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Acta Neurochirurgica. Supplement

Yasuhiko Kaku, Hiroaki Takei, Masafumi Miyai, Kentarou Yamashita, Jouji Kokuzawa
BACKGROUND AND AIMS: The surgical treatment of intrinsic brainstem lesions remains a major challenge. In this article we present the results of using an infratentorial-supracerebellar (ITSC) approach for the resection of intrinsic ponto-mesencephalic lesions. MATERIALS AND METHODS: The authors reviewed the cases of 16 patients. In seven of them, a paramedian ITSC transcollicular approach was used to resect intrinsic mid-brain lesions, and in the other nine patients, an intermediate or lateral ITSC infra-trochlear approach was used for ponto-mesencephalic lesions...
2016: Acta Neurochirurgica. Supplement
Naoya Kuwayama
BACKGROUND AND PURPOSE: There are few reports describing the prevalence of dural arteriovenous fistulas (dAVFs). We conducted a nation-wide retrograde survey on the clinical frequency and the status of treatment of dAVFs in Japan. METHODS: The first questionnaire was sent to 1,236 certified neurosurgery clinics in Japan to ask about the number of patients treated and the location of dAVF during the 5 years from 1998 to 2002. The second questionnaire was sent to 102 large-volume centers to ask the patients' ages, gender, location of the fistula, clinical presentation, treatment modalities, clinical and radiological results, and recurrence...
2016: Acta Neurochirurgica. Supplement
Alessandro Bertuccio, Chiara Robba, Giannantonio Spena, Pietro Primo Versari
INTRODUCTION: Dural arteriovenous fistulas (DAVFs) is a challenging condition in vascular neurosurgery. Development of new endovascular techniques has progressively modified treatment strategies; however, surgery is still considered a valid option of treatment of this pathology. MATERIALS AND METHODS: From a retrospective analysis of our database, we selected 107 patients who underwent surgical treatment for DAVFs. Patients were grouped into five categories according to the Borden and Cognard classifications...
2016: Acta Neurochirurgica. Supplement
Michihiro Tanaka
BACKGROUND: The distribution of intracranial dural AVFs (DAVFs) may be affected by the embryological bony structures that consist of membranous bone and endochondral bone. METHODS: We retrospectively analyzed the distribution of the shunt points in 58 consecutive cases of DAVFs. Shunt points were identified with selective digital subtraction angiography, high-resolution cone beam computed tomography (CT), or three-dimensional rotation angiography. All the shunt points were plotted on the map of the skull base in relation to the topography of the endochondral bone and the membranous bone...
2016: Acta Neurochirurgica. Supplement
L Renieri, N Limbucci, S Mangiafico
Brain AVMs are complex malformations, usually congenital, that need a deep understanding of anatomy and pathophysiology to be safely treated. Nowadays, embolization and radiosurgery are carried out more frequently due to their reduced invasiveness as compared to conventional neurosurgery. This paper aims to describe different and new endovascular approaches that allow the interventionalist to treat almost all the small AVMs and to reduce the nidus of the bigger ones in order to facilitate the surgical or radiosurgical intervention...
2016: Acta Neurochirurgica. Supplement
Andreas Gruber, Gerhard Bavinzski, Klaus Kitz, Stephan Barthelmes, Magdalena Mayr, Engelbert Knosp
In this study we report and analyze the results of a multimodality management concept for intracranial arteriovenous malformations (AVMs), including microsurgery, embolization, and gamma knife radiosurgery. The study population consists of a consecutive series of 294 patients treated for 304 intracranial AVMs over a 10-year period.
2016: Acta Neurochirurgica. Supplement
M Ferlisi, T Zanoni, G Moretto, A Pasqualin
Seizures are common symptoms of supratentorial arteriovenous malformations (AVMs). The potential risk factors for epilepsy in patients with AVMs are still controversial. The reported long-term outcome of seizures after surgical treatment of AVMs is variable and the data available are mainly from small retrospective case series.We identified all consecutive patients between 1990 and 2006 who underwent microsurgical resection of supratentorial AVMs at our institute. Pre-operative risk factors for seizures, intra-operative characteristics, long-term neurological disability, and seizure outcome (Engel's classification) were recorded and analyzed...
