Monday, February 11, 2013

Neurological surgery: The influence of physical and mental demands on humans performing complex oper

Available online 8 February 2013
Publication year: 2013
Source:Journal of Clinical Neuroscience

Performing neurological surgery is an inherently demanding task on the human body, both physically and mentally. Neurosurgeons routinely perform "high stakes" operations in the setting of mental and physical fatigue. These conditions may be not only the result of demanding operations, but also influential to their outcome. Similar to other performance-based endurance activities, training is paramount to successful outcomes. The inflection point, where training reaches the point of diminishing returns, is intensely debated. For the neurosurgeon, this point must be exploited to the maximum, as patients require both the best-trained and best-performing surgeon. In this review, we explore the delicate balance of training and performance, as well as some routinely used adjuncts to improve human performance.








Júlio Leonardo B. Pereira
Phone: (+1) 424-2301706
Linkedin:http://www.linkedin.com/in/juliommais 
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Structural and functional brain changes related to different types of physical activity across the l

Available online 8 February 2013
Publication year: 2013
Source:Neuroscience & Biobehavioral Reviews

Physical activity has been shown to improve cognitive functioning. Research has largely focused on cognitive facilitation by cardiovascular exercise in older adults. Only few studies have investigated younger age groups or other types of physical activity. In this paper we review and summarize common results found in recent studies of metabolic (i.e. cardiovascular and resistance) and coordinative exercise. Findings from human motor learning are utilized to complement results on coordinative exercise. Results show that both types of exercise affect the brain differently. We propose possible mechanisms by which physical activity facilitates cognitive performance by briefly reviewing microscopic structural changes in animal research. Lastly, we highlight open research questions.

Highlights

► Review of imaging studies targeting effects of physical activity on cognition. ► Evidence from structural, functional and connectivity data in different age groups. ► Discriminative results for metabolic and coordinative exercise. ► Motor learning research compliments findings of coordination studies.







Júlio Leonardo B. Pereira
Phone: (+1) 424-2301706
Linkedin:http://www.linkedin.com/in/juliommais 
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The Evolution of Endovascular Treatment of Carotid Cavernous Fistulas: A Single-Center Experience

Available online 9 February 2013
Publication year: 2013
Source:World Neurosurgery

Object Carotid-cavernous fistulas (CCFs) are pathologic arteriovenous shunts between the carotid artery and cavernous sinus. The resulting venous congestion within the cavernous sinus accounts for the classic ocular symptoms associated with these lesions. Endovascular treatment of CCFs has evolved over time to include a variety of transarterial and transvenous embolization techniques. The present series comprises our institutional experience with the endovascular treatment of CCF. Methods We reviewed our prospectively maintained clinical database for patients with CCF evaluated between December 1995 and August 2012. Clinical and demographic data were extracted from medical records, operative notes, and radiographic reports. Cerebral angiograms were reviewed. Results The study included 100 (42 direct CCF, 58 indirect CCF) patients. Of the 42 patients with direct CCF (dCCF), endovascular treatment was possible in 40 (95%), with an overall 8% morbidity and 2% mortality. Before March 2004, dCCF were primarily treated using detachable balloons. Following the withdrawal of detachable balloons from the market, coil embolization emerged as the first-line treatment. It was accomplished either transarterially or transvenously and often incorporated balloon or stent protection of the parent vessel. After initial treatment, 33 patients (82%) exhibited complete obliteration of their fistula while an additional 4 (10%) patients demonstrated fistula thrombosis on follow-up angiography. Endovascular access was achieved in 48 (83%) of the 58 patients with indirect CCF (iCCF). In this cohort, the morbidity rate was 8% and there were no deaths. Transvenous approaches were used to treat 88% of these patients and included both transfemoral venous access to the cavernous sinus and direct access through the ophthalmic veins. Immediate fistula occlusion was observed in 37 (77%) patients, and 1 of the 11 patients with a residual fistula progressed to thrombosis on follow-up. Transarterial embolization alone was used in 6 cases, and 5 required combined transvenous/ transarterial approaches. Conclusions For dCCF, the lack of availability of detachable balloons led to the adoption of both transarterial and transvenous coil embolization with adjunctive techniques of parent vessel protection. For iCCF, advances in techniques of venous access have facilitated treatment of lesions with restricted venous outflow. Treatment strategies for CCF continue to evolve with advances in endovascular techniques.








Júlio Leonardo B. Pereira
Phone: (+1) 424-2301706
Linkedin:http://www.linkedin.com/in/juliommais 
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Current Purpose and Practice of Hypertonic Saline in Neurosurgery: A Review of the Literature

Available online 9 February 2013
Publication year: 2013
Source:World Neurosurgery

Objective To review and summarize controversies and current concepts regarding the use of hypertonic saline during perioperative period in Neurosurgery. Methods Relevant literature was searched on Pubmed and Scopus electronic database to identify all studies that have investigated the use of hypertonic saline in Neurosurgery. Results Fluid management during the course of neurosurgical practice has been debated at length, especially strategies to control intracranial pressure and small volume resuscitation. The goal of fluid therapy includes minimizing cerebral edema, preserving intravascular volume, and maintaining cerebral perfusion pressure. Mannitol is widely recognized as the 'gold-standard' for treating intracranial hypertension but can result in systemic hypotension. Thus, hypertonic saline provides volume expansion and may improve cerebral and systemic hemodynamics. However, recently published prospective data regarding the use of osmotic agents fails to establish clear guidelines in neurosurgical patients. Conclusion We suggest hypertonic saline will emerge as an alternative to mannitol, especially for a long term use or multiple doses are needed and lead to a great opportunity for collaborative research.








Júlio Leonardo B. Pereira
Phone: (+1) 424-2301706
Linkedin:http://www.linkedin.com/in/juliommais 
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The molecular basis of intervertebral disc degeneration

Available online 8 February 2013
Publication year: 2013
Source:The Spine Journal

Background Intervertebral disc (IVD) degeneration remains a clinically important condition for which treatment is costly and relatively ineffective. The molecular basis of degenerative disc disease has been an intense focus of research recently, which has greatly increased our understanding of the biology underlying this process. Purpose To review the current understanding of the molecular basis of disc degeneration. Study design Review article. Methods A literature review was performed to identify recent investigations and current knowledge regarding the molecular basis of IVD degeneration. Results The unique structural requirements and biochemical properties of the disc contribute to its propensity toward degeneration. Mounting evidence suggests that genetic factors account for up to 75% of individual susceptibility to IVD degeneration, far more than the environmental factors such as occupational exposure or smoking that were previously suspected to figure prominently in this process. Decreased extracellular matrix production, increased production of degradative enzymes, and increased expression of inflammatory cytokines contribute to the loss of structural integrity and accelerate IVD degeneration. Neurovascular ingrowth occurs, in part, because of the changing degenerative phenotype. Conclusions A detailed understanding of the biology of IVD degeneration is essential to the design of therapeutic solutions to treat degenerative discs. Although significant advances have been made in explaining the biologic mediators of disc degeneration, the inhospitable biochemical environment of the IVD remains a challenging environment for biological therapies.








Júlio Leonardo B. Pereira
Phone: (+1) 424-2301706
Linkedin:http://www.linkedin.com/in/juliommais 
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