Spontaneous cervical and cerebral arterial dissections: diagnosis and management.

Arterial dissections of head and neck arteries were first identified pathologically in the 1950s, but not until the 1970s and the 1980s did they begin to be widely recognized as a clinical entity. Carotid and vertebral artery dissections account for only 2% of all ischemic strokes, but they account for approximately 20% of thromboembolic strokes in patients younger than 45 years. The cause of supra-aortic dissections can be either spontaneous or traumatic.

Three-dimensional hemodynamics in intracranial aneurysms: influence of size and morphology.

Purpose: To use four-dimensional (4D)-flow MRI for the comprehensive in vivo analysis of hemodynamics and its relationship to size and morphology of different intracranial aneurysms (IA). We hypothesize that different IA groups, defined by size and morphology, exhibit different velocity fields, wall shear stress, and vorticity.

Materials And Methods: The 4D-flow MRI (spatial resolution = 0.

Intracranial aneurysms in previously irradiated fields: literature review and case report.

Objective: Radiotherapy is a common treatment for a variety of disease processes in the central nervous system; it has an ever-increasing number of indications and applications. With the life expectancy of cancer patients increasing, delayed complications of radiation have become more apparent. One such potential complication is the appearance of intracranial aneurysms in the irradiated field.

Experience with a simulator-based angiography course for neurosurgical residents: beyond a pilot program.

Background: Simulation is an increasingly useful means of teaching in the era of duty hour restrictions. Since the completion of our diagnostic cerebral angiography simulator curriculum pilot program, we have performed this resident course at 2 Congress of Neurological Surgeons (CNS) annual meetings with larger participant numbers.

Objective: To report the ongoing results of these courses.

Adenosine-induced flow arrest to facilitate intracranial aneurysm clip ligation does not worsen neurologic outcome.

Background: When temporary arterial occlusion of the parent artery is difficult for anatomical reasons, or when inadvertent aneurysmal rupture occurs during surgical dissection, adenosine administration can be used to produce flow arrest and brief, profound systemic hypotension that can facilitate intracranial aneurysm clip ligation. There is a concern, however, that the flow arrest and profound hypotension produced by adenosine, although brief, may cause cerebral ischemia and therefore worsen neurologic outcome compared with other techniques to facilitate aneurysm clip ligation. Therefore, we performed a retrospective, case-control study to determine whether adenosine-induced flow arrest had negative effects on the neurologic outcome of our patients.

Ultrasound-guided trigeminal nerve block via the pterygopalatine fossa: an effective treatment for trigeminal neuralgia and atypical facial pain.

Background: Patients presenting with facial pain often have ineffective pain relief with medical therapy. Cases refractory to medical management are frequently treated with surgical or minimally invasive procedures with variable success rates. We report on the use of ultrasound-guided trigeminal nerve block via the pterygopalatine fossa in patients following refractory medical and surgical treatment.

A didactic and hands-on module enhances resident microsurgical knowledge and technical skill.

Background: Simulation has been adopted as a powerful training tool in many areas of health care. However, it has not yet been systematically embraced in neurosurgery because of the absence of validated tools, assessment scales, and curricula.

Objective: To use our validated microanastomosis module and scale to evaluate the effects of an educational intervention on the performance of neurosurgery residents at the 2012 Congress of Neurological Surgeons Annual Meeting.

Developing a neurosurgical simulation-based educational curriculum: an overview.

Background: The science of medicine has undergone rapid advancement and expansion as a result of significant technological innovations, and this has affected the training of neurosurgical residents.

Objective: To develop a simulation-based neurosurgical educational curriculum to improve resident education.

Methods: The Congress of Neurological Surgeons established a Simulation Committee to explore the use of this technology in maximizing neurosurgical education.

Predictors of 30-day readmission after subarachnoid hemorrhage.

Background: Readmission within 30 days is increasingly evaluated as a measure of quality of care. There are few data on the rates of readmission after subarachnoid hemorrhage (SAH).

Objective: We sought to determine the predictors of 30-day readmission in patients with SAH.

Cerebral arteriovenous malformation: complex 3D hemodynamics and 3D blood flow alterations during staged embolization.

Complex hemodynamics in cerebral arteriovenous malformations (AVM) are thought to play a key role in their pathophysiology. We applied 4D flow magnetic resonance imaging (MRI) for the detailed evaluation of AVM function at baseline and to investigate the impact of staged embolization on AVM hemodynamics in a patient with a Spetzler-Martin grade III AVM. The patient underwent three embolization procedures resulting in >50% nidal casting and obliteration of several arteriovenous fistulae.

Reasons for readmission after carotid endarterectomy.

Objective: With increasing oversight of postoperative outcomes with the Patient Protection and Affordable Care Act, the reduction of readmissions is necessary to avoid financial penalties. This article provides a multi-institutional, multivariate analysis of the pre- and postoperative patient factors associated with readmission after carotid endarterectomy (CEA).

Methods: Using the National Surgical Quality Improvement Program from 2011, we considered 8456 patients.

New-generation oral anticoagulants for the prevention of stroke: implications for neurosurgery.

A new generation of oral anticoagulants, namely direct thrombin inhibitors and factor Xa inhibitors, have recently been approved for clinical use in patients with atrial fibrillation. These novel families of drugs have been shown to have favorable efficacy and safety profiles in multiple clinical settings, particularly in the prevention of atrial fibrillation-related stroke, and are likely to become part of everyday practice, making a crossover to neurosurgical patients inevitable. Concern has risen regarding the complexity of managing intracranial and intraspinal hemorrhages related to these drugs.

Surgical treatment of elevated intracranial pressure: decompressive craniectomy and intracranial pressure monitoring.

Surgical techniques that address elevated intracranial pressure include (1) intraventricular catheter insertion and cerebrospinal fluid drainage, (2) removal of an intracranial space-occupying lesion, and (3) decompressive craniectomy. This review discusses the role of surgery in the management of elevated intracranial pressure, with special focus on intraventricular catheter placement and decompressive craniectomy. The techniques and potential complications of each procedure are described, and the existing evidence regarding the impact of these procedures on patient outcome is reviewed.

Incorporation of extruded coils into the third nerve in association with third nerve palsy.

The extrusion of the coil complex outside of the aneurysmal dome is thought to be an important mechanism by which the aneurysm neck and fundus recanalize, but the migration of the coil loops and their incorporation inside vital nervous structures has not been clearly described. We reviewed the medical literature on coil extrusion and migration and report a rare case of third nerve palsy due to direct damage caused by coil loop migration that resolved after surgery. A 25-year-old woman presented with subarachnoid hemorrhage and painful left third nerve palsy.

Orbital metastasis of pituitary growth hormone secreting carcinoma causing lateral gaze palsy.

Background: Although pituitary adenoma is one of the most common intracranial tumors, it rarely progresses secondarily into a metastatic carcinoma. Commonalities in reported cases include subtotal resection at presentation, treatment with radiation therapy, and delayed metastatic progression. Pathologic descriptions of these lesions are varying and inconsistent.

Intracranial 4D flow MRI: toward individualized assessment of arteriovenous malformation hemodynamics and treatment-induced changes.

Background And Purpose: Arteriovenous malformations are an important etiology of hemorrhagic stroke. However, current imaging modalities and risk do not provide insights into individual AVM hemodynamics and its role in pathophysiology. The aims of this study are to determine whether intracranial 4D flow MR imaging can provide insights into arteriovenous malformation hemodynamics independent of the Spetzler-Martin grade and to report the changes in flow observed during staged embolization.