Prediction of Outcomes for Ruptured Aneurysm Surgery.

Background and Purpose- Predicting long-term functional outcomes after intracranial aneurysmal rupture can be challenging. We developed and validated a scoring system-the Southwestern Aneurysm Severity Index-that would predict functional outcomes at 1 year after clipping of ruptured aneurysms. Methods- Ruptured aneurysms treated microsurgically between 2000 and 2014 were included.

Microsurgical Treatment of Previously Coiled Intracranial Aneurysms: Systematic Review of the Literature.

Objective: To assess indications, complications, clinical outcomes, and technical nuances of microsurgical treatment of previously coiled intracranial aneurysms.

Methods: A systematic review of the literature was performed using PubMed/MEDLINE and EMBASE databases from January 1990 to December 2013. English-language articles reporting on microsurgical treatment of previously coiled intracranial aneurysms were included.

The A1-A2 diameter ratio may influence formation and rupture potential of anterior communicating artery aneurysms.

Background: Specific morphological factors contribute to the hemodynamics of the anterior communicating artery (AComA). No study has examined the role of the A2 segment on AComA aneurysm presence and rupture.

Objective: To examine the possibility that the ratio between A1 and A2 segments (A1-2 ratio) represents an independent risk factor for presence and rupture of AComA aneurysms (AComAAs).

Magnetization spoiling in radial FLASH contrast-enhanced MR digital subtraction angiography.

Purpose: To increase the in-plane spatial resolution and image update rates of 2D magnetic resonance (MR) digital subtraction angiography (DSA) pulse sequences to 0.57 × 0.57 mm and 6 frames/sec, respectively, for intracranial vascular disease applications by developing a radial FLASH protocol and to characterize a new artifact, not previously described in the literature, which arises in the presence of such pulse sequences.

Endovascular coils: properties, technical complications and salvage techniques.

Endovascular coil embolization has become an accepted and often first-line treatment for ruptured and unruptured intracranial aneurysms. While the complications of endovascular therapy of intracranial aneurysms have been well vetted in the literature, there are few reports solely concerning the complications and salvage techniques related to either the technical aspects of coil deployment or to the devices themselves. In this review the structural details of commonly used endovascular coils, technical complications related to coiling and salvage techniques used when these complications occur are discussed.

Bending the curve: preoperative determination of bypass graft length and trajectory with curved planar reformatted computed tomography angiography: technical note.

Background And Importance: Cerebral revascularization continues to be an important technique for the treatment of cerebrovascular and vaso-occlusive diseases, and determination of appropriate graft sources and recipients is paramount to the success of the procedure. A tension-free anastomosis requires that harvested grafts be of an appropriate length to avoid complications. Volume-rendered contrast-enhanced computed tomography data sets may be useful in determining the desired length and path of the bypass graft and in the evaluation of appropriate recipient vessels.

Idiopathic pontine Streptococcus salivarius abscess in an immunocompetent patient: management lessons through case illustration and literature review.

A 55-y-old woman with no previous medical history presented with a 3-day history of progressive headache, nausea, emesis, right-sided facial numbness, and right-sided extremity weakness. Serial magnetic resonance imaging demonstrated rapid enlargement of a left-sided ring-enhancing dorsal pontine lesion with an exophytic portion, raising concern for an abscess. A stereotactically guided left-sided retrosigmoid craniotomy for abscess incision and decompression was performed given the rapid progression of her neurological deficits.

Adenosine for temporary flow arrest during intracranial aneurysm surgery: a single-center retrospective review.

Background: Clip application for temporary occlusion is not always practical or feasible. Adenosine is an alternative that provides brief periods of flow arrest that can be used to advantage in aneurysm surgery, but little has been published on its utility for this indication.

Objective: To report our 2-year consecutive experience with 40 aneurysms in 40 patients for whom we used adenosine to achieve temporary arterial occlusion during aneurysm surgery.

Adult presentation of a familial-associated vein of galen aneurysmal malformation: case report.

Background And Importance: Vein of Galen aneurysmal malformations (VGAMs) arise from persistent arteriovenous shunting from primitive choroidal vessels into the median prosencephalic vein of Markowski, the embryonic precursor of the vein of Galen. VGAMs rarely present past infancy, and their natural history in adults is unknown. We report the first case of a familial-associated VGAM in an asymptomatic adult female patient.

Rupture of cerebral myxomatous aneurysm months after resection of the primary cardiac tumor.

Background: The natural history of cerebral aneurysms derived from metastatic spread of cardiac myxomas is not well known, and their management presents many dilemmas.

Methods: Case report and literature review.

Results: An 18-year-old man presented with an intraparenchymal hemorrhage several months after resection of an atrial myxoma.

Accelerating time-resolved MRA with multiecho acquisition.

A new four-dimensional magnetic resonance angiography (MRA) technique called contrast-enhanced angiography with multiecho and radial k-space is introduced, which accelerates the acquisition using multiecho while maintaining a high spatial resolution and increasing the signal-to-noise ratio (SNR). An acceleration factor of approximately 2 is achieved without parallel imaging or undersampling by multiecho (i.e.

