Journal of neurosurgery
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Journal of neurosurgery · Jul 2009
Stent-assisted coil embolization followed by a stent-within-a-stent technique for ruptured dissecting aneurysms of the intracranial vertebrobasilar artery. Clinical article.
A ruptured dissecting aneurysm of the vertebrobasilar artery (VBA-DA) is a well-known cause of acute subarachnoid hemorrhage (SAH) with a high rate of early rebleeding. Internal trapping of the parent artery, including the dissected segment, is one of the most reliable techniques to prevent rebleeding. However, for a ruptured VBA-DA not suitable for internal trapping, the optimal treatment method has not been well established. The authors describe their experience in treating ruptured VBA-DAs not amenable to internal trapping of the parent artery with stent-assisted coil embolization (SAC) followed by a stent-within-a-stent (SWS) technique. ⋯ The SAC-SWS technique seems to be a feasible and effective reconstructive treatment option for a ruptured VBA-DA. The technique may be considered as an alternative therapeutic option in selected patients with ruptured VBA-DAs unsuitable for internal trapping of the parent artery.
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Journal of neurosurgery · Jul 2009
Case ReportsExtended intracranial applications for ethylene vinyl alcohol copolymer (Onyx): mycotic and dissecting aneurysms. Technical note.
The authors describe the off-label use of Onyx for embolization of fusiform mycotic and dissecting intracranial aneurysms based on their experience with 3 patients treated at the University of Utah Hospital from 2006 through 2007. Technical success in occluding the parent artery/aneurysm was achieved in all patients. There were no complications. The authors conclude that Onyx can be used to achieve occlusion of fusiform mycotic and dissecting intracranial aneurysms in conjunction with parent artery occlusion.
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Journal of neurosurgery · Jul 2009
Comparative StudyEffect of country or continent of treatment on outcome after aneurysmal subarachnoid hemorrhage. Clinical article.
Prognostic factors for outcome after aneurysmal subarachnoid hemorrhage (SAH) include the clinical and pathological characteristics of the patient and hemorrhage as well as some aspects of treatment. Because treatment can vary between countries and continents, the authors used a large database of patients with SAH to determine the effect of the geographic location of treatment on outcome. ⋯ Despite the variations in treatment that undoubtedly exist between countries and continents, the location of treatment had minimal effect on outcome. Outcome was influenced mostly by clinical characteristics on admission such as neurological grade, patient age, and amount of SAH.
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Journal of neurosurgery · Jul 2009
Case ReportsThrombosis and hemorrhage in the acute period following Gamma Knife surgery for arteriovenous malformation. Case report.
Bleeding of an arteriovenous malformation (AVM) following stereotactic radiosurgery (SRS) is a known risk during the latency interval, but hemorrhage in the 30-day period following radiosurgery rarely has been reported in the literature. The authors present the case of a 57-year-old man who underwent Gamma Knife surgery for a large AVM, and they provide radiographic documentation of a thrombus in the primary draining vein immediately preceding an AVM hemorrhage within 9 days after radiosurgery. They postulate that the pathophysiology of an AVM hemorrhage in the acute period following SRS is related to an association among tissue irradiation, acute inflammatory response, and vessel thrombosis. ⋯ The authors present the planning images and subsequent CT scans demonstrating a new venous thrombus in the primary draining vein. An acute inflammatory response following radiosurgery with resultant acute venous thrombus formation and venous obstruction is proposed as one mechanism of an AVM hemorrhage in this patient. Radiographic evidence of the time course of thrombosis and hemorrhage supports the hypothesis that acute venous obstruction is a cause of intracranial hemorrhage.
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Journal of neurosurgery · Jul 2009
A novel pressure sensor with an optical system for coil embolization of intracranial aneurysms. Laboratory investigation.
In endovascular coil embolization for an intracranial aneurysm, the excessive pressure created during coil insertion into an aneurysm can cause a catastrophic rupture or dislodge a microcatheter tip from the aneurysm dome, resulting in insufficient embolization. Such undue mechanical pressure can only be subjectively detected by the subtle tactile feedback the surgeon experiences. Therefore, the authors of this study developed a new sensor device to measure the coil insertion pressure via an optical system. ⋯ This new sensor device adequately measures coil insertion pressure. This system provides potentially safer and more reliable aneurysm embolizations.