World Neurosurg
-
The revascularization technique has remained indispensable for complex aneurysms. However, risk factors for low-flow related ischemic complications (LRICs) and neurologic worsening (NW) have been less well documented. We evaluated the risk factors for LRICs and NW in 67 patients treated with extracranial to intracranial bypass graft using radial artery or saphenous vein graft for complex internal carotid artery (ICA) aneurysm with ICA occlusion. ⋯ The present study showed that regardless of the graft type, the MCAP ratio was associated with LRICs, which were related to late NW in patients with complex ICA aneurysms treated by extracranial to intracranial high-flow bypass graft.
-
The proximal segment of the anterior cerebral artery (A1) is among the most uncommon locations for occurrence of an intracranial aneurysm. These aneurysms may be missed if small or misinterpreted when they are near the internal cerebral artery bifurcation or Anterior Communicating Artery region. The association with congenital vascular anomalies and multiplicity makes them unique. ⋯ A1 aneurysms are rare, with wide anatomic variations. In this article, we discuss those variations in detail with illustrative cases and pictures. We also discussed the microsurgical and endovascular strategies to encounter them highlighting the technical challenges.
-
Failure of direct revascularization with superficial temporal artery (STA)-middle cerebral artery (MCA) bypass for Moyamoya disease (MMD) is comparatively rare. However, for those cases where a bypass fails to prevent further ischemic attacks, safe and efficient rescue strategies are needed. We present our experience with radial artery grafts for secondary revascularization of MMD. ⋯ Rescue bypass with a radial artery graft provides a useful function. Although delayed graft failure may occur, this procedure is successful if the patients remain symptom free with the development of collateral flow.
-
Case Reports
Rescue retrieval of a fully deployed low-profile intracranial stent after acute occlusion.
The use of self-expandable stents for endovascular treatment of intracranial aneurysms has increased over time. Different types of stent malpositioning, such as stent migration, distortion, incomplete opening, and apposition, can occur as a complication of the stent deployment procedure. In this report, we present a successful retrieval of a low-profile stent after full deployment in a dissecting posterior-inferior cerebellar artery because of incomplete apposition and subsequent acute occlusion of the stent.
-
The present study investigates outcomes in patients undergoing elective primary versus revision fusion surgery for lumbar degenerative pathologies with the use of a large population based database. ⋯ The association of a likely postoperative complication in patients undergoing revision lumbar spine fusion compared with those undergoing primary fusion procedures at the same region of the spine is quantified. Our analysis provides baseline estimates that could aid in preoperative risk stratification and as an adjunct in patient education and counseling, and policy makers for higher reimbursements for these sicker patients.