2016: Acta Neurochirurgica. Supplement
Alessandro Della Puppa, Renato Scienza
OBJECT: The authors report their personal experience with brain arterio-venous malformations (bAVMs) surgery with a multimodal flow-assisted approach. METHODS: Data from patients who consecutively underwent bAVM resection with the assistance of indocyanine green video-angiography (ICG-VA), micro-flow probe flowmetry, and temporary arterial clipping test under intra-operative monitoring, were retrospectively analyzed. RESULTS: Twenty seven patients were enrolled in the study...
2016: Acta Neurochirurgica. Supplement
Atsushi Tsuji, Kazuhiko Nozaki
Although treatment options for cerebral arteriovenous malformations (AVMs) have changed since the advent of endovascular surgery and radiosurgery, microsurgery is still the major treatment option since it is effective for immediate cure. We proposed, and have applied, a revised treatment strategy to patients at our institution from February 2008 to May 2014, in which the final goal was disappearance of the nidus on angiography in patients who underwent surgical intervention. We followed 67 patients with cerebral AVMs, and in the 59 patients who had surgical intervention, the cure rate was 89...
2016: Acta Neurochirurgica. Supplement
Luigi A Lanterna, Carlo Brembilla, Paolo Gritti, Claudio Bernucci
BACKGROUND: Moyamoya (MM) is a very rare cerebrovascular disease, particularly in Caucasians. We describe the results of an Italian case series where the mainstay of treatment was a bypass or a combined approach. METHODS: An analysis of a prospectively collected database was carried out. The main objective was to investigate (1) the risk of perioperative stroke and surgical complications, (2) the risk of new ischemic events, and (3) the risk of new hemorrhages at follow-up (mean follow-up: 2...
2016: Acta Neurochirurgica. Supplement
Hiroshi Abe, Toshiro Katsuta, Koichi Miki, Toshio Higashi, Tooru Inoue
BACKGROUND: Superficial temporal artery (STA) to middle cerebral artery (MCA) bypass is one of the most common surgical procedures performed for direct extracranial (EC) to intracranial (IC) bypasses. We describe a temporary steno-occlusive change in the STA that was caused by mouth opening after the STA-MCA bypass (so-called big bite ischemic phenomenon) in an adult patient with moyamoya disease. The aim of this study was to assess the incidence of this phenomenon in patients with atherosclerosis...
2016: Acta Neurochirurgica. Supplement
Masaki Ito, Yoshimasa Niiya, Masashi Kojima, Hiroyuki Itosaka, Motoyuki Iwasaki, Ken Kazumata, Shoji Mabuchi, Kiyohiro Houkin
BACKGROUND: External carotid artery (ECA) positioned laterally to the internal carotid artery (ICA) at the level of the common carotid artery (CCA) bifurcation is occasionally encountered during carotid endarterectomy (CEA). This study aimed to determine the frequency of this phenomenon and provide technical tips for performing CEA. METHODS: The study included 199 consecutive patients (209 carotid arteries) who underwent CEA at Otaru Municipal Medical Center in 2007-2014...
2016: Acta Neurochirurgica. Supplement
Tetsuya Tsukahara
BACKGROUND AND PURPOSE: The indications for carotid endarterectomy (CEA) and carotid artery stenting (CAS) have not been established. CEA is more appropriate than CAS if soft atherosclerotic plaques are included in the stenotic lesion, since such soft plaques are associated with a high incidence of ischemic complications during CAS. This report presents our surgical methods and the clinical results of CEA and CAS, and suggests an appropriate treatment strategy using plaque diagnosis, especially for high-risk patients...
2016: Acta Neurochirurgica. Supplement
Jyoji Nakagawara
Hemodynamic cerebral ischemia has been conceptually confirmed by positron emission tomography (PET) imaging, and misery perfusion could be compensated with both vascular and metabolic reserve; however, these compensatory reserve capacities do not always respond in the same manner from short-term to long-term compromise of hemodynamic cerebral ischemia.In patients with acute misery perfusion, CMRO2 is immediately compensated by a marked increase of OEF combined with a limited increase of CBV. In patients with chronic misery perfusion, a moderate increase of OEF is compatible with a moderate increase of CBV, which could correlate with a moderate decrease of vascular reserve (VR)...
