Neurosurgery
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This is the largest contemporary series examining long-term clinical and angiographic follow-up of unclippable wrapped intracranial aneurysms. ⋯ Wrapping or clip-wrapping of unclippable intracranial aneurysms is safe and seems to confer protection against aneurysmal growth or subarachnoid hemorrhage.
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Anterior lumbar interbody fusion (ALIF) has proven effective for indications including discogenic back pain, nonunion, and instability. Current practice involves posterior pedicle screw augmentation of the ALIF procedure (ALIF-PPS). This approach requires intraoperative repositioning of the patient for percutaneous posterior pedicle screw placement. We have developed a novel technique in which the ALIF procedure is augmented with anterior pedicle screws (APS; ALIF-APS). In this study, we introduce this new technique and compare the biomechanical stability of the novel ALIF-APS with the current standard ALIF-PPS. ⋯ We demonstrate a new technique in a cadaveric specimen whereby the ALIF procedure is augmented with APS fixation using neuronavigation and fluoroscopy. Biomechanical evaluation of the constructs suggests that the ALIF-APS has comparable stability with ALIF-PPS. APS augmentation of ALIF has potential advantages over the current standard ALIF-PPS because it can 1) eliminate the patient repositioning step, 2) minimize the total number of incisions and the total operative time, and 3) protect against dislocation of the ALIF interbody graft or cage. Work is in progress to develop a low-profile system for the novel APS constructs described here.
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In patients who are not candidates for intravenous tissue plasminogen activator, intra-arterial (IA) therapy is an alternative. Current recanalization rates are 50 to 60% for IA thrombolysis. Stent-assisted recanalization in the setting of acute stroke after failed thrombolysis may improve recanalization rates. ⋯ Stent-assisted recanalization for acute stroke resulting from intracranial thrombotic occlusion is associated with a high recanalization rate and low intracranial hemorrhage rate. These initial results suggest that stenting may be an option for recalcitrant cerebral arterial occlusions.
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To investigate the number of subsidences of inserted cervical carbon fiber cages and to define predictive factors for subsidence. ⋯ Although the high number of subsidence of cages has never been described before, clinical outcome and fusion rate is comparable with the literature.
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Comparative Study
Retractable self-expandable stent for endovascular treatment of wide-necked intracranial aneurysms: preliminary experience.
Intracranial stenting combined with endosaccular coiling is a therapeutic alternative for the endovascular treatment (EVT) of wide-necked intracranial aneurysms. The current limitation of available stents is the impossibility to reposition them once they are partially deployed. Recently, the first retractable self-expandable stent has been developed and we sought to evaluate the use of this stent for EVT of wide-necked intracranial aneurysms. ⋯ The Leo stent appears very useful for EVT of wide-necked intracranial aneurysms. The advantage of this stent is the possibility to reposition it which allows a very precise positioning across the aneurysm neck.