AJNR. American journal of neuroradiology
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AJNR Am J Neuroradiol · Jun 2012
Explaining clinical effects of deep brain stimulation through simplified target-specific modeling of the volume of activated tissue.
Although progress has been made in understanding the optimal anatomic structures as target areas for DBS, little effort has been put into modeling and predicting electromagnetic field properties of activated DBS electrodes and understanding their interactions with the adjacent tissue. Currently, DBS is performed with the patient awake to assess the effectiveness and the side effect spectrum of stimulation. This study was designed to create a robust and rather simple numeric and visual tool that provides sufficient and practical relevant information to visualize the patient's individual VAT. ⋯ Stimulation effects during DBS can be readily explained with this simple VAT model. Its implementation in daily clinical routine might help in understanding the types of tissues activated during DBS. This technique might have the potential to facilitate DBS implantations with the patient under general anesthesia while yielding acceptable clinical effectiveness.
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AJNR Am J Neuroradiol · Jun 2012
Hospitalization costs for endovascular and surgical treatment of ruptured aneurysms in the United States are substantially higher than Medicare payments.
Endovascular and surgical options are both available for treatment of ruptured cerebral aneurysms. Knowledge of the costs relative to Medicare reimbursement for hospitalization of these patients is important for understanding the economic impact of these patients on hospitals. ⋯ Hospitalization costs for patients undergoing clipping and coiling of unruptured cerebral aneurysms are substantially higher than Medicare payments.
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AJNR Am J Neuroradiol · Jun 2012
Endovascular treatment of ruptured brain AVMs in the acute phase of hemorrhage.
Patients with ruptured brain AVMs are at considerable risk of repeat hemorrhage, particularly when associated intranidal or flow-related aneurysms are present. There is controversy about the timing of diagnosis and treatment of patients with hemorrhagic stroke. We present our results of endovascular treatment of ruptured AVMs in the acute phase. ⋯ Endovascular treatment with Onyx in the acute phase cured most ruptured AVMs. All 9 AVM-associated aneurysms that were considered the source of hemorrhage could be excluded from the circulation. In patients with AVM-related hemorrhagic stroke, prompt angiographic diagnosis and treatment may improve prognosis by reducing repeat hemorrhage rate.
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AJNR Am J Neuroradiol · Jun 2012
ReviewIntracranial dural arteriovenous fistulas: classification, imaging findings, and treatment.
Intracranial DAVFs are pathologic dural-based shunts and account for 10%-15% of all intracranial arteriovenous malformations. These malformations derive their arterial supply primarily from meningeal vessels, and the venous drainage is either via dural venous sinuses or through the cortical veins. ⋯ Cross-sectional imaging techniques by using CT and MR imaging aid in the diagnosis, but conventional angiography remains the most accurate method for complete characterization and classification of DAVFs. The pattern of venous drainage observed on dynamic vascular imaging determines the type of DAVF and correlates with the severity of symptoms and the risk of hemorrhage.