Surg Neurol
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Review Case Reports
Spinal giant intradural perimedullary arteriovenous fistula: clinical and neuroradiological study in one case with review of literature.
Giant intradural perimedullary arteriovenous fistula with massive spinal cord compression is rare. The therapeutic difficulties include whether endovascular embolization or direct surgical excision should be selected. We present a patient with the largest giant spinal intradural perimedullary arteriovenous fistula shown by magnetic resonance imaging so far reported, who was successfully treated by a combination of endovascular embolization and direct surgery. ⋯ We recommend that such a huge perimedullary arteriovenous fistula with a rapid transit time, and severe cord and root compression, should be treated with embolization followed by surgical excision.
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Comparative Study
Indirect revascularization for moyamoya disease: is there a beneficial effect for adult patients?
It is generally accepted that excellent development of collateral circulation can be achieved through indirect nonanastomotic bypass procedures for pediatric patients with moyamoya disease. However, there are no definitive conclusions about the effect of indirect revascularization for adult patients. To clarify the value of indirect bypass surgery for adult moyamoya disease, we have analyzed their follow-up angiographic results in comparison with those of the pediatric patients. ⋯ The results suggest that advancing age apparently affects the development of collateral formation through the indirect bypass. Consequently, direct bypass is thought to be the main treatment option for patients older than 40.
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Case Reports
Omental transplantation using a superficial temporal artery previously used for encephaloduroarteriosynangiosis.
Childhood moyamoya disease is a chronically progressive cerebrovascular occlusive disease affecting the territories of the anterior, middle, and posterior cerebral arteries. Surgery used in treatment of moyamoya disease to vascularize the brain include direct and indirect anastomoses. ⋯ In summary, OMT using a branch of the STA used in previously performed EDAS is required for patients with moyamoya disease who continue to manifest paraparesis, urinary incontinence, and/or progressive mental retardation even after multiple EDAS.
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Twenty patients with thoracic disc herniations underwent removal of the transverse process, articular facet, pedicle, and rib--a procedure described by Larson as the lateral extracavitary approach. Eleven patients presented with myelopathy: five mild, nine moderate, and four severe. ⋯ Postoperative follow-up ranged from 1 to 8 years. The pros and cons of each of the surgical approaches to this type of lesion are considered with reference to the published data.