Neurosurgery
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With a globally aging population, it is imperative to develop specific treatment strategies for intracranial aneurysms in the elderly. However, the optimal management of intracranial aneurysms in the elderly remains controversial, particularly for the unruptured aneurysms. Although endovascular treatment is increasingly being used for the management of aneurysms, large endovascular series in the elderly population are relatively lacking, especially with regard to the unruptured aneurysms. We present our single-center endovascular experience in treating intracranial aneurysms in 63 consecutive patients 70 years of age and older. ⋯ The elderly patients should merit strong consideration for endovascular treatment of both ruptured and symptomatic unruptured intracranial aneurysms. However, in elderly patients with high-grade subarachnoid hemorrhage, morbidity and mortality rates remain high.
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In this study, we evaluated the difference in incidence of symptomatic vasospasm between ruptured aneurysms in the anterior and posterior circulation using multiple logistic regression analysis. ⋯ Although a poor clinical grade and a severe SAH classification on admission such as Hunt and Hess grade and Fisher's classification are established powerful predictors of symptomatic vasospasm, ruptured vertebrobasilar aneurysm are for the first time reported to be a predictor of symptomatic vasospasm based on results of a recent reliable statistical analysis.
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To better understand the presentation, management, and outcome of syringobulbia in the pediatric age group. ⋯ Syringobulbia is strongly associated with Chiari malformation and syringomyelia, and patients often present because of cranial nerve palsies. Posterior fossa decompression is a safe and effective treatment.
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To determine the effect of Neuroform stent (Boston Scientific/Target, Fremont, CA) deployment on parent vessel lumen and detect in-stent changes in patients harboring wide-necked intracranial aneurysms treated with the stent-coil technique. ⋯ Intracranial stenting using a soft self-expanding stent without angioplasty induced a statistically, but not clinically, significant decrease in cross sectional area. Further research and longer-term follow-up are needed to elucidate the mechanism and clinical importance of this response.
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The objective of this study was to assess the collateral circulation and blood flow velocity in arteries forming collateral circulation in patients with cerebral aneurysms and the occlusion of the brachiocephalic vessels. ⋯ Occlusion of the brachiocephalic vessels leads to formation of collateral circulation through the circle of Willis and the extracranial collaterals connecting the external and internal carotid arteries. An increase in blood flow velocity is commonly observed in intracranial arteries forming a collateral pathways. In some cases, not excluding arteries with a cerebral aneurysm, the increase in blood flow velocity is insignificant or none at all. This study shows that formation of a cerebral aneurysm is not always related to an increase in the flow velocity of collateral arteries.