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.

Pathogenesis of subcortical hyperintense lesions on magnetic resonance imaging of the brain. Observations in patients undergoing controlled therapeutic internal carotid artery occlusion.

Background And Purpose: Factors associated with the pathogenesis of subcortical hyperintense lesions on magnetic resonance imaging of the brain are not known. We describe four cases of de novo genesis of subcortical hyperintense lesions in patients undergoing controlled therapeutic internal carotid artery occlusion, and we speculate on associated pathophysiological mechanisms.

Methods: Twelve consecutive patients underwent controlled therapeutic internal carotid artery occlusion for symptomatic giant cerebral aneurysm using the detachable balloon technique under full anticoagulation.

Comparison and spacial correlation of interictal HMPAO-SPECT and FDG-PET in intractable temporal lobe epilepsy.

The respective contribution of interictal HMPAO-SPECT and FDG-PET to the imaging of the epileptogenic zone in intractable temporal lobe epilepsy is not known. Ten consecutive patients with drug resistant focal epilepsy of temporal lobe origin were studied with prolonged noninvasive video-EEG monitoring, magnetic resonance imaging, interictal FDG-PET and HMPAO-SPECT. Five patients demonstrated unitemporal and 5 patients bitemporal interictal and/or ictal EEG epileptiform abnormalities.

Factors predisposing to clinical disability in patients with cavernous malformations of the brain.

The factors predisposing to an aggressive clinical course in cavernous malformations of the brain are not known. Disabilities from neurological deficits and from seizures were assessed and graded in 84 patients harboring 100 cavernous malformations and were correlated with patient sex and age, lesion size, lesion location, lesion multiplicity, and previous overt hemorrhage. Univariate analysis showed that female sex, infratentorial lesion location, and previous gross hemorrhage were significantly associated with subsequent neurological disability.

Application of magnetic resonance angiography to neurosurgical practice: a critical review of 150 cases.

The potential role of magnetic resonance angiography (MRA) in clinical neurosurgical practice was evaluated in 150 consecutive patients in an attempt to define clinical situations in which it aided in diagnosis, helped guide treatment options, and/or possibly eliminated the need for conventional catheter angiography. Among patients with nonvascular pathology (n = 42), MRA provided useful clinical information in 55% of cases, and could have effectively replaced catheter angiography in 76% of cases. In this group of patients, MRA provided excellent depiction of tumour and vessel relationships, and in conjunction with conventional imaging modalities reliably ruled out the question of tumour versus aneurysm whenever that question was raised.

Alternating sequential intracarotid BCNU and cisplatin in recurrent malignant glioma.

The authors entered 43 patients with recurrent malignant glioma in a trial of alternating sequential intracarotid BCNU and cisplatin. Protocol design was alternating courses of BCNU (2 doses, 300 to 400 mg each) and cisplatin (2 doses, 150 to 200 mg each) each at 4-week to 6-week intervals. Eight of 40 patients (20%) evaluable after the first course of BCNU showed partial or minor response.

Constant infusion of morphine for intractable cancer pain using an implanted pump.

In the past, pain control for chronic pain syndromes using narcotic infusion has been carried out primarily via the intrathecal (subarachnoid) route. This report presents one of the first large series of terminally ill cancer patients with intractable pain treated with continuous epidural morphine infusions by means of implanted pumps and epidural spinal catheters. The purpose of the study was to demonstrate that the epidural route is effective with minimal complications, and that screening with temporary epidural catheter infusions results in a high rate of subsequent pain relief.