Detachable balloon embolization: concomitant use of a second safety balloon.

We describe a relatively unusual case of carotid cavernous fistula in association with a persistent trigeminal artery, presumably related to aneurysm rupture near the carotid origin of the vessel. We emphasize the use of a second, nondetachable balloon solely for the purpose of stabilizing placement of the first device at the time of detachment.

Assessment of the efficacy of noninvasive screening for patients with asymptomatic neck bruits.

Background And Purpose: Several recent clinical trials have shown that endarterectomy is efficacious in patients with asymptomatic carotid artery stenosis. The purpose of this study was to evaluate the effectiveness of various test strategies for screening and diagnosing carotid artery disease.

Methods: We constructed a model of the natural history of carotid artery disease using literature-based estimates of the prevalence and incidence of carotid artery stenosis and associated morbidity and mortality.

Current implications for the efficacy of noninvasive screening for occult intracranial aneurysms in patients with a family history of aneurysms.

Although the technology exists for accurate noninvasive screening for intracranial aneurysms, the efficacy of screening depends on several key parameters of the natural history of aneurysms. Recent studies suggest that the prevalence of intracranial aneurysms may reach 20% in the subpopulation of patients with a family history of these lesions; other key parameters are less certain. The authors investigated factors that impact the efficacy of screening to establish interim guidelines.

Intracranial hypertension after resection of cerebral arteriovenous malformations. Predisposing factors and management strategy.

Background And Purpose: Surgical excision of cerebral arteriovenous malformations (AVMs) may be complicated by postoperative breakthrough edema and hemorrhage and by intracranial hypertension. Embolization, staged resection, and meticulous surgical technique have decreased but not completely eliminated this complication. In this study we prospectively assess the prevalence of intracranial hypertension after excision of cerebral AVMs, examine factors predisposing to this complication, and document the outcome of aggressive monitoring and treatment of elevated intracranial pressure (ICP).

Stereotactic and computer-assisted neurosurgery at the Cleveland Clinic: review of 501 consecutive cases.

Background: Stereotactic and computer-assisted techniques have revolutionized the diagnosis and treatment of many disorders of the brain by directing surgical instruments, the surgeon's hands, or focused radiation to an imaged target along predefined routes.

Methods: This report reviews the basic principles and techniques of stereotactic and computer-assisted procedures in 501 consecutive procedures.

Results: Procedures performed include biopsy; decompression of cysts, hematomas, ventricles, and abscesses; "point," computer-assisted volumetric, and frameless stereotactic resection of brain lesions; placement of depth electrodes; treatment of movement or pain disorders; implantation of radioactive seeds in malignant tumors; and radiosurgery.