Evaluation of surgical technique on outcomes from ruptured aneurysms of the middle cerebral artery.

Objective: To determine the effect of surgical technique on outcomes from ruptured middle cerebral artery aneurysms (RMCAA).

Methods: A retrospective review was performed of patients with RMCAA, who were treated at the authors' institutions. The study compares the clipping efficacy, the postoperative CT findings as well as the clinical outcome in 87 acute operated patients.

Comparison of minimally invasive fusion and instrumentation versus open surgery for severe stenotic spondylolisthesis with high-grade facet joint osteoarthritis.

Purpose: The object of this study was to compare minimally invasive surgery (MIS) with open surgery in a severely affected subgroup of degenerative spondylolisthetic patients with severe stenosis (SDS) and high-grade facet osteoarthritis (FJO).

Methods: From January 2009 to February 2010, 49 patients with severe SDS and high-grade FJO were treated using either MIS or open TLIF. Intraoperative and diagnostic data, including perioperative complications and length of hospital stay (LOS), were collected, using retrospective chart review.

The impact of timing of cranioplasty in patients with large cranial defects after decompressive hemicraniectomy.

Background: It is unclear how soon after a decompressive hemicraniectomy that cranioplasty be safely performed in a patient in whom the ICP has been normalized. Early surgery has been associated with infection, intracerebral hematoma, and complications due to persistent or recurrent brain edema. Delayed cranioplasty of large cranial defects exposes the patient to different conditions known in the literature as the syndrome of the sinking skin flap.

White matter tract alterations assessed with diffusion tensor imaging and tractography in patients with solid posterior fossa tumors.

Background: This study assesses the tract alterations observed before and after resection of solid posterior fossa tumors (PFTs) using diffusion tensor imaging (DTI) and white matter tractography (WMT).

Materials And Methods: Pre- and post-surgical DTI and WMT data were acquired in eight patients undergoing surgical resections of PFT. A tensor deflection algorithm was used to reconstruct the tracts adjacent to the lesions.

Delayed outcome from surgically treated patients with benign nerve associated tumors of the extremities larger than 5 cm.

Background: The purpose of this work was to analyse the surgical procedure used and the outcome from patients with solitary nerve associated benign tumors of the extremities (SNABTE) >5 cm.

Methods: A 15 year review was performed for all patients with SNABTE treated in our department. The surgical procedures used (complete or incomplete tumor removal, with or without nerve preservation), the needs for grafting techniques as well as the outcome were analysed.

Angiographic computed tomography and computed tomographic angiography techniques: actual interventional and diagnostic possibilities of their use in patients with cerebral aneurysms.

Since the introduction of radiological examination techniques, such as an angiographic computed tomography (ACT) and a computed tomographic angiography (CTA), the diagnosis and treatment planning for cerebral aneurysms became quicker and safer. Unfortunately, the state of development of these techniques, and their possible indications and benefits are still today restricted to specialized centers. The objective of this update was to analyze the current scientific evidence about their actual interventional and diagnostic use and identify the individual advantages of each through a literature review and personal experience-based data.

The influence of configuration and location of ruptured distal cerebral anterior artery aneurysms on their treatment modality and results: analysis of our casuistry and literature review.

Objective: To assess the influence of configuration and location of ruptured distal cerebral anterior artery aneurysms on their treatment modality and results.

Method: The influence of the aneurysm configuration (basic or complex configuration) and location (infracallosal or supracallosal) on the treatment-related radiological results (partial or complete aneurysm occlusion) and clinical outcome (favorable or unfavorable) was retrospectively analysed in all admitted patients with ruptured pericallosal aneurysms within the last 10 years. The expected benefit from each form of treatment was individually discussed.

Unusual sequestered disc fragments simulating spinal tumors and other space-occupying lesions. Clinical article.

Object: In this study the authors evaluated disease incidence, treatment, and outcome in patients with unusual sequestered disc fragments simulating spinal tumors or another space-occupying lesion on preoperative MR imaging.

Methods: The authors retrospectively reviewed data from the last 3000 patients with a histological diagnosis of disc herniation. Patients with preoperative MR imaging findings that simulated a spinal tumor or other space-occupying lesion were individually analyzed.

