Neuromodulation and the Gut-Brain Axis: Therapeutic Mechanisms and Implications for Gastrointestinal and Neurological Disorders.

The gut-brain axis (GBA) represents a complex, bidirectional communication network that intricately connects the gastrointestinal tract with the central nervous system (CNS). Understanding and intervening in this axis opens a pathway for therapeutic advancements for neurological and gastrointestinal diseases where the GBA has been proposed to play a role in the pathophysiology. In light of this, the current review assesses the effectiveness of neuromodulation techniques in treating neurological and gastrointestinal disorders by modulating the GBA, involving key elements such as gut microbiota, neurotrophic factors, and proinflammatory cytokines. Through a comprehensive literature review encompassing PubMed, Google Scholar, Web of Science, and the Cochrane Library, this research highlights the role played by the GBA in neurological and gastrointestinal diseases, in addition to the impact of neuromodulation on the management of these conditions which include both gastrointestinal (irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), and gastroesophageal reflux disease (GERD)) and neurological disorders (Parkinson's disease (PD), Alzheimer's disease (AD), autism spectrum disorder (ASD), and neuropsychiatric disorders). Despite existing challenges, the ability of neuromodulation to adjust disrupted neural pathways, alleviate pain, and mitigate inflammation is significant in improving the quality of life for patients, thereby offering exciting prospects for future advancements in patient care.

Bilateral Giant Supraclinoid Carotid Aneurysms Causing Obstructive Hydrocephalus: Case Report and Literature Review.

Intracranial aneurysms are common conditions that are usually asymptomatic and found incidentally, yet they can rupture and lead to subarachnoid hemorrhage, in addition to causing mass effects, especially with larger aneurysms. Bilateral supraclinoid aneurysms are extremely rare and were reported in only two instances. These aneurysms can cause a range of symptoms and require careful management. We present the case of a 42-year-old man with no concomitant medical conditions who presented with a persistent headache and deteriorating visual acuity over time. Neurological examination was unremarkable. Connective tissue diseases were ruled out by clinical and laboratory testing. Bilateral large, partly thrombosed supraclinoid segment fusiform aneurysms of the internal carotid artery that are causing midbrain compression and obstructive hydrocephalus were shown by brain CT, CT angiography, MRI, and MR angiography (MRA). Both surgery and endovascular treatment were denied by the patient. However, a ventriculoperitoneal shunt was placed in an outside center and relieved the patient's symptoms. The patient is being followed up. In conclusion, bilateral giant aneurysms of the internal carotid artery present unique challenges and can lead to various clinical manifestations and effects on surrounding structures. In this case, we reported the first instance of obstructed hydrocephalus caused by the largest bilateral supraclinoid carotid aneurysms.

Neuroprotection: Surgical approaches in traumatic brain injury.

Background: This review is centered on the pivotal role of surgical interventions within the comprehensive management of traumatic brain injury (TBI). Surgical strategies are indispensable components of TBI care, encompassing primary injury management and the alleviation of secondary injury processes, including the handling of intracranial hemorrhages (ICHs), contusions, and mass lesions. Methods: A systematic review was carried out by searching databases including PubMed, Embase, and Scopus. The inclusion criteria involved studies discussing surgical strategies for TBI, with a focus on primary injury management, ICHs, contusions, and mass lesions. More recent articles were prioritized, and data were synthesized to assess the impact of surgical interventions on TBI outcomes. Results: The evolution of surgical technologies has heralded a transformation in TBI management. These advancements encompass minimally invasive procedures, neuroimaging-guided surgeries, and robotic-assisted techniques, all geared toward optimizing patient outcomes. Conclusion: Surgical interventions within TBI care present unique challenges, such as timing considerations, patient selection criteria, and postoperative care. This review underscores the critical significance of multidisciplinary collaboration among neurosurgeons, neurologists, and critical care specialists. Such collaboration is essential to tailor surgical strategies to the individualized needs of patients. Moreover, the review highlights emerging trends in TBI surgery and underscores the ongoing imperative of research endeavors aimed at refining surgical protocols and ultimately enhancing patient outcomes.

Bilateral Arteriovenous Shunting Through Pial and Perforating Vessels With Multiple Strokes in a Patient With Hepatopulmonary Syndrome.

Hepatopulmonary syndrome (HPS) is a condition characterized by chronic liver disease, intrapulmonary arteriovenous shunting, and increased alveolar-arterial oxygen gradient. This case report presents a 54-year-old male patient with a history of stroke, liver cirrhosis, portal vein thrombosis, hypertension, diabetes, and bladder cancer, who presented with worsening headaches and confusion over the course of five years. Digital subtraction angiogram (DSA) revealed multiple bilateral arteriovenous shunts, suggesting a shunting mechanism similar to that observed in HPS. We propose that this unique case could provide valuable insights into the parallels between the pathophysiology of HPS and diffuse arteriovenous shunting in the brain and the increased risk of ischemic and hemorrhagic events in both cases. Further studies are needed to establish a clearer understanding of this relationship and its implications for patients with chronic liver disease.