Neurosurgery
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Case Reports
Rupture of a large ophthalmic segment saccular aneurysm associated with closed head injury: case report.
Although each year approximately 30,000 to 50,000 cases of subarachnoid hemorrhage in the United States are caused by the rupture of intracranial saccular aneurysms, there is little information in the literature documenting the association of aneurysmal rupture with closed head injury. ⋯ Although the association of head trauma and aneurysmal subarachnoid hemorrhage is rare, the presence of significant basal subarachnoid blood on a computed tomographic scan should alert the physician to the possibility of a ruptured aneurysm.
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Case Reports
Balloon-assist technique for endovascular coil embolization of geometrically difficult intracranial aneurysms.
The balloon-assist or neck-remodeling technique is an adjunctive method devised for the endovascular coil embolization of aneurysms characterized by a wide neck or unfavorable geometric features. Since its initial description, there have been few data to corroborate its utility, efficacy, and safety in aneurysm embolization. ⋯ The balloon-assist method of coil embolization is characterized by promising intermediate-term angiographic and clinical outcomes and acceptable morbidity and mortality rates. Although this adjunctive method requires the use of an additional microcatheter and consequently involves a higher level of technical complexity, it extends the range of aneurysms that can be successfully treated with electrolytically detachable coils via an endovascular approach.
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The optimal surgical treatment of Chiari malformation is unclear, especially in patients with hydromyelia. Various surgical approaches have included suboccipital craniectomy, syringostomy, obex plugging, syringosubarachnoid shunting, and fourth ventriculosubarachnoid shunting. The purpose of this study is to differentiate extradural and intradural approaches in the treatment of Chiari I malformation. ⋯ PFD, C1 laminectomy, and duraplasty for the treatment of Chiari I malformation may lead to a more reliable reduction in the volume of concomitant hydromyelia, compared with PFD and C1 laminectomy alone. However, there seems to be a subset of patients whose symptoms will resolve and whose hydromyelic cavity will decrease with the removal of bone only. These patients seem to undergo a volumetric increase in the posterior fossa. Further studies are needed to better characterize these patients, to determine which patients with Chiari I malformation are better served with bony decompression only, and which will require duraplasty to resolve their hydromyelia.
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Contrast extravasation after intra-arterial thrombolysis for stroke occurs frequently and is identifiable on a computed tomographic (CT) scan, but it is often unrecognized or misdiagnosed. Few articles describing this phenomenon have been published. The clinical outcomes of patients after contrast extravasation are poorly understood. We designed a grading system to predict outcomes after contrast extravasation and tested the grading scale prospectively. ⋯ This grading system should prove useful as a preliminary guide for predicting outcomes of patients with contrast extravasation after intra-arterial thrombolysis for stroke. Further analysis in a large cohort of prospective patients is necessary to ensure extensibility.
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Neuroendovascular surgery/interventional neuroradiology is a relatively new subspecialty that has been evolving since the mid-1970s. During the last 2 decades, significant advances have been made in this field of minimally invasive therapy for the treatment of intracranial cerebral aneurysms; acute stroke therapy intervention; cerebral arteriovenous malformations; carotid-cavernous sinus fistulae; head, neck, and spinal cord vascular lesions; and other complex cerebrovascular diseases. Advanced postresidency fellowship programs have now been established in North America, Europe, and Japan, specifically for training in this new subspecialty. ⋯ These training standard guidelines were unanimously endorsed by the Executive Committee of the Joint Section of Cerebrovascular Neurosurgery in April 1999, by the Executive Committee of the American Society of Interventional and Therapeutic Neuroradiology and the American Society of Neuroradiology in May 1999, and by the Executive Council of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons in June 1999. The guidelines for residency/ fellowship education have now been endorsed by the parent organizations of both the interventional and diagnostic neuroradiology communities, as well as both senior organizations representing neurosurgery in North America. These guidelines for training should be used as a reference and guide by any institution establishing a training program in neuroendovascular surgery/interventional neuroradiology.