Journal of neurosurgery
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Journal of neurosurgery · May 2013
Morphological and clinical risk factors for the rupture of anterior communicating artery aneurysms.
Patients with ruptured anterior communicating artery (ACoA) aneurysms have historically been observed to have poor neuropsychological outcomes, and ACoA aneurysms have accounted for a higher proportion of ruptured than unruptured aneurysms. Authors of this study aimed to investigate the morphological and clinical characteristics predisposing to ACoA aneurysm rupture. ⋯ Findings in the present study demonstrated that the anterior projection of an ACoA aneurysm may be related to rupturing. The authors would perhaps recommend treatment to patients with unruptured ACoA aneurysms that have an anterior dome projection, a bleb(s), and a size ≥ 5 mm.
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Journal of neurosurgery · May 2013
Targeting accuracy of transcranial magnetic resonance-guided high-intensity focused ultrasound brain therapy: a fresh cadaver model.
This work aimed at evaluating the accuracy of MR-guided high-intensity focused ultrasound (MRgHIFU) brain therapy in human cadaver heads. ⋯ Despite its limits (temperature, vascularization), the human cadaver model is effective for studying the accuracy of MRgHIFU brain therapy. With the 1-MHz system investigated here, there is millimetric accuracy.
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Journal of neurosurgery · May 2013
Preoperative percutaneous mapping of the frontal branch of the facial nerve to assess the risk of frontalis muscle palsy after a supraorbital keyhole approach.
Although a supraorbital keyhole approach utilizing an eyebrow incision and supraorbital minicraniotomy is one of the most commonly used keyhole approaches for treating cerebral aneurysms, the risk of frontalis muscle palsy due to an injury of the frontal branch of the facial nerve remains a serious drawback to a supraorbital keyhole approach as a minimally invasive surgical technique. Therefore, the authors attempted to evaluate the risk of frontalis muscle palsy by mapping the frontal nerve branch in the lower forehead using a nerve conduction study in individual patients. ⋯ Percutaneous mapping of the frontal branch of the facial nerve using a nerve conduction study can be used to assess the risk of postoperative frontalis muscle palsy following a supraorbital keyhole approach. The patients with the highest risk of postoperative palsy showed a clear CMAP exclusively at 1.0 cm along the inclined line measured from the supraorbital margin.
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Journal of neurosurgery · May 2013
Case ReportsThe failure of preoperative ethylene-vinyl alcohol copolymer embolization to improve outcomes in arteriovenous malformation management: case series.
Ethylene-vinyl alcohol copolymer embolization is increasingly used preoperatively in the resection of brain arteriovenous malformations (AVMs). However, the case for embolization improving the outcome of resection has not been evaluated. In this paper the authors set out to compare outcomes after surgery for brain AVMs in 2 consecutive periods of practice. In the first period, selective embolization was used without the use of ethylene-vinyl alcohol copolymer. In the second period, selective embolization with ethylene-vinyl alcohol copolymer was performed. ⋯ Outcomes for brain AVM surgery were not improved by ethylene-vinyl alcohol copolymer embolization. Preoperative embolization of high-grade AVMs with an ethylene-vinyl alcohol copolymer did not prevent those hemorrhagic complications which embolization is hypothesized to prevent based on theoretical speculations but not demonstrated in practice.
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Journal of neurosurgery · May 2013
Endovascular treatment of proximal and distal posterior inferior cerebellar artery aneurysms.
Surgical clipping of posterior inferior cerebellar artery (PICA) aneurysms can be challenging and carries a potentially significant risk of morbidity and mortality. Experience with endovascular therapy has been limited to a few studies. The authors assess the feasibility, safety, and efficacy of endovascular therapy in the largest series of proximal and distal PICA aneurysms to date. ⋯ Endovascular therapy is a feasible, safe, and effective treatment in patients with proximal and distal PICA aneurysms, providing excellent patient outcomes and adequate protection against rehemorrhage. The long-term incidence of aneurysm recanalization appears to be high, especially in distal aneurysms, and requires careful angiographic follow-up.