Neurosurgery
-
The promising results of the Solitaire Flow Restoration (FR) With the Intention for Thrombectomy (SWIFT) trial recently led toFood and Drug Administration (FDA) approval of theSolitaire FR stent retriever device for recanalization of cerebral vessels in patients with acute ischemic stroke. ⋯ Our study shows that a variety of other endovascular approaches are used in conjunction with Solitaire FR in actual practice in the United States.Early postmarket results suggest that Solitaire FR is an effective tool for endovascular treatment of acute ischemic stroke.
-
Ethylene vinyl alcohol co-polymer (Onyx) is widely used for the embolization of arteriovenous malformations of the brain, head, and neck. Balloon-assisted Onyx embolization may provide additional unique advantages in the treatment of AVMs when compared to traditional catheter-based techniques. ⋯ The balloon microcatheters showed excellent navigability, and there were no problems with retrieval or with the repeated inflation and deflation of the balloons. A proximal Onyx plug, which is crucial in many AVM embolizations, was not necessary with this technique. Additionally, fluoroscopy and procedural times seemed lower with this technique compared to conventional embolization methods.
-
Preoperative embolization of meningiomas remains contentious, with persisting uncertainty over the safety and efficacy of this adjunctive technique. ⋯ The complication rate was 3.7%. No relationship between the embolic agent and the degree of devascularization was observed. Achieving a complete devascularization resulted in a lower blood transfusion requirement, considered an indirect measure of operative blood loss. This series demonstrates that pre-operative meningiomaembolization is safe and may reduce operative blood loss. We present distal intratumoral injection of liquid embolic as a safe and effective alternative to more established particle embolization techniques.
-
BACKGROUND AND IMPORTANCE:: Spinal extradural arteriovenous fistula (SEDAVF) with parenchymal drainage (Type A) is a rare clinical entity that causes venous congestive myelopathy. Treatment includes endovascular and open microsurgical interventions. We reviewed the clinical records of patients treated for a Type-A SEDAVF to evaluate the feasibility of our treatment strategy. ⋯ Overall, all patients stabilized or improved neurologically and experienced no recurrence. To treat a Type-A SEDAVF, either TVE or microsurgical intradural drainer occlusion can be used for satisfactory long-term results with minimal surgical risks. For a case with multiple intradural draining veins, detachment of the venous lake should be considered.
-
BACKGROUND AND IMPORTANCE:: The goal of spinal dural arteriovenous fistula (DAVF) treatment is to permanently occlude the proximal draining vein and the fistula itself, which can be achieved by open surgery or by endovascular treatment. The endovascular approach is currently the primary treatment, but it requires the presence of an access as close to the site of the fistula as possible. This case illustrates that the retro-corporeal artery may be an alternative option in case of previous embolization failure with proximal occlusion of the radicular arteries. ⋯ Given the proximal occlusion of these feeders during the first embolization, the dilated retro-corporeal arteries were approached through the contralateral L2 and L3 radicular arteries. Complete occlusion of the fistula was achieved with Onyx in a single session with progressive improvement of preoperative neurological deficit. The retro-corporeal artery may provide a safe alternative approach to spinal DAVFs in cases where a conventional endovascular approach failed, thus avoiding invasive surgical treatment.