World Neurosurg
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Transvenous coil embolization of the affected venous outlet is the most effective treatment method for the management of nontraumatic adult dural arteriovenous fistulas (DAVFs). However, such an approach is not always feasible. We discuss nontraumatic adult DAVFs that were treated with transarterial coil embolization of the proximal venous outlet at our facility, as well as cases previously reported in the literature. ⋯ If a distally enlarged feeding artery is observed among the multiple feeding arteries, it suggests the existence of a large fistula and may serve as an access route for transarterial venous coil embolization. This procedure may offer a more effective and safer treatment than other endovascular approaches.
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Comparative Study
Navigated high frequency ultrasound: description of technique and clinical comparison with conventional intracranial ultrasound.
Conventional curved or sector array ultrasound (cioUS) is the most commonly used intraoperative imaging modality worldwide. Although highly beneficial in various clinical applications, at present the impact of linear array intraoperative ultrasound (lioUS) has not been assessed for intracranial use. We provide a technical description to integrate an independent lioUS probe into a commercially available neuronavigation system and evaluate the use of navigated lioUS as a resection control in glioblastoma surgery. ⋯ lioUS can be used as a safe and precise tool for intracranial image-guided resection control of glioblastomas. It can be integrated in a commercially available navigation system and shows a significant higher detection rate of residual tumor compared with conventional cioUS.
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Temporary artery occlusion (TAO) during intracranial aneurysm surgery is a key element in facilitating aneurysm dissection and clipping. Despite its significance, knowledge of its effects on long-term clinical outcome in patients undergoing elective clipping for unruptured aneurysms is limited. This study evaluated the safety of this technique in this patient population by 1 surgeon. ⋯ This study did not demonstrate any relationship between limited duration of TAO and clinical outcome. Posterior circulation aneurysms are associated with worse long-term clinical outcomes in patients with electively clipped, unruptured aneurysms.
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This study sought to describe a single institution's experience treating arteriovenous malformations (AVMs) of the basal ganglia, thalamus, and insula in a multimodal fashion. ⋯ Modern treatment of deep AVMs includes a multidisciplinary approach utilizing microsurgery, SRS, embolization, and observation. Supplementary grading adds meaningfully to traditional Spetzler-Martin grading to guide patient selection. Surgical resection is more likely to result in obliteration compared with SRS, and is associated with satisfactory results in carefully selected patients.
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Although surgical fixation is usually not part of the first-line treatment of spinal lesions in patients with multiple myeloma, there are some unique clinical situations (such as the presence of acute onset of neurological deficits) in which spinal decompression and instrumentation may be required. In such scenario, because of the presence of poor bone quality, the strength of the spinal construct is of paramount importance. Although several studies have demonstrated the benefits of cement augmentation in increasing the pullout strength of pedicle screw fixation, the injection of cement during placement of pedicle screws may hamper the possibility of additional circumferential screw fixation. In addition, cement injection into vertebral bodies full of tumor and in the presence of adjacent epidural disease may incur in higher risks of tumor extravasation and worsening of neurological deficits than cement injection after initiation of adjuvant therapies. ⋯ In spite of the associated challenges of such an interventional procedure due to the presence of extensive hardware, carrying out delayed trans-instrumentation vertebroplasty after 360-degree circumferential fixations is not only feasible, but in our opinion, may constitute the best strategy to optimize the strength of spinal instrumentation in challenging scenarios involving poor bone quality, such as in patients with multiple myeloma.