Neurosurgery
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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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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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Dolenc has pioneered the extradural approach to the anterior clinoid process (ACP) in approaching the cavernous sinus, clinoidal space, and orbital apex. A key step is the division of the frontotemporal dural fold (FTDF). Less experienced surgeons may not be as versatile in their three-dimensional understanding of the superior orbital fissure and thus may risk injury to its contents. Through our cadaveric and subsequent clinical experience, we have devised a modification of the approach that permits safer handling of the contents of the superior orbital fissure. ⋯ This technical modification of the extradural approach of Dolenc is a simple, safe, and valuable adjunct to the exposure of the ACP. We recommend its use particularly by relatively inexperienced surgeons.
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Little information about the natural history of incidental meningiomas exists in the literature. The aim of this study was to determine the natural history of asymptomatic meningiomas by comparing different methods of growth rate calculation to establish a strategy for dealing with these tumors. ⋯ The majority of incidental meningiomas show minimal growth; thus, they may be observed without surgical intervention unless specific symptoms appear. Tumor growth is associated with patient age. The initial tumor size is not considered a predictive factor for tumor growth. Radiological features, such as calcification or T2 signal intensity, may provide useful information to predict the growth potential of meningiomas.
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Cervical myelopathy induced by vascular compression is rare. We report a case caused by bilateral persistence of the first intersegmental arteries (a vertebral artery anomaly). Myelopathy was successfully treated with vascular decompression. ⋯ The pain disappeared promptly after surgery. Surgical decompression, with anchoring of an anomalous vertebral artery to the dura, can relieve pain and other symptoms resulting from vascular cord compression.