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Recent studies have shown that drugs that are normally unable to cross the blood-brain barrier (BBB) following intravenous injection can be transported across this barrier by binding to poly(butyl cyanoacrylate) nanoparticles and coating with polysorbate 80. However, the mechanism of this transport so far was not known. In the present paper, the possible involvement of apolipoproteins in the transport of nanoparticle-bound drugs into the brain is investigated. Poly(butyl cyanoacrylate) nanoparticles loaded with the hexapeptide dalargin were coated with the apolipoproteins AII, B, CII, E, or J without or after precoating with polysorbate 80. In addition, loperamide-loaded nanoparticles were coated with apolipoprotein E alone or again after precoating with polysorbate 80. After intravenous injection to ICR mice the antinociceptive threshold was measured by the tail flick test. Furthermore, the antinociceptive threshold of polysorbate 80-coated dalargin-loaded nanoparticles was determined in ApoEtm1Unc and C57BL/6J mice. The results show that only dalargin or loperamide-loaded nanoparticles coated with polysorbate 80 and/or with apolipoprotein B or E were able to achieve an antinociceptive effect. This effect was significantly higher after polysorbate-precoating and apolipoprotein B or E-overcoating. With the apolipoprotein E-deficient ApoEtm1Unc mice the antinociceptive effect was considerably reduced in comparison to the C57BL/6J mice. These results suggest that apolipoproteins B and E are involved in the mediation of the transport of drugs bound to poly(butyl cyanoacrylate) nanoparticles across the BBB. Polysorbate 80-coated nanoparticles adsorb these apolipoproteins from the blood after injection and thus seem to mimic lipoprotein particles that could be taken up by the brain capillary endothelial cells via receptor-mediated endocytosis. Bound drugs then may be further transported into the brain by diffusion following release within the endothelial cells or, alternatively, by transcytosis. [ABSTRACT FROM AUTHOR]

Certain aneurysms of the anterior circulation continue to offer a technical challenge for safe exposure and clipping. The purpose of this paper was to describe the cranio-orbital approach for surgical clipping of complex aneurysms and to evaluate prospectively the associated complications of this approach. Prospective audit of all patients undergoing cranio-orbital approach for aneurysm surgery from 1997 to 2004 by the senior author. Twenty-five patients, eight male and 17 female, median age of 52 years, range 28 – 73. All patients had a standard pterional approach supplemented by an orbital osteotomy. In the 7-year period 367 patients underwent treatment for their aneurysms (169 clipped and 198 coiled). Of the 169 patients who were operated on, 29 had a skull base approach, of which 25 were cranio-orbital. The aneurysm location was as follows: 16 middle cerebral artery (MCA), three carotid bifurcation, four anterior communicating artery (ACOMM), one ophthalmic and one basilar. There were no approach-related complications. The cranio-orbital craniotomy can be a useful adjunct in the surgical treatment of giant or complex aneurysms. It offers the following advantages over a standard pterional approach: reduces operative distance; allows easy splitting of the sylvian fissure; and provides a wide arc of exposure with multiple working corridors. [ABSTRACT FROM AUTHOR]

In this paper, a mathematical model for the description of cerebral hemodynamics is developed. This model is able to simulate the regulation mechanisms working on the small cerebral arteries and arterioles, and thus to adapt dynamically the blood flow in brain. Special interest is laid on the release of catecholamines and their effect on heart frequency, cardiac output and blood pressure. Therefore, this model is able to describe situations of severe head injuries in a very realistic way. [ABSTRACT FROM AUTHOR]

The negative surface charge of brain microvessel endothelial cells is derived from the special composition of their membrane lipids and the thick endothelial surface glycocalyx. They are important elements of the unique defense systems of the blood–brain barrier. The tissue-specific properties, components, function and charge of the brain endothelial glycocalyx have only been studied in detail in the past 15 years. This review highlights the importance of the negative surface charge in the permeability of macromolecules and nanoparticles as well as in drug interactions. We discuss surface charge and glycoxalyx changes in pathologies related to the brain microvasculature and protective measures against glycocalyx shedding and damage. We present biophysical techniques, including a microfluidic chip device, to measure surface charge of living brain endothelial cells and imaging methods for visualization of surface charge and glycocalyx. [ABSTRACT FROM AUTHOR]

