, of which 1 had been subsequently converted to a ventriculopleural shunt. Indications for conversion to a VA shunt were intra-abdominal infection in 6 cases and chronic pleuritic chest pain in 1 patient. The venous entry was the subclavian vein in all cases. All patients have remained asymptomatic since the operation. There were no complications associated with the procedures, with follow-up ranging from 2 to 12 months. This technique is a viable alternative to the open cervical approach for venous entry to the right atrium in the pediatric population.
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Affiliation(s)
- G W Britz
- Department of Neurosurgery, University of Washington School of Medicine, Wash., USA
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Baxter AB, Nevitt AW, Britz GW. Cerebral infarct in a victim of vehicular polytrauma. AJR Am J Roentgenol 1998; 170:506. [PMID: 9456975 DOI: 10.2214/ajr.170.2.9456975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- A B Baxter
- Department of Radiology, Harborview Medical Center, Seattle, WA 98104, USA
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Abstract
Diffuse villous hyperplasia of the choroid plexus, which is distinct from bilateral choroid plexus papillomas, is extremely rare and is often associated with hydrocephalus due to the overproduction of cerebrospinal fluid (CSF). The authors describe an infant with hydrocephalus, diagnosed by computerized tomography scanning, who developed ascites following placement of a ventriculoperitoneal shunt and, subsequently, demonstrated excessive CSF production when the shunt was externalized. The patient was later successfully treated by placement of a ventriculoatrial shunt. Magnetic resonance imaging demonstrated diffuse villous hyperplasia of the choroid plexus as the cause of the patient's hydrocephalus. The literature on diffuse villous hyperplasia of the choroid plexus is reviewed.
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Affiliation(s)
- G W Britz
- Department of Neurological Surgery, University of Washington School of Medicine and Children's Hospital Medical Center, Seattle, USA
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Britz GW, Haynor DR, Kuntz C, Goodkin R, Gitter A, Maravilla K, Kliot M. Ulnar nerve entrapment at the elbow: correlation of magnetic resonance imaging, clinical, electrodiagnostic, and intraoperative findings. Neurosurgery 1996; 38:458-65; discussion 465. [PMID: 8837796 DOI: 10.1097/00006123-199603000-00007] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The diagnosis of ulnar nerve entrapment at the elbow has relied primarily on clinical and electrodiagnostic findings. Recently, magnetic resonance imaging (MRI) has been used in the evaluation of peripheral nerve entrapment disorders to document signal and configuration changes in nerves. We performed a prospective study on a population of 31 elbows in 27 patients with ulnar nerve entrapment at the elbow. The study correlated MRI findings with clinical, electrodiagnostic, and operative findings. A control population consisting of 10 asymptomatic subjects also was studied by MRI. Electrodiagnostic evaluation confirmed ulnar neuropathy in 24 (77%) elbows of the 31, with localization to the elbow region in 21 (68%). MRI, using a short tau inversion recovery sequence, demonstrated increased signal of the ulnar nerve in 30 (97%) elbows of the 31 and enlargement of the ulnar nerve in 23 (74%). No MRI abnormalities were found in the control population. MRI signal increase of the ulnar nerve occurred an average of 27 mm proximal to the distal humerus and extended distally an average of 4 mm below the distal humerus. The mean total length of increased ulnar nerve signal was 34 mm. Ulnar nerve enlargement occurred an average of 19 mm proximal to the distal humerus and extended distally an average of 8 mm above the distal humerus. The mean total length of ulnar nerve enlargement was 12 mm. The 12 patients who underwent a surgical procedure for ulnar nerve entrapment were found to have ulnar nerve compression, with 9 (75%) having excellent and 3 (25%) having good postoperative results. In this study, MRI was both sensitive and specific in diagnosing ulnar nerve entrapment at the elbow as defined by clinical, electrodiagnostic, and operative findings.
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Affiliation(s)
- G W Britz
- Department of Neurological Surgery, University of Washington, and Seattle Veterans Administration Medical Center, USA
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Britz GW, Haynor DR, Kuntz C, Goodkin R, Gitter A, Kliot M. Carpal tunnel syndrome: correlation of magnetic resonance imaging, clinical, electrodiagnostic, and intraoperative findings. Neurosurgery 1995; 37:1097-103. [PMID: 8584150 DOI: 10.1227/00006123-199512000-00009] [Citation(s) in RCA: 83] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
We undertook a prospective study of 43 wrists in 32 patients who had been clinically diagnosed as having carpal tunnel syndrome (study group) and 5 wrists in people who had no symptoms (control group), correlating the clinical, electrodiagnostic, intraoperative, and magnetic resonance imaging (MRI) findings. MRI of the carpal tunnel and thenar eminence was performed, using coronal and axial T1- and T2-weighted, proton density, and short tau inversion recovery sequences. Abnormalities of the median nerve, as revealed by MRI, were found in 43 of 43 (100%) wrists in the study group and in 0 of 5 (0%) wrists in the control group. Increased signal of the median nerve was seen in 41 of 43 (95%) wrists, increased signal of the flexor tendon sheath in 41 of 43 (95%), volar bowing of the flexor retinaculum in 39 of 43 (91%), increased distance between the flexor tendons in 37 of 43 (86%), and abnormal nerve configuration in 28 of 43 (65%). Increased short tau inversion recovery signal of the thenar muscles was found in 5 of 43 (12%) wrists, all of which had undergone severe denervation changes, as revealed by electromyography. Operative release was performed for 27 of 43 (63%) wrists, and follow-up was obtained for 42 of 43 (98%). A good or excellent postoperative outcome resulted for 20 of 27 (74%) patients, a fair outcome for 2 of 27 (7%), and a poor outcome for 4 of 27 (15%), and 1 of 27 (4%) patients was lost to follow-up. For patients undergoing carpal tunnel release whose MRI revealed an abnormal nerve configuration, the outcome was improved, with good or excellent results in 15 of 18 (83%) patients. No association with outcome was seen with median nerve or flexor tendon signal changes, increased interspace between the flexor tendons, or flexor retinaculum bowing. Our results indicate that MRI is a sensitive diagnostic modality that can demonstrate signal and configurational abnormalities of the median nerve in patients diagnosed with carpal tunnel syndrome. Increased signal of the thenar muscles, as revealed by MRI, using short tau inversion recovery sequences, occurs only in muscles that have undergone severe denervation changes, as revealed by electromyography.
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Affiliation(s)
- G W Britz
- Department of Neurological Surgery, University of Washington, Seattle, USA
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