This is the first study to demonstrate the in vivo mechanisms of intracranial aneurysm formation. The inflammatory response that follows endothelial injury is the basic step in the pathogenesis of these lesions. In this study the investigators have expanded the understanding of the origin of intracranial aneurysms and have contributed to the further development of measures to prevent and treat aneurysms.
Introduction: Since the introduction of MRI, the incidence of Chiari I malformations (cerebellar tonsils ectopia) has increased. The clinical significance of this finding remains questionable in some instances. Recently, cine flow MRI has added to the understanding of the dynamics of cerebrospinal fluid at the craniocervical junction and to the pathophysiology of the Chiari I malformation. The present study attempts to analyze the role of cine flow MRI in Chiari I malformations. Materials and methods: Between January 1990 and December 2000, 24 patients were identified who met the following inclusion criteria: patients diagnosed with Chiari I malformation who had had an MRI of the brain including the craniocervical junction, clinical follow-up for at least six months, and cine flow studies had to have been performed preand postoperatively. The cine flow studies were repeated during followup if the patients were not surgical candidates. Patients harboring intracranial space occupying lesions or lumboperitoneal shunts were excluded. Sixteen of the 24 selected patients underwent 18 operations and 8 were followed conservatively. There was a wide variation in clinical presentations. Twelve patients had cerebellar tonsils protruding more than 5 mm below the foramen magnum, and in 12 patients the descent of the cerebellar tonsils was less than
Objective: Craniotomy and evacuation is the standard treatment of acute epidural hematoma (EDH). Here, the authors report their experience in nonoperative management of acute EDH in children with mild head injury. Methods: The authors retrospectively reviewed charts of patients with conservatively treated EDH at the Department of Neurosurgery, King Abdulla University Hospital, Irbid, Jordan, between August 2003 and October 2007. All patients had a Glasgow Coma Scale score of 14 or 15, and an initial computerized tomography (CT) scan demonstrating an EDH with or without skull fractures. Follow-up included neurological examination and brain CT. Results: Six children (3 boys, 3 girls) with acute EDH were successfully managed at our department without surgical intervention. The Glasgow Outcome Scale score of all patients was 5, with no posttraumatic sequelae. Follow-up brain CT showed complete resolution of the EDH within 2–3 months. Conclusions: Our results demonstrated that pediatric EDH can be managed nonoperatively. The pronounced increase in the number of CT examinations for patients with head injuries has resulted in a greater proportion of EDH detected in conscious patients. We recommend such treatment be performed in specialized pediatric neurosurgical centers under close neurological observation.
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