Journal of neurosurgery
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Journal of neurosurgery · Jun 2019
Case ReportsFlow diversion and microvascular plug occlusion for the treatment of a complex unruptured basilar/superior cerebellar artery aneurysm: case report.
The authors present the unusual case of a complex unruptured basilar artery terminus (BAT) aneurysm in a 42-year-old symptomatic female patient presenting with symptoms of mass effect. Due to the fusiform incorporation of both the BAT and left superior cerebellar artery (SCA) origin, simple surgical or endovascular treatment options were not feasible in this case. ⋯ The patient recovered well from her neurological symptoms. This case report illustrates the successful use of a combined staged deconstructive/reconstructive endovascular approach utilizing 2 endoluminal tools, PED and MVP, to reconstruct the BAT and occlude a complex aneurysm.
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Journal of neurosurgery · Jun 2019
Endovascular treatment for emergent large vessel occlusion due to severe intracranial atherosclerotic stenosis.
The optimal treatment strategy for patients with emergent large vessel occlusion (ELVO) due to underlying severe intracranial atherosclerotic stenosis (ICAS) is unclear. The purpose of this study was to compare treatment outcomes from intracranial angioplasty with or without stenting and intraarterial infusion of a glycoprotein IIb/IIIa inhibitor in patients with ELVO due to severe ICAS, and to investigate predictors of outcome after endovascular therapy in such patients. ⋯ Both intracranial angioplasty/stenting and intraarterial infusion of a glycoprotein IIb/IIIa inhibitor are effective and safe in the treatment of underlying severe ICAS in acute stroke patients with ELVO. In addition, a lack of a history of stroke/TIA was the only independent predictor of good outcome after endovascular therapy in such patients.
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Journal of neurosurgery · Jun 2019
Epidemiology of ruptured brain arteriovenous malformation: a National Cohort Study in Korea.
Brain arteriovenous malformation (BAVM) is a rare cerebrovascular disease that causes intracranial hemorrhage. Although several reports have demonstrated the epidemiological features of BAVM in Western countries, no epidemiological investigations regarding BAVM have been reported in Korea. The authors aimed to investigate the national epidemiology of ruptured BAVM in a Korean population. ⋯ The standardized incidence of ruptured BAVMs was 3.6 per 100,000 person-years in Korea. Ruptured BAVMs resulted in high mortality and disability rates.
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Journal of neurosurgery · Jun 2019
Longitudinal survey of cranial case log entries during neurological surgery residency training.
The purpose of this study was to analyze national trends in adult cranial cases performed by neurological surgery residents as logged into the Accreditation Council for Graduate Medical Education (ACGME) system. ⋯ Neurosurgical residents reported increasing case volumes for most cranial procedures between 2009 and 2017. This increase was observed despite work hour limitations set forth in 2003 and 2011. Of note, an inverse relationship between open vascular and endovascular procedures was observed, with a decrease in open vascular procedures and an increase in endovascular procedures performed during the study period. When compared to the ACGME required minimums, neurosurgery residents gained much more exposure to cranial procedures than was expected. Additionally, a larger caseload throughout training suggests that residents are graduating with greater competency and experience in cranial neurosurgery.
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Journal of neurosurgery · Jun 2019
Pace of movement: the role of single neurons in the subthalamic nucleus.
The ability to modulate the pace of movement is a critical factor in the smooth operation of the motor system. The authors recently described distinct and overlapping representations of movement kinematics in the subthalamic nucleus (STN), but it is still unclear how movement pace is modulated according to the demands of the task at the neuronal level in this area. The goal of this study was to clarify how different movement paces are being controlled by neurons in the STN. ⋯ These findings suggest that disparate schemes are utilized in the STN for neuronal recruitment for motor control of the upper and lower extremities. The results indicate a distributed model of motor control within the STN, where the active neuronal population changes when modifying the task condition and pace.