Neurosurgery
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Case Reports
Sole stenting bypass for the treatment of vertebral artery aneurysms: technical case report.
Vertebrobasilar aneurysms have a risk of rupture ranging from 2.5 to 50% (especially those larger than 7 mm) and a repeat bleeding rate of between 30 and 70%. For this reason, patients with aneurysms larger than 7 mm should be treated. Considering the high complexity of surgical approaches in this area, an increasing number of reported cases are being treated with endovascular therapy. The purpose of this article is to determine the effectiveness and safety of sole stenting bypass in the treatment of three consecutive patients with vertebrobasilar aneurysms. ⋯ The sole stenting bypass technique seems to be a good alternative for the treatment of complex vertebral aneurysms by inducing thrombosis of the aneurysm with preservation of the parent vessel lumen.
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Case Reports
Monorail snare technique for the recovery of stretched platinum coils: technical case report.
Coil stretching represents a potentially hazardous technical complication not infrequently encountered during the embolization of cerebral aneurysms. Often, the stretched coil cannot be advanced into the aneurysm or withdrawn intact. The operator is then forced to attempt to retract the damaged coil, which may result in coil breakage, leaving behind a significant length of potentially thrombogenic stretched coil material within the parent vessel. To overcome this problem, we devised a technique to snare the distal, unstretched, intact portion of the platinum coil by use of the indwelling microcatheter and stretched portion of the coil as a monorail guide. ⋯ The monorail snare technique represents a fast, safe, and easy method by which a stretched coil can be removed.
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Although rare in developed countries, hydatid disease is a serious parasitic infection in endemic areas. Spinal disease most commonly involves the thoracic region, and involvement of the upper cervical spine is extremely rare. In this report, a case of hydatid disease involving the craniocervical junction is presented, along with a review of the literature. ⋯ Hydatid disease should be considered in the differential diagnosis of spinal cord compression, especially in endemic areas. Although the chance of obtaining a cure is unlikely, radical surgery coupled with antihelminthic therapy seems to provide long-lasting relief.
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To introduce the possibility of volume-rendered helical computed tomographic (CT) angiographic data sets by use of Medtronic StealthStation Treon surgical navigation technology (Medtronic Surgical Navigation Technologies, Louisville, CO) and to evaluate the clinical usefulness of the method in planning and performing surgical treatment of intracranial aneurysms. ⋯ Reports in the literature indicate that information gathered by CT angiography with volume rendering shows a significant impact on aneurysm management. The StealthStation system upgraded with the adequate algorithm seems to provide a time- and cost-effective method of performing automated 3-D volume rendering of CT angiography and provides an interesting alternative to the available investigation modalities in case of emergency.
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Comparative Study
Rapidly rising incidence of cerebrospinal fluid shunting procedures for idiopathic intracranial hypertension in the United States, 1988-2002.
Obesity, a major risk factor for idiopathic intracranial hypertension (IIH), is rapidly increasing in all ages of the United States population. We studied trends in the incidence of cerebrospinal fluid (CSF) shunts for IIH in the United States between 1988 and 2002, using a national hospital discharge database. ⋯ The incidence of CSF shunting for IIH is increasing in the population of the United States at about the same relative rate as morbid obesity. Studies to establish the best shunting method in IIH and to explore alternative treatment strategies, such as optic nerve sheath fenestration and bariatric surgery, are urgently needed.