Preoperative measurement of acetazolamide-induced changes in CBF, which is performed using SPECT scanning, can be used to identify patients at risk for hyperperfusion after CEA. In addition, post-CEA monitoring of CBF performed using SPECT scanning results in the timely and reliable identification of patients at risk for hyperperfusion syndrome.
Although various biomaterials such as ceramics or titanium alloy are widely used in neurosurgery, the susceptibility artifacts that appear around these materials cause problems when a magnetic resonance (MR) imager is used to assess lesions after surgery. The purpose of the present study was to quantify the susceptibility artifacts produced by various biomaterials used for neurosurgical implants. Using a 3-tesla MR imaging unit, we obtained MR images of various biomaterials, including six types of ceramics, a cobalt-based alloy (Elgiloy), pure titanium, a titanium alloy, and stainless steel. All implants shared a uniform size and shape. In each image, a linear region of interest was defined across the center of the biomaterial in the transverse direction, and the diameter of the susceptibility artifact was calculated. The ceramics produced a considerably smaller artifact diameter than those produced by other biomaterials. Among the types of ceramics, zirconia was found to produce the smallest artifact diameter. Among the remaining biomaterials, the diameters of the artifacts decreased in order from that associated with stainless steel to those associated with cobalt-based alloys, pure titanium, and titanium alloy. Little difference was observed between the artifact diameters associated with pure titanium and titanium alloy. Ceramics are the most suitable biomaterials for minimizing artifacts in high-field MR imaging.
Magnetic resonance (MR) imaging is an important diagnostic tool for neurosurgical diseases but susceptibility artifacts caused by biomaterial instrumentation frequently causes difficulty in visualizing postoperative changes. The susceptibility artifacts caused by neurosurgical biomaterials were compared quantitatively by 0.5, 1.5, and 3.0 Tesla MR imaging. MR imaging of uniform size and shape of pieces ceramic (zirconia), pure titanium, titanium alloy, and cobalt-based alloy was performed at 0.5, 1.5, and 3.0 Tesla. A linear region of interest was defined across the center of the biomaterial in the transverse direction, and the susceptibility artifact diameter was calculated. Susceptibility artifacts developed around all biomaterials at all magnetic field strengths. The artifact diameters caused by pure titanium, titanium alloy, and cobalt-based alloy increased in the order of 0.5, 1.5, to 3.0 Tesla magnetic fields. The artifact diameter of ceramic was not influenced by magnetic field strength, and was the smallest of all biomaterials at all magnetic field strengths. The artifacts caused by biomaterials except ceramic increase with the magnetic field strength. Ceramic instrumentation will minimize artifacts in all magnetic fields.
The relatively high rate of post-operative recurrence in the treatment of chronic subdural hematoma (CSDH) is a significant problem. Goreisan is an herbal medicine that exhibits a hydragogue effect by inhibiting the expression of aquaporins, and its efficacy in preventing post-operative CSDH recurrence has been suggested by several case trials. This multi-center prospective randomized controlled trial was performed to investigate the preventative effect of goreisan on post-operative CSDH recurrence. Patients with symptomatic CSDH over 60 years old undergoing burr hole surgery were enrolled in this study. The patients were randomly allocated to the control group or the goreisan group, in which oral administration of goreisan (7.5 g daily) was continued for 12 weeks. The primary end-point was the post-operative recurrence rate at 12 weeks and the secondary end-point was hematoma volume reduction rates on computed tomography scan at 12 weeks. The analyses were performed not only on patients of all ages older than 60 years, but also on patients divided into those over or under 75 years old. One hundred and eighty patients were followed and analyzed (the control group, n = 88; the goreisan group, n = 92). The recurrence rates considering patients of all ages and patients under 75 years old were relatively low in the goreisan group but without a significant difference. The hematoma volume reduction rates showed no significant difference. Based on the results of the present study, a larger-scale study including more cases is necessary in future to confirm the efficacy of goreisan.
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