Neurosurgery
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Aneurysms arising from the internal carotid artery in close relation to the clinoid process have been called paraclinoid aneurysms. The surgical management of these aneurysms poses technical challenges, and such patients are frequently referred for endovascular treatment. We reviewed our experience with endovascular coil embolization of paraclinoid aneurysms to evaluate the safety and efficacy of this treatment modality. ⋯ The results of this study indicate that endovascular treatment is a safe and effective therapeutic alternative in ruptured and unruptured paraclinoid aneurysms. The endovascular treatment may also confer a positive impact in terms of the length of hospital stay.
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Giant arteriovenous malformations (AVMs) (i.e., those greater than 6 cm at maximum diameter) are difficult to treat and often carry higher treatment morbidity and mortality rates than do smaller AVMs. In this study, we reviewed the treatment, angiographic results, and clinical outcomes in 53 patients with giant AVMs who were treated at Stanford between 1987 and 2001. ⋯ The results in this series of patients with giant AVMs, which represents the largest series reported to date, suggest that selected symptomatic patients with giant AVMs can be treated successfully with good outcomes and acceptable risk. Multimodality treatment is usually necessary to achieve AVM obliteration.
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Case Reports
Trigeminal neuralgia in a patient with a dural arteriovenous fistula in Meckel's cave: case report.
Trigeminal neuralgia is often the result of vascular compression at the root entry zone of the trigeminal nerve. We report a case of trigeminal neuralgia in a patient with a dural arteriovenous fistula in Meckel's cave. Endovascular closure of the fistula resulted in elimination of the patient's pain at the gasserian ganglion level. ⋯ Trigeminal neuralgia may be associated with complex vascular lesions around the base of the brain and along the course of the trigeminal nerve. The evaluation of patients with trigeminal neuralgia should include high-quality, thin-section, magnetic resonance imaging scans, to exclude the possibility of vascular lesions and other structural lesions. In particular, patients who are being evaluated for surgical treatment of trigeminal neuralgia should undergo magnetic resonance imaging, with a focus on the course of the trigeminal nerve.
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For many years, the central nervous system (CNS) has been described as "immunologically privileged" and devoid of conventional immune reactivity. However, our more current understanding of neuroimmunology supports a different view. Although immune mechanisms within the CNS may behave differently from those located at peripheral anatomic sites, it is now widely accepted that biologically relevant immune responses can and do occur within the brain and that these responses can play important roles in CNS disease. The objective of this present review is to explore key aspects of recent insights into the cellular interactions involved in neuroimmunology, which may suggest more rational approaches to the immunotherapy of neurosurgical disorders. ⋯ Modern advances in molecular medicine and basic immunology have yielded a plethora of new data about CNS immunobiology. The design of effective immunotherapeutic strategies for CNS diseases requires a contemporary understanding of the basic tenets of how the immune system works. The current renaissance in this field may give neurosurgeons hope that, in the future, immunotherapy-based paradigms may be able to successfully treat neurosurgical diseases that are currently refractory to traditional therapies.