International Journal of Neurology and Neurosurgery

Objective: The goal of this study was to investigate the markers of the endothelial cell disorder after  subarachnoid hemorrhage (SAH) and the impact of open and endovascular surgery to the vasculature after SAH. Methods: 50 patients were enrolled in this prospective study. 25 patients underwent open surgery and Guglielmi detachable coil embolization, respectively. Serial blood samples were collected on post SAH days 0, 1, 7, and 14. von Willebrand factor (vWF), plasminogen activator inhibitor-1 (PAI-1), E-selectin levels were determined as markers of endothelial cell perturbation. The levels of 6-keto prostaglandin F1 alpha (6-ktPG) were measured as a marker of endothelial cell function. Results: The symptomatic vasospasm was observed in nine patients (six in open surgery and three in endovascular surgery). In both treatment strategies,the serum levels of vWF were elevated from day 0 to day 14. Serum levels of PAI-1 and E-selectin were higher in open surgery than endovascular surgery in day 7 and 14 significantly (p<0.05).The serum levels 6-ktPG were  higher in endovascular surgery than open surgery in day 4 and 7 significantly (p<0.05). Conclusion: Elevation of parameters on endothelial perurbation and coagulopathy were recognized in both procedures.The inhibition of fibrinolysis by PAI-1, theexpression of adhesion molecule, and endothelial dysfunction were  higher in open surgery than endovascular surgery. This preliminary result suggests that endothelial disorder associated with open surgical procedure may be predominant than endovascular surgery. running title: Endothelial disorder after SAH.

Keywords: endothelial disorder, subarachnoid hemorrhage, endovascular surgery, surgery, open surgery, vasospasm.

The surgical management issues of 157 cases of trigeminal neurinoma treated over a 20-year period were analyzed. The case records and radiologic material of these patients who were operated on in the Neurosurgery Department at King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, between the year 1989 and 2009 were retrospectively analyzed. The appropriateness of the selected surgical route is studied. Apart from the other typical presenting features of trigeminal schwannoma, 12 patients presented with the rarely reported symptom of pathologic laughter. Three approaches were found appropriate to treat these tumors: the infratemporal fossa interdural approach, the lateral and anterior basal subtemporal approach, and the retrosigmoid approach. For tumors extending extracranially, a ‘reverse skull base approach’ that involved basal temporal craniotomy was used. In 129 (82%) cases, total tumor excision was achieved. Two patients died during the postoperative period. During an average follow-up of 52 months, there has been a recurrence in 5 cases. Radical surgery is associated with an excellent clinical outcome and long-term tumor control. A majority of tumors, even those that are large and multicompartmental, can be removed in a single surgical stage and exposure.

Key Words: gasserian ganglion, retrosigmoid approach, subtemporal approach, trigeminal neurinoma  

Aspergillus fumigatus is the most common human pathogen in the genus spergillus.Intracranial granulomas, abscesses, and blood vessel invasion are characteristic features of aspergillosis.Presenting features are those of focal neurologic deficits due to intracranial mass lesions. Paranasal sinus or repiratory tract fungal infection is usually concomitant. Aggressive surgical excision combined with systemic antifungal therapy is the mainstay of treatment. Liposomal preparation of amphotericin B offers better penetration of the drug with reduced side effects. The prognosis  for central nervous system aspergillosis is poor and the disease is usually fatal.

Key words: Aspergilloma, brain, fungi, amphotericin