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Biomedical subjects

R R Vindlacheruvu

Publications and source records attributed to R R Vindlacheruvu.

9 recordsLinked to original sources
PubMed2005

Supraorbital eyebrow minicraniotomy for anterior circulation aneurysms.

BACKGROUND: We report our experience with the minimally invasive supraorbital approach to aneurysms of the ipsilateral anterior cerebral circulation. METHODS: A prospective review of all patients who underwent operations to clip aneurysms in Newcastle between 1993 and 2002. RESULTS: Fifty-six aneurysms were clipped via minicraniotomy in 47 patients. Six patients presented with acute subarachnoid hemorrhage (SAH), 40 patients were admitted for elective clipping, and 1 patient presented with an SAH, had the responsible aneurysm clipped and was readmitted later for elective clipping of a further aneurysm. Bilateral supraorbital craniotomies were performed in 3 patients. In 6 patients, multiple aneurysms were clipped via a single craniotomy. All aneurysms were well visualized with the microscope. Endoscopic assistance was not found necessary. All were successfully clipped. Two aneurysms ruptured while being clipped. There was no direct mortality from surgery. One patient died later from a separate posterior circulation aneurysm. One patient had a significant long-term deficit but remained independent, and 1 had 3 seizures over the 12 months after surgery. This represents a 4% morbidity at 1 year. CONCLUSION: Selected anterior cerebral circulation aneurysms can be clipped with low morbidity, using an ipsilateral minicraniotomy preserving the orbital rim, and without using an endoscope. The types of aneurysm selection criteria and operative equipment used are described.

Adult↗
PubMed2005

Risk-benefit analysis of the treatment of unruptured intracranial aneurysms.

OBJECTIVES: To determine under what circumstances repair of unruptured intracranial aneurysms may be beneficial. METHODS: A life expectancy analysis of patients with unruptured aneurysms with and without repair based on prospective data from the International Study of Unruptured Intracranial Aneurysms (ISUIA). RESULTS: Life years are lost at all ages by repairing anterior circulation aneurysms under 7 mm in diameter in patients with no history of a subarachnoid haemorrhage from another aneurysm (incidental). For all other aneurysms the number of life years saved by repair is dependent on the patient's age at the time when repair is undertaken. Between 2 and 40 years are saved by repairing aneurysms in patients aged 20 years. These benefits fall to 0 when remaining life expectancy falls below 15-35 years, corresponding to the age range of 45-70 years. CONCLUSIONS: Repair of unruptured aneurysms benefits patients harbouring them by improving life expectancy except in certain circumstances. The exceptions are patients with remaining life expectancy less than 15-35 years or aged 45-70 (depending on aneurysm size and location) and patients with aneurysms of the anterior circulation under 7 mm in diameter with no history of a previous subarachnoid haemorrhage. These results are based on the findings of the ISUIA and are dependent on their accuracy.

Adolescent↗
PubMed2003

The impact of interventional neuroradiology on service in a neurosurgical unit.

Endovascular treatment of cerebral aneurysms has rapidly evolved and has transformed neurosurgical practice. We evaluated the influence of an interventional neuroradiology service on cerebral aneurysm management. We performed a retrospective analysis of all aneurysms treated in our unit before and after the establishment of endovascular treatment. All patients (n = 248: 78M: 170F aged 10-78 years) who underwent aneurysm treatment between 1996 and 1999 were included in the analysis. Length of in-patient stay on neurosurgical ward, GOS at 6-month follow-up and complications of treatment were the factors chosen for the analysis. Definitive treatment was attempted in 306 of 374 aneurysms detected (203 surgical and 103 endovascular). During the last 2 years of the study period, 46% of all aneurysms were coiled. Endovascular treatment of ruptured aneurysms tended to be sooner than surgery, but in-patient stay following treatment was the same. No significant difference in GOS at 6-month follow-up was found (chi2 = 0.18). Coiling of unruptured aneurysms reduced in-patient stay when compared with surgery (t-test, p < 0.001), fewer complications occurred, but no difference in outcome was seen at follow up (chi2 = 1.09). Our data suggest that the long-term morbidity following subarachnoid haemorrhage is not related to treatment modality. Coiling is the preferred treatment for unruptured aneurysms. The GOS is insensitive to the detection of the perceived benefits of coiling. The increasing role of interventional neuroradiology has direct effects on many aspects of neurosurgical practice.

