Extracranial-Intracranial Microsurgical Bypass Using a Y-Shaped Vein Graft From the Hand.

While extracranial-intracranial (EC-IC) bypass is commonly performed by neurosurgeons with specific expertise in cerebrovascular surgery, they can also be performed together with microvascular plastic surgeons. At our institution, some EC-IC bypass cases have evolved to be performed by neurosurgeons and plastic surgeons in a combined approach. Given the plastic surgeons' expertise and volume of experience in performing microvascular surgery, their skills are utilized in performing the donor vessel dissection as well as the bypass itself.

Efficacy and safety of a third stereotactic radiosurgery for recurrent trigeminal neuralgia: an international, multicenter study.

Background And Objectives: Trigeminal Neuralgia (TN) is a debilitating facial pain disorder, often necessitating surgical interventions when medication proves insufficient. Stereotactic Radiosurgery (SRS) is an established therapeutic option. Limited studies explored the feasibility of a third SRS procedure.

Acute management of ruptured cavernous malformation of the optic nerve: illustrative case.

Background: A cavernous malformation of the optic nerve (CMON) is a rare condition that often presents with an abrupt decline in vision. Acute management of ruptured optic nerve cavernous malformations is generally surgical, although the timing of surgery is controversial.

Observations: A 47-year-old female experienced the sudden loss of vision in her left eye.

Facial Nerve Schwannoma Treatment with Stereotactic Radiosurgery (SRS) versus Resection followed by SRS: Outcomes and a Management Protocol.

 Stereotactic radiosurgery (SRS) and resection are treatment options for patients with facial nerve schwannomas without mass effect.  This article evaluates outcomes of patients treated with SRS versus resection + SRS.  We retrospectively compared 43 patients treated with SRS to 12 patients treated with resection + SRS.

Hemifacial spasm: a neurosurgical perspective.

Hemifacial spasm (HFS) causes both physical and psychological disabilities that significantly impact quality of life. Medical management with serial botulinum toxin injections provides transient spasm relief and is widely reported as highly effective, as compared to no treatment. While there is an excellent potential for disease cure with microvascular decompression (MVD) surgery, utilization rates remain very low in North America (approximately 10%) and many patients are not adequately informed of this surgical option.

Adverse radiation effects in volume-staged radiosurgery for large arteriovenous malformations: a multiinstitutional study.

Objective: The optimal treatment paradigm for large arteriovenous malformations (AVMs) is controversial. One approach is volume-staged stereotactic radiosurgery (VS-SRS). The authors previously reported efficacy of VS-SRS for large AVMs in a multiinstitutional cohort; here they focus on risk of symptomatic adverse radiation effects (AREs).

Effect of Anatomic Segment Involvement on Stereotactic Radiosurgery for Facial Nerve Schwannomas: An International Multicenter Cohort Study.

Background: Facial nerve schwannomas are rare, challenging tumors to manage due to their nerve of origin. Functional outcomes after stereotactic radiosurgery (SRS) are incompletely defined.

Objective: To analyze the effect of facial nerve segment involvement on functional outcome for these tumors.

Earlier radiosurgery leads to better pain relief and less medication usage for trigeminal neuralgia patients: an international multicenter study.

Objective: Trigeminal neuralgia (TN) is a chronic pain condition that is difficult to control with conservative management. Furthermore, disabling medication-related side effects are common. This study examined how stereotactic radiosurgery (SRS) affects pain outcomes and medication dependence based on the latency period between diagnosis and radiosurgery.

Using strength-duration analysis to identify the afferent limb of the lateral spread response in hemifacial spasm patients during microvascular decompression surgery.

Strength-duration analysis has been used to identify excitability differences between motor and sensory axons in human peripheral mixed nerves. The trigeminal and facial nerves have both been suggested to play a role in mediating the lateral spread response (LSR) in patients with hemifacial spasm (HFS). We sought to investigate this hypothesis by analyzing strength-duration properties of spasm side mentalis M wave and o.

Dose response and architecture in volume staged radiosurgery for large arteriovenous malformations: A multi-institutional study.

Background: Optimal treatment paradigm for large arteriovenous malformations (AVMs) is controversial. Volume-staged stereotactic radiosurgery (VS-SRS) provides an effective option for these high-risk lesions, but optimizing treatment for these recalcitrant and rare lesions has proven difficult.

Methods: This is a multi-centered retrospective review of patients treated with a planned prospective volume staging approach to stereotactically treat the entire nidus of an AVM with volume stages separated by intervals of 3-6 months.

A Proposed Grading Scale for Predicting Outcomes After Stereotactic Radiosurgery for Dural Arteriovenous Fistulas.

Background: There are presently no grading scales that specifically address the outcomes of cranial dural arteriovenous fistula (dAVF) after stereotactic radiosurgery (SRS).

Objective: To design a practical grading system that would predict outcomes after SRS for cranial dAVFs.

Methods: From the International Radiosurgery Research Foundation (University of Pittsburgh [41 patients], University of Pennsylvania [6 patients], University of Sherbrooke [2 patients], University of Manitoba [1 patient], West Virginia University [2 patients], University of Puerto Rico [1 patient], Beaumont Health System 1 [patient], Na Homolce Hospital [13 patients], the University of Virginia [48 patients], and Yale University [6 patients]) centers, 120 patients with dAVF treated with SRS were included in the study.

