Gamma knife radiosurgery for benign tumors with symptoms from brainstem compression.

Purpose: This study evaluated the role of radiosurgery in the management of symptomatic patients with brainstem compression from benign basal tumors.

Methods And Materials: Over a 17-year, period 246 patients (202 vestibular schwannomas and 44 meningiomas) with brainstem compression from benign skull-base tumors were managed with Gamma Knife radiosurgery. Median tumor volumes were 3.

Low incidence of symptomatic strokes after carotid stenting without embolization protection devices for extracranial carotid stenosis: a single-institution retrospective review.

Objective: Carotid angioplasty and stenting (CAS) remains the primary modality of treating individuals with carotid stenosis and significant comorbidities or anatomically difficult lesions. The use of embolization protection devices (EPD) has been mandated by the cerebrovascular community even though the ability of these devices to prevent symptomatic strokes is not supported by the current literature. Our goal was to assess the clinical and radiological outcomes of patients who underwent CAS without EPDs at our hospital from 1996 to 2006.

Initial experience with bioactive cerecyte detachable coils: impact on reducing recurrence rates.

Objective: Despite proven safety of endovascular coil embolization of intracranial aneurysms, the potential need for retreatment remains criticized. The goal of this prospective study was to assess the safety, durability, and effect on recanalization rates of the Cerecyte (Micrus Corp., Sunnyvale, CA) bioactive coil.

Endovascular coil embolization of ruptured and unruptured posterior circulation aneurysms: review of a 10-year experience.

Objective: Treatment of posterior circulation aneurysms poses a great technical challenge for the practicing neurosurgeon. The advent of endovascular techniques has made such treatment more feasible. We report our experience with the endovascular management of ruptured and unruptured posterior circulation aneurysms during the past 10 years.

Endovascular management of intracranial aneurysms: current experience and future advances.

Objective: The past 15 years have seen a revolution in the treatment of intracranial aneurysms. Endovascular technology has evolved rapidly since the Food and Drug Administration approval of Guglielmi detachable coils in 1995, which now allows successful treatment of most aneurysms. The authors provide a review of their 11-year experience at Jefferson Hospital for Neuroscience with endovascular embolization of intracranial aneurysms and discuss clinical trial outcomes and future directions of this treatment method.

Radiosurgery for dural arteriovenous fistulas.

Objective: Dural arteriovenous fistulas (DAVFs) comprise 10% to 15% of all arteriovenous malformations. Recent studies have demonstrated promising results when radiosurgery is used for DAVFs. We retrospectively analyzed our patients with DAVFs who received stereotactic radiosurgery with or without embolization.

The role of carotid angioplasty and stenting in carotid revascularization.

Objectives: The gold standard procedure for carotid revascularization has been carotid endarterectomy. Several randomized trials demonstrate that it is more efficacious than medical management in stroke prevention for both symptomatic and asymptomatic patients when performed with low surgical morbidity. However, many high-risk patients not included in these trials are now being referred for carotid revascularization.

Lumbar microdiscectomy: a historical perspective and current technical considerations.

A historical review is presented of the original descriptions of lumbar discectomy, focusing on the evolution toward a less invasive surgical approach following the introduction of the operating microscope. From the initial work in Europe by Yasargil and Caspar to the popularization of microdiscectomy by Williams and Wilson in the United States, this procedure has successfully reduced operative time, surgical morbidity, and incision size while allowing patients to return to work faster. Emphasis is placed on the importance of a careful preoperative clinical and radiographic evaluation by identifying factors that may help in the prediction of a successful surgical outcome.

Periprocedural morbidity and mortality associated with endovascular treatment of intracranial aneurysms.

Background And Purpose: Despite experience and technological improvements, endovascular treatment of intracranial aneurysms still has inherent risks. We evaluated cerebral complications associated with this treatment.

