Publications by authors named "Charles Prestigiacomo"

Background: Glomus tumors around the jugular foramen and inner ear can have variable presentations, including lower cranial nerve palsies, tinnitus, hearing loss, or palpable neck mass. In general, these tumors are benign paragangliomas with the definitive treatment consisting of radiosurgery or surgery. Endovascular embolization can be added as a critical adjunctive therapy to reduce the tumor vascularity before surgical resection.

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Article Synopsis
  • The study explores the infratentorial presigmoid retrolabyrinthine suprameatal approach (PRSA) for surgically treating aneurysms in the proximal third of the anterior inferior cerebellar artery (AICA), which traditionally requires complex techniques.
  • Researchers conducted dissections and analyzed morphometric parameters in cadaveric heads to assess the approach's feasibility and anatomical variations.
  • Findings suggest that the PRSA corridor allows for effective access to AICA aneurysms without risking hearing or balance, emphasizing the importance of individualized preoperative assessments to identify suitable patients.
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Interest in the relational anatomy of the anterior neck among spine surgeons increased after the popularization of anterior cervical discectomy and fusion in the 1950s. Five surface landmarks and their relationship to specific spinal levels have been routinely described, comprising the angle of the mandible for the C2-C3 interspace, the hyoid bone for the C3 body, the thyroid cartilage for the C4-C5 disc, and the cricoid cartilage and carotid tubercle for the C6 body. We aimed to investigate the origins of these anatomic relationships and their application in modern practice.

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  • The study focuses on the supratentorial extension of the presigmoid retrolabyrinthine suprameatal approach (PRSA) for improved surgical access to brain structures.
  • Research involved performing the procedure on five human cadaver heads to quantitatively measure surgical accessibility and qualitatively assess the visibility of critical brain areas.
  • Results showed a 102.65% increase in surgical accessibility, revealing more of the brainstem and cranial nerves, which helps in planning complex surgeries for central skull base lesions.
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  • - Transcortical surgical approaches are utilized to treat various brain conditions like tumors, vascular issues, infections, and more, yet there's a lack of systematic research on common access points and complications associated with these surgeries.
  • - A scoping review was conducted involving 50 studies and over 2,600 patients, revealing that brain tumors, especially gliomas, are the most common issue treated, with the transcortical-transtemporal approach being the most used.
  • - The findings suggest that choosing the right cortical incision based on the type and location of the lesion leads to generally acceptable postoperative outcomes, with good outcomes reported in over half of the cases.
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  • * After receiving treatment, the removed clot was found to resemble malignancy, leading to further imaging that revealed cancerous masses in multiple areas of the body.
  • * The report emphasizes the importance of pathological evaluations in identifying atypical blood clots and raises awareness about tumor embolic strokes, which are often overlooked in cancer patients.
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Ischemic stroke, which accounts for 87% of cerebrovascular accidents, is responsible for massive global burden both in terms of economic cost and personal hardship. Many stroke survivors face long-term disability-a phenotype associated with an increasing number of genetic variants. While clinical variables such as stroke severity greatly impact recovery, genetic polymorphisms linked to functional outcome may offer physicians a unique opportunity to deliver personalized care based on their patient's genetic makeup, leading to improved outcomes.

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Background And Importance: Neurointervention is a very competitive specialty in the United States due to the limited number of training spots and the larger pool of applicants. The training standards are continuously updated to ensure solid training experiences. Factors affecting candidate(s) selection have not been fully established yet.

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Article Synopsis
  • This study reviews how advanced imaging techniques improved our ability to analyze the shape of cerebral aneurysms in 3D and how these shapes relate to whether they have ruptured.
  • The researchers found 39 studies suitable for their meta-analysis, identifying 17 specific 3D shape measures, of which 11 showed significant links to rupture risk.
  • Key findings indicated that the nonsphericity index, undulation index, elongation, flatness, and sphericity were particularly strong indicators of aneurysm rupture risk based on their analysis.
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Objective: Patients with dural venous sinus thrombosis (DVST) in select populations following traumatic brain injury (TBI), including those with blunt mechanism or depressed skull fractures, have been shown to have an increased risk of mortality. The purpose of this study was to assess these findings in a mixed population of head trauma patients.

Methods: The authors performed a case-control study using propensity score matching by reviewing 17 years (2004-2021) of data from their institutional trauma registry.

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Objectives: Thrombectomy improves outcomes in patients with basilar artery (BA) occlusion. We hypothesized that the anatomic configuration of the BA bifurcation, classified as T- or Y-shaped, may impact the outcome as a T-shaped BA would involve more deep penetrating arteries of the midbrain and thalamus.

