Anticoagulation for Hypercoagulable Patients Associated with Complications after Large Cranioplasty Reconstruction.

Background: Despite advancements in materials and techniques used for cranial reconstruction, complication rates following reconstructive cranioplasty remain significant.

Methods: In this study, the authors assessed the association of perioperative anticoagulation use and/or a hypercoagulable state with minor (i.e.

Restenosis After Carotid Endarterectomy: Insight Into Risk Factors and Modification of Postoperative Management.

Background: Restenosis after carotid endarterectomy (CEA) is a potential complication after surgery for carotid stenosis. Stroke after CEA is a debilitating complication secondary to restenosis, and modification of postoperative care may be necessary to decrease the incidence of postoperative stroke after CEA. We sought to identify the clinical and patient factors that are associated with this complication.

Risk Factors Associated with Ipsilateral Ischemic Events Following Carotid Endarterectomy for Carotid Artery Stenosis.

Objective: Patients undergoing carotid endarterectomy (CEA) are at risk of developing ipsilateral stroke or transient ischemic attacks (TIAs). In this study, we explored factors associated with development of these events following CEA in patients with long-term follow-up.

Methods: We performed a retrospective analysis of all neurosurgical patients who underwent CEA and presented with ipsilateral ischemic stroke, TIA, or amaurosis fugax.

Delayed Hemorrhage After Treatment of Brain Arteriovenous Malformations (AVMs).

Objective: The risk of delayed hemorrhage occurring greater than 2 years after treatment in brain arteriovenous malformations (AVMs) rarely is reported. In this study, we compare the risk of delayed hemorrhage across different treatment modalities.

Methods: We performed a retrospective chart review of treated patients with a single intracranial AVM seen at our institution from 1990 to 2013.

Algorithmic Approach to Overcome Scalp Deficiency in the Setting of Secondary Cranial Reconstruction.

Background: Multidisciplinary approaches have shown improved outcomes in secondary cranial reconstruction, however, scalp deficiency remains a common obstacle for tension-free scalp closure during cranioplasty. Therefore, our objective was to create an algorithmic approach using a novel concept of "component separation" to help minimize potential complications.

Methods: The authors tested the hypothesis of achieving greater scalp mobility by way of "component separation" in a half-scalp, bilateral cadaver study, and describe within 2 clinical examples.

Long-term Outcomes of Patients With Giant Intracranial Arteriovenous Malformations.

Background: Giant intracranial arteriovenous malformations (AVMs) are rare cerebrovascular lesions that pose management challenges.

Objective: To further clarify outcomes in patients with giant cerebral AVMs managed with conservative or interventional therapies.

Methods: We performed a retrospective review of all patients diagnosed with AVMs evaluated at our institution from 1990 to 2013.

Post-hemorrhagic hydrocephalus presenting as cauda equina syndrome in a patient with spinal dysraphism.

Hydrocephalus has varied presentations in patients with a history of spinal dysraphism. This is a unique case of post-subarachnoid hemorrhage hydrocephalus presenting as cauda equina syndrome. We report on a 32-year-old woman with remotely repaired spinal defect who experienced subarachnoid hemorrhage and underwent anterior communicating artery aneurysm clipping.

Surgical complications following malignant brain tumor surgery: An analysis of 2002-2011 data.

Objectives: To estimate the incidence of surgical complications and associated in-hospital morbidity and mortality following surgery for malignant brain tumors.

Patients And Methods: The Nationwide Inpatient Sample (NIS) database was queried from 2002 to 2011. All adult patients who underwent elective brain surgery for a malignant brain tumor were included.

Lower Risk of Intracranial Arteriovenous Malformation Hemorrhage in Patients With Hereditary Hemorrhagic Telangiectasia.

Background: Patients diagnosed with hereditary hemorrhagic telangiectasia (HHT) are at risk of developing intracranial arteriovenous malformations (AVM). However, the clinical manifestations and natural history of HHT-related AVMs remain unclear due to the rarity of these lesions.

Objective: To clarify the clinical characteristics and hemorrhagic risk in HHT-related AVMs.

Imaging the spontaneous obliteration of a cerebral arteriovenous malformation using c-arm cone beam computed tomography: A case report.

Background: Spontaneous occlusion of a cerebral arteriovenous malformation (AVM) without treatment is a rare occurrence.

Case Description: We report the case of a 56-year-old male who presented with aphasia and right hemiparesis secondary to intracerebral and intraventricular hemorrhage. Diagnostic digital subtraction angiography (DSA) and c-arm cone beam computed tomography (CBCT) demonstrated a 5 mm Spetzler-Martin Grade III left thalamic AVM drained by the internal cerebral vein.

Hemorrhage risk and clinical features of multiple intracranial arteriovenous malformations.

The aim of this report is to examine clinical characteristics, treatment strategies, and annual hemorrhage incidence rate for patients with multiple arteriovenous malformations (MAVM). The PubMed and EMBASE databases and the arteriovenous malformations (AVM) database at The Johns Hopkins Hospital were searched to identify patients with MAVM. Data related to demographics, clinical features, management, and treatment outcomes were analyzed with descriptive statistics.

Treatment of Intracranial Aneurysms: Clipping Versus Coiling.

Intracranial aneurysms (IAs) have an estimated incidence of up to 10 % and can lead to serious morbidity and mortality. Because of this, the natural history of IAs has been studied extensively, with rupture rates ranging from 0.5 to 7 %, depending on aneurysm characteristics.

Natural history and treatment of craniocervical junction dural arteriovenous fistulas.

Dural arteriovenous fistulas (DAVFs) located at the craniocervical junction are rare vascular malformations with distinctive features, and their natural history and the optimal treatment strategy remains unclear. We retrospectively reviewed eight patients with craniocervical junction DAVF who were evaluated at our institution between 2009 and 2012. We also conducted a MEDLINE search for all reports of craniocervical junction DAVF between 1970 and 2013, and reviewed 119 patients from 56 studies.

Immediate Single-Stage Cranioplasty Following Calvarial Resection for Benign and Malignant Skull Neoplasms Using Customized Craniofacial Implants.

Unlabelled: Craniectomy defects following resection of calvarial lesions are most often reconstructed using on-table manufacturing. With the advent of computer-aided design/manufacturing and customized craniofacial implants (CCIs), there seems to be more suited alternatives. In this study, the authors report their institutional experience and outcome using immediate, single-stage, CCI-based reconstruction for benign and malignant skull neoplasm defects.

Immediate procedural outcomes in 44 consecutive Pipeline Flex cases: the first North American single-center series.

Background: Flow diversion is an established technique for treatment of cerebral aneurysms. The Pipeline embolization device (PED) is the only FDA-approved flow diverting stent in the USA. A second-generation device, PED Flex, has recently been released with modifications to the delivery system.

Contralateral approach for clipping of bilateral anterior circulation aneurysms.

Patients with bilateral anterior circulation aneurysms present a management challenge. These lesions may be treated in a staged manner or alternatively, for select patients, a contralateral approach may be utilized to treat bilateral aneurysms with a single surgery. In this narrated video illustration, we present the case of a 57-year-old woman with incidentally discovered bilateral aneurysms (left middle cerebral artery [MCA], left anterior choroidal artery and right MCA).

Intra-DIC (distal intracranial catheter) deployment of the Pipeline embolization device: a novel rescue strategy for failed device expansion.

Background: The Pipeline embolization device (PED) is a braided flow diverter that requires a combination of meticulous maneuvers to assure proper device opening and expansion. Mechanical, anatomical, or technical challenges can result in a partially deployed PED with failed expansion.

Objective: To present a new alternative method of PED deployment using the Navien distal intracranial catheter (DIC) as a salvage maneuver for cases where PED opening fails with standard techniques.

Flow diversion of large internal carotid artery aneurysms with the surpass device: impressions and technical nuance from the initial North American experience.

Background: Flow diversion is an important tool for treatment of cerebral aneurysms, particularly large and giant aneurysms. The Surpass flow diverter is a new system under evaluation in the USA.

Objective: To report our initial experience of 20 cases with the Surpass flow diverter to demonstrate its basic properties, the required triaxial delivery platform, and the methodologies used to deploy it during treatment of large internal carotid artery (ICA) aneurysms

Methods: Twenty patients with ICA aneurysms ≥10 mm with ≥4 mm neck treated as part of the Surpass IntraCranial Aneurysm Embolization System Pivotal Trial (the SCENT trial; Stryker) were included.

Clostridium novyi-NT can cause regression of orthotopically implanted glioblastomas in rats.

Glioblastoma (GBM) is a highly aggressive primary brain tumor that is especially difficult to treat. The tumor's ability to withstand hypoxia leads to enhanced cancer cell survival and therapy resistance, but also yields a microenvironment that is in many aspects unique within the human body, thus offering potential therapeutic opportunities. The spore-forming anaerobic bacterium Clostridium novyi-NT(C.

Racial Associations with Hemorrhagic Presentation in Cerebral Arteriovenous Malformations.

Background: Studies focusing on hemorrhagic presentation of brain arteriovenous malformations (AVMs) have largely limited their analysis to angiographic features. We report the importance of race/ethnicity as a clinical factor associated with hemorrhagic AVM presentation in addition to previously reported angiographic features.

Methods: Data were prospectively and retrospectively collected on patients (N = 194) during the period 1993-2010 who presented with a single intracranial AVM, and baseline characteristics were compared for hemorrhagic presentation versus nonhemorrhagic presentation.

Serial Imaging Surveillance for Patients With a History of Intracranial Aneurysm: Risk of De Novo Aneurysm Formation.

Background: Although rare, de novo intracranial aneurysms (DNIAs) may develop in patients with a history of intracranial aneurysms (IAs).

Objective: To evaluate the benefit of routine radiographic screening for DNIAs.

Methods: Data for 2153 patients with IAs were retrospectively analyzed.

Quantitative analysis of dual-purpose, patient-specific craniofacial implants for correction of temporal deformity.

Background: The development of computer-assisted design, virtual modeling, and computed tomography has allowed precise customization of implants for patients who undergo neurosurgical or craniofacial surgery procedures. However, such techniques and implant designs have not adequately addressed temporal asymmetry due to postoperative bone resorption, temporalis muscle malposition/foreshortening, and/or temporal fat pad atrophy.

Objective: We hypothesized that an alteration in customized craniofacial implant (CCI) design with a strategic extension inferolaterally and excessive material bulking would provide simultaneous reconstruction of coexisting temporal skull defects and therefore reduce the effect of soft tissue deformities.

Impact of resident participation on morbidity and mortality in neurosurgical procedures: an analysis of 16,098 patients.

Object: The authors sought to determine the impact of resident participation on overall 30-day morbidity and mortality following neurosurgical procedures.

Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients who had undergone neurosurgical procedures between 2006 and 2012. The operating surgeon(s), whether an attending only or attending plus resident, was assessed for his or her influence on morbidity and mortality.

Predictors of functional outcome following treatment of posterior fossa arteriovenous malformations.

Posterior fossa arteriovenous malformations (AVM) present particular therapeutic challenges. Studies aimed at clarifying risk of hemorrhage focus on obliteration rates, but few have addressed functional outcomes in these patients. In this study, we aim to explore the predictors of good functional outcome for posterior fossa AVM after treatment.