Partly due to poor blood-brain barrier drug penetration the treatment options for many brain diseases are limited. To safely enhance drug delivery to the brain, glutathione PEGylated liposomes (G-Technology®) were developed. In this study, in rats, we compared the pharmacokinetics and organ distribution of GSH-PEG liposomes using an autoquenched fluorescent tracer after intraperitoneal administration and intravenous administration. Although the appearance of liposomes in the circulation was much slower after intraperitoneal administration, comparable maximum levels of long circulating liposomes were found between 4 and 24 h after injection. Furthermore, 24 h after injection a similar tissue distribution was found. To investigate the effect of GSH coating on brain delivery in vitro uptake studies in rat brain endothelial cells (RBE4) and an in vivo brain microdialysis study in rats were used. Significantly more fluorescent tracer was found in RBE4 cell homogenates incubated with GSH-PEG liposomes compared to non-targeted PEG liposomes (1.8-fold, p < 0.001). In the microdialysis study 4-fold higher ( p < 0.001) brain levels of fluorescent tracer were found after intravenous injection of GSH-PEG liposomes compared with PEG control liposomes. The results support further investigation into the versatility of GSH-PEG liposomes for enhanced drug delivery to the brain within a tolerable therapeutic window. [ABSTRACT FROM AUTHOR]

The aim of this study was to analyse and compare the cerebral arterial circle, its anastomoses, its branches and the manner of blood supply in 20 individuals of the Camelidae family. The Camelidae family was represented byCamelus bactrianus(n = 8),Camelus dromedarius(n = 2),Lama guanicoe(n = 5) andLama glama(n = 5). We performed the analyses on post-mortem material obtained from Polish zoological gardens. Arteries of the heads were injected with pigmented acetone solution of vinyl superchloride. Arteries of the brain base inCamelusandLamaspecies are similar. In contrast, the pattern of brain base arteries in Camelidae differs from the patterns described in other species of the Artiodactyla order. Specific traits of the base brain arterial pattern in Camelidae may prove useful as a taxonomic exponent of the animals within the Artiodactyla order. [ABSTRACT FROM AUTHOR]

Dendrimers are branched polymers with spherical morphology. Their tuneable chemistry and surface modification make them valuable nanomaterials for biomedical applications. In view of possible dendrimer uses as brain-aimed nanocarriers, the authors studied amine- and lipid-functionalised (G4) polyamidoamine (PAMAM) biocompatibility with cell population forming the blood-brain barrier (BBB). Both amine-PAMAM and lipid-PAMAM dendrimers were able to enter endothelial and primary neural cells. However, only amine-PAMAM damaged cell membranes in a dose-dependent manner. Transmission electron microscopy evidenced the ability of dendrimers to precipitate salts and serum components present in culture medium that slightly increased toxicity of the amine-PAMAM. Amine- and lipid-PAMAM were both able to cross the BBB and differently induced CD11b and CCR2 overexpression on primary CX3CR1-GFP murine microglia in vitro. These data emphasise the role of dendrimer surface functionalisation in toxicity and neural immune cell activation, raising concerns about possible neuroinflammatory reactions. [ABSTRACT FROM AUTHOR]

Introduction. Interpositional grafts are often used for extracranial to intracranial artery bypass procedures. However, donors often suffer from size mismatch and donor site morbidity. We sought a novel donor vessel that has not been used for these procedures. Materials and methods. In 10 adult cadavers, we dissected the length of the anterior interosseous artery (AIA). A pterional craniotomy was performed on each with overlying superficial temporal artery skeletonized and the proximal middle cerebral artery (MCA) and supraclinoid segment of the internal carotid artery (ICA) isolated. Measurements were made and the artery was transected proximally and distally. Harvested segments of the AIA were anastomosed to the superficial temporal artery at the root of the zygoma and cranially to the MCA or ICA. Redundant graft was trimmed and the anterior interosseous anastomosed to the recipient vessel. Results. Mean proximal and distal diameters for the AIA were 2 mm and 1 mm, respectively. Mean length before dissecting the pronator quadratus muscle was 13.5 cm, and after dissecting was 17 cm. There was adequate length of the AIA for grafting between the superficial temporal artery at the root of the zygoma and the MCA and ICAs at the skull base. In fact, each specimen had a mean excess length of 3 cm. Conclusion. The AIA is more than long enough to graft the superficial temporal artery at the root of the zygoma to the vessels of the anterior and posterior circulations. This obviates the possibility of ischemic complications following radial artery harvest and graft size mismatch when using other grafts. Indications for the potential use of the AIA may be limited, but they include special situations such as second craniotomy with a previously damaged superficial temporal artery. [ABSTRACT FROM AUTHOR]

