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Neurosurgical Focus

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https://www.readbyqxmd.com/read/28565993/use-of-the-pipeline-embolization-device-in-the-treatment-of-iatrogenic-intracranial-vascular-injuries-a-bi-institutional-experience
#1
Julius Griauzde, Vijay M Ravindra, Neeraj Chaudhary, Joseph J Gemmete, Marcus D Mazur, Christopher D Roark, William T Couldwell, Min S Park, Philipp Taussky, Aditya S Pandey
OBJECTIVE Flow-diverting devices have been used for the treatment of complex intracranial vascular pathology with success, but the role of these devices in treating iatrogenic intracranial vascular injuries has yet to be clearly defined. Here, the authors report their bi-institutional experience with the use of the Pipeline embolization device (PED) for the treatment of iatrogenic intracranial vascular injuries. METHODS The authors reviewed a retrospective cohort of patients with iatrogenic injuries to the intracranial vasculature that were treated with the PED between 2012 and 2016...
June 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28565992/pipeline-flow-diversion-of-ruptured-blister-aneurysms-of-the-supraclinoid-carotid-artery-using-a-single-device-strategy
#2
Robert W Ryan, Amir S Khan, Rebecca Barco, Armen Choulakian
OBJECTIVE Ruptured blister aneurysms remain challenging lesions for treatment due to their broad, shallow anatomy and thin, fragile wall. Historical challenges with both open microsurgical approaches and intrasaccular endovascular approaches have led to increased use of flow diversion for management of these aneurysms. However, the optimum paradigm, including timing of treatment, use of dual antiplatelet therapy, and number of flow-diverter devices to use remains unknown. The authors describe their experience with ruptured blister aneurysms treated with flow diversion at their institution, and discuss rates of rebleeding and number of devices used...
June 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28565991/platelet-testing-in-flow-diversion-a-review-of-the-evidence
#3
L Ian Taylor, James C Dickerson, Robert J Dambrino, M Yashar S Kalani, Philipp Taussky, Chad W Washington, Min S Park
OBJECTIVE Although the use of dual antiplatelet therapy with flow diversion is recommended and commonplace, the testing of platelet inhibition is more controversial. METHODS The authors reviewed the medical literature to establish and describe the physiology of platelet adhesion, the pharmacology of antiplatelet medications, and the mechanisms of the available platelet function tests. Additionally, they present a review of the pertinent neurointerventional and interventional cardiology literature. RESULTS Competing reports in the neurointerventional literature argue for and against the use of routine platelet function testing, with adjustments to the dosage or medications based on the results...
June 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28565990/transcirculation-pipeline-embolization-device-deployment-a-rescue-technique
#4
Edison P Valle-Giler, Elias Atallah, Stavropoula Tjoumakaris, Robert H Rosenwasser, Pascal Jabbour
The Pipeline embolization device (PED) has become a very important tool in the treatment of nonruptured cerebral aneurysms. However, a patient's difficult anatomy or vascular stenosis may affect the device delivery. The purpose of this article was to describe an alternate technique for PED deployment when ipsilateral anatomy is not amenable for catheter navigation. A 44-year-old woman with a symptomatic 6-mm right superior hypophyseal artery aneurysm and a known history of right internal carotid artery dissection presented for PED treatment of her aneurysm...
June 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28565989/pipeline-embolization-device-for-recurrence-of-previously-treated-aneurysms
#5
David Dornbos, Constantine L Karras, Nicole Wenger, Blake Priddy, Patrick Youssef, Shahid M Nimjee, Ciarán J Powers
OBJECTIVE The utilization of the Pipeline embolization device (PED) has increased significantly since its inception and original approval for use in large, broad-necked aneurysms of the internal carotid artery. While microsurgical clipping and advances in endovascular techniques have improved overall efficacy in achieving complete occlusion, recurrences still occur, and the best modality for retreatment remains controversial. Despite its efficacy in this setting, the role of PED utilization in the setting of recurrent aneurysms has not yet been well defined...
June 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28565988/postprocedural-midterm-and-long-term-results-of-cerebral-aneurysms-treated-with-flow-diverter-devices-7-year-experience-at-a-single-center
#6
Francesco Briganti, Giuseppe Leone, Luigi Cirillo, Oreste de Divitiis, Domenico Solari, Paolo Cappabianca
OBJECTIVE Flow diversion has emerged as a viable treatment option for selected intracranial aneurysms and recently has been gaining traction. The aim of this study was to evaluate the safety and effectiveness of flow-diverter devices (FDDs) over a long-term follow-up period. METHODS The authors retrospectively reviewed all cerebral aneurysm cases that had been admitted to the Division of Neurosurgery of the Università degli Studi di Napoli between November 2008 and November 2015 and treated with an FDD. The records of 60 patients (48 females and 12 males) harboring 69 cerebral aneurysms were analyzed...
