Decompressive hemicraniectomy, strokectomy, or both in the treatment of malignant middle cerebral artery syndrome.

Objective: We sought to evaluate the impact of a craniotomy for strokectomy (CS) with bone replacement, decompressive hemicraniectomy (DHC), or DHC with a strokectomy (DHC+S) on outcome after malignant supratentorial infarction.

Methods: We conducted a retrospective cohort study of cases of malignant supratentorial infarction treated by CS (n = 18), DHC (n = 17), or DHC+S (n = 33) at our institution from 2002 to 2008. End points included functional outcome measured by the modified Rankin Scale and incidence of mortality at 1 year.

Repair of intracranial vessel perforation with Onyx-18 using an exovascular retreating catheter technique.

Numerous techniques have been described to treat intracranial vessel perforation during endovascular interventions. We describe a novel application of Onyx-18 for the treatment of intracranial catheter perforations by sealing the vessel from the outside while retracting the catheter into the arterial lumen.

Benign perimesencephalic hemorrhage occurring after previous aneurysmal subarachnoid hemorrhage: a case report.

Introduction: Both aneurysmal subarachnoid hemorrhage and benign perimesencephalic hemorrhage are well-described causes of spontaneous subarachnoid hemorrhage that arise as a result of different pathologic processes. To the best of the authors' knowledge, there have been no reports of both vascular pathologies occurring in the same individual.

Case Presentation: A 51-year-old Caucasian woman with a history of aneurysmal subarachnoid hemorrhage presented five years after her initial treatment with ictal headache, meningismus, nausea and emesis similar to her previous bleeding event.

Endovascular revascularization of chronic symptomatic vertebrobasilar occlusion.

Background And Purpose: Acute basilar artery occlusion is associated with a high risk of stroke, mortality, and poor outcome in survivors. Timely vessel revascularization is critical to improve the clinical outcome in this condition. A subset of patients survives acute occlusion with mild or no disability and some of these individuals develop recurrent ischemic events despite optimal medical therapy.

In-stent thrombosis and stenosis after neck-remodeling device-assisted coil embolization of intracranial aneurysms.

Background: Intrinsic thrombosis and stenosis are complications associated with the use of neck-remodeling devices in the treatment of intracranial aneurysms.

Objective: To examine the technical and anatomic factors that predict short- and long-term stent patency.

Methods: We undertook a retrospective review of 161 patients who underwent coil embolization of 168 ruptured and unruptured aneurysms assisted by the use of a neck-remodeling device.

Endovascular treatment of basilar artery occlusion by manual aspiration thrombectomy.

Background And Purpose: Basilar artery occlusion remains one of the most devastating subtypes of stroke. Intravenous and intra-arterial therapy have altered the natural history of this disease; however, clinical results remain poor. Therefore, exploring more aggressive and innovative management is warranted.

Lower extremity monoparesis after aneurysmal subarachnoid hemorrhage.

Two patients presented with acute subarachnoid hemorrhage from a ruptured intracranial aneurysm. Both patients were treated via endovascular coil embolization, and both developed delayed lower extremity monoparesis without associated symptoms that resolved over the ensuing months. An extensive work-up lead us to propose the following hypothesis: the painless peripheral neuropathy likely resulted from nerve root irritation from abundant subarachnoid blood in the lumbar cistern.

Intraoperative computed tomography image-guided navigation for posterior thoracolumbar spinal instrumentation in spinal deformity surgery.

Object: Placement of thoracolumbar pedicle screws in spinal deformity surgery has a reported inaccuracy rate as high as 30%. At present, image-guided navigation systems designed to improve instrumentation accuracy typically use intraoperative fluoroscopy or preoperative CT scans. The authors report the prospective evaluation of the accuracy of posterior thoracolumbar spinal instrumentation using a new intraoperative CT operative suite with an integrated image guidance system.

Cavernous malformation tumors: a case study and review of the literature.

Objective: To summarize the current literature on the surgical management of cavernous malformations of the cerebellopontine angle in accordance with the experience at our institution.

Methods: A systematic literature review on cavernous malformations of the cerebellopontine angle yielded 14 case reports relevant to the disease. In addition, the authors include their own report of a 16-year-old girl with such a lesion cured by surgical resection.

Endovascular treatment of atypical posterior circulation aneurysms: technical results and review of the literature.

Background: we report our technical success and complication rates in treating posterior circulation aneurysms at sites other than the basilar apex, superior cerebellar artery origin, or the posterior inferior cerebellar artery origin via endovascular embolization or sacrifice.

Materials And Methods: we retrospectively reviewed case records for patients undergoing coil embolization of atypical posterior circulation aneurysms from January 2003 to December 2007.

Results: thirty-two aneurysms in 32 patients were treated.

A new live animal training model for off-pump coronary bypass surgery.

Training models are needed to perform accurate off-pump coronary artery bypass (OPCAB) surgery and to test evolving new technologies like minimally invasive devices and robotics. We describe a simple, effective and reproducible live animal training model to perform multiple arterial anastomoses on the beating heart that would maximize the use of available resources for training purposes.