Comparative use of turkey and chicken wing brachial artery models for microvascular anastomosis training.

Object: The aim of this study was to describe a turkey wing model for microvascular anastomosis training and compare it to the previously outlined chicken wing model.

Methods: The authors compared diameter measurements in each of 5 turkey and 5 chicken brachial arteries at 3 equidistant points. Usable vessel length was measured (from joint to joint) in each of the specimens.

Craniocervical arterial dissections as sequelae of chiropractic manipulation: patterns of injury and management.

Object: Chiropractic manipulation of the cervical spine is a known cause of craniocervical arterial dissections. In this paper, the authors describe the patterns of arterial injury after chiropractic manipulation and their management in the modern endovascular era.

Methods: A prospectively maintained endovascular database was reviewed to identify patients presenting with craniocervical arterial dissections after chiropractic manipulation.

Styloidogenic jugular venous compression syndrome: diagnosis and treatment: case report.

Background And Importance: Intracranial venous hypertension is known to be associated with venous outflow obstruction. We discuss the diagnosis and treatment of mechanical venous outflow obstruction causing pseudotumor cerebri.

Clinical Presentation: We report 2 patients presenting with central venous outflow obstruction secondary to osseous compression of the internal jugular veins at the craniocervical junction.

Advances in the treatment and outcome of brainstem cavernous malformation surgery: a single-center case series of 300 surgically treated patients.

Background: Brainstem cavernous malformations (BSCMs) are relatively uncommon, low-flow vascular lesions. Because of their relative rarity, relatively little data on their natural history and on the efficacy and durability of their treatment.

Objective: To evaluate the long-term durability of surgical treatment of BSCMs and to document patient outcomes and clinical complications.

Simultaneous posterior communicating artery aneurysm clipping and selective amygdalohippocampectomy via direct lateral access through the mesial temporal lobe to the basal cisterns.

We report a 23-year-old man with intractable epilepsy and an incidental posterior communicating artery aneurysm who was treated simultaneously for both pathologies. He was counseled regarding the potential to treat both pathologies with one procedure. He elected to undergo a simultaneous approach.

Delayed presentation of traumatic cerebral and dural arteriovenous fistulae after a BB gun accident in a pediatric patient: case report.

Background And Importance: To present a case of traumatic cortical and dural arteriovenous fistula (AVF) after a BB gun accident.

Clinical Presentation: The patient presented with a small left frontal subdural hematoma and small contusions in the left frontal lobe after he was shot with a BB. He had no skull fractures or significant midline shift.

Outcomes following resection of intramedullary spinal cord cavernous malformations: a 25-year experience.

Object: The management of intramedullary spinal cord cavernous malformations (CMs) is controversial. At Barrow Neurological Institute, the authors selectively offer surgical treatment for symptomatic spinal cord CMs. The purpose of this paper is to review the clinical outcomes in patients after resection of these lesions based on a single-center experience over a 25-year period.

Repeat surgery for hypothalamic hamartoma in refractory epilepsy.

Object: Hypothalamic hamartomas (HHs) often cause pharmacoresistant epilepsy, incapacitating behavioral abnormalities, and cognitive decline. Surgical intervention offers the patient the best opportunity of seizure resolution, which occurs in approximately 50%–60% of patients, and improvement in both cognitive and behavioral difficulties. For those in whom the initial operation has failed, further medical treatment options remain quite limited, whereas, in some cases, a second surgery may improve seizure outcome.

Surgical approaches to hypothalamic hamartomas.

Object: Hypothalamic hamartomas (HHs) are devastating lesions causing refractory epilepsy, rage attacks, social ineptitude, and precocious puberty. Microsurgical and/or endoscopic resection offers an excellent risk/benefit profile for cure or improvement of epilepsy.

Methods: The authors reviewed a prospective database maintained during the first 7 years of the Barrow Hypothalamic Hamartoma program.

A history of the Barrow Neurological Institute.

The Barrow Neurological Institute (BNI), founded in 1961, is in partnership with St. Joseph's Hospital and Medical Center and part of the Catholic Healthcare West system. The BNI is a relative newcomer to academic neuroscience.

Syndrome of alternating hypernatremia and hyponatremia after hypothalamic hamartoma surgery.

Object: In this paper, the authors' goal was to describe the occurrence of alternating hypernatremia and hyponatremia in pediatric patients who underwent resection of hypothalamic hamartomas (HHs) for epilepsy. Hypernatremia in patients after pituitary or hypothalamic surgery can be caused by diabetes insipidus (DI), whereas hyponatremia can occur due to a syndrome of inappropriate antidiuretic hormone, cerebral salt wasting, or excessive administration of desmopressin (DDAVP). The triphasic response after surgery in the pituitary region can also explain variations in sodium parameters in such cases.

Long-term outcome after emergency resection of hypothalamic hamartomas for status gelasticus.

Object: Gelastic seizures are epileptic events characterized by bouts of laughter. They are rare and mostly associated with hypothalamic hamartomas (HHs). Status gelasticus, a rare form of status epilepticus, is defined as a prolonged cluster of gelastic seizures (> 20-30 minutes) without necessarily involving loss of awareness between seizures.

