Neurosurgery clinics of North America
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Neurosurg. Clin. N. Am. · Jan 2012
ReviewEndovascular treatment of cranial arteriovenous malformations and dural arteriovenous fistulas.
Pial arteriovenous malformations (AVMs) and dural arteriovenous fistulas (DAVFs) are high-flow vascular lesions with abnormal communications between the arterial and venous system. AVMs are congenital lesions, whereas DAVFs are considered acquired lesions. ⋯ The primary goal of treatment is to eliminate the risk of bleeding or at least decrease it. Because the epidemiology, clinical presentation, and classification of AVMs and DAVFs have been covered in previous articles in this issue, the authors only briefly touch on these subjects as they relate to endovascular treatment.
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Neurosurg. Clin. N. Am. · Jan 2012
ReviewSelection of treatment modalities or observation of arteriovenous malformations.
This article provides management guidelines for arteriovenous malformations (AVMs). Management options include observation, surgical excision, endovascular embolization, and radiosurgery. ⋯ The article stratifies each lesion based on the AVM and patient characteristics to either observation or a single or multimodal treatment arm. The treatment of an AVM must be carefully weighed in each patient because of the risk of neurologic injury in functional areas of the brain and weighed against the natural history of hemorrhage.
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Neurosurg. Clin. N. Am. · Jan 2012
Review Case ReportsAcute management of ruptured arteriovenous malformations and dural arteriovenous fistulas.
Arteriovenous malformations of the brain (AVMs) are a major cause of stroke in young, healthy individuals and present multiple diagnostic and therapeutic challenges, particularly in the acute setting. Although the flow hemodynamics, biology, epidemiology, and natural history of AVMs have been extensively studied, little data have been published on AVM surgery in the acute setting, and acute surgery has been claimed to possibly increase the risk of persistent neurological deficits. Although it is usually preferable to defer AVM surgery for a few weeks or months, acute surgical (open and endovascular) management is essential in specific clinical and radiological settings.
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Neurosurg. Clin. N. Am. · Oct 2011
Review Comparative StudyTrigeminal nerve stimulation: seminal animal and human studies for epilepsy and depression.
The unique ability to stimulate bilaterally, extracranially, and non-invasively may represent a significant advantage to invasive neuromodulation therapies. In humans thus far the technique has been applied noninvasively, and is termed external trigeminal nerve stimulation (eTNSTM).
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Neurosurg. Clin. N. Am. · Oct 2011
Multicenter Study Clinical TrialResponsive neurostimulation suppresses synchronized cortical rhythms in patients with epilepsy.
Deep brain stimulation (DBS) is an established treatment for Parkinson's disease, and is increasingly used for other neuropsychiatric conditions including epilepsy. Nevertheless, neural mechanisms for DBS and other forms of neurostimulation remain elusive. ⋯ Neurostimulation acutely suppressed gamma frequency (35-100 Hz) phase-locking. This may represent a therapeutic mechanism by which responsive neurostimulation can suppress epileptiform activity and disconnect stimulated regions from downstream targets in epilepsy and other neuropsychiatric conditions.