Neurosurgery
-
Historical Article
History of endovascular surgery: personal accounts of the evolution.
Endovascular therapy has continuously evolved since it was first described in 1904. It was first used as a technique to inject particles to follow the flow into vascular lesions, and from the mid-seventies on, microballoons were developed to reach targets in the arterial vascular tree. Arteriovenous malformations were approached with catheters, the tip mounted by calibrated leak balloons. ⋯ The elegance of the endovascular approach was an important argument for this technology from its inception, but in early years, restricted endovascular efficacy limited the efficiency of embolizations. Increasing experience and exploding new technologies have made endovascular techniques not only safer but also as effective as microsurgery. The number of vascular pathologies where microsurgery is the only option is decreasing, and training in vascular neurosurgery may become the privilege of specialized centers in the future.
-
Review Meta Analysis
Review of treatment trials in human spinal cord injury: issues, difficulties, and recommendations.
To provide a comprehensive review of the treatment trials in the field of spinal cord injury, emphasizing what has been learned about the effectiveness of the agents and strategies tested and the quality of the methodology. The review aims to provide useful information for the improvement of future trials. The review audience includes practitioners, researchers, and consumers. ⋯ A large number of trials in the field of spinal cord injury have been conducted, but with few proven gains for patients. This review reveals several shortcomings in trial design and makes several recommendations for improvement.
-
Review Clinical Trial
Endovascular management of intracranial aneurysms: current experience and future advances.
The past 15 years have seen a revolution in the treatment of intracranial aneurysms. Endovascular technology has evolved rapidly since the Food and Drug Administration approval of Guglielmi detachable coils in 1995, which now allows successful treatment of most aneurysms. The authors provide a review of their 11-year experience at Jefferson Hospital for Neuroscience with endovascular embolization of intracranial aneurysms and discuss clinical trial outcomes and future directions of this treatment method. ⋯ Long-term studies evaluating experience with aneurysm coil embolization during the past decade indicate that this is a safe and durable treatment method. The introduction of stent-assist techniques has improved the management of wide-neck aneurysms. Future technology developments will likely improve the durability of endovascular treatment further by delivering bioactive agents that promote aneurysm thrombosis beyond the coil mass alone. It is clear that endovascular therapy of both ruptured and unruptured aneurysms is becoming a mainstay of practice in this patient population. Although not replacing open surgery, the continued improvements have allowed aneurysms that previously were amenable only to open clip ligation to be treated safely with durable long-term outcomes.