Use of intraoperative duplex ultrasonography for identification and patch repair of kinking stenosis after carotid endarterectomy: a single-surgeon retrospective experience.

Objective: To provide an incidence and descriptive evaluation of kinking of the internal carotid artery (ICA) after carotid endarterectomy (CEA) in a consecutive CEA series that included the use of intraoperative duplex ultrasonography (IDUS) monitoring and to determine the effect of kink patch repair on long-term postoperative ICA restenosis.

Methods: The electronic medical records and IDUS recordings of all CEA cases performed over a 10-year period (March 2000 to October 2010) by a single neurosurgeon were retrospectively reviewed to assess cases of kinking after CEA.

Results: IDUS assisted in the identification of 27 of 285 cases (9.

Myoepithelioma of the skull: a case report.

Background And Importance: Myoepithelioma of bone is a rare osseous tumor thought to be related to myoepithelial lesions found at other anatomic sites such as the salivary gland and skin. These tumors are composed of varying proportions of epithelial and myoepithelial cells and exhibit a spectrum of biologic behavior ranging from benign to malignant. We present the first reported case of myoepithelioma of the skull.

Carotid endarterectomy in nonagenarians.

Hypothesis: The North American Symptomatic Carotid Endarterectomy Trial and the European Carotid Surgery Trial demonstrated that a greater benefit from carotid endarterectomy (CEA) was seen in elderly compared with younger patients. However, no patients older than 89 years were included in either study. We hypothesized that CEA is safe and effective in patients 89 years and older.

Treatment of vertebral artery dissecting aneurysm by aneurysm trapping and posterior inferior cerebellar artery reimplantation. Case report.

The author presents the case of a patient with a ruptured vertebral artery dissecting aneurysm in which the posterior inferior cerebellar artery (PICA) arose from the wall of the aneurysm. The aneurysm was treated by trapping and the PICA was anastomosed to the vertebral artery proximal to the dissection. This technique allows intraoperative obliteration of the aneurysm while maintaining normal blood flow to the PICA.

Spinal cord tethering after traumatic paraplegia with late neurological deterioration.

The case of a 49-year-old man with traumatic complete T-5 paraplegia of 30 years' duration is presented. Over the last 10 years, he developed cervical myelopathy suggestive of syringomyelia. Work-up, including metrizamide myelography and delayed computerized tomography scanning, revealed an atrophic cord without a syrinx, and a complete block to contrast material at T-5.

Cerebral and cardiovascular responses to changes in head elevation in patients with intracranial hypertension.

To establish if an optimum level of head elevation exists in patients with intracranial hypertension, the authors examined changes in intracranial pressure (ICP), systemic and pulmonary pressures, systemic flows, and intrapulmonary shunt fraction with the patient lying flat, and then with the head elevated at 15 degrees, 30 degrees, and 60 degrees. Cerebral perfusion pressure (CPP) was calculated. The lowest mean ICP was found with elevation of the head to 15 degrees (a fall of -4.

The influence of systemic arterial pressure and intracranial pressure on the development of cerebral vasogenic edema.

The influence of intracranial pressure (ICP), systemic arterial pressure (SAP), and cerebral perfusion pressure (CPP) upon the development of vasogenic cerebral edema is largely unknown. To study their relationship, the authors have produced an osmotic disruption of the blood-brain barrier unilaterally in rabbits by injecting 1 cc/kg of 2M NaCl into the left internal carotid artery. The amount of vasogenic edema produced was assessed by quantitation of the extravasation of Evans blue dye into the area of maximum blood-brain barrier breakdown by means of optical densitometry following formamide extraction.

Treatment of ischemic deficits from vasospasm with intravascular volume expansion and induced arterial hypertension.

In 58 patients with progressive neurological deterioration from angiographically confirmed cerebral vasospasm after spontaneous subarachnoid hemorrhage, arterial hypertension was induced in an attempt to improve their deficits. The most effective regimen consisted of intravascular volume expansion, blockade of the vagal depressor response, and the administration of antidiuretics and vasopressor agents. With this protocol, arterial blood pressure could be sustained at high levels for prolonged periods.

The natural history of asymptomatic carotid bifurcation plaques.

Seventy-three patients with an angiographically identified asymptomatic stenosis (greater than 50%) and/or ulceration of the common carotid bifurcation have been followed from 6 months to 10 years (average 4 years). All patients had previously undergone contralateral carotid endarterectomy for a transient ischemic attack (TIA) or minor stroke in that carotid territory. During follow-up, 22 patients (30%) developed new symptoms of cerebral ischemia.

Selective spinal cordectomy: clinicopathological correlation.

The operation of selective spinal cordectomy is rarely performed. The cases of 10 paraplegic patients who underwent this procedure are presented. Their clinical indications were varied, including posttraumatic syringomyelia, uncontrollable leg spasticity, posttraumatic spontaneous neurogenic leg pain, and repair of a myelomeningocele gibbus.

Thoracic myelopathy secondary to ossified ligamentum flavum.

The authors report a case of ossification of the ligamentum flavum at T-10 and T-11 associated with compressive myelopathy. Metrizamide myelography with computerized tomography allowed precise preoperative diagnosis and anatomic localization of the lesion. The patient had satisfactory and prompt improvement after surgical intervention.

Presentation and management of mesencephalic hematoma. Report of two cases.

Two patients presenting with a mesencephalic hematoma are reported. Clinical features, particularly paralysis of all vertical eye movements and a marked tendency to fall backwards when standing, allowed accurate localization of these lesions. In one case, the etiology was a proven arteriovenous malformation, and the other was suspected to be due to hypertensive arteriolar rupture.

Management of fractures of the thoracolumbar and lumbar spite.

Eleven cases of fracture or fracture/dislocation of the thoracolumbar or lumbar spine were studied to determine the effectiveness of three methods of management of the injuries. Ten of the patients had a neurological deficit as well as a spinal injury. All cases were studied by computed tomographic (CT) scanning of the injury site before and after treatment.

Extradural masses at the foramen magnum in children.

This report describes the clinical features, treatment, and sequelae in 3 children with extradural masses in the region of the foramen magnum. Such lesions are rare, their nature diverse, and their treatment hazardous. The common presenting feature was neck stiffness.

Intramural hematoma of the gastric cardia.

A case of intramural hematoma of the gastric cardia occurring in a young woman with S.L.E.