Neurosurgery
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Vertebral origin angioplasty and stenting (VOAS) with bare metal stents is associated with a high rate of in-stent restenosis (ISR). ⋯ VOAS with drug-eluting stents was associated with a low incidence of periprocedural complications. Although the rate of restenosis was half that seen with the use of bare metallic stents, 21% of patients still developed moderate or severe ISR. These patients may require>or=1 revascularization procedures. The risk of delayed stent thrombosis may necessitate lifelong dual antiplatelet medications.
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The reported cumulative risk of post-angiographic obliteration (post-AO) hemorrhage from arteriovenous malformations (AVMs) following gamma knife radiosurgery (GKRS) over 10 years is 2.2%. ⋯ Our results suggest that AVMs that show an increase in the size of the enhanced region within 1 year of angiographic obliteration should be followed up with caution for post-AO hemorrhage. Persisting enhancement itself is not positively associated with subsequent hemorrhage.
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Little is known regarding meningiomas that primarily arise from the floor of the middle fossa as opposed to the sphenoid wing, the cavernous sinus, the anterior petrous ridge, or the lateral convexity dura. ⋯ We present the clinical characteristics and surgical outcome of a series of patients presenting with meningiomas primarily arising from the concave floor of the middle cranial fossa. Given the relatively uncommon nature of these lesions, more investigation into the clinical behavior of this entity is warranted.
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Posterior cervical stabilization for cervical fractures is common, and numerous techniques for fixation have been described. This case describes the novel usage of C1 laminar screws due to a persistent intersegmental artery and congenital fusion of C2-C3. ⋯ Posterior fixation for fractures of the cervical spine is common; however, the use of C1 posterior arch screws for fractures has not previously been described. The presence of a persistent intersegmental course of the vertebral artery, a rare but reported anomaly, should be regarded as a contraindication to placement of C1 lateral mass screws and necessitates careful consideration of the available surgical options.
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The sequelae of aneurysmal subarachnoid hemorrhage (SAH) include vasospasm and hydrocephalus. ⋯ Intraventricular tPA is a safe and effective treatment for reducing both angioplasty and shunting rates in patients with SAH H&H Grades 3 to 5. A randomized trial is indicated.