Endoscopic-assisted resection of vestibular schwannomas in high-riding jugular bulb.

The present surgical video demonstrates safe opening of the internal auditory canal (IAC) during vestibular schwannoma surgery via a retrosigmoid approach in the sitting position. Resection of the intrameatal portion of a tumor is important for progression-free survival. Preoperative thin-sliced CT revealed a high-riding jugular bulb obscuring the trajectory.

Endoscopic Endonasal Resection of C1-C2 Pannus, a Step-by-Step Surgical and Anatomical Description: 2-Dimensional Operative Video.

Expanded endonasal endoscopic approaches provide access to the entire central skull base and craiocervical junction. The authors present a case of an 81-year-old man who presented with progressive spastic quadriparesis to the point of being wheel-chair bound. Cervical spine computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated multilevel extensive spondylitic changes with a large pannus at the C1-2 junction, severely compressing the spinal cord ( Figs.

Characteristics of Large-Vessel Occlusion Associated with COVID-19 and Ischemic Stroke.

The mechanisms and phenotype of ischemic stroke associated with coronavirus disease 2019 (COVID-19) remain uncertain. A retrospective study was conducted in patients with COVID-19 presenting with ischemic stroke from March 1 to May 25, 2020, and cases with large-vessel occlusion were identified. To provide baseline institutional stroke data within and outside the COVID-19 pandemic, all consecutive ischemic stroke and TIA admissions (COVID and non-COVID) to the hospital during a 10-week period from March 1 to May 10, 2020, were collected and compared with data from the same time period in 2019.

Multimodal Management of Carotid-Cavernous Fistulas.

Background: Techniques for endovascular management of carotid-cavernous fistulas (CCFs) have evolved over the years. Current strategies include transarterial or transvenous approaches and direct puncture or exposure of the cavernous sinus. Rarely, complex CCFs may require multiple approaches or procedures.

Endoscope-assisted resection of a brainstem cavernoma.

Procedures on cavernous malformations of the brainstem are challenging due to their eloquent location. This accounts especially for recurrent cavernomas as surgical scars, adhesions, and functional shift might have occurred since primary surgery. We report on a 38-year-old female patient with a large recurrent brainstem cavernoma, who underwent previous successful surgery and experienced recurrent bleeding about 2 years later.

Combined Use of Intraoperative Indocyanine Green and Dynamic Angiography in Rotational Vertebral Artery Occlusion.

Rotational vertebral artery occlusion (RVAO) is a well-documented surgically amenable cause of vertebrobasilar insufficiency. Traditionally, patients have been imaged using dynamic rotational angiography. We report a case of RVAO in which intraoperative indocyanine green angiography (ICGA) was used to confirm adequate surgical decompression of the VA.

Extradural clinoidectomy for resection of clinoidal meningioma.

Extradural anterior clinoidectomy is a versatile technique to increase exposure of the sellar and parasellar region. It is of particular use in the resection of clinoidal meningiomas, as sphenoidal and clinoidal hyperostosis can cause compression of the optic nerve. Extradural clinoidectomy follows a series of steps, consisting of (1) unroofing of the superior orbital fissure, (2) unroofing of the optic canal, (3) removal of the optic strut, and (4) removal of the anterior clinoid process.

Genetic associations of intracranial aneurysm formation and sub-arachnoid hemorrhage.

Risk factors for cerebral aneurysms typically include age, hypertension, smoking, and alcohol usage. However, the possible connection of aneurysms with genetic conditions such as Marfan's syndrome, polycystic kidney disease, and neurofibromatosis raises the question of possible genetic risk factors for aneurysm, and additionally, genetic risk factors for rupture. We conducted a literature review using the PubMed database for studies regarding genetic correlation with cerebral aneurysm formation as well as rupture from December 2008 to Jun 2015.

Epidemiology, clinical presentation, diagnostic