Stereotactic Radiosurgery for Cavernous Sinus Versus Noncavernous Sinus Dural Arteriovenous Fistulas: Outcomes and Outcome Predictors.

Background: Dural arteriovenous fistulas (DAVFs) can be categorized based on location.

Objective: To compare stereotactic radiosurgery (SRS) outcomes between cavernous sinus (CS) and non-CS DAVFs and to identify respective outcome predictors.

Methods: This is a retrospective study of DAVFs treated with SRS between 1988 and 2016 at 10 institutions.

Hemorrhage risk of cerebral dural arteriovenous fistulas following Gamma Knife radiosurgery in a multicenter international consortium.

Objective: The authors performed a study to evaluate the hemorrhagic rates of cerebral dural arteriovenous fistulas (dAVFs) and the risk factors of hemorrhage following Gamma Knife radiosurgery (GKRS).

Methods: Data from a cohort of patients undergoing GKRS for cerebral dAVFs were compiled from the International Radiosurgery Research Foundation. The annual posttreatment hemorrhage rate was calculated as the number of hemorrhages divided by the patient-years at risk.

A Propensity Score-Matched Cohort Analysis of Outcomes After Stereotactic Radiosurgery in Older versus Younger Patients with Dural Arteriovenous Fistula: An International Multicenter Study.

Objective: This study aims to evaluate the outcomes of Gamma Knife stereotactic radiosurgery (SRS) for dural arteriovenous fistulas (dAVFs) in older patients (≥65 years) compared with younger patients (age <65 years).

Methods: Two groups with a total of 96 patients were selected from a database of 133 patients with dAVF from 9 international medical centers with a minimum 6 months follow-up. A 1:2 propensity matching was performed by nearest-neighbor matching criteria based on sex, Borden grade, maximum radiation dose given, and location.

A history of the Jannetta procedure.

Peter Jannetta was a neurosurgery resident when he proposed the neurovascular compression theory. He built upon the astute observations of Dandy, Gardner, and others who, in the era before the operating microscope, had successfully ventured into the posterior fossa. In 1965, Jannetta performed cranial nerve microdissections for dental students and identified the trigeminal portio intermedia.

Geographic Disparities in the Surgical Management of Hemifacial Spasm in Canada.

Background: We aimed to interrogate the Canadian Institute for Health Information (CIHI) database in order to determine the geographic distribution and outcomes of microvascular decompression (MVD) for the treatment of hemifacial spasm (HFS).

Methods: The CIHI database was searched from 2004 to 2017 for relevant diagnostic and procedure codes. A new database was populated with the following categories: year, institution, province, number of interventions per year, and mean length of stay.

Evaluation of stereotactic radiosurgery for cerebral dural arteriovenous fistulas in a multicenter international consortium.

Objective: In this multicenter study, the authors reviewed the results obtained in patients who underwent Gamma Knife radiosurgery (GKRS) for dural arteriovenous fistulas (dAVFs) and determined predictors of outcome.

Methods: Data from a cohort of 114 patients who underwent GKRS for cerebral dAVFs were compiled from the International Gamma Knife Research Foundation. Favorable outcome was defined as dAVF obliteration and no posttreatment hemorrhage or permanent symptomatic radiation-induced complications.

Microsurgical rhizotomy for trigeminal neuralgia in MS patients: technique, patient satisfaction, and clinical outcomes.

Objective: Patients with multiple sclerosis (MS)-associated trigeminal neuralgia (TN) have higher recurrence and retreatment rates than non-MS patients. The optimal management strategy and role for microsurgical rhizotomy (MSR) for MS-TN remains to be determined. The aim of this study was to report time to treatment failure (TTF) and pain scores following MSR compared to percutaneous and Gamma Knife procedures.

Trigeminal Neuralgia due to Vertebrobasilar Artery Compression.

Objective: Classical trigeminal neuralgia (cTN) is rarely caused by ectatic vertebrobasilar artery compression of the trigeminal nerve. These patients present a surgical challenge and often are not considered for microvascular decompression (MVD) due to assumed risk.

Methods: A review of patients who were surgically treated by the senior author between 1997 and 2016 with an admitting diagnosis of cTN was performed.

Stereotactic Radiosurgery for Trigeminal Neuralgia in Patients With Multiple Sclerosis: A Multicenter Study.

Background: Facial pain response (PR) to various surgical interventions in patients with multiple sclerosis (MS)-related trigeminal neuralgia (TN) is much less optimal. No large patient series regarding stereotactic radiosurgery (SRS) has been published.

Objective: To evaluate the clinical outcomes of MS-related TN treated with SRS.

Stereotactic Radiosurgery for Intracranial Ependymomas: An International Multicenter Study.

Background: Stereotactic radiosurgery (SRS) is a potentially important option for intracranial ependymoma patients.

Objective: To analyze the outcomes of intracranial ependymoma patients who underwent SRS as a part of multimodality management.

Methods: Seven centers participating in the International Gamma Knife Research Foundation identified 89 intracranial ependymoma patients who underwent SRS (113 tumors).