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Endovascular neurosurgery

Jinlu Yu, Yunbao Guo, Baofeng Xu, Kan Xu
The middle meningeal artery (MMA) is a very important artery in neurosurgery. Many diseases, including dural arteriovenous fistula (DAVF), pseudoaneurysm, true aneurysm, traumatic arteriovenous fistula (AVF), moyamoya disease (MMD), recurrent chronic subdural hematoma (CSDH), migraine and meningioma, can involve the MMA. In these diseases, the lesions occur in either the MMA itself and treatment is necessary, or the MMA is used as the pathway to treat the lesions; therefore, the MMA is very important to the development and treatment of a variety of neurosurgical diseases...
2016: International Journal of Medical Sciences
J Scott Pannell, David R Santiago-Dieppa, Arvin R Wali, Brian R Hirshman, Jeffrey A Steinberg, Vincent J Cheung, David Oveisi, Jon Hallstrom, Alexander A Khalessi
This study establishes performance metrics for angiography and neuroendovascular surgery procedures based on longitudinal improvement in individual trainees with differing levels of training and experience. Over the course of 30 days, five trainees performed 10 diagnostic angiograms, coiled 10 carotid terminus aneurysms in the setting of subarachnoid hemorrhage, and performed 10 left middle cerebral artery embolectomies on a Simbionix Angio Mentor™ simulator. All procedures were nonconsecutive. Total procedure time, fluoroscopy time, contrast dose, heart rate, blood pressures, medications administered, packing densities, the number of coils used, and the number of stent-retriever passes were recorded...
August 29, 2016: Curēus
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
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
Basak Topkoru, Emrah Egemen, Ihsan Solaroglu, John Zhang
Subarachnoid hemorrhage (SAH) following rupture of an intracranial is associated with high mortality and morbidity. The late deterioration of the patient's neurological status or late cognitive dysfunctions even after secure clipping or decent endovascular treatment which is defined as delayed ischemic neurological deficits recently has been attributed to vasospasm. Due to the failure of specific anti-vasospastic agents in clinical trials researchers focused to explore new pathological mechanisms to be responsible for the delayed deterioration of the patients suffering from SAH...
September 5, 2016: Current Drug Targets
Bradley A Gross, Felipe C Albuquerque, Karam Moon, Andrew F Ducruet, Cameron G McDougall
BACKGROUND/OBJECTIVE: The optimal management of residual or recurrent clipped aneurysms is infrequently addressed in the literature. METHODS: We reviewed our endovascular database from January 1998 to May 2016 to identify patients with clipped aneurysms undergoing subsequent endovascular treatment, evaluating treatment approach, and clinical and angiographic outcomes. RESULTS: 60 patients underwent endovascular treatment of residual/recurrent clipped aneurysms; 7 rebled prior to endovascular therapy...
August 8, 2016: Journal of Neurointerventional Surgery
Vijay M Ravindra, Marcus D Mazur, Min S Park, Craig Kilburg, Christopher J Moran, Rulon L Hardman, William T Couldwell, Philipp Taussky
BACKGROUND: Precisely defining complications, which are used to measure overall quality, is necessary for critical review of delivery of care and quality improvement in endovascular neurosurgery, which lacks common definitions for complications. Furthermore, in endovascular interventions, events that may be labeled complications may not always negatively affect outcome. Our objective is to provide precise definitions for quality evaluation within endovascular neurosurgery. Thus, we propose an endovascular-specific classification system of complications based on our own patient series...
August 2, 2016: World Neurosurgery
Venko Filipce, Aleksandar Caparoski, Zoran Milosevic
The management of intracranial aneurysms has changed dramatically in recent years. The science and technology advancement have resulted in new therapeutic options for their treatment. There is an increased interest among neurosurgeons to perform endovascular procedures for intracranial aneurysms. This has become a part of the neurosurgical residency in the US. We are presenting our first experience of ruptured aneurysm coiling using stent assisted technique.
2015: Prilozi (Makedonska Akademija Na Naukite i Umetnostite. Oddelenie za Medicinski Nauki)
Alexander Hammer, Anahi Steiner, Ghassan Kerry, Gholamreza Ranaie, Eduard Yakubov, David Lichtenstern, Ingrid Baer, Hendrik Janssen, Christian M Hammer, Stefan Kunze, Hans-Herbert Steiner
OBJECTIVE: This prospective multicenter study was designed to compare the endovascular treatment results of ruptured aneurysms with the outcome of microsurgical clipping. METHODS: Six hundred and sixty one cases of ruptured intracranial aneurysms with consecutive subarachnoid hemorrhage between 1997 and 2014 of 2 large medical centers have been recorded and analyzed. Two hundred and seventy one cases of subarachnoid hemorrhage were subjected to endovascular treatment while 390 cases underwent microsurgical treatment...
July 13, 2016: World Neurosurgery
Hormuzdiyar H Dasenbrock, Michael O Nguyen, Kai U Frerichs, Donovan Guttieres, William B Gormley, M Ali Aziz-Sultan, Rose Du
OBJECTIVE Although the prevalence of obesity is increasing rapidly both nationally and internationally, few studies have analyzed outcomes among obese patients undergoing cranial neurosurgery. The goal of this study, which used a nationwide data set, was to evaluate the association of both obesity and morbid obesity with treatment outcomes among patients with aneurysmal subarachnoid hemorrhage (SAH); in addition, the authors sought to analyze how postoperative complications for obese patients with SAH differ by the treatment modality used for aneurysm repair...
