Journal of neurosurgery
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Journal of neurosurgery · Oct 2010
The impact of therapeutic modality on outcomes following repair of ruptured intracranial aneurysms: an administrative data analysis. Clinical article.
Enrolling a selected sample of ruptured intracranial aneurysms, the International Subarachnoid Aneurysm Trial (ISAT) found endovascular coiling to be superior to microsurgical clipping. The performance of coiling in a more general population of ruptured aneurysms has not been adequately studied. ⋯ The results of the current analysis call into question the generalizability of the ISAT to all ruptured aneurysms. Given the limitations inherent in this form of analysis, further clinical studies—rigorously assessing the performance of endovascular therapy in patients with non-ISAT-like aneurysms—are indicated.
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Journal of neurosurgery · Oct 2010
The presigmoid approach to anterolateral pontine cavernomas. Clinical article.
Anterolateral cavernomas of the pons have been surgically removed via a variety of approaches, commonly retrosigmoid or transventricular. The goal in this study was to evaluate the presigmoid approach as an alternative. ⋯ The presigmoid approach is recommended for the resection of anterolateral pontine cavernomas. With this approach, the need for cerebellar retraction is nearly eliminated. The lateral "presigmoid" entry point creates a trajectory that allows complete resection of even deep lesions at this level, or anterior to the internal acoustic meatus.
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Journal of neurosurgery · Oct 2010
Case ReportsCardiac arrest after intracisternal papaverine instillation during intracranial aneurysm surgery. Case report.
Cerebral vasospasm induced by aneurysmal subarachnoid hemorrhage is still a leading cause of morbidity and death. This 50-year-old man underwent surgery for aneurysm clipping. ⋯ Bradycardia, hypotension, and sinus arrest developed in the first minute after applying the papaverine. Thus, the authors concluded that the application of papaverine to the surgical area can result in fatal bradycardia and hypotension.
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Journal of neurosurgery · Oct 2010
Stereotactic radiosurgery for deep-seated cavernous malformations: a move toward more active, early intervention. Clinical article.
The role of radiosurgery in the treatment of cavernous malformations (CMs) remains controversial. It is frequently recommended only for inoperable lesions that have bled at least twice. Rehemorrhage can carry a substantial risk of morbidity, however. The authors reviewed their practice of treating deep-seated inoperable CMs to assess the complication rate of radiosurgery, the impact that radiosurgery might have on rebleeding, and whether a more active, earlier intervention is justified in managing this condition. ⋯ Stereotactic radiosurgery is a safe management strategy for CMs in eloquent sites with the marked advantage of reducing rebleed risks in patients with repeated pretreatment hemorrhages. The benefit in treating CMs with a single bleed is less clear. Note, however, that repeated hemorrhage carries a significant risk of increased morbidity far in excess of any radiosurgery-related morbidity, and the authors assert that this finding justifies the early active management of deep-seated CMs.
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Journal of neurosurgery · Oct 2010
Case ReportsAcute extracranial-intracranial bypass using a radial artery graft along with trapping of a ruptured blood blister–like aneurysm of the internal carotid artery. Clinical article.
Fragile aneurysm walls and poorly defined necks render the surgical treatment of blood blister–like aneurysms (BBAs) located at nonbranching sites of the supraclinoid internal carotid artery extremely challenging. Such aneurysms have a remarkable tendency to rupture during surgery, especially during the acute period. The authors describe the clinical course of patients with subarachnoid hemorrhage (SAH) caused by BBA rupture and emphasize the value of internal carotid artery trapping combined with high-flow extracranial-intracranial (trapping/EC-IC) bypass during the acute period following SAH. ⋯ Ruptured BBAs were successfully treated with a trapping/EC-IC bypass during the acute SAH period. This surgical strategy for treating BBAs during the acute period might be a promising option for these rare but high-risk lesions.