World Neurosurg
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Comparative Study
The impact of associated nidal lesions in outcome of brain arteriovenous malformations after radiosurgery with or without embolization.
Radiosurgery is a valuable option to treat arteriovenous malformations. There are correlations between some morphologic nidal features and final results, and the benefits of preradiosurgical embolization have not been well established thus far. ⋯ An untreated arteriovenous fistula inside the arteriovenous malformation at the moment of stereotactic radiosurgery was associated with lower cure rates (P = 0.001). Embolization followed by radiosurgery was not superior to radiosurgery alone; however, targeted embolization of intranidal arteriovenous fistulas to increase obliteration rates and to protect the patient from bleeding during the radiosurgery latency period should be considered.
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One disadvantage of carotid artery stenting (CAS) is a high incidence of distal embolism (DE) during or after the procedure. Patients with unstable plaque are considered at high risk for DE and plaque protrusion (PP) after stent placement, which can cause postprocedural ischemic complications. This study was conducted to compare the rate and size of PP between the CASPER stent, a new-generation double-layer micromesh stent, and conventional stents as assessed by optical frequency domain imaging (OFDI), and also to evaluate the efficacy of CAS with the CASPER stent in cases with unstable plaque. ⋯ On OFDI evaluation after CAS, the degree of PP was significantly smaller in the CASPER stent group compared with the conventional stent group. This result provides new insight into the use of CAS to treat carotid artery stenosis with unstable plaque.
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Patients with Moyamoya or other intracranial steno-occlusive disease are at risk for developing aneurysms associated with flow through collateral vessels. Because these lesions are rare, the optimal management remains unclear. Here, we describe 2 cases of microsurgical repair of ruptured collateral vessel aneurysms associated with middle cerebral artery (MCA) occlusion. ⋯ Our experience suggests that patients with MCA occlusion can harbor associated aneurysms related to flow through collateral vessels and can present with hemorrhage. Microsurgical repair of these aneurysms can be performed safely to prevent rebleeding.
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In symptomatic unruptured intracranial aneurysms (UIAs), data on long-term functional outcome are sparse in the literature, even in the light of modern interdisciplinary treatment decisions. We therefore analyzed our in-house database for prognostic factors and long-term outcome of neurologic symptoms after microsurgical/endovascular treatment. ⋯ This recent study presents for the first time a detailed analysis of relevant prognostic factors for long-term recovery of cranial nerve/brainstem compression symptoms in an interdisciplinary treatment concept, which was excellent in most patients, with lowest recovery rates in optic nerve compression. Symptom recovery was remarkably higher in the long-term compared with recovery at discharge.
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Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening disease with an often fatal clinical course leading to irreversible loss of brain function (ILBF) (i.e., brain death). The purpose of this study was to assess the prevalence and characteristics of patients with aSAH who became organ donors after diagnosis of ILBF. ⋯ ILBF in the setting of fatal aSAH is a prevalent diagnosis with complex demands for neurointensive care physicians. We demonstrated the clinical characteristics and epidemiologic factors of patients with aSAH converting to organ donors.