July 15, 2016: Journal of Neurosurgery
Corinna Clio Zygourakis, Caterina Liu, Philip V Theodosopoulos, Michael T Lawton, Adams Dudley, Ralph Gonzales
INTRODUCTION: Although several articles have shown variation in rates and costs of spinal procedures, there is a paucity of similar research in cranial neurosurgery. Our goal is to determine which factors underlie the variation in cost for the 2 most common intracranial neurosurgical diagnosis-related groups (DRGs): 025 (craniotomy and endovascular intracranial procedure with a major complication or comorbidity [MCC]) and 027 (craniotomy and endovascular intracranial procedure without a complication or comorbidity [CC]/MCC)...
August 2016: Neurosurgery
Justin M Moore, Christoph J Griessenauer, Raghav Gupta, Nimer Adeeb, Apar S Patel, Christopher S Ogilvy, Ajith J Thomas
The management of cerebrovascular disease has advanced considerably in 2015. Five randomized control trials have firmly established the role of endovascular thrombectomy for ischemic strokes due to large vessel occlusion. The randomized trial of intraarterial treatment for acute ischemic stroke (MR CLEAN) (Berkhemer et al. NEJM 2015;372:11-20) was the first of a series on the topic. There was a total of 5 randomized controlled trials published showing benefit in terms of functional outcomes at 90days for mechanical thrombectomy including the Endovascular Therapy for Ischemic stroke with perfusion-imaging selection (EXTEND IA) (Campbell et al...
September 2016: Clinical Neurology and Neurosurgery
Jean Raymond
BACKGROUND: From Luessenhop's early clinical experience until the present day, experimental methods have been introduced to make progress in endovascular neurosurgery. METHODS: A personal historical narrative, spanning the 1980s to 2010s, with a review of past opportunities, current problems, and future perspectives. RESULTS: Although the technology has significantly improved, our clinical culture remains a barrier to methodologically sound and safe innovative care and progress...
September 2016: World Neurosurgery
Michael A Silva, Alfred P See, Hormuzdiyar H Dasenbrock, Ramsey Ashour, Priyank Khandelwal, Nirav J Patel, Kai U Frerichs, Mohammad A Aziz-Sultan
Successful application of endovascular neurosurgery depends on high-quality imaging to define the pathology and the devices as they are being deployed. This is especially challenging in the treatment of complex cases, particularly in proximity to the skull base or in patients who have undergone prior endovascular treatment. The authors sought to optimize real-time image guidance using a simple algorithm that can be applied to any existing fluoroscopy system. Exposure management (exposure level, pulse management) and image post-processing parameters (edge enhancement) were modified from traditional fluoroscopy to improve visualization of device position and material density during deployment...
June 24, 2016: Journal of Neurosurgery
A Jessey Chugh, Jonathan R Pace, Justin Singer, Curtis Tatsuoka, Alan Hoffer, Warren R Selman, Nicholas C Bambakidis
OBJECTIVE The field of neurosurgery is constantly undergoing improvements and advances, both in technique and technology. Cerebrovascular neurosurgery is no exception, with endovascular treatments changing the treatment paradigm. Clipping of aneurysms is still necessary, however, and advances are still being made to improve patient outcomes within the microsurgical treatment of aneurysms. Surgical rehearsal platforms are surgical simulators that offer the opportunity to rehearse a procedure prior to entering the operative suite...
May 13, 2016: Journal of Neurosurgery
Peng Qi, Daming Wang, Jiachun Liu, Lijun Wang, Jun Lu
OBJECTIVE: To explore the feasibility, safety and efficacy of endovascular reconstructive treatment by multiple overlapping stents with or without coils. METHODS: Totally 17 patients of vertebrobasilar fusiform aneurysms treated by multiple overlapping stents with or without coils between September 2011 and September 2015 in Department of Neurosurgery, Beijing Hospital were retrospectively reviewed. There were 15 male and 2 female patients with mean age of (47±13) years...
May 1, 2016: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Xia Li, Feng Han, Yanwei Chen, Jun Tian, Zhenmin Wang, Ping'an Sun, Minrui Zhang, Yan Cao, Yan Han, Xiaofan Jiang, Zhou Fei
OBJECTIVE: To investigate the endovascular treatments for the ruptured aneurysms located at anterior communicating artery complex (ACoAC). METHODS: The data of patients with ruptured ACoAC aneurysms treated in Department of Neurosurgery, First Affiliated Hospital to Fourth Military Medical University from May 2013 to December 2014 was retrospectively analyzed. Sixty-six cases were recruited including 50 male and 16 female patients. The patients aged from 31 to 69 years old, averaging (51±8) years...
May 1, 2016: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
F Fortea, J Masjuan, F Arikán-Abello, A Rovira, A González, J Arenillas, J Fernández Alen, J Gállego
BACKGROUND: The development of endovascular techniques has put Interventional Neuroradiology (INR) as the first-option treatment in the majority of vascular diseases of the central nervous system. Scientific societies in developed countries have created standard procedures for training and accreditation for a safe practice in these procedures. DISCUSSION: In Spain, we are waiting for the development of the legislation on the accreditation for specialists which will establish the official formative model to achieve an accreditation in INR...
April 30, 2016: Neurología: Publicación Oficial de la Sociedad Española de Neurología
V V Krylov, V L Lemenev, V G Dashyan, V A Lukyanchikov, A S Tokarev, O Yu Nakhabin, N A Polunina, I V Senko, V A Dalibaldyan, E V Grigorieva, A B Klimov, V E Ryabukhin
Surgical revascularization of the brain is one of the most important trends in the development of neurosurgery. Restoration of adequate blood flow through pre- and intracerebral arteries promotes prevention and treatment of ischaemic lesions of the brain in various pathology. The present work was aimed at analysing the experience gained in performing revascularizing operations in patients with cerebral aneurysms at the department of neurosurgery. The authors analysed therapeutic outcomes in a total of 45 patients presenting with giant and complex aneurysms of cerebral arteries and treated from 2009 to 2014...
2016: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
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