World Neurosurg
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Therapeutic embolization of the common carotid artery (CCA), internal carotid artery (ICA), and vertebral artery (VA) is necessary in the treatment of a subset of chronic arteriovenous fistulas (AVFs), hemorrhages, highly vascularized neoplasms before resection, and giant aneurysms. There are currently no reports of the use of the AMPLATZER Vascular Plug II (AVP II) device to occlude the CCA, ICA, or VA. The objective of this article is to present the Duke Cerebrovascular Center experience using the AVP II device in neurointerventional applications. ⋯ The AVP II device is relatively large, self-expanding vascular occlusion device that safely allows enhanced, rapid take-down of the CCA, ICA, and VA with low risk of distal migration.
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One significant drawback during a cranial reoperation is the presence of meningocerebral adhesions. The appearance of connective tissue bridges between the inner surface of the dura and the pia-arachnoid is mostly related to dural closure and the condition in which the surgical field was left in the previous surgery. This study was done to determine the benefit of placing a thin-layer gelatin sponge of polypeptides subdurally to prevent meningocerebral adhesions. ⋯ This study proves that, during the dural closure, placing a thin layer of gelatin sponge in the subdural space is a safe and effective method for preventing meningocerebral adhesions.
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The purpose of this study was to describe the effectiveness of local vascularized flaps for the repair of various skull base defects. ⋯ Local vascularized flap utilization in open reconstruction of the skull base has an excellent success rate, with no second donor site morbidity. The success is comparable to free tissue transplant reconstruction and should be in the armamentarium of every neurosurgeon and skull base surgeon. Appropriate incision planning and preoperative evaluation and selection is essential for the success of this type of reconstructive technique.
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Although rupture of cerebral aneurysms typically occurs at the fragile wall at the apex or pole, some aneurysms rupture through the body or the neck. The purpose of this study was to clarify the association between aneurysm rupture points and hemodynamic features through the use of computational fluid dynamics (CFD) analysis. ⋯ This study highlights the relationship between the local hemodynamic features and the rupture points observed during the microsurgical clipping. CFD may determine a rupture point of aneurysms using the feature of markedly low WSS.
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Biography Historical Article
The Cushing-Dandy conflict—the Dandy family perception of the discord.
The rivalry between Harvey Cushing and Walter Dandy has long fascinated neurosurgeons. Once a mentor to Dandy, Cushing saw his pupil's cunning prowess in the laboratory and unique surgical skill rival his own, and he took years to embrace some of Dandy's innovations, the most well-known of which was the technique of ventriculography. In this report, Dandy's great grandson draws on his family archives and personal letters of Dandy to lineate the evolution of the Dandy-Cushing relationship.