We have an important and instructive review article in this issue from Prof Robert F Spetzler, Professor of Neurosurgery, University of Arizona, entitled “Surgical Treatment of Brainstem Cavernous Malformations.” Brainstem cavernous malformations are particularly challenging to contemporary neurosurgeons. The article reviews the natural history and surgical outcome of these lesions, and discusses the surgical approaches used. They concluded that despite the challenging location of these lesions in the brainstem, appropriately selected lesions can be resected surgically with acceptable rates of morbidity and mortality.
Tsuei et al reported 8 cases of paired aneurysms involving fenestrated vertebrobasilar junction and demonstrated the flow patterns of the paired aneurysms by qualitative computational fluid dynamics (CFD) analysis. Flow simulations by CFD were consistent with the angiographic findings. They concluded intrinsic wall defects at fenestrated vertebrobasilar junction and specific hemodynamic stresses from 2 inflows may contribute to the formation of a pair of dumbbell-shaped aneurysms.
Huang and Liu et al retrospectively analyzed the clinical symptoms and neuroradiologic findings in 73 patients who had a spontaneous arterial dissection of cervicocranial vessels verified by angiographic or magnetic resonance imaging. There are 24 cases in the anterior circulation group and 49 cases in the posterior circulation. The leading presentation in the anterior circulation group was ischemic stroke (79.2%), and in the posterior circulation group, it was subarachnoid hemorrhage (44.9%) followed by ischemic stroke (42.8%). All the cases except 1 with ischemic stroke or headache were conservatively treated with anticoagulants or antiplatelets. Surgical or endovascular intervention was performed on 18 cases. None had rebleeding. They advocated aggressive treatment for those with subarachnoid hemorrhage to prevent rebleeding.
Liu et al reported a preliminary study of neuromodulation on cervical spinal cord combined with hyperbaric oxygen in comatose patients. Severe brain injury remains in a substantial number of survivors who then developed to a vegetative state. Both spinal cord stimulation and hyperbaric oxygen therapy have shown some benefits in the treatment of comatose patients. In this study, 12 patients with prolonged consciousness impairment received cervical spinal cord stimulation for 1 year combined with simultaneous hyperbaric oxygen therapy for the first 3 months. Improvement of GCS score, cerebral blood perfusion, and persistent vegetative state score were observed in these 12 comatose patients after the combined treatment.
Wang and Choy et al reported the characteristics of bicycle-related head injury among school-aged children in the Taipei area. The authors collected the basic patient information of those with bicycle-related head injuries from 5 hospitals in the Taipei area. Because global warming is getting more and more serious, the issue of energy conservation and carbon reduction has become very important. The bicycle is the only transport vehicle that saves energy and does not emit carbon. Furthermore, bicycling has become a popular leisure sport. However, bicycle infrastructures are notoriously inadequate and bikeway facilities are not well equipped in Taiwan. Consequently, bicycle-related accidents and injuries have increased drastically. The authors emphasized the enforcement of bicycling infrastructure and bicycling safety programs to reduce the related injuries.
Yang et al advocate an alternative option in the treatment of acute ruptured small aneurysms embolized with an undersized coil. They reported 12 patients with acute ruptured small aneurysms (2-3 mm in size) treated with a single coil embolization, and all obtained successful results without procedure-related complications. They concluded that embolization with undersized coil packing with loose coil core could provide protection from rebleeding for very small ruptured aneurysms.
Chen and Tsai et al studied the epidemiology of patients who received international medical repatriation in Taiwan. The number of people traveling abroad has increased markedly in Taiwan in recent years. Air medical transportation will be necessary when local medical facilities do not approximate the international standard. Furthermore, the medical repatriation expense is covered by the national health insurance. Chen and Tsai et al studied the predominance of disease patterns accounting for the major aeromedical transportation. Neurologic diseases are the reason for most of the Taiwanese patients who require medical transportation, because these conditions need more timely and safer aeromedical transport than other diseases. Well-trained medical escorts and comprehensive logistic arrangements are necessary and essential for safe and effective medical transportation.
Brain tissue scarring (gliosis) was believed to be the major cause of epileptic focus after brain injury, and prevention of scarring could reduce the incidence of seizure. Lin et al used the 3% hyaluronic acid gel coating on the cortical brain defect of Sprague-Dawley rats to reduce the marginal glial scarring. The study demonstrated that hyaluronic acid could inhibit glial scarring both in thickness and in the number of glial cells. However, the amount of hyaluronic acid to obtain adequate inhibition of scarring needs further investigation.
Lin and Yang et al reported that biochemical alteration in CSF precedes behavioral deficits in Parkinsonian rats induced by 6-hydroxydonamine. They infused different doses of 6-hydroxydonamine into the medial forebrain bundle of rats bilaterally and examined the animals' movement behaviors, biomechemical alterations in CSF, and dopaminergic neuronal number in the substantia nigra pars compacta (SNpc). The study demonstrated that animals with more than 70% dopaminergic neuronal loss in the SNpc exhibited behavioral bradykinesia and rigidity, and a decrease of homovanillic acid in CSF. The results suggest that monitoring homovanillic acid level in CSF may allow early detection of the loss of dopaminergic neurons in the SNpc preceding the onset of Parkinsonian symptoms in humans.
Traumatic brain injuries (TBIs) are a major cause of disability and death in accidents. The Brain Trauma Foundation published the guidelines for the management of severe TBI. However, there are some different views on trauma mechanisms, pathogenesis, and management in different areas. Individualized guidelines for different countries would be necessary. Liao and Chiu et al organized a committee from the Taiwan Neurotrauma Society to be responsible to complete the first evidence-based, clinical practice guidelines for severe TBIs. The guidelines will provide concepts and recommendations to promote the quality of care for patients with severe TBIs in Taiwan.
Lee et al evaluated the systemic and local effects of a copolymer bone hemostatic agent (Ostene) on a bony defect in a rabbit model. The Ostene was cleared by the US Food and Drug Administration for use as an implant and for control of bleeding from bone surfaces. The material was water-soluble alkylene oxide copolymers, which are eliminated via the kidney. The authors studied systemic and local inflammatory reactions of rabbits treated with Ostene. They concluded that Ostene is absorbable and induces neither systemic inflammation (including renal function) nor local inflammation in rabbits, and possesses the potential to replace bone wax for bone hemostasis.
Fay et al reported they first used fibrin glue as an embolic agent for intralesional injection into a large holovertebral aneurysmal bone cyst of the axis. The intralesional injection of fibrin glue effectively reduces blood loss during surgery and allows successful 1-stage posterior resection of the aneurysmal bone cyst.
We are deeply concerned about the news declared by the publisher of Surgical Neurology that at the end of December 2009, the journal would have a new editor and editorial board, and Surgical Neurology would no longer be published by Elsevier. The journal World Neurosurgery with Michael L. J. Apuzzo as Editor-in-Chief would be published by Elsevier. Surgical Neurology has been a well-known, established international journal with a long history and steady progression, with the impact factor rising from 0.34 to 1.54 in recent years.
It has been 1 of the 4 leading neurosurgical journals in the world. The publication of the supplements from various local societies in countries around the world is a particularly unique feature of Surgical Neurology. This publication policy greatly facilitates the communication of basic research and clinical experience of neuroscience among different countries. This policy is something that cannot and should not be taken lightly. We emphasize that this unique tradition should be maintained and continued under any circumstances.
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