Materials And Methods: In this 2-center retrospective cohort study, we included patients with stroke due to distal BA occlusion and performed blinded classification of their BA distal bifurcation as either T- or Y-shaped.

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Pseudoaneurysms of the middle meningeal artery are rare events following head trauma. Given the potential for significant morbidity and mortality associated with pseudoaneurysm rupture, it is recommended that they be treated early. Endovascular embolization is a viable alternative to open surgical intervention.

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Importance: The effects of moderate systolic blood pressure (SBP) lowering after successful recanalization with endovascular therapy for acute ischemic stroke are uncertain.

Objective: To determine the futility of lower SBP targets after endovascular therapy (<140 mm Hg or 160 mm Hg) compared with a higher target (≤180 mm Hg).

Design, Setting, And Participants: Randomized, open-label, blinded end point, phase 2, futility clinical trial that enrolled 120 patients with acute ischemic stroke who had undergone successful endovascular therapy at 3 US comprehensive stroke centers from January 2020 to March 2022 (final follow-up, June 2022).

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Article Synopsis
  • - The study explores a new surgical technique called the infratentorial presigmoid retrolabyrinthine approach to safely access anterolateral pontine lesions, avoiding common issues linked to traditional methods.
  • - Researchers conducted dissections on cadaveric specimens, finding that this new approach provided good visibility and access to the pontine area, with metrics indicating promising surgical accessibility.
  • - The findings suggest this minimally invasive technique could improve treatment options for challenging pontine lesions, but further clinical studies are needed to assess its effectiveness in live patients.
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The authors present a case of a patient with a hypoplastic right vertebral artery (VA) ending in the posterior inferior cerebellar artery who sustained an acute onset basilar artery occlusion. A balloon-guided catheter was used to proximally occlude the dominant left VA, and aspiration was applied until reversal of flow was achieved in the basilar artery. Thus, basilar artery reperfusion was achieved without the need for stent-retrieval thrombectomy.

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Preincisional localization has become ubiquitous within spinal neurosurgery and has served as the foundation for modern minimally invasive surgery techniques. Dr. Ralph Bingham Cloward, renowned for his contributions to the field of spinal fusion, was a strong advocate and early adopter of diskography.

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Background: Delayed cerebral ischemia (DCI) may significantly worsen the functional status of patients with aneurysmal subarachnoid hemorrhage (aSAH). Several authors have designed predictive models for early identification of patients at risk of post-aSAH DCI. In this study, we externally validate an extreme gradient boosting (EGB) forecasting model for post-aSAH DCI prediction.

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Background: Aneurysm morphology has been correlated with rupture. Previous reports identified several morphologic indices that predict rupture status, but they measure only specific qualities of the morphology of an aneurysm in a semiquantitative fashion. Fractal analysis is a geometric technique whereby the overall complexity of a shape is quantified through the calculation of a fractal dimension (FD).

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Objective: The "presigmoid corridor" covers a spectrum of approaches using the petrous temporal bone either as a target in treating intracanalicular lesions or as a route to access the internal auditory canal (IAC), jugular foramen, or brainstem. Complex presigmoid approaches have been continuously developed and refined over the years, leading to great heterogeneity in their definitions and descriptions. Owing to the common use of the presigmoid corridor in lateral skull base surgery, a simple anatomy-based and self-explanatory classification is needed to delineate the operative perspective of the different variants of the presigmoid route.

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Article Synopsis
  • The article discusses a medical procedure called PTAS used to treat a narrowing of the basilar artery (BAS), which can be very dangerous.
  • Researchers looked at different studies involving 1,016 patients to see how well PTAS worked and what problems might occur.
  • They found that PTAS is usually safe and effective for patients whose BAS symptoms don't get better with medication, but more research is needed for even better results.
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Purpose: Odontoidectomy for ventral compressive pathology may result in O-C1 and/or C1-2 instability. Same-stage endonasal C1-2 spinal fusion has been advocated to eliminate risks associated with separate-stage posterior approaches. While endonasal methods for C1 instrumentation and C1-2 trans-articular stabilization exist, no hypothetical construct for endonasal occipital instrumentation has been validated.

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Background: Color-labeling injections of cadaveric heads have revolutionized education and teaching of neurovascular anatomy. Silicone-based and latex-based coloring techniques are currently used, but limitations exist because of the viscosity of solutions used.

Objective: To describe a novel "triple-injection method" for cadaveric cranial vasculature and perform qualitative and semiquantitative evaluations of colored solution penetration into the vasculature.

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