2016: Acta Neurochirurgica. Supplement
Juhana Frösen
Saccular intracranial aneurysm (sIA) is a relatively common disease that can potentially cause a devastating, life-threatening intracranial hemorrhage. Many sIAs never rupture and thus do not necessitate interventions, making the detection of rupture-prone sIAs a very relevant clinical problem. Moreover, because currently available methods to prevent sIA rupture have significant risks of morbidity and mortality, diagnostic tools that can predict imminent rupture and help plan proper timing of prophylactic interventions, can improve patient care...
2016: Acta Neurochirurgica. Supplement
Tadayoshi Nakagomi, Kazuhide Furuya, Junichi Tanaka, Shigehiko Takanashi, Takehiro Watanabe, Takayuki Shinohara, Akiko Ogawa, Norio Fujii
Clipping surgeries for 139 consecutive unruptured middle cerebral aneurysms were performed between April 1991 and March 2014. Left hemiparesis occurred in one case (0.7 %). Transient symptoms arose in six patients due to perforator injury, arterial branch occlusion, damage to the venous system, or chronic subdural hematoma. Neither mortality nor decline in cognitive function was noted in this study. Clipping surgery for unruptured middle cerebral artery aneurysms can be done with minimal morbidity. However, meticulous management during the perioperative period as well as the use of modern technologies during the surgery, such as MEP monitoring and ICG videoangiography, are needed for safe and secure clipping surgery...
2016: Acta Neurochirurgica. Supplement
Jan-Karl Burkhardt, Giuseppe Esposito, Jorn Fierstra, Oliver Bozinov, Luca Regli
AIM: Managing ruptured giant internal carotid artery (ICA) aneurysms in an emergency situation is very challenging. By reporting two cases, we discuss the role of the Excimer Laser-assisted Non-occlusive Anastomosis (ELANA) technique as an armamentarium for cerebrovascular surgeons dealing with giant ICA aneurysms presenting with subarachnoid hemorrhage (SAH). MATERIALS AND METHODS: The management of two consecutive patients treated with ELANA bypass during a 6-month period (June- December 2013) for ruptured giant ICA aneurysms in an emergency setting is presented...
2016: Acta Neurochirurgica. Supplement
Giuseppe Esposito, Jorn Fierstra, Luca Regli
In this chapter we discuss the rationale of partial trapping strategies and associated flow-replacement bypass surgery for managing complex intracranial aneurysms (IAs).
2016: Acta Neurochirurgica. Supplement
Yasuhiko Kaku, Hiroaki Takei, Masafumi Miyai, Kentarou Yamashita, Jouji Kokuzawa
BACKGROUND AND AIMS: Cerebral revascularization strategies may become necessary in select patients who present with challenging cerebral aneurysms. In this study, we present the techniques of a moderate-flow extra-intracranial bypass using a short interposition vein graft and concurrent aneurysm management. METHODS: The short interposition vein graft was used for the reconstruction of complex cerebral aneurysms in nine patients. In eight of them, the superficial temporal artery (STA) main trunk was used as a donor site for the anastomosis of a short interposition vein graft, and an extracranial vertebral artery (VA) was used in one case...
2016: Acta Neurochirurgica. Supplement
Takayuki Hara, Shintaro Arai, Yoshiaki Goto, Tsuguhito Takizawa, Tatsuya Uchida
BACKGROUND: During surgery for cerebral aneurysm, revascularization techniques are occasionally needed to (1) treat an aneurysm (trapping or flow alteration); (2) preserve blood flow during temporary parent artery occlusion (insurance); and (3) repair accidentally injured vessels (troubleshooting). Herein we present our surgical case experiences. METHODS: Revascularization modalities were employed in 33 (7.6 %) of 452 cases of surgically treated aneurysms. The aneurysm locations and associated required bypass procedures were: (1) 7 middle cerebral artery (MCA) aneurysms with 7 superficial temporal artery (STA)-MCA bypass procedures; (2) 10 internal carotid artery (ICA) aneurysms with 9 high-flow and 1 STA-MCA procedures; (3) 10 vertebro-basilar artery aneurysms with 2 high-flow, 6 occipital artery (OA)-posterior ICA, and 1 STA-superior cerebellar artery (SCA) procedures; (4) 1 posterior cerebral artery (PCA) aneurysm with OA-PCA bypass; and (5) 5 anterior cerebral artery aneurysms with 4 A3-A3 and 1 A3-STA-A3 procedure...
2016: Acta Neurochirurgica. Supplement
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