Acta neurochirurgica
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Acta neurochirurgica · Aug 2012
Review Case ReportsSTA-ACA bypass using the contralateral STA as an interposition graft for the treatment of complex ACA aneurysms: report of two cases and a review of the literature.
Bypass surgery has been used as a remedy for the complex cerebral aneurysm, which was unsolved with the clipping method. However, little has been reported about bypass options for anterior cerebral artery (ACA) aneurysms. ⋯ To achieve complete obliteration of the aneurysm, we performed a superficial temporal artery (STA)-ACA bypass using contralateral STA as interposition grafts with endovascular trapping without any ischemic events. These cases show that STA-ACA bypass using contralateral STA interposition graft is a feasible option to maintain blood supply to the ACA territory if a proximal ACA lesion requires trapping.
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Superficial temporal artery to middle cerebral artery (STA-MCA) bypass is a time-honored, crucial procedure employed in the management of well-selected patients with cerebrovascular ischemic disease, particularly moyamoya. In addition, its application to complex cerebral aneurysms and neoplasms requiring vessel sacrifice for complete resection continues to stand the test of time. ⋯ With careful attention to the surgical nuances of STA-MCA bypass, this indispensable procedure is a hemisphere-preserving technique that can be performed with high patency and low morbidity rates.
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Intracranial arterial dolichoectasia is a condition in which arteries demonstrate an increase in length and diameter, with the vertebrobasilar system being the most commonly affected segment. Because the criteria for and degree of vertebrobasilar dolichoectasia are usually established on three-dimensional time-of-flight MR angiography, we presented the results of an anatomic study of vertebrobasilar dolichoectasia cadaveric specimens. ⋯ We noted a predisposition of males older than 40 years to arterial dolichoectasia in the vertebrobasilar system, independently from population group, as well as its asymptomatic appearance, independently from the presence of atherosclerotic plaques.
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Acta neurochirurgica · Aug 2012
Predictors of work status and quality of life 9-13 years after aneurysmal subarachnoid hemorrahage.
Aneurysmal subarachnoid hemorrhage (SAH) causes long-term psychosocial impairments even in patients who regain functional independence. Little is known about predictors of these impairments. We studied how early clinical data and neuropsychological results predict work status and health-related quality of life (HRQoL) 9-13 years after SAH. ⋯ Questionnaire ratings of patients' psychosocial impairments 1 year after SAH give important information for the long-term prediction of their work status and HRQoL. In the long run, patients' unemployment becomes strongly associated with higher age, while their performance of usual activities can be predicted with learning and memory results.
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Acta neurochirurgica · Aug 2012
Surgical treatment of symptomatic cerebral cavernous malformations in eloquent brain regions.
Despite the increased risk of hemorrhage and deteriorating neurological function of once-bled cerebral cavernous malformations (CM), the management of eloquently located CMs remains controversial. ⋯ Despite the high postoperative transient morbidity, the majority improved profoundly during follow-ups. Compared with natural history, surgical treatment should be considered for all eloquent symptomatic CMs. Dorsal brainstem location and poor preoperative neurological status are associated with an increased postoperative morbidity.