Neurosurgery
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Few could have imagined the tremendous growth of endovascular surgery over the past 40 years. Endovascular therapy has greatly enhanced the care of the patient in neurosurgery, spine surgery, and head and neck surgery. Progress in technology and techniques continue to push forward the boundaries of what is deemed "treatable," assuming acceptable risk. ⋯ Maximizing the accessibility of these routes to highly specific regions of the central nervous system provides an elegant and minimalist approach to treating diseases of the central nervous system with almost no "footprints" of ever having accessed the region. In the future, safe, efficient and intelligent delivery systems that may enhance or alter the tissue's response may result in successful treatment of cerebrovascular diseases, as well as other diseases of the craniospinal axis. The growth of nanotechnology, metallurgy, synthetic polymers, imaging, and training will all combine to help grow the technology and the science that is surgical endovascular neuroradiology.
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Review Meta Analysis
Review of treatment trials in human spinal cord injury: issues, difficulties, and recommendations.
To provide a comprehensive review of the treatment trials in the field of spinal cord injury, emphasizing what has been learned about the effectiveness of the agents and strategies tested and the quality of the methodology. The review aims to provide useful information for the improvement of future trials. The review audience includes practitioners, researchers, and consumers. ⋯ A large number of trials in the field of spinal cord injury have been conducted, but with few proven gains for patients. This review reveals several shortcomings in trial design and makes several recommendations for improvement.
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Review
Therapy of brain arteriovenous malformations: multimodality treatment from a balanced standpoint.
The three therapeutic modalities for arteriovenous malformation (AVM) treatment (surgery, embolization, and radiotherapy) developed in the past years with specific tools, each tool with its own qualities. Soon after the implementation of embolization for treatment of AVMs, this technique was used in combination with microsurgery; since the development of radiosurgery, treatment algorithms combining embolization with surgery and eventual subsequent radiosurgery, embolization with radiosurgery, or surgery with subsequent radiosurgery have been reported. ⋯ Institutions with an endovascular background embolize AVMs with the aim of maximal occlusion rates and view surgery or radiosurgery as a technique to be used if the goal of total endovascular occlusion cannot be achieved. Radiosurgeons receive patients after incomplete embolization or surgical extirpation or a combination of both.
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Review
The role of neuroendovascular therapy for the treatment of brain arteriovenous malformations.
Neuroendovascular embolization represents a critical component of the multidisciplinary management of cerebral arteriovenous malformations. Safe and effective embolization may be performed only in the context of a well-designed, rational treatment plan that is fundamentally based on a clear understanding of the natural history of the lesion, as well as the cumulative risks of multimodality treatment. This article outlines the role of neuroendovascular embolization in arteriovenous malformation therapy with a specific emphasis on decision making in the context of formulating a treatment plan. The authors also provide a summary of the available embolic agents and their technical application, potential intraprocedural and periprocedural complications, and postprocedural management.
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Giant intracranial aneurysms present unique therapeutic intricacies. The purpose of this study was to evaluate the anatomic and hemodynamic characteristics of these lesions and the current endovascular and combined surgical and endovascular techniques available for their treatment. ⋯ Although there are a wide variety of endovascular therapeutic options for the treatment of giant intracranial aneurysms, none of the current techniques is completely successful and free of complications in the management of these complex lesions. A detailed and individualized analysis of each case in conjunction with sufficient understanding of the anatomy and hemodynamics of a particular aneurysm should guide the therapeutic decision. Further research advances will assist in elucidating the factors predisposing to genesis, progression, and aggressive clinical manifestations of these giant lesions.