Methods: From October 1998 to October 2002, 180 consecutive patients underwent 131 procedures for 118 ruptured aneurysms and 79 procedures for 72 unruptured aneurysms.

Carotid artery angioplasty and stent placement for recurrent stenosis.

Object: The use of endovascular management for recurrent carotid artery (CA) stenosis is rapidly expanding due to the increased surgical risk associated with repeated carotid endarterectomy (CEA). Carotid artery angioplasty and stent placement for recurrent CA stenosis offers a less invasive strategy with fewer procedural complications and may provide a more durable treatment. The authors report on their experience with this procedure in the management of recurrent CA stenosis.

Frequency and management of recurrent stenosis after carotid artery stent implantation.

Object: To determine the rate of hemodynamically significant recurrent carotid artery (CA) stenosis after stent-assisted angioplasty for CA occlusive disease, the authors analyzed Doppler ultrasonography data that had been prospectively collected between October 1998 and September 2002 for CA stent trials.

Methods: Patients included in the study participated in at least 6 months of follow-up review with serial Doppler studies or were found to have elevated in-stent velocities (> 300 cm/second) on postprocedure Doppler ultrasonograms. Hemodynamically significant (> or = 80%) recurrent stenosis was identified using the following Doppler criteria: peak in-stent systolic velocity at least 330 cm/second, peak in-stent diastolic velocity at least 130 cm/second, and peak internal carotid artery/common carotid artery velocity ratio at least 3.

Stent-assisted coil placement for unruptured cerebral aneurysms.

Object: The treatment of wide-necked cerebral aneurysms represents a challenging problem for neurosurgeons. The recent development of stents has provided clinicians with the ability to treat these aneurysms while keeping the parent vessel patent. The long-term occlusion rate of aneurysms treated with stent-assisted coil placement has yet to be investigated.

Gamma knife radiosurgery for trigeminal schwannomas.

Background: Trigeminal schwannomas are uncommon tumors that may be microsurgically removed in selected cases, albeit with significant risk for new neurological morbidity. We evaluated the role of stereotactic radiosurgery as an alternative for patients with newly diagnosed or residual trigeminal schwannomas.

Methods: The records of 23 patients who underwent radiosurgery for trigeminal schwannoma were reviewed.

A rare case of a ruptured middle meningeal aneurysm causing intracerebral hematoma in a patient with moyamoya disease.

Moyamoya disease is infrequently associated with intracranial aneurysms arising from the circle of Willis vessels or from "peripheral" branches of choroidal and meningeal vessels. We present a rare case of a moyamoya-related aneurysm arising along the dural junction of multiple meningeal branches from the external carotid artery causing intracerebral hemorrhage. Endovascular coil embolization of the middle meningeal artery (MMA) and occipital artery (OA) led to delayed aneurysm obliteration without rehemorrhage.

Alcohol embolization of carotid-cavernous indirect fistulae.

Objective: Carotid-cavernous fistulae (CCFs) are abnormal communications between the carotid artery and cavernous sinus that may present with rapid visual deterioration and extraocular paresis as a result of increasing intraocular pressure requiring emergent treatment to preserve vision. We present a technique of balloon-assisted ethanol embolization of the cavernous carotid artery supply to indirect CCFs providing immediate reduction in intraocular pressure with symptomatic improvement.

Methods: We reviewed clinical and angiographic data and present a retrospective case series illustrating six patients who underwent endovascular embolization because of worsening visual acuity and extraocular motility disorder caused by CCFs.

Target-specific multimodality endovascular management of carotid artery blow-out syndrome.

We describe a novel multimodality endovascular approach to safely control hemorrhage from a carotid artery pseudoaneurysm and tumor vasculature associated with a squamous cell carcinoma. This approach was used in the case of a 68-year-old man who had previously undergone a laryngectomy, chemotherapy, and brachytherapy and who subsequently experienced acute oropharyngeal bleeding. Angiography detected a carotid artery pseudoaneurysm and significant tumor vascularity.