Return to golf after spine surgery.

Object: no published evidence indicates when patients can resume golfing after spine surgery. The objective of this study is to provide data from surveys sent to spine surgeons.

Methods: a survey of North American Spine Society members was undertaken querying the suggested timing of return to golf.

Gamma Knife surgery for hypothalamic hamartomas and epilepsy: patient selection and outcomes.

Object: The authors present outcomes obtained in patients who underwent Gamma Knife surgery (GKS) at 1 institution as part of a multimodal treatment of refractory epilepsy caused by hypothalamic hamartomas (HHs).

Methods: Between 2003 and 2010, 19 patients with HH underwent GKS. Eight patients had follow-up for less than 1 year, and 1 patient was lost to follow-up.

Comparison of two antibiotic-impregnated ventricular catheters: a prospective sequential series trial.

Background: External ventricular drains (EVDs) are valuable adjuncts in the management of neurosurgical patients but are associated with a significant risk of cerebrospinal fluid (CSF) infection (range, 0% to 27%); a review of 23 studies reported a mean of 8.8%.

Objective: To compare the efficacy of 2 different antibiotic-impregnated EVD catheters in preventing CSF infections.

Cavernous malformations of the brainstem presenting in childhood: surgical experience in 40 patients.

Background: Brainstem cavernous malformations (BSCMs) are believed to compose 9% to 35% of all cerebral cavernous malformations, but these lesions have been reported in children in very limited numbers.

Objective: To review surgical outcomes of pediatric patients with BSCMs treated at 1 institution.

Methods: We retrospectively analyzed the course of 40 pediatric patients (19 males, 21 females; age range, 10 months to 18.

Comparison of dural grafts in Chiari decompression surgery: Review of the literature.

Background: Decompression of Chiari malformation is a common procedure in both pediatric and adult neurosurgery. Although the necessity for some bony removal is universally accepted, other aspects of Chiari surgery are the subject of debate. The most controversial points include the optimal amount of bony removal, the use of duraplasty (and the type of material), the need for subarachnoid dissection, and the need for tonsillar shrinkage.

Surgical approaches to brainstem cavernous malformations.

Brainstem cavernous malformations (CMs) are low-flow vascular lesions in eloquent locations. Their presentation is often marked with symptomatic hemorrhages that appear to occur more frequently than hemorrhage from supratentorial cavernomas. Brainstem CMs can be removed using 1 of the 5 standard skull-base approaches: retrosigmoid, suboccipital (with or without telovelar approach), supracerebellar infratentorial, orbitozygomatic, and far lateral.

Orbitozygomatic resection for hypothalamic hamartoma and epilepsy: patient selection and outcome.

Purpose: This study aims to examine the outcomes of ten patients after orbitozygomatic (OZ) pterional surgery in cases of refractory epilepsy caused by hypothalamic hamartomas (HH).

Methods: Ten patients with HH and treatment-resistant epilepsy (mean age 18.3 years, range 0.

Treatment of distal posterior cerebral artery aneurysms: a critical appraisal of the occipital artery-to-posterior cerebral artery bypass.

Objective: This is the largest contemporary series of distal posterior cerebral artery (PCA) aneurysms treated by use of endovascular coiling and stenting as well as surgical clipping, clip wrapping, and bypass techniques. We propose a new treatment paradigm.

Methods: The location, size, type of aneurysm, clinical presentation, treatment, complications, and outcomes associated with 34 distal PCA aneurysms in 33 patients (15 females, 18 males; mean age, 44 years) were reviewed retrospectively.

Safety of carotid endarterectomy while on clopidogrel (Plavix). Clinical article.

Object: Many patients undergoing carotid endarterectomy (CEA) regularly take clopidogrel, a permanent platelet inhibitor. The authors sought to determine whether taking clopidogrel in the period before CEA leads to more bleeding or other complications.

Methods: The authors performed a retrospective, institutional review board–approved review of 182 consecutive patients who underwent CEA.

Developmental venous anomaly, cavernous malformation, and capillary telangiectasia: spectrum of a single disease.

Developmental venous anomalies (DVAs), cavernous malformations, and capillary telangiectasias are related vascular malformations of the central nervous system. Mixed lesions of the central nervous system vasculature have been reported in a host of combinations, including many possible concomitant combinations of cavernous malformations, venous anomalies, capillary telangiectasias, and arteriovenous malformations (AVMs). We describe the natural history of disease in a female with developmental venous anomaly, cavernous malformation, and capillary telangiectasias appearing in sequence.

Cerebrovascular accidents in patients with a ventricular assist device.

Objective: A cerebrovascular accident is a devastating adverse event in a patient with a ventricular assist device. The goal was to clarify the risk factors for cerebrovascular accident.

Methods: Prospectively collected data, including medical history, ventricular assist device type, white blood cell count, thrombelastogram, and infection, were reviewed retrospectively in 124 patients.