Neurosurgery
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Comparative Study
Internal carotid artery aneurysms occurring at the origin of fetal variant posterior cerebral arteries: surgical and endovascular experience.
A fetal variant posterior cerebral artery (fetal PCA) is an embryological remnant in which the PCA is primarily supplied via the anterior cerebral circulation. Internal carotid artery (ICA) aneurysms originating from the takeoff of fetal PCA vessels deserve special attention before surgical or endovascular obliteration because of a greater potential for ischemic injury. We present the first series of ICA-posterior communicating artery (PComA) aneurysms originating at the takeoff of fetal PCA vessels that were treated by surgical or endovascular intervention. ⋯ ICA-PComA aneurysms originating from fetal PCA vessels may pose a more substantial risk for infarction and subsequent neurological sequelae with surgical or endovascular obliteration. Fetal variant circulations were identified at the PComA origin in 11% of ICA-PComA aneurysm patients and were more commonly encountered in women. The decision of surgical versus endovascular treatment of fetal PCA aneurysms must be carefully considered, given the greater potential for ischemic injury with parent vessel occlusion.
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Comparative Study
Comparison of N-butyl cyanoacrylate and onyx for the embolization of intracranial arteriovenous malformations: analysis of fluoroscopy and procedure times.
Intracranial arteriovenous malformations (AVM) may be managed through staged preoperative embolization and resection. Two commonly used liquid embolics are N-butyl cyanoacrylate (nBCA; Cordis Microvascular, Inc., New Brunswick, NJ) and Onyx (ev3, Inc., Irvine, CA). We sought to compare the utility of these agents in terms of fluoroscopy and procedure times. ⋯ Onyx AVM embolization requires increased fluoroscopy and procedure times compared with nBCA. Further investigation is necessary to justify increased radiation exposure and procedure time associated with Onyx.
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Because surgery in elderly patients should be minimally invasive, interspinous process distraction has been widely used in this group to treat lumbar canal stenosis. We developed a new interspinous process distraction spacer composed of hydroxyapatite ceramic. In this work, we demonstrate the usefulness of this novel device. ⋯ Our ceramic spacer is useful in the treatment of elderly patients with lumbar canal stenosis. Treatment comprises an easy surgical procedure and produces no metal artifact on radiological evaluations, such as magnetic resonance imaging and computed tomographic scans.
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The goal of this report is to analyze the hemodynamic characteristics of low- and high-flow arteriovenous malformations (AVM) using computerized electrical models. ⋯ These electrical models seem to be useful in simulating and studying the behavior of flow and pressure in the different parts of the AVM nidus (arterial, arteriolar, arteriolar-venular, venular, venous) before and after treatment. The models can also be used to devise and simulate new treatment strategies that might lead to improved treatment of these highly complex vascular malformations of the brain.
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Multicenter Study Comparative Study
Angiographic patterns of Wingspan in-stent restenosis.
A classification system developed to characterize in-stent restenosis (ISR) after coronary percutaneous transluminal angioplasty with stenting was modified and applied to describe the appearance and distribution of ISR occurring after Wingspan (Boston Scientific, Fremont, CA) intracranial percutaneous transluminal angioplasty with stenting. ⋯ Wingspan ISR typically occurs as a focal lesion. In more than half of ISR cases, the ISR lesion was more extensive than the original lesion treated in terms of lesion length or stenosis severity. Supraclinoid internal carotid artery and middle cerebral artery lesions have a propensity to develop more severe posttreatment stenosis.