June 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28565987/prolapse-of-the-pipeline-embolization-device-in-aneurysms-incidence-management-and-outcomes
#7
Visish M Srinivasan, Andrew P Carlson, Maxim Mokin, Jacob Cherian, Stephen R Chen, Ajit Puri, Peter Kan
OBJECTIVE The Pipeline embolization device (PED) is frequently used in the treatment of anterior circulation aneurysms, especially around the carotid siphon, with generally excellent results. However, the PED has its own unique technical challenges, including the occurrence of device foreshortening or migration leading to prolapse into the aneurysm. The authors sought to determine the incidence of this phenomenon, the rescue strategies, and outcomes. METHODS Four institutional databases of neuroendovascular procedures were reviewed for cases of intracranial aneurysms treated with PEDs...
June 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28565986/pipeline-embolization-device-versus-coiling-for-the-treatment-of-large-and-giant-unruptured-intracranial-aneurysms-a-cost-effectiveness-analysis
#8
Arvin R Wali, Charlie C Park, David R Santiago-Dieppa, Florin Vaida, James D Murphy, Alexander A Khalessi
OBJECTIVE Rupture of large or giant intracranial aneurysms leads to significant morbidity, mortality, and health care costs. Both coiling and the Pipeline embolization device (PED) have been shown to be safe and clinically effective for the treatment of unruptured large and giant intracranial aneurysms; however, the relative cost-to-outcome ratio is unknown. The authors present the first cost-effectiveness analysis to compare the economic impact of the PED compared with coiling or no treatment for the endovascular management of large or giant intracranial aneurysms...
June 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28565985/endovascular-management-of-fusiform-aneurysms-in-the-posterior-circulation-the-era-of-flow-diversion
#9
Ahmed J Awad, Justin R Mascitelli, Reham R Haroun, Reade A De Leacy, Johanna T Fifi, J Mocco
Fusiform aneurysms are uncommon compared with their saccular counterparts, yet they remain very challenging to treat and are associated with high rates of rebleeding and morbidity. Lack of a true aneurysm neck renders simple clip reconstruction or coil embolization usually impossible, and more advanced techniques are required, including bypass, stent-assisted coiling, and, more recently, flow diversion. In this article, the authors review posterior circulation fusiform aneurysms, including pathogenesis, natural history, and endovascular treatment, including the role of flow diversion...
June 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28565984/novel-use-of-flow-diversion-for-the-treatment-of-aneurysms-associated-with-arteriovenous-malformations
#10
Craig Kilburg, Philipp Taussky, M Yashar S Kalani, Min S Park
The use of flow-diverting stents for intracranial aneurysms has become more prevalent, and flow diverters are now routinely used beyond their initial scope of approval at the proximal internal carotid artery. Although flow diversion for the treatment of cerebral aneurysms is becoming more commonplace, there have been no reports of its use to treat flow-related cerebral aneurysms associated with arteriovenous malformations (AVMs). The authors report the cases of 2 patients whose AVM-associated aneurysms were managed with flow diversion...
June 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28565983/vision-outcomes-in-patients-with-paraclinoid-aneurysms-treated-with-clipping-coiling-or-flow-diversion-a-systematic-review-and-meta-analysis
#11
Michael A Silva, Alfred P See, Hormuzdiyar H Dasenbrock, Nirav J Patel, Mohammad A Aziz-Sultan
OBJECTIVE Patients with paraclinoid aneurysms commonly present with visual impairment. They have traditionally been treated with clipping or coiling, but flow diversion (FD) has recently been introduced as an alternative treatment modality. Although there is still initial aneurysm thrombosis, FD is hypothesized to reduce mass effect, which may decompress the optic nerve when treating patients with visually symptomatic paraclinoid aneurysms. The authors performed a meta-analysis to compare vision outcomes following clipping, coiling, or FD of paraclinoid aneurysms in patients who presented with visual impairment...
June 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28565982/introduction-the-treatment-of-cerebral-aneurysms-flow-diversion-and-beyond
#12
Adam S Arthur, Philipp Taussky, Min S Park, Michael F Stiefel, Robert H Rosenwasser
No abstract text is available yet for this article.
June 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28565981/complications-associated-with-the-use-of-flow-diverting-devices-for-cerebral-aneurysms-a-systematic-review-and-meta-analysis
#13
Geng Zhou, Ming Su, Yan-Ling Yin, Ming-Hua Li
OBJECTIVE The objective of this study was to review the literature on the use of flow-diverting devices (FDDs) to treat intracranial aneurysms (IAs) and to investigate the safety and complications related to FDD treatment for IAs by performing a meta-analysis of published studies. METHODS A systematic electronic database search was conducted using the Springer, EBSCO, PubMed, Medline, and Cochrane databases on all accessible articles published up to January 2016, with no restriction on the publication year...
June 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28565980/update-on-flow-diverters-for-the-endovascular-management-of-cerebral-aneurysms
#14
Gary Rajah, Sandra Narayanan, Leonardo Rangel-Castilla
Flow diversion has become a well-accepted option for the treatment of cerebral aneurysms. Given the significant treatment effect of flow diverters, numerous options have emerged since the initial Pipeline embolization device studies. In this review, the authors describe the available flow diverters, both endoluminal and intrasaccular, addressing nuances of device design and function and presenting data on complications and outcomes, where available. They also discuss possible future directions of flow diversion...
