Clinical Course of Unilateral Moyamoya Disease.

Background: The natural history of unilateral moyamoya disease (MMD) progressing to bilateral MMD remains an enigma in modern vascular neurosurgery. Few, small series with limited follow-up have reported relatively high rates of contralateral stenosis progression.

Objective: To review our large series of unilateral MMD patients and evaluate radiographic and surgical progression rates, and identify any factors associated with progression.

Treatment of posterior circulation fusiform aneurysms.

Objective: Perforator arteries, the absence of an aneurysm discrete neck, and the often-extensive nature of posterior circulation fusiform aneurysms present treatment challenges. There have been advances in microsurgical and endovascular approaches, including flow diversion, and the authors sought to review these treatments in a long-term series at their neurovascular referral center.

Methods: The authors performed a retrospective chart review from 1990 to 2018.

Translamina Terminalis Approach to Laser-Assisted Resection of Thalamomesencephalic Cavernous Malformation.

Cavernous malformations of the midbrain require careful consideration of the risks and benefits of intervention as well as the optimal surgical approach for these challenging lesions. Excellent results can be achieved with careful surgical planning and technique. We demonstrate a contralateral left pterional craniotomy for a translamina terminalis approach to carbon dioxide laser-assisted microsurgical resection of a thalamomesencephalic cavernoma in a 59-year-old woman with progressive debilitating diplopia secondary to partial third nerve palsy (Video 1).

Contralateral Vasospasm in an Uncomplicated Elective Anterior Communicating Artery Aneurysm Clipping.

Background: Cerebral vasospasm following clipping of an unruptured aneurysm is a rare phenomenon. When it does occur, cerebral vasospasm usually occurs on the side ipsilateral to the surgical intervention.

Case Description: A 68-year-old man underwent right-sided pterional craniotomy for clipping of an unruptured anterior communicating artery aneurysm and experienced contralateral vasospasm 5 days later.

Pregnancy after direct cerebral bypass for moyamoya disease.

Objective: Moyamoya disease (MMD) disproportionately affects young to middle-aged women. The main treatment for this challenging disease is cerebral bypass surgery. Vascular neurosurgeons often need to counsel women regarding pregnancy following bypass for MMD, but there is a paucity of data.

Microsurgical rhizotomy for trigeminal neuralgia in MS patients: technique, patient satisfaction, and clinical outcomes.

Objective: Patients with multiple sclerosis (MS)-associated trigeminal neuralgia (TN) have higher recurrence and retreatment rates than non-MS patients. The optimal management strategy and role for microsurgical rhizotomy (MSR) for MS-TN remains to be determined. The aim of this study was to report time to treatment failure (TTF) and pain scores following MSR compared to percutaneous and Gamma Knife procedures.

Trigeminal neuropathy associated with an enlarging arachnoid cyst in Meckel's cave: case report, management strategy and review of the literature.

We describe a rare case and novel management strategy of painful trigeminal neuropathy caused by an arachnoid cyst confined to Meckel's cave. A 57-year-old female presented with several years of progressive trigeminal pain and signs of trigeminal deafferentation, including sensory loss, corneal anesthesia and mastication muscle atrophy. Medical treatment with carbamazepine provided partial and temporary pain control.

Failed microvascular decompression surgery for hemifacial spasm due to persistent neurovascular compression: an analysis of reoperations.

OBJECT Microvascular decompression (MVD) surgery for hemifacial spasm (HFS) is potentially curative. The findings at repeat MVD in patients with persistent or recurrent HFS were analyzed with the aim to identify factors that may improve surgical outcomes. METHODS Intraoperative findings were determined from review of dictated operative reports and operative diagrams for patients who underwent repeat MVD after prior surgery elsewhere.