Thrombectomy and stenting of pseudoaneurysm from transcarotid artery revascularization.

Background: Transcarotid artery revascularization (TCAR) is becoming an increasingly popular treatment of carotid stenosis. Despite this rapid adoption, little in the literature describes the associated complications of this procedure.

Case Description: We report a case of a left M1 large-vessel occlusion following treatment of symptomatic, high-grade carotid stenosis with a TCAR procedure approximately three weeks earlier.

An Endovascular Surgery Experience in Far-Forward Military Healthcare-A Case Series.

Introduction: The advancement of interventional neuroradiology has drastically altered the treatment of stroke and trauma patients. These advancements in first-world hospitals, however, have rarely reached far forward military hospitals due to limitations in expertise and equipment. In an established role III military hospital though, these life-saving procedures can become an important tool in trauma care.

Strategies to minimize complications during intraoperative aneurysmal hemorrhage: a personal experience.

Background: The occurrence of intraoperative rupture (IOR) of an aneurysm is one of the most precarious moments in microsurgery, and the management of IOR profoundly affects operative outcomes.

Methods: The authors describe their personal experiences during the past decade with managing intraoperative aneurysm rupture for microsurgical treatment of complex cerebral aneurysm procedures.

Results: Steps to avoid and manage IOR depend on the stage of the operation or phase of dissection and on aneurysm location and configuration.

Effect of antiplatelet therapy and platelet function testing on hemorrhagic and thrombotic complications in patients with cerebral aneurysms treated with the pipeline embolization device: a review and meta-analysis.

Purpose: The pipeline embolization device (PED) necessitates dual antiplatelet therapy (APT) to decrease thrombotic complications while possibly increasing bleeding risks. The role of APT dose, duration, and response in patients with hemorrhagic and thromboembolic events warrants further analysis.

Methods: A PubMed and Google Scholar search from 2009 to 2014 was performed using the following search terms individually or in combination: pipeline embolization device, aneurysm(s), and flow diversion, excluding other flow diverters.

Advances in surgical approaches to dural fistulas.

Dural arteriovenous fistulas are abnormal connections of dural arteries to dural veins or venous sinuses originating from within the dural leaflets. They are usually located near or within the wall of a dural venous sinus that is frequently obstructed or stenosed. The dural fistula sac is contained within the dural leaflets, and drainage can be via a dural sinus or retrograde through cortical veins (leptomeningeal drainage).

An examination of aneurysm rerupture rates with epsilon aminocaproic acid.

Background: Epsilon aminocaproic acid (EACA) has been used in the past to prevent cerebral aneurysm rerupture. Recent studies have indicated that short-term treatment with EACA can lower rebleeding rates without significantly increasing ischemic or thrombotic complications or permanent shunt rates. The goal of this study is to determine the efficacy of EACA in the prevention of aneurysm rerupture at a high volume subarachnoid hemorrhage center.

Pial arteriovenous fistula resulting from ventriculostomy.

Objective: Ventriculostomy complications are well documented in the literature. We report the first known example of an arteriovenous fistula created during passage of a ventriculostomy catheter for the treatment of hydrocephalus.

Methods: A 47-year-old female patient initially presented with a subarachnoid hemorrhage and an anterior communicating artery aneurysm.

Anomalous course of the intracranial internal carotid artery into the orbit: case report.

In this report, a case of anomalous internal carotid artery looping into the orbital apex is presented. The patient was a 41-year-old man with sudden onset headache, suggestive of aneurysmal subarachnoid hemorrhage (SAH). Imaging with CT demonstrated a perimesencephalic distribution of blood.

Microsurgical and endovascular management of pericallosal aneurysms.

Background: Pericallosal, or A2 bifurcation, aneurysms are an infrequently encountered cause of subarachnoid hemorrhage (SAH). While the International Subarachnoid Aneurysm Trial showed improved outcomes for patients with any ruptured anterior circulation aneurysm treated with embolization, there was also a higher recurrence rate for embolized aneurysms. Notably, there were relatively few pericallosal aneurysms.

ε-Aminocaproic acid in angiographically negative subarachnoid hemorrhage patients is safe: a retrospective review of 83 consecutive patients.

Background: ε-Aminocaproic acid (EACA) has been used to reduce the rate of cerebral aneurysm rerupture before definitive treatment. In centers administering EACA to patients with a subarachnoid hemorrhage (SAH), patients eventually diagnosed with angiographically negative subarachnoid hemorrhage (ANSAH) may also initially receive EACA, perhaps placing them at increased risk for ischemic complications.

