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To investigate the association between subarachnoid hemorrhage-induced delayed cerebral vasospasm (DCVS) and oxidative stress, an oxidation product, hydroperoxide, was measured in 3 specimens: peripheral arterial blood, cerebrospinal fluid (CSF), and internal jugular venous blood (IJVB).Hydroperoxide was measured using the diacron reactive oxygen metabolites (d-ROMs) test. The hydroperoxide levels were evaluated based on the rate of change in the d-ROMs test value on day 6 relative with that on day 3 (d-ROMs change rate).The subjects were 20 patients. The d-ROMs change rate in IJVB was significantly higher in patients with DCVS on day 6 than in those without it (P.01). When the patients were classified into the following 3 groups: Group A (no DCVS occurred throughout the clinical course); Group B (DCVS occurred, but no cerebral infarction [CI] was induced); and Group C (DCVS occurred and caused CI), the d-ROMs change rate in IJVB was the highest in Group C, followed by Group B then A (P.01). The d-ROMs change rates in peripheral arterial blood and CSF were not related to the development of DCVS.It was concluded that the more severe DCVS occurs and is more likely to progress to CI as the IJVB hydroperoxide level rises early after the development of subarachnoid hemorrhage.

Subarachnoid hemorrhage (SAH) causes dynamic changes in cerebral blood flow (CBF), and results in delayed ischemia due to vasospasm, and early perfusion deficits before delayed cerebral vasospasm (CVS). The present study examined the severity of cerebral circulatory disturbance during the early phase before delayed CVS and whether it can be used to predict patient outcome. A total of 94 patients with SAH underwent simultaneous xenon computed tomography (CT) and perfusion CT to evaluate cerebral circulation on Days 1-3. Cerebral blood flow (CBF) was measured using xenon CT and the mean transit time (MTT) using perfusion CT and calculated cerebral blood volume (CBV). Outcome was evaluated with the Glasgow Outcome Scale (good recovery [GR], moderate disability [MD], severe disability [SD], vegetative state [VS], or death [D]). Hunt and Hess (HH) grade II patients displayed significantly higher CBF and lower MTT than HH grade IV and V patients. HH grade III patients displayed significantly higher CBF and lower MTT than HH grade IV and V patients. Patients with favorable outcome (GR or MD) had significantly higher CBF and lower MTT than those with unfavorable outcome (SD, VS, or D). Discriminant analysis of these parameters could predict patient outcome with a probability of 74.5%. Higher HH grade on admission was associated with decreased CBF and CBV and prolonged MTT. CBF reduction and MTT prolongation before the onset of delayed CVS might influence the clinical outcome of SAH. These parameters are helpful for evaluating the severity of SAH and predicting the outcomes of SAH patients.

The trans-sylvian approach is one of the most frequently employed neurosurgical procedures, but it is difficult for medical students to understand the approach stereoscopically. A three-dimensional model equipped with an arachnoid membrane and sylvian vein was developed which can be repeatedly used to simulate surgery for the education of medical students and residents in the trans-sylvian approach. The model was prepared using existing models of the skull bone, brain, and cerebral artery. Polyvinylidene chloride film, commonly used as plastic wrap for food, was adopted for the arachnoid membrane, and wetted water-insoluble tissue paper for the arachnoid trabeculae. The sylvian vein was prepared by ligating woolen yarn with cotton lace thread at several sites. Students and residents performed the trans-sylvian approach under a microscope, and answered a questionnaire survey. Using this model, simulation of division of the arachnoid membrane and arachnoid trabeculae, and dissection of the sylvian vein was possible. In the questionnaire, the subjects answered 8 questions concerning understanding of the stereoscopic anatomy of the sylvian fissure, usefulness of the simulation, and interest in neurosurgical operation using the following ratings: yes, very much; yes; somewhat; not very much; or not at all. All items rated as ‘yes, very much’ and ‘yes’ accounted for more than 70% of answers. This model was useful for medical students to learn the trans-sylvian approach. In addition, repeated practice is possible using cheap materials, which is advantageous for an educational model.