4D radial acquisition contrast-enhanced MR angiography and intracranial arteriovenous malformations: quickly approaching digital subtraction angiography.

Background And Purpose: The current gold standard for imaging intracranial AVMs involves catheter-based techniques, namely cerebral digital subtraction angiography (DSA). However, DSA presents some procedural risks to the patient. Unfortunately, AVM patients usually undergo multiple DSA exams throughout their diagnostic and therapeutic course, significantly increasing their procedural risk exposure.

Cavernous carotid aneurysms: to treat or not to treat?

Most cavernous carotid aneurysms (CCAs) are considered benign lesions, most often asymptomatic, and to have a natural history with a low risk of life-threatening complications. However, several conditions may exist in which treatment of these aneurysms should be considered. Several options are currently available regarding the management of CCAs with resultant good outcomes, namely expectant management, luminal preservation strategies with or without addressing the aneurysm directly, and Hunterian strategies with or without revascularization procedures.

Unruptured intracranial aneurysms and the assessment of rupture risk based on anatomical and morphological factors: sifting through the sands of data.

Aneurysmal subarachnoid hemorrhage continues to have high rates of morbidity and mortality for patients despite optimal medical and surgical management. Due to the fact that aneurysmal rupture can be such a catastrophic event, preventive treatment is desirable for high-risk lesions. Given the variability of the literature evaluating unruptured aneurysms regarding basic patient population, clinical practice, and aneurysm characteristics studied, such as size, location, aspect ratio, relationship to the surrounding vasculature, and the aneurysm hemodynamics, a meta-analysis is nearly impossible to perform.

Posterior fossa arteriovenous malformations.

Arteriovenous malformations (AVMs) of the posterior fossa are complex neurovascular lesions that are less common than their supratentorial counterparts, accounting for < 15% of all AVMs. The majority of patients with these lesions present with intracranial hemorrhage, a factor that has been consistently shown to increase one's risk for subsequent bleeding. Studies have additionally shown a posterior fossa or deep AVM location to portend a more aggressive natural history.

Endovascular options in the treatment of delayed ischemic neurological deficits due to cerebral vasospasm.

The second leading cause of death and disability in patients with aneurysmal subarachnoid hemorrhage (SAH) is delayed cerebral ischemia due to vasospasm. Although up to 70% of patients have been shown to have angiographic evidence of vasospasm, only 20-30% will present with clinical changes, including mental status changes and neurological deficits that necessitate acute management. Endovascular capabilities have progressed to become viable options in the treatment of cerebral vasospasm.

Radial sliding-window magnetic resonance angiography (MRA) with highly-constrained projection reconstruction (HYPR).

Sufficient temporal resolution is required to image the dynamics of blood flow, which may be critical for accurate diagnosis and treatment of various intracranial vascular diseases, such as arteriovenous malformations (AVMs) and aneurysms. Highly-constrained projection reconstruction (HYPR) has recently become a technique of interest for high-speed contrast-enhanced magnetic resonance angiography (CE-MRA). HYPR provides high frame rates by preferential weighting of radial projections while maintaining signal-to-noise ratio (SNR) by using a high SNR composite.

Endovascular embolization of a recurrent cervical giant cell neoplasm using N-butyl 2-cyanoacrylate.

Pre-operative endovascular embolization of spinal giant cell tumors (GCTs) has been an effective strategy to reduce blood loss during surgical resection. Traditionally, spinal GCTs have been embolized with polyvinyl acetate (PVA) particles. We present the pre-operative embolization of a recurrent cervical GCT with N-butyl 2-cyanoacrylate (NBCA) rather than PVA.

Advanced noninvasive imaging of spinal vascular malformations.

Spinal vascular malformations (SVMs) are an uncommon, heterogeneous group of vascular anomalies that can render devastating neurological consequences if they are not diagnosed and treated in a timely fashion. Imaging SVMs has always presented a formidable challenge because their clinical and imaging presentations resemble those of neoplasms, demyelination diseases, and infection. Advancements in noninvasive imaging modalities (MR and CT angiography) have increased during the last decade and have improved the ability to accurately diagnose spinal vascular anomalies.

Revascularization for complex intracranial aneurysms.

The modern management of intracranial aneurysms includes both constructive and deconstructive strategies to eliminate the aneurysm from the circulation. Both microsurgical and endovascular techniques are used to achieve this goal. Although most aneurysms can be eliminated from the circulation with simple clip reconstruction and/or coil insertion, some require revascularization techniques to enhance tolerance of temporary arterial occlusion during clipping of the aneurysm neck or to enable proximal occlusion or trapping.

Giant intracranial aneurysms: endovascular challenges.

The treatment of giant aneurysms remains a formidable challenge for endovascular and surgical strategies. The use of endovascular techniques in a deconstructive (e.g.

Infectious intracranial aneurysms in the pediatric population: endovascular treatment with Onyx.

Objects: Infectious intracranial aneurysms present a treatment challenge in the pediatric population. Current endovascular strategies and tools have been developed, which make treatment of infectious intracranial aneurysms with liquid embolics safe and effective. This study reviews the use of the liquid embolic Onyx in the treatment of infectious intracranial aneurysms in the pediatric population.