Adolescent↗
PubMed2003

The impact of interventional neuroradiology on neurosurgical training.

Aneurysmal subarachnoid haemorrhage carries a high mortality and morbidity. Surgical treatment (craniotomy and clipping of the aneurysm) has been, until recently, the gold standard treatment. Endovascular embolisation treatment has rapidly evolved and the evidence available suggests that the results are as good as surgery. Endovascular treatment successfully occludes the aneurysm to prevent re-haemorrhage, whilst reducing the procedural morbidity when compared to craniotomy and clipping. It is perceived to be of particular benefit for aneurysms in the posterior cerebral circulation where operative morbidity and mortality are significantly higher than for aneurysms on the anterior circle of Willis. The establishment of endovascular treatment has reduced the number of cases being treated surgically, and this has had a significant effect on surgical training. We analysed the management of all ruptured aneurysms treated in our unit over a 4-year period. During the same period, an endovascular service was established in the unit. We devised a novel system for the angiographic grading of aneurysms in order to evaluate the impact that coiling has had on surgical training. The results show that as few as four aneurysms per year would be appropriate for specialist registrars to operate upon. We propose some mechanisms for maintaining high quality surgical training.

Adolescent↗
PubMed1999

MRI-guided stereotactic brain biopsy: a review of 33 cases.

MRI is being increasingly used for the detection of intracranial lesions. MRI-guided stereotactic brain biopsy is infrequently performed. We audited our recent experience of this procedure, and demonstrated that it is feasible and comparable to CT-guided biopsy in terms of diagnostic accuracy with a low procedural morbidity. We critically analyse its future role in the presence of more recent developments.

Adult↗
PubMed1997

Intramedullary thoracic cord metastasis managed effectively without surgery.

Spinal intramedullary metastases present with rapidly progressing neurological deficits and have an extremely poor prognosis. Prompt investigation and management are required. This case history illustrates that radiotherapy and steroids can be effective in returning motor function. The behaviour of the primary tumour and the stage of the disease influence whether surgery is appropriate.

Bronchial Neoplasms↗
PubMed1992

Non-photic phase shifting of the circadian activity rhythm of Syrian hamsters: the relative potency of arousal and melatonin.

This study investigated the relative potency of melatonin and arousal as Zeitgebers in the non-photic phase shifting of circadian rhythmicity in the adult Syrian hamster. Animals held under dim red light (DD) exhibited robust free-running rhythms of wheel-running activity. Melatonin (1 mg/kg) or ethanolic saline vehicle, delivered manually by subcutaneous injection after removing the animal from its cage, resulted in phase advances of the activity rhythm. This effect was phase dependent, injections at CT 8 and 10 being effective (CT 12 = anticipated activity onset), whereas injection at CT 2, 6, 14 and 20 did not cause a shift. There was no significant difference between the magnitude or timing of phase shifts in response to injections of saline or melatonin. To determine whether the observed shifts were related to arousal of the animals induced by handling, a second group held under DD were fitted with chronic s.c. cannulae so that melatonin solution or vehicle could be delivered remotely at projected CT 10. Neither solution had any effect upon the free-running rhythm. However, when these animals received manual s.c. injection of saline or melatonin solution, they exhibited phase advances similar to those observed in Expt. 1. These results fail to support the hypothesis that melatonin can exert a chemically specific, acute phase-shifting action in the adult Syrian hamster. They do, however, demonstrate the potent effect of arousing stimuli upon the circadian clock in this species.

Animals↗
PubMed1991

Lack of evidence for a role for the lipoxygenase pathway in increases in cytosolic calcium evoked by ADP and arachidonic acid in human platelets.

We have investigated the possibility that metabolism of arachidonic acid by the lipoxygenase pathway contributes to ADP-evoked rises in [Ca2+], in human platelets. 30 microM BW A4C did not affect ADP-evoked Ca2+ signals, but inhibited 12-lipoxygenase activity in platelet homogenates. Another lipoxygenase inhibitor, MK 866 was similarly without effect on ADP-evoked Ca2+ signals. ADP was found to liberate little arachidonic acid, and formation of the lipoxygenase product 12-HETE was not detectable. The rise in [Ca2+]i evoked by arachidonic acid was completely inhibited by the cyclooxygenase inhibitors aspirin or indomethacin. These results indicate that lipoxygenase products do not play an essential role in mediating rises in [Ca2+]i evoked by ADP, or by arachidonic acid.

Adenosine Diphosphate↗