Objective: To evaluate the effect of short-term EACA on outcomes and secondary measures in patients with ANSAH.

Indocyanine green videoangiography for confirmation of bypass graft patency.

Objective: The aim of the study is to determine the efficacy of indocyanine green (ICG) videoangiography for confirmation of vascular anastomosis patency in both extracranial-intracranial and intracranial-intracranial bypasses.

Methods: Intraoperative ICG videoangiography was used as a surgical adjunct for 56 bypasses in 47 patients to assay the patency of intracranial vascular anastomosis. These patients underwent a bypass for cerebral ischemia in 31 instances and as an adjunct to intracranial aneurysm surgery in 25.

Endovascular treatment of an aneurysm of a persistent primitive hypoglossal artery with complete resolution of brainstem compressive symptoms: case report.

Background And Importance: Aneurysms of the posterior circulation may manifest with neurological deficits related to mass effect on the brainstem. We present an unusual case of an aneurysm resulting in selective lower-extremity weakness and gait instability.

Clinical Presentation: A 61-year-old man presents with progressively worsening gait instability over the course of several months.

Endovascular therapy of very small aneurysms of the anterior communicating artery: five-fold increased incidence of rupture.

Background: Intraprocedural rupture is a dangerous complication of endovascular treatment. Small ruptured anterior communicating artery (ACoA) aneurysms and microaneurysms present a challenge for both surgical and endovascular therapies to achieve obliteration. An understanding of the complication rates of treating ruptured ACoA microaneurysms may help guide therapeutic options.

Antithrombotic states and outcomes in patients with angiographically negative subarachnoid hemorrhage.

Background: Antithrombotic states are encountered frequently, either because of medical therapy or by preexistent pathological states, and may affect the severity of hemorrhagic strokes such as angiographically negative subarachnoid hemorrhages.

Objective: To determine the effects of antithrombotic states on the outcomes of patients with angiographically negative subarachnoid hemorrhage by examining data pooled from 2 institutions.

Methods: This is a retrospective review of patients who experienced angiographically negative subarachnoid hemorrhage at 2 institutions over the past 5 years.

Open biopsy in patients with acute progressive neurologic decline and absence of mass lesion.

Objective: Patients with acute to subacute neurologic decline undergo a battery of imaging and laboratory tests to determine a diagnosis and treatment plan. Often, after an extensive evaluation, a brain biopsy is recommended as yet another tool to assist in determining the diagnosis. The goal of this retrospective cohort analysis is to measure the sensitivity of open brain biopsy in this patient population, compare these results with the preoperative presumed diagnosis, and evaluate if the biopsy result significantly alters treatment.

Indocyanine green videoangiography in the management of dural arteriovenous fistulae.

Objective: To evaluate the usefulness of indocyanine green (ICG) videoangiography in the operative management of dural arteriovenous fistulae (dAVFs).

Methods: Intraoperative ICG videoangiography was used as a surgical adjunct in 25 patients with cranial and spinal dural arteriovenous fistulae to identify the fistula and verify its complete obliteration. The findings on ICG videoangiography were compared with intraoperative and/or postoperative imaging.

EGFRvIII antibody-conjugated iron oxide nanoparticles for magnetic resonance imaging-guided convection-enhanced delivery and targeted therapy of glioblastoma.

The magnetic nanoparticle has emerged as a potential multifunctional clinical tool that can provide cancer cell detection by magnetic resonance imaging (MRI) contrast enhancement as well as targeted cancer cell therapy. A major barrier in the use of nanotechnology for brain tumor applications is the difficulty in delivering nanoparticles to intracranial tumors. Iron oxide nanoparticles (IONP; 10 nm in core size) conjugated to a purified antibody that selectively binds to the epidermal growth factor receptor (EGFR) deletion mutant (EGFRvIII) present on human glioblastoma multiforme (GBM) cells were used for therapeutic targeting and MRI contrast enhancement of experimental glioblastoma, both in vitro and in vivo, after convection-enhanced delivery (CED).

Full scope of options.

Objective: The purpose of Clinical Problem Solving articles is to present management challenges to give practicing neurosurgeons insight into how field leaders address these dilemmas. This illustration is accompanied by a brief review of the literature on the topic.

Presentation: The case of a 16-year-old boy presenting with headaches is presented.