June 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28565979/flow-diversion-of-tandem-cerebral-aneurysms-a-multi-institutional-retrospective-study
#15
Al-Wala Awad, Karam Moon, Nam Yoon, Marcus D Mazur, M Yashar S Kalani, Philipp Taussky, Cameron G McDougall, Felipe C Albuquerque, Min S Park
OBJECTIVE Flow diversion has proven to be an efficacious means of treating cerebral aneurysms that are refractory to other therapeutic means. Patients with tandem aneurysms treated with flow diversion have been included in larger, previously reported series; however, there are no dedicated reports on using this technique during a single session to treat this unique subset of patients. Therefore, the authors analyzed the outcomes of patients who had undergone single-session flow diversion for the treatment of tandem aneurysms...
June 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28565978/off-label-uses-of-the-pipeline-embolization-device-a-review-of-the-literature
#16
Purvee D Patel, Nohra Chalouhi, Elias Atallah, Stavropoula Tjoumakaris, David Hasan, Hekmat Zarzour, Robert Rosenwasser, Pascal Jabbour
The Pipeline embolization device (PED) is the most widely used flow diverter in endovascular neurosurgery. In 2011, the device received FDA approval for the treatment of large and giant aneurysms in the internal carotid artery extending from the petrous to the superior hypophyseal segments. However, as popularity of the device grew and neurosurgeons gained more experience, its use has extended to several other indications. Some of these off-label uses include previously treated aneurysms, acutely ruptured aneurysms, small aneurysms, distal circulation aneurysms, posterior circulation aneurysms, fusiform aneurysms, dissecting aneurysms, pseudoaneurysms, and even carotid-cavernous fistulas...
June 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28565977/endovascular-treatment-of-blister-aneurysms
#17
Geoffrey W Peitz, Christopher A Sy, Ramesh Grandhi
Blister aneurysms are rare cerebrovascular lesions for which the treatment methods are reviewed here, with a focus on endovascular options. The reported pathogenesis of blister aneurysms varies, and hemodynamic stress, arterial dissection, and arteriosclerotic ulceration have all been described. There is consensus on the excessive fragility of blister aneurysms and their parent vessels, which makes clipping technically difficult. Open surgical treatment is associated with high rates of complications, morbidity, and mortality; endovascular treatment is a promising alternative...
June 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28463624/evaluation-of-robot-guided-minimally-invasive-implantation-of-2067-pedicle-screws
#18
Naureen Keric, Christian Doenitz, Amer Haj, Izabela Rachwal-Czyzewicz, Mirjam Renovanz, Dominik M A Wesp, Stephan Boor, Jens Conrad, Alexander Brawanski, Alf Giese, Sven R Kantelhardt
Objective Recent studies have investigated the role of spinal image guidance for pedicle screw placement. Many authors have observed an elevated placement accuracy and overall improvement of outcome measures. This study assessed a bi-institutional experience following introduction of the Renaissance miniature robot for spinal image guidance in Europe. Methods The medical records and radiographs of all patients who underwent robot-guided implantation of spinal instrumentation using the novel system (between October 2011 and March 2015 in Mainz and February 2014 and February 2016 in Regensburg) were reviewed to determine the efficacy and safety of the newly introduced robotic system...
May 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28463623/accuracy-of-robot-guided-versus-freehand-fluoroscopy-assisted-pedicle-screw-insertion-in-thoracolumbar-spinal-surgery
#19
Granit Molliqaj, Bawarjan Schatlo, Awad Alaid, Volodymyr Solomiichuk, Veit Rohde, Karl Schaller, Enrico Tessitore
OBJECTIVE The quest to improve the safety and accuracy and decrease the invasiveness of pedicle screw placement in spine surgery has led to a markedly increased interest in robotic technology. The SpineAssist from Mazor is one of the most widely distributed robotic systems. The aim of this study was to compare the accuracy of robot-guided and conventional freehand fluoroscopy-guided pedicle screw placement in thoracolumbar surgery. METHODS This study is a retrospective series of 169 patients (83 women [49%]) who underwent placement of pedicle screw instrumentation from 2007 to 2015 in 2 reference centers...
May 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28463622/initial-experience-with-a-robotically-operated-video-optical-telescopic-microscope-in-cranial-neurosurgery-feasibility-safety-and-clinical-applications
#20
Lior Gonen, Srikant S Chakravarthi, Alejandro Monroy-Sosa, Juanita M Celix, Nathaniel Kojis, Maharaj Singh, Jonathan Jennings, Melanie B Fukui, Richard A Rovin, Amin B Kassam
OBJECTIVE The move toward better, more effective optical visualization in the field of neurosurgery has been a focus of technological innovation. In this study, the authors' objectives are to describe the feasibility and safety of a new robotic optical platform, namely, the robotically operated video optical telescopic-microscope (ROVOT-m), in cranial microsurgical applications. METHODS A prospective database comprising patients who underwent a cranial procedure between April 2015 and September 2016 was queried, and the first 200 patients who met the inclusion criteria were selected as the cohort for a retrospective chart review...
May 2017: Neurosurgical Focus
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