Neurosurgery
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Few could have imagined the tremendous growth of endovascular surgery over the past 40 years. Endovascular therapy has greatly enhanced the care of the patient in neurosurgery, spine surgery, and head and neck surgery. Progress in technology and techniques continue to push forward the boundaries of what is deemed "treatable," assuming acceptable risk. ⋯ Maximizing the accessibility of these routes to highly specific regions of the central nervous system provides an elegant and minimalist approach to treating diseases of the central nervous system with almost no "footprints" of ever having accessed the region. In the future, safe, efficient and intelligent delivery systems that may enhance or alter the tissue's response may result in successful treatment of cerebrovascular diseases, as well as other diseases of the craniospinal axis. The growth of nanotechnology, metallurgy, synthetic polymers, imaging, and training will all combine to help grow the technology and the science that is surgical endovascular neuroradiology.
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Controlled Clinical Trial
Early experience from the application of a noninvasive magnetic resonance imaging-based measurement of intracranial pressure in hydrocephalus.
The decision for surgical intervention in hydrocephalic patients presenting with symptoms suggesting raised intracranial pressure (ICP) is challenging because radiographic ventricular size often lacks the specificity to predict abnormal ICP. An early assessment of the potential clinical usefulness of a noninvasive magnetic resonance imaging-based measurement of ICP (MR-ICP) in symptomatic hydrocephalic patients is reported. ⋯ A finding of a normal MR-ICP value in hydrocephalic patients presenting with symptoms suggestive of abnormal ICP is a strong predictor for resolution of symptoms or stable outcome without surgical intervention.
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Review
Therapy of brain arteriovenous malformations: multimodality treatment from a balanced standpoint.
The three therapeutic modalities for arteriovenous malformation (AVM) treatment (surgery, embolization, and radiotherapy) developed in the past years with specific tools, each tool with its own qualities. Soon after the implementation of embolization for treatment of AVMs, this technique was used in combination with microsurgery; since the development of radiosurgery, treatment algorithms combining embolization with surgery and eventual subsequent radiosurgery, embolization with radiosurgery, or surgery with subsequent radiosurgery have been reported. ⋯ Institutions with an endovascular background embolize AVMs with the aim of maximal occlusion rates and view surgery or radiosurgery as a technique to be used if the goal of total endovascular occlusion cannot be achieved. Radiosurgeons receive patients after incomplete embolization or surgical extirpation or a combination of both.
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Endovascular neurosurgical procedures are complex, requiring significant planning, foresight, and coordination. The neuroanesthetist is an integral part of these procedures, organizing efforts of the technicians and nurses and responding to the needs of the neurointerventionalist. The purpose of this article is to review, in detail, the role of the neuroanesthetist in the endovascular operating room. An overview of all areas either partially or completely managed by the anesthetist is provided.
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Giant intracranial aneurysms present unique therapeutic intricacies. The purpose of this study was to evaluate the anatomic and hemodynamic characteristics of these lesions and the current endovascular and combined surgical and endovascular techniques available for their treatment. ⋯ Although there are a wide variety of endovascular therapeutic options for the treatment of giant intracranial aneurysms, none of the current techniques is completely successful and free of complications in the management of these complex lesions. A detailed and individualized analysis of each case in conjunction with sufficient understanding of the anatomy and hemodynamics of a particular aneurysm should guide the therapeutic decision. Further research advances will assist in elucidating the factors predisposing to genesis, progression, and aggressive clinical manifestations of these giant lesions.