Object. Endovascular coiling is a common treatment for ruptured intracranial aneurysms. However, concerns have been raised over the durability of this treatment. The aim of this study was to establish the rate of recurrence and retreatment of coiled aneurysms treated in our unit. Methods. We performed a retrospective analysis of 264 surviving patients with ruptured aneurysms treated by endovascular coiling between November 2003 and April 2007. Data was collected on patient age, location of aneurysm, angiogram results and any subsequent retreatment. Results. Follow-up angiography performed at 6 months was available in 239 cases (91%) and revealed 158 (66%) aneurysms completely occluded, 51 (21%) had neck recurrence and 31 (13%) had significant recurrence. Thirty (12.6%) aneurysms required retreatment over a mean follow-up period of 46 (range 24-66) months. Younger age predisposed to a higher risk of recurrence and retreatment. Aneurysms of the anterior communicating and anterior cerebral arteries were less likely to recur or require retreatment (relative risk 0.42 and 0.29, respectively); aneurysms of the posterior communicating arteries were more likely to recur (relative risk 2.22). Aneurysms of the basilar and carotid arteries were more likely to undergo retreatment (relative risk 2.84 and 2.46, respectively). Conclusion. Long-term follow-up is required for ruptured aneurysms treated by coiling. Certain subgroups may require closer follow-up due to the increased risk of recurrence or retreatment, such as younger patients and those with aneurysms of the posterior communicating, basilar or carotid arteries. [ABSTRACT FROM AUTHOR]

In the last few years, there has been a growing focus on faster computational methods to support clinicians in planning stenting procedures. This study investigates the possibility of introducing computational approximations in modelling stent deployment in aneurysmatic cerebral vessels to achieve simulations compatible with the constraints of real clinical workflows. The release of a self-expandable stent in a simplified aneurysmatic vessel was modelled in four different initial positions. Six progressively simplified modelling approaches (based on Finite Element method and Fast Virtual Stenting – FVS) have been used. Comparing accuracy of the results, the final configuration of the stent is more affected by neglecting mechanical properties of materials (FVS) than by adopting 1D instead of 3D stent models. Nevertheless, the differences showed are acceptable compared to those achieved by considering different stent initial positions. Regarding computational costs, simulations involving 1D stent features are the only ones feasible in clinical context. [ABSTRACT FROM AUTHOR]

This case report demonstrates that pulsed ultrasound (US), when used for a total of 20 treatment sessions, provided symptom relief to a patient with chronic rhinosinusitis (CRS). A 16-year-old boy with a 12-month history of rhinosinusitis and candidate for sinus surgery was referred for ultrasound therapy. He presented with facial pain/pressure, nasal obstruction, and postnasal drip (total sinusitis score=7). On computed tomographic (CT) scanning, the total opacification of the right maxillary sinus was observed. The ostiomeatal complex was occluded (total CT score=6). Pulsed ultrasound was administered three times a week, every other day. After 10 treatment sessions, his symptoms were resolved with exception of nasal obstruction being mild (total sinusitis score=2). On CT scan, right maxillary sinus showed partial improvement (total CT score=2). After additional 10 treatments, the nasal obstruction was resolved, and follow-up CT scan of his sinuses showed that right maxillary sinus was clear and normal. At 6-month follow-up, the positive effects were maintained and the patient reported no recurrence of symptoms. Twenty sessions of pulsed ultrasound therapy eradicated the CRS and resolved the symptoms. [ABSTRACT FROM AUTHOR]

Recent morphological, cladistic and molecular phylogenetic studies suggest a strong relationship between Cratenemertidae and Reptantia. In contrast to other hoplonemerteans, these groups have complex cerebral organs located behind the pre-cerebral septum possessing both sensory and 'sac-type' epithelial components in the canal structure and a robust single-layered rhynchocoel wall composed of interwoven circular and longitudinal muscle fibres. Four specimens collected by the US Antarctic Program, listed in an earlier cladistic study as 'Antarctic C', distinct from other Hoplonemertea and related to Cratenemertidae and Reptantia, are described herein as Cinclidonemertes mooreae fam., gen. et sp. nov. They have complex cerebral organs, with the same two types of canal epithelium, lying against the sides of the brain and extending below and behind it ventrally, a lattice-like rhynchocoel wall with partial interweaving, and four large shallow cup-shaped eyes with little pigment as opposed to the numerous heavily pigmented deep-cup ocelli of Cratenemertidae and Reptantia. [ABSTRACT FROM AUTHOR]

Objective: To evaluate Doppler velocimetry parameters (resistance index [RI], pulsatility index [PI] and systolic/diastolic [S/D] ratio) of maternal-fetal circulation before and after magnesium sulfate administration in pregnant women with severe preeclampsia. Methods: A prospective observational cohort analysis of 40 women with severe preeclampsia was performed. Doppler ultrasonography scans were performed before and 20 minutes after intravenous administration of magnesium sulfate. Maternal parameters such as heart rate, and systolic, diastolic and mean arterial pressure were recorded. Doppler flow velocity parameters (RI, PI and S/D ratio) were evaluated in the uterine, umbilical and middle cerebral arteries. The different mean values obtained before and after magnesium sulphate were analyzed using the paired t-test. Results: There was a statistically significant increase in mean maternal heart rate and a statistically significant decrease in systolic, diastolic and mean maternal blood pressure before and after administration of magnesium sulphate (p < 0.001). Resistance index decreased in the umbilical (p = 0.003; 95% CI: 0.008 - 0.03) and middle cerebral artery (p = 0.001; 95% CI: 0.01 - 0.05) and in both uterine arteries. Likewise, there was a significant reduction in the PI and S/D ratio in all the arteries assessed. Conclusions: Maternal administration of intravenous magnesium sulfate in preeclampsia leads to an increase in maternal heart rate and a decrease in systolic, diastolic and mean arterial blood pressure. A reduction in the resistance index, pulsatility index and S/D ratio was recorded in the uterine, umbilical and cerebral arteries. [ABSTRACT FROM AUTHOR]

The neuropsychological outcome and Health Related Quality of Life (HRQOL) after SAH have been largely believed to be unrelated to the location of the ruptured aneurysm. This notion needs verification due to the contemporary availability of more sensitive neuropsychological test batteries and more recent clinical observations of deviant behaviour after SAH. To this end, we compared patients with ruptured aneurysms on respectively the anterior communicating artery (ACoA) (n = 24) or middle cerebral artery (MCA) (n = 22). All patients underwent an extensive neuropsychological examination, clinical interview and answered questionnaires 12 months after SAH. We found mild to moderate discrepancies from population norm in test scores on a number of areas of cognitive functioning in both patient groups, with a consistent, but statistically non-significant trend towards better functioning in MCA patients despite of the fact that patients with ruptured MCA aneurysms were initially in a poorer clinical condition and more often had intracranial haematomas. We observed slight reductions in executive functions, on the first conditions on the Delis-Kaplan Executive Functioning System (D-KEFS) tests, and some measures of memory functions in the ACoA patients. ACoA patients seemed to have problems with initiation of problem solving behaviour. None of the patient groups scored for apathy and depression. Some measures of HRQOL were equally reduced as compared to the population norm in both groups. ACoA patients remained longer on sick-leave compared to MCA patients. [ABSTRACT FROM AUTHOR]

The objective was to characterize the biodistribution of nanoscale ceria from blood and its effects on oxidative stress endpoints. A commercial 5% crystalline ceria dispersion in water (average particle size ~31±4 nm) was infused intravenously into rats (0, 50, 250 and 750 mg/kg), which were terminated 1 or 20 h later. Biodistribution in rat tissues was assessed by microscopy and ICP-AES/MS. Oxidative stress effects were assessed by protein-bound 4-hydroxy 2-trans-nonenal (HNE), protein-bound 3-nitrotyrosine (3-NT), and protein carbonyls. Evans blue (EB)-albumin and Na fluorescein (Na2F) were given intravenously as blood-brain barrier integrity markers. The initial ceria t½ in blood was ~7 min. Brain EB and Na2F increased some at 20 h. Microscopy revealed peripheral organ ceria agglomerations but little in the brain. Spleen Ce concentration was >liver >blood >brain. Reticuloendothelial tissues cleared ceria. HNE was significantly increased in the hippocampus at 20 h. Protein carbonyl and 3-NT changes were small. The nanoparticle characterizations before and after biodistribution, linked with the physiological responses, provide a foundation for evaluating the effects of engineered nanomaterial physico-chemical properties on peripheral organ distribution, brain entry and resultant toxicity. [ABSTRACT FROM AUTHOR]

Conclusion. Topical application of dexamethasone may support autoregulation of cochlear blood flow (CBF), although it had no direct effect on CBF. Objectives. Although intratympanic steroid therapy for patients with inner ear disorders is common, the mechanism by which steroids exert their effect is unclear. We investigated the response of CBF to topical application of dexamethasone onto the round window. Materials and methods. Two concentrations of dexamethasone (3.3 mg/ml and 33 mg/ml dexamethasone in 0.5 µl saline) were applied to the round windows of rats, and CBF responses were measured using a laser Doppler flowmeter. The effects on CBF of a 2 h occlusion of the anterior inferior cerebellar artery (AICA) and subsequent release of the clamp with or without previous dexamethasone application were investigated. Results. No significant change in CBF was observed after topical application of dexamethasone, and it did not affect the decrease in CBF caused by AICA occlusion. However, recovery of CBF after release of the AICA clamp was better in animals treated with dexamethasone than in those that did not receive dexamethasone. [ABSTRACT FROM AUTHOR]

Objective. To establish normative data for the peak systolic velocity of the middle cerebral artery (MCA-PSV) of fetuses in the second half of pregnancy using multiples of the median and percentile reference range. Methods. A cross-sectional study was performed in 90 healthy fetuses at between 23 and 35 weeks of gestation. A bi-dimensional axial scan of the brain, including the thalami and cavitas septi pellucidi was obtained. The circle of Willis was visualized using color flow mapping. Pulsed-wave Doppler velocimetry of the MCA was performed close to the artery's origin, with a beam-vessel angle below 20°. A table with the multiples of the median (MoM) of the MCA-PSV for each gestational age was generated and Pearson's correlation coefficient (r) was calculated. Regression modeling across gestational age was performed to obtain the reference values. Results. There was a strong correlation between the MCA-PVS and gestational age (r = 0.70; p < 0.001). Values for the MCA-PSV for the following MoM were calculated: 1.0, 1.29, 1.50, and 1.55. The MCA-PSV 2.5th and 97.5th centiles ranged from 24.33 cm2/s to 78.36 cm2/s, respectively, between weeks 23 and 35. Conclusions. A nomogram for the fetal MCA-PSV during the second half of pregnancy was generated. [ABSTRACT FROM AUTHOR]

We investigated the effects of global system for mobile communication (GSM) microwave exposure on the permeability of the blood-brain barrier and signs of neuronal damage in rats using a real GSM programmable mobile phone in the 900 MHz band. Ninety-six non-anaesthetized rats were either exposed to microwaves or sham exposed in TEM-cells for 2 h at specific absorption rates of average whole-body Specific Absorption Rates (SAR) of 0.12, 1.2, 12, or 120 mW/kg. The rats were sacrificed after a recovery time of either 14 or 28 d, following exposure and the extravazation of albumin, its uptake into neurons, and occurrence of damaged neurons was assessed. Albumin extravazation and also its uptake into neurons was seen to be enhanced after 14 d (Kruskal Wallis test: p = 0.02 and 0.002, respectively), but not after a 28 d recovery period. The occurrence of dark neurons in the rat brains, on the other hand, was enhanced later, after 28 d (p = 0.02). Furthermore, in the 28-d brain samples, neuronal albumin uptake was significantly correlated to occurrence of damaged neurons (Spearman r = 0.41; p < 0.01). [ABSTRACT FROM AUTHOR]

A 63-year-old man with a history of alcohol dependence ingested elemental mercury as a suicide gesture. Serial abdominal X-rays showed gradual but incomplete clearance of mercury from the colon. Routine chest X-ray showed evidence of punctate radiopaque materials in the lower lobe of the right lung. Blood and urine mercury levels both exceeded thresholds considered to be associated with cognitive dysfunction. Elicited cognitive deficits were most prominent in processing speed, flexibility, and response inhibition. Semantic fluency, visuospatial processing, and recall memory for visual and low-context verbal material were also affected. The deficits may have been attributable primarily to alcohol abuse. Elemental mercury is not readily absorbed from the gastrointestinal tract; however, mercury vapor, which was inhaled inadvertently, readily crosses the blood-brain barrier and is neurotoxic. We argue, therefore, that mercury toxicity is more likely than not to have been a factor contributing to the patient's cognitive dysfunction. [ABSTRACT FROM AUTHOR]

The technology of spinal canal endoscopy has developed slowly over the 20th and 21st centuries. Contributions have been made by many innovators; however, only recently has this technique been developed and refined sufficiently to be used clinically. Further study is needed to determine whether this technique holds advantages over alternative, currently used techniques of medication delivery into the epidural space. Real-time, direct visual examination of epidural anatomy currently enables the identification of epidural pathology and localization of pain generators. This ability to examine epidural pathology apart from operative trauma and to direct the delivery of medication is not duplicated by any other technique currently available. The future may hold the promise of minimally invasive and effective therapy for both radicular and perhaps other forms of disabling back pain. [ABSTRACT FROM AUTHOR]

BVR was 77 years old when he sustained a large posterior cerebral artery territory infarct. Medical, cognitive and functional data collected on four occasions over 10 years initially revealed circumscribed neurological signs, no functional or cognitive deficits. BVR became significantly impaired only after two other strokes, 3 years before death. On brain MRI, the lesions involved large portions of the right occipital and temporal cortices, the right thalamus, and the left cerebellum, as well as thinning of the corpus callosum. Postmortem investigations revealed additional recent vascular lesions in the occipital region. This case study underscores the importance of comprehensive assessment methods combining neurological, neuroimaging and cognitive tools. [ABSTRACT FROM AUTHOR]

Previously it was shown that poly(butyl cyanoacrylate) (PBCA) nanoparticles coated with polysorbate 80 are able to cross the blood-brain barrier (BBB) after i.v. administration. The objective of the present study was to investigate the influence of polysorbate 80 and doxorubicin-loading on the body distribution in rats. The biodistribution profile and brain concentration of 14 C-radiolabeled PBCA nanoparticles, polysorbate 80 coated 14 C-PBCA nanoparticles, and doxorubicin-loaded 14 C-PBCA nanoparticles were determined by radioactivity counting after i.v. administration in rats. The 14 C-PBCA nanoparticles showed a significant accumulation in the organs of the reticuloendothelial system (RES). Polysorbate 80 coating of the 14 C-PBCA nanoparticles decreased this accumulation to about 40% after 1 h post injection. The brain concentration was increased about 2-fold after polysorbate 80-coating at this time point. The presence of doxorubicin in this preparation, however, decreased the brain concentration to levels similar to uncoated particles, probably caused by the positive charge of this compound. After longer time periods after injection the differences between the three preparations decreased. [ABSTRACT FROM AUTHOR]

This prospective study examined the relationship between post-stroke recovery of aphasia and changes in cerebral blood flow (CBF). To address the question of right hemisphere (RH) involvement in restitution of language, we tested the hypothesis that the increase in perfusion of the RH is crucial for early recovery from aphasia. Twenty-four right-handed patients with acute aphasia following left hemisphere (LH) ischaemic stroke were examined twice with a six-month interval. At each session CBF and language scores were measured on the same stroke patients. Language was measured by selected tasks derived from the Boston Diagnostic Aphasia Examination (BDAE). The SPECT scans were obtained using (99m)Tc-ECD on a triple-head gamma camera Multispect-3. Although initial CBF measured for the whole group of aphasic patients was not a predictor for future language recovery for either hemisphere, increased perfusion of the RH during a six-month interval was found to parallel the recovery of aphasic disorders. There was a correlation between the change in the right parietal CBF (but not the left) and a change in numerous language abilities. Nevertheless, only CBF values on the left predicted performance on the language tests at initial and follow-up examinations. When the area damaged on structural imaging was excluded from perfusion analysis, only subcortical CBF change on the left showed a positive correlation with language improvement. Thus, the cerebral mechanism associated with early recovery from aphasia is a dynamic and complex process that may involve both hemispheres. Probably this mechanism involves functional reorganisation in the speech-dominant (damaged) hemisphere and regression of haemodynamic disturbances in the non-dominant (structurally intact) hemisphere. [ABSTRACT FROM AUTHOR]

Postclipping cerebral angiography is generally not practised in the UK. The International Subarachnoid Trial (ISAT) data show that coiling compared favourably with clipping in the early posttreatment phase. We present a 4-year, single unit experience comparing cerebral angiography at 6 months postclipping and postcoiling, defining the proportion of aneurysms in either group, which were incompletely excluded from the cerebral circulation after treatment. There were 4 'dog-ear' remnants (4.6%) in the clipping group of 86 aneurysms, one of which required further surgery. Thirty-one out of 82 (37.8%) coiled aneurysms that underwent check angiography were inadequately excluded from the cerebral circulation at 6 months. Of these, to date, four patients have undergone re-coiling. Although the immediate complications of coiling may be less than those of clipping (ISAT), it seems that the degree and permanence of exclusion of an aneurysm from the cerebral circulation may be more secure with surgery. In summary, the rates of incomplete aneurysmal exclusion from the cerebral circulation, the requirement for reintervention and the requirement for continuing surveillance were all higher in the coiled population than in the clipped population. [ABSTRACT FROM AUTHOR]