Adjuvant hyperbaric oxygen treatment of acute brain herniation after microsurgical clipping of a recurring cerebral aneurysm: a case report

Introduction: Acute brain herniation is a life-threatening neurological condition that occasionally develops due to severe complications following cerebral aneurysm clipping. Strategies for managing acute brain herniation have not improved substantially during the past decade. Hyperbaric oxygen treatment (HBOT) may alleviate harmful effects of cerebral hypoxia, which is one of the most important pathophysiological features of acute brain herniation and, therefore, may be useful as an adjuvant therapy for acute brain herniation. A case treated with adjuvant HBOT is reported. Case report: A 60-year-old asymptomatic man presented with a recurring left middle cerebral artery bifurcation aneurysm with previous stent-assisted embolisation. After craniotomy for surgical clipping of the aneurysm, disturbance of consciousness and right hemiplegia occurred. Computed tomography (CT) images suggested simultaneous cerebral ischaemia and intracranial haemorrhage. Pharmacologic treatment resulted in no improvement. A CT scan acquired five days after surgery showed uncal and falcine herniation. HBOT was administered five days after surgery, and the patient’s condition dramatically improved. He became conscious, and his hemiplegia improved following seven sessions of HBOT. Simultaneously, CT images showed regression of the acute brain herniation. Conclusions: The patient had recovered completely at one year post-treatment. HBOT may be effective in the treatment of acute brain herniation following cerebral aneurysm clipping.

De novo aneurysm formation after the contralateral middle cerebral aneurysm clipping operation: a case report and review of literature

A left middle cerebral artery aneurysm was ruptured and clipped, but a de novo aneurysm on contralateral side ruptured within 5 years in a 38-year-old man. The cause of the formation of de novo aneurysms is unknown and is not consistent with most of current reports.

Effect and Mechanism of Lidocaine Pretreatment Combined with Dexmedetomidine on Oxidative Stress in Patients with Intracranial Aneurysm Clipping

This study aimed to explore the effect and mechanism of lidocaine pretreatment combined with dexmedetomidine on oxidative stress in patients with intracranial aneurysm clipping. Many studies have used various drugs such as lidocaine to explore the effect and mechanism of lidocaine pretreatment. A total of 80 patients with intracranial aneurysm clipping surgery were randomly divided into 4 groups: the single lidocaine group, single dexmedetomidine group, lidocaine combined with dexmedetomidine group, and control group. The thread embolism method was used to establish a stable intracranial aneurysm model of Hashimoto rats. Fifty adult rats were randomly divided into a sham operation group, ligation of the left common carotid artery and bilateral posterior branch of renal artery, lidocaine group, dexmedetomidine group, and lidocaine combined with dexmedetomidine group. The colorimetric method was used to determine the oxidative stress indicators in brain tissue: MDA content, SOD activity, and T-AOC content. The western blot method characterized the protein levels related to oxidative stress: nNOS, iNOS, and NADPH oxidase subunits p22phox, gp91phox, and p47phox. The differences in each index between the groups were statistically significant ( P < 0.05 ). Animal experiment results revealed that the content of MDA in the brain tissue of rats in the LD group was significantly lower than that in the single-drug group and sham group. The T-AOC and SOD concentrations in the LD group were significantly higher than those in the single-drug group and sham group, and the differences between the groups were statistically significant ( P < 0.05 ). The protein expression of the LD group was significantly lower than that of the drug-alone group and model group, and the difference between groups was statistically significant ( P < 0.05 ). To sum up, lidocaine pretreatment combined with dexmedetomidine can effectively maintain the hemodynamic stability of patients with intracranial aneurysm clipping and reduce postoperative oxidative stress response. Its mechanism of action may be related to the inhibition of oxidative stress damage mediated by nNOS, iNOS, and p22phox, gp91phox, and p47phox in the hippocampus. Our study has significant and applicable medical aspects in lidocaine pretreatment combined with dexmedetomidine on oxidative stress in patients.

Surgical treatment of patients with combined oncological and vascular pathology of the brain

The aim of the study were describing the results of surgical treatment of patients with combined oncological and vas‑ cular pathology of the brain and analyzing the scientific literature on the treatment of such combined diseases.Materials and methods. Four patients who underwent surgery for combined oncological and vascular brain pathology in 2020 year in Federal Center for Brain and Neurotechnology and in Sklifosovsky Research Institute of Emergency Care. A review of the literature on the features of the treatment of this category of patients was carried out.Results. Surgery of such combinations is not routine for neurosurgeons; each case deserves special attention. We operated on two patients simultaneously, оne – aneurysm clipping and radiosurgical treatment of the tumor were performed.

Improving Neurosurgery Resident Microdissection Through Placental Simulation

ABSTRACT Prior work has shown that the human placenta is an available and realistic model for microdissection simulation. We sought to find a measurable improvement in the technical skills of neurosurgical residents with deliberate practice of microdissection tasks using a placental model. Postgraduate year (PGY) 1 to 3 neurosurgery residents were consented. A 1-min video of each participant's baseline skills skeletonizing placental vessels was recorded. Participants underwent 10 practice sessions with intermittent informal feedback for 30-60 min over 18 mo. Another 1-min video was recorded following the 10th dissection. The videos were blinded and assessed by 3 board eligible or certified microsurgical neurosurgeons using a modified Objective Structured Assessment of Aneurysm Clipping Skills. Performance was compared via t-testing among four domains: instrument handling, time flow and forward planning, quality of dissection, and respect for tissue. Microdissection, instrument handling, and quality of dissection were significantly improved after deliberate practice with the placental simulator (P &lt; .05). Improvement was seen in time flow and forward planning and respect for tissue; however, this failed to be significant. Subjectively, residents expressed enjoyment performing the exercise. They also expressed a desire for demonstrations or videos to watch before practice sessions. The placental simulation model provides microsurgical skill development with minimal deliberate practice sessions. Practice exercises are favorably regarded and interest in continuing them is strong by residents. Residents expressed a desire to make the dissection more deliberate with demonstration, breakdown of steps, and mimicry, which could improve the effectiveness and enjoyment of the skills session.

Aplastic or twig-like middle cerebral artery harboring unruptured cerebral aneurysms treated by clipping and bypass surgery: illustrative case

BACKGROUND Aplastic or twig-like middle cerebral artery (Ap/T-MCA) is a congenital MCA anomaly. It may present with symptoms of both hemorrhage and ischemia, similar to moyamoya disease, and hemodynamic stress may play an essential role in the development of symptoms in both clinical entities. The optimal treatment remains controversial in symptomatic patients with Ap/T-MCA. This report discussed the treatment method for a patient with Ap/T-MCA with unruptured aneurysms who presented with intraventricular hemorrhage (IVH) treated by aneurysm clipping and bypass surgery. OBSERVATIONS In a 46-year-old woman with a sudden headache, computed tomography showed left IVH. Magnetic resonance angiography showed a left MCA aneurysm and MCA trunk stenosis. Three-dimensional angiography demonstrated a plexiform arterial network and multiple aneurysms arising from the MCA and in the plexiform network, leading to the diagnosis of Ap/T-MCA harboring unruptured aneurysms. The patient was successfully treated by craniotomy with aneurysm clipping and bypass surgery to prevent further intracranial hemorrhages and/or aneurysm rupture. LESSONS Especially in cases such as Ap/T-MCA, in which hemodynamic stress has a significant effect, the optimal treatment method should be based on vascular morphology and the impact of hemodynamic stress.