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Acta Neurochirurgica. Supplement

Hiroshi Abe, Takashi Morishita, Kazuhiro Samura, Kenji Yagi, Masani Nonaka, Tooru Inoue
Cerebellar hemorrhage (CH) is a severe life-threatening disorder, and surgical treatment is often required in an emergency situation. Even in cases in which the surgical procedure is successful, functional recovery is likely to be delayed because of cerebellar symptoms such as ataxia and gait disturbance. Here, we briefly review the efficacy of hybrid assistive limb (HAL) treatment in neurosurgical practice and propose a new comprehensive treatment strategy for CH to facilitate early neurological recovery. We have experienced cases of ataxic gait due to various etiologies, treated with rehabilitation using the HAL, and our data showed that HAL treatment potentially improves ataxic gait and balance problems...
2018: Acta Neurochirurgica. Supplement
Hans-Jakob Steiger
The key to becoming an expert in a surgical field is mainly practice and perseverance. The old-fashioned system of teaching from one older person to a younger one, by simple demonstration, imitation, and practice, cannot be replaced in the surgical field by more modern didactic tools. Structured and explicit concepts, however, can accelerate the learning process. Structured concepts consist of a system of specifics-for example, types of aneurysms in the field of vascular pathology-and standard operating procedures...
2018: Acta Neurochirurgica. Supplement
Michihiro Tanaka
The topographical distribution of dural arteriovenous fistulas (DAVFs) was analyzed based on the embryological anatomy of the dural membrane. Sixty-six consecutive cases of intracranial and spinal DAVFs were analyzed based on the angiography, and each shunt point was identified according to the embryological bony structures. The area of dural membranes was categorized into three different groups: a ventral group located on the endochondral bone (VE group), a dorsal group on the membranous bone (DM group), and a falcotentorial group (FT group) in the falx cerebri, tentorium cerebelli, falx cerebelli, and diaphragma sellae...
2018: Acta Neurochirurgica. Supplement
Daisuke Maruyama, Tetsu Satow, Hiroharu Kataoka, Hisae Mori, Eika Hamano, Yoji Orita, Seiichiro Eguchi, Jun C Takahashi
BACKGROUND: This study aimed to evaluate the selection and outcomes of multimodal interventional treatment for unruptured brain arteriovenous malformations (uAVMs) in ARUBA-eligible patients in a single institution. METHODS: We retrospectively reviewed the data of 94 patients with uAVMs treated between 2002 and 2014. They were divided into an intervention group and a conservative group. The primary outcome was defined as the composite of death or symptomatic stroke...
2018: Acta Neurochirurgica. Supplement
Mattia Del Maestro, Sabino Luzzi, Massimo Gallieni, Donatella Trovarelli, Aldo Victor Giordano, Massimo Gallucci, Alessandro Ricci, Renato Galzio
Preoperative embolization is complementary to surgery for large brain arteriovenous malformations (AVMs). From January 2005 to December 2015, 69 patients harboring an AVM were managed in our department by the same surgeon (RG). Forty one were ruptured and 65 were supratentorial. Thirty nine smaller AVMs were treated with surgery stand-alone, whereas, for 30 larger malformations, surgery was combined with adjuvant treatment involving preoperative staged embolization and/or, less frequently, radiosurgery. In all patients treated with surgery alone, complete resection of AVM was achieved...
2018: Acta Neurochirurgica. Supplement
Yusuke Egashira, Yukiko Enomoto, Keita Yamauchi, Masanori Tsujimoto, Shinichi Yoshimura, Toru Iwama
Carotid artery stenting (CAS) has been widely accepted as a valuable therapeutic alternative to carotid endarterectomy (CEA) for high-grade carotid stenosis. Because carotid revascularization including CAS is usually performed in patients with minimal or no neurological deficits, utmost care should be taken to avoid periprocedural complications. The major concerns associated with CAS are embolic stroke, hyperperfusion syndrome (HPS), and perioperative myocardial infarction.Plaque characteristics, cerebral blood flow (CBF) in the affected cerebral hemisphere, and concomitant coronary artery disease prior to CAS are all important to assess the risks of these complications and are routinely evaluated...
2018: Acta Neurochirurgica. Supplement
V Benes, O Bradac
OBJECTIVE: We analyzed the results of internal carotid artery (ICA) stenosis treatment at our institution according to the treatment modality-carotid endarterectomy (CEA) vs. carotid artery stenting (CAS). METHODS: During 2003-2015, a total of 1894 procedures were performed for ICA stenosis. CEA was done in 1064 cases and CAS in 830 cases.The primary outcome was disabling stroke (mRS > 2) or myocardial infarction within 30 days of treatment. Secondary outcomes were transitory ischemic attacks (TIAs), minor strokes (stroke without impaired activities of daily living), and any other significant complications...
2018: Acta Neurochirurgica. Supplement
Peter Birkeland, Jens Lauritsen
In this first population-based study of moyamoya disease (MMD) in Europe, the authors identified 56 patients with MMD in Denmark during the period 1994-2015 using nationwide registers. The overall incidence was 0.047 per 100,000 person-years, which is about one-tenth that reported in Japan. Otherwise the epidemiological features were comparable: there was a bimodal age distribution with peaks in the age groups 0-9 years and 30-39 years, with twice as many females as males.
2018: Acta Neurochirurgica. Supplement
Giuseppe Esposito, Sandra Dias, Jan-Karl Burkhardt, Oliver Bozinov, Luca Regli
The identification and preparation of a very good quality donor artery is a crucial step in every superficial temporal artery to middle cerebral artery (STA-MCA) bypass.For flow-preservation bypass performed for trapping of complex MCA aneurysms, the key element is the correct target of the recipient artery. When a cortical recipient artery (M4 segment of the MCA) is selected, this vessel must be a terminal branch of the artery whose sacrifice is necessary for definitive aneurysmal treatment.In this chapter we report on two techniques for (1) intraoperative mapping and preparation of good quality STA branch as the donor artery for STA-MCA bypass (mostly in the case the frontal branch of the STA needs to be used) and (2) selective identification of the correct superficial (M4 cortical) "recipient" artery in flow-preservation STA-MCA bypass performed for managing complex MCA aneurysms...
2018: Acta Neurochirurgica. Supplement
Yasuhiko Kaku, Tetsuya Yamada, Kiyomitsu Kanou, Naoki Oka, Kentarou Yamashita, Jouji Kokuzawa
BACKGROUND AND AIMS: The superficial temporal artery to middle cerebral artery (STA-MCA) bypass procedure has continually evolved and new strategies have been advocated to reduce anesthetic or surgical mortality and morbidity. Further simplifying and decreasing the invasiveness of STA-MCA bypass by performing this operation without endotracheal general anesthesia was deemed feasible in certain subsets of patients. METHODS: We performed STA-MCA bypass using local anesthesia using a sedative in 45 patients with hemodynamically compromised cerebrovascular occlusive disease as well as multiple comorbidities in the period between February 2010 and April 2016...
2018: Acta Neurochirurgica. Supplement
Giuseppe Esposito, Martina Sebök, Sepideh Amin-Hanjani, Luca Regli
BACKGROUND AND AIMS: Cerebral bypasses are categorized according to function (flow augmentation or flow preservation) and to characteristics: direct, indirect or combined bypass, extra-to-intracranial or intra-to-intracranial bypass, and high-, moderate- or low-capacity bypass. We critically summarize the current state of evidence and grades of recommendation for cerebral bypass surgery. METHODS: The current indications for cerebral bypass are discussed depending on the function of the bypass (flow preservation or augmentation) and analyzed according to level of evidence criteria...
2018: Acta Neurochirurgica. Supplement
L Pescatori, M P Tropeano, A Santoro
BACKGROUND: Surgical treatment of complex aneurysms often requires the execution of a revascularization procedure. Even if avoiding the concomitant trapping of the aneurysm during the bypass procedure (waiting for the subsequent endovascular or spontaneous closure) permits one to verify the graft's patency and patient's adaptation to increased flow, the hemodynamic changes induced by the bypass may cause the aneurysmal rupture. Whether or not to perform the concomitant trapping of the aneurysm still remains a dilemma...
2018: Acta Neurochirurgica. Supplement
Shingo Toyota, Tetsuya Kumagai, Tetsu Goto, Kanji Mori, Takuyu Taki
BACKGROUND AND AIMS: To assess the technical points of surgical clipping for recurrent aneurysms after coiling, we examine a consecutive series of 14 patients who underwent re-treatment. MATERIALS AND METHODS: From 2009 to 2016, 27 recurrent aneurysms after coiling were re-treated with endovascular treatment or surgical clipping. Of these, 14 were re-treated surgically. In cases where the remnant neck was sufficiently large, neck clipping was chosen. Where the remnant neck was too small and the border between the thrombosed and non-thrombosed portion was distinct, partial clipping was chosen...
2018: Acta Neurochirurgica. Supplement
Alberto Pasqualin, Pietro Meneghelli, Angelo Musumeci, Alessandro Della Puppa, Giacomo Pavesi, Giampietro Pinna, Renato Scienza
Intraoperative flowmetry (IF) has been recently introduced during cerebral aneurysm surgery in order to obtain a safer surgical exclusion of the aneurysm. This study evaluates the usefulness of IF during surgery for cerebral aneurysms and compares the results obtained in the joined surgical series of Verona and Padua to the more recent results obtained at the neurosurgical department of Verona.In the first surgical series, between 2001 and 2010, a total of 312 patients were submitted to IF during surgery for cerebral aneurysm at the neurosurgical departments of Verona and Padua: 162 patients presented with subarachnoid hemorrhage (SAH) whereas 150 patients harbored unruptured aneurysms...
2018: Acta Neurochirurgica. Supplement
Koichi Iwasaki, Hiroki Toda, Hirokuni Hashikata, Masanori Goto, Hitoshi Fukuda
The authors describe extradural anterior clinoidectomy without the use of a high-speed drill or ultrasonic device to clip paraclinoid and basilar aneurysms, which can eliminate potential complications related to traditional power drilling or ultrasonic device use. This method involves four steps: (1) partial osteotomy of the sphenoid wing at the superior orbital fissure (SOF); (2) peeling of the dura propria of the temporal lobe from the inner cavernous membrane of the SOF; (3) isolation and resection of the exposed meningo-orbital band to expose the superolateral aspect of the anterior clinoid process (ACP); and (4) piecemeal rongeuring of ACP and the roof of the optic canal...
2018: Acta Neurochirurgica. Supplement
Naoki Otani, Terushige Toyooka, Satoru Takeuchi, Arata Tomiyama, Yasuaki Nakao, Takuji Yamamoto, Kojiro Wada, Kentaro Mori
BACKGROUND: Extradural temporopolar approach can provide extensive exposure of the anterior clinoid process, which can prevent intraoperative neurovascular injury in anterior clinoidectomy for paraclinoid aneurysms. The present study investigates the usefulness of this modified technique, and operative nuances are discussed here. METHODS: We retrospectively reviewed the medical charts of 30 consecutive patients with paraclinoid aneurysms who underwent treatment with this modified extradural temporopolar approach between September 2009 and March 2016...
2018: Acta Neurochirurgica. Supplement
Sabino Luzzi, Massimo Gallieni, Mattia Del Maestro, Donatella Trovarelli, Alessandro Ricci, Renato Galzio
Giant intracranial aneurysms (GIAs) and very large intracranial aneurysms (VLAs) have a poor natural history because of a high incidence of bleeding and strokes. These lesions always represent a great challenge for neurosurgeons and interventional neuroradiologists because of some peculiar intrinsic features such as size, angioarchitecture, wide neck, mass effect, intraluminal thrombosis, atherosclerotic changes, involvement of branches and perforators, and a frequent need to perform revascularization procedures...
2018: Acta Neurochirurgica. Supplement
Massimo Gallieni, Mattia Del Maestro, Sabino Luzzi, Donatella Trovarelli, Alessandro Ricci, Renato Galzio
Endoscope-assisted microneurosurgery (EAM) combines endoscopic and microsurgical techniques for the treatment of deeply located intracranial lesions. During aneurysm surgery, endoscopic assistance may aid in the visualization of perforating arteries, especially when minimally invasive approaches are used. Between 2002 and 2015, a total of 183 patients with 208 intracranial aneurysms were surgically treated in our department. EAM was performed in 191 procedures. In all, 159 aneurysms were located in the anterior circulation and 49 in the posterior circulation...
2018: Acta Neurochirurgica. Supplement
Torstein R Meling
BACKGROUND: Temporary parent vessel clip occlusion in aneurysm surgery is not always practical or feasible. Adenosine-induced transient cardiac arrest may serve as an alternative. METHODS: All patients who underwent microsurgical clipping of intracranial aneurysms under adenosine-induced asystole performed by the author between September 2011 and July 2014 were retrospectively reviewed. RESULTS: A total of 16 craniotomies were performed and 16 aneurysms were clipped under adenosine-induced asystole (in 8 basilar arteries, 7 internal carotid arteries, and 1 middle cerebral artery) in 14 patients (8 females, 6 males)...
2018: Acta Neurochirurgica. Supplement
Alberto Feletti, Xiangdong Wang, Sandeep Talari, Tushit Mewada, Dilshod Mamadaliev, Riki Tanaka, Yasuhiro Yamada, Yamashiro Kei, Daisuke Suyama, Tukasa Kawase, Yoko Kato
INTRODUCTION: There are many controversies about computational fluid dynamics (CFD) findings and aneurysm initiation, growth, and ultimate rupture. The aim of our work was to analyze CFD data in a consecutive series of patients and to correlate them with intraoperative visual aneurysm findings. METHODS: Hemoscope software (Amin, Ziosoft Corporation, Minato ward, Tokyo, Japan) was used to process images from 17 patients who underwent clipping of 18 aneurysms. Pressure (P), wall shear stress (WSS) gradient and vectors, normalized WSS, and streamlines (SL) direction and velocity were assessed...
2018: Acta Neurochirurgica. Supplement
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