Atypical causes of nontraumatic intracranial subarachnoid hemorrhage.

Background: To analyze the management and outcome of patients presenting with atypical causes of intracranial subarachnoid hemorrhage (SAH).

Methods: We performed a review of our last 820 nontraumatic-SAH patients and analyzed the management and outcome of patients where the SAH origin was not a ruptured aneurysm. The Glasgow Outcome Scale (GOS) was used to assess outcome 3 months after event.

Interdisciplinary treatment selection in admitted patients with acute subarachnoid hemorrhage.

Objective: To review the angiographic and clinical outcomes from acute (first 6 hours after bleeding) interdisciplinary treated patients with ruptured intracranial aneurysm.

Method: An interventional neuroradiologist and a neurosurgeon set the emergent treatment of 100 consecutive patients with subarachnoid hemorrhage (SAH) harboring 111 cerebral aneurysms. Decisions were based on the patient's clinical condition, aneurysm's morphology and location, presence of intracranial mass-occupying process (IMOP), angiographic flow distribution patterns and treatment-related risk profit.

Acute management of poor condition subarachnoid hemorrhage patients.

Poor condition subarachnoid hemorrhage (SAH) patients present a high mortality and morbidity. In this study, we reviewed the acute interventional (surgical and endovascular) management of 109 SAH-poor condition patients, who were treated as early as logistically possible after confirming stable circulation parameters. Patients over the age of 70 years, without clinical response to painful stimulation were excluded.

Volume assessment of intracranial large meningiomas and considerations about their microsurgical and clinical management.

Objective: To assess the volume of large intracranial meningiomas and analyse their different microsurgical and clinical managements.

Method: The volume of 45 large meningiomas treated in our department during the last 9.5 years was retrospectively assessed using recorded neuronavigation data.

Assessment of the clipping efficacy of intracranial aneurysms: analysis of the employed methodology in relation to case difficulty.

Objective: To assess intracranial aneurysms clipping efficacy (CE) employing different angiographic techniques in relation to the case difficulty.

Method: In the past 6 years, 152 patients harboring 179 aneurysms who underwent surgical clipping in our department were angiographically examined to confirm aneurysm occlusion. Intraoperative angiography (IA), post-operative conventional (PCA) and three-dimensional angiography were single or sequentially performed based on the surgeon's concern about case difficulty.

Reliability of neuronavigation-assisted trans-sphenoidal tumor resections.

Objective: To analyse the surgical reliability of neuronavigation-assisted trans-sphenoidal tumor resections.

Method: In the past 7 years, all patients, who underwent neuronavigation-assisted trans-sphenoidal tumor resection in our department, were additionally intraoperatively controlled with a radioscopic device. Tumor removal was repeatedly checked up with the navigator and the tip of the pointer was correlated with the lateral intraoperative skull radiologic examination to confirm the real pointer deepness, spatial location and trajectory.

Severe intracranial bleedings during endovascular procedures: outcome of surgically treated patients.

Objective: Severe intracranial bleedings (SIBs) during endovascular procedures (EPs) are accompanied by acute intracranial hypertension and brain herniation signs. The purpose of this study was to determine the effectiveness of urgent surgical management and its related patient outcome in cases with such a fatal complication.

Method: Medical records were reviewed retrospectively for the last 750 patients treated in our department in the past 12 years with acute non-traumatic intracranial bleeding, who underwent a diagnostic or therapeutic EP.

Early combined cranioplasty and programmable shunt in patients with skull bone defects and CSF-circulation disorders.

Objective: This study assesses the clinical outcome after early combined cranioplasty (own frozen bone) and shunt implantation (Codman-Medos programmable VP shunt) in patients with skull bone defects and cerebrospinal fluid (CSF) circulation disorders.

Method: Medical records were reviewed retrospectively for the last 100 patients with CSF disorders after trauma or subarachnoid hemorrhage (SAH), who previously underwent decompressive craniotomy owing to therapy-resistant brain swelling. Patients treated with early (5 to 7 weeks after injury) combined cranioplasty and shunt implantation were analysed and a follow-up for the survivors was obtained.

Experimental cerebral arteriovenous fistulas.

Objective: The aim of this paper is to analyse and summarize the main advances in experimental research on cerebral arteriovenous fistulas.

Methods: A detailed analysis of the literature and my own research experience were employed to outline the methodology whereby experimental cerebral arteriovenous fistulas are created and further studied.

Results: The analysis and quantification of the anatomical and functional variables in different experimental cerebral arteriovenous fistula models make it possible to develop more appropriate and individual ways of treatment in affected patients.

Benefits of adapting minimal invasive techniques to selected patients with spontaneous supratentorial intracerebral hematomas.

Objectives: This study assesses the benefits of adapting minimal invasive techniques (MIT) to selected patients with spontaneous supratentorial intracerebral hematomas (SSICHs).

Methods: The study compares the post-operative residual clot volume and clinical outcome of 89 selected, MIT evacuated SSICH-patients to those of 138 unselected cases operated in our department. Selection criteria includes patient age, early admission and MIT treatment.

Hyperacute measurement of brain-tissue oxygen, carbon dioxide, pH, and intracranial pressure before, during, and after cerebral angiography in patients with aneurysmatic subarachnoid hemorrhage in poor condition.

Background: The objective of this study was to examine early changes of intracranial pressure (ICP) and brain oxygenation before, during, and after cerebral angiography in patients with poor-grade subarachnoid hemorrhage (SAH).

Methods: Fourteen patients with poor-grade SAH without intracerebral hematoma were studied. A significant change in monitored variables (arterial gases, ICP, brain-tissue oxygen pressure [Ptio(2)], brain-tissue carbon dioxide pressure, and pH) was defined as a register deviation of more than 20% compared with the baseline.

Evaluation of invasiveness and efficacy of 2 different keyhole approaches to large basal ganglia hematomas.

Background: The aim of this study was to evaluate the invasiveness and efficacy of 2 different keyhole approaches to large basal ganglia hematomas (LBGHs).

Methods: The invasiveness and efficacy of the temporal (15 cases) and the frontal (15 cases) microsurgical keyhole approach were retrospectively evaluated in 30 early-operated patients with LBGH, using recorded neuronavigation data. Invasiveness was assessed calculating the angles of brain retraction and the volume of brain exposed to surgery.

Why, when, and how spontaneous intracerebral hematomas should be operated.

Patients with spontaneous intracerebral hematomas experience higher mortality and suffer more severe deficits than any other stroke subtype. Although significant intracerebral hematoma (ICH)-related death and severe neurological deficits arise from hematoma mass effect and intraventricular extension, further clinical deterioration related to rebleeding and/or perihematomal brain edema development often occurs. Many studies have shown that the level of disability and mortality after ICH also depends on the Glasgow Coma Scale (GCS) score, hemorrhage size and patient age.

Pseudo-aneurysms associated with intracranial surgery: case report.

We describe a patient in whom two non-symptomatic internal carotid artery and middle cerebral artery pseudo-aneurysms were diagnosed 1 year following the surgical removal of a clinoidal meningioma. The unusual number, location, form and evolution (actual follow up of 6 years) of these pseudo-aneurysms differentiate them from other vascular lesions associated with surgery. It is important to understand the mechanism of vascular injury in order to understand imaging features and the possible methods of treatment.

Cerebral vein thrombosis associated with aneurysmal subarachnoid bleeding: implications for treatment.

Background: Cerebral vein thrombosis associated with aneurysmal subarachnoid bleeding is an uncommon event rarely described in the literature. We report here a case and summarize the problems in the management of this patient.

Case Description: A 48-year-old female suffered from two episodes of severe headache and vomiting 7 days before and on the day of admission.

Unruptured large intracranial aneurysms in patients with transient cerebral ischemic episodes.

This report analyzes the treatment of six patients with transient cerebral ischemic episodes in combination with large unruptured aneurysm. Priority treatment of the symptomatic lesions had to be delayed in five cases because the large aneurysms were ipsilateral to stenoses of the internal carotid artery. The hemodynamic effect of surgery on the compromised cerebral circulation was pre-examined with digital subtraction angiography and technetium-99m ((99m)Tc) single photon emission computed tomography.