Pre- and Post-stenting Cerebral Blood Flow Velocities in Patients with Carotid Artery Stenosis.

PURPOSE: This study evaluated the hemodynamic effects of carotid artery stenting (CAS) on cerebral blood flow velocity (CBFV) in patients with carotid artery stenosis, before, 3 d, and 3 months after the procedure using transcranial Doppler ultrasound (TCD). METHODS: The study included 36 patients with atheromatous carotid artery stenosis. Cerebral computed tomography (CT) or magnetic resonance imaging (MRI) was performed in every patient, and carotid stenosis was evaluated using duplex sonography, CT, and MRI angiography before the procedure. To obtain baseline values, the CBFV was evaluated 1 d before CAS. Follow-up TCD evaluations were performed 3 d and 3 months postoperatively. RESULTS: The median degree of internal carotid artery (ICA) stenosis in the participants was 90% (range 50%-99%). The median CBFV at the anterior cerebral artery (ACA) was significantly lower on the ipsilateral side than on the contralateral side before stenting; however, there were no significant differences in CBFV in the ipsi and contralateral middle cerebral artery (MCA). The median CBFV in the ipsilateral MCA increased significantly 3 d after the procedure and remained higher than the basal values after 3 months. CONCLUSIONS: We observed significant increases in the median CBFV and pulsatility index (PI) in the MCA bilaterally, especially on the stented side, measured 3 d and 3 months after stenting in patients with severe ICA stenosis.

A Clinical Analysis of Microvascular Decompression Surgery with Sacrification of the Superior Petrosal Venous Complex for Trigeminal Neuralgia: A Single-Surgeon Experience.

AIM: To report the surgical outcomes in patients with trigeminal neuralgia (TN) who underwent microvascular decompression (MVD) with superior petrosal vein sacrification. MATERIAL AND METHODS: Data from 63 patients, whose information was obtained from a group of 113 patients who underwent surgery from 2008 to 2018, were reviewed retrospectively by the first author who was not part of the surgical team, and the pain conditions were evaluated objectively. RESULTS: Following surgery, pain relief occurred in 84% of patients during the early postoperative period and in 69.8% of patients during long-term follow-up. The major offending vessel was the superior cerebellar artery. CONCLUSION: MVD surgery, in particular for patients with typical pain, is one of the most effective treatment strategies for TN. Superior petrosal vein sacrification is a safe method that helps neurosurgeons to visualise the surgical area and perform a better work-up. Neurosurgeons should not be afraid to carry out superior petrosal vein sacrification.

Latencies to first interictal epileptiform discharges in different seizure types during video-EEG monitoring.

PURPOSE: Interictal epileptiform discharges (IEDs) have high diagnostic value concerning patients with epilepsy and the instances of obtaining IEDs increase with longer recording times. However, the merit of a single, extended electroencephalography (EEG) recording in detecting IEDs has not been substantiated. We aimed to determine the optimal duration of an EEG required to diagnose epilepsy in different seizure types. METHODS: Overall, 84 patients-29 with generalised onset epilepsy and 55 with focal onset epilepsy-were evaluated. Long-term video electroencephalographic monitoring (VEM) was analysed to find the first definite IED besides assessing the first seizure and latency. RESULTS: The median latency of the first IED (12 min, ranging from 1 to 440 min vs. 55 min, ranging from 2 to 7500 min; p = 0.014) and the median duration of a VEM recording (2 d, ranging from 1 to 10 d vs. 3 d, ranging from 1 to 10 d; p = 0.012) were found significantly lower in the generalised epilepsy group compared with that in the focal epilepsy group. CONCLUSIONS: Generalised onset epilepsy showed a significantly shorter latency to IED and VEM duration compared with focal onset epilepsy. In our data set, all the patients with generalised onset epilepsy had interictal IED within 10 h, but the patients with focal onset epilepsy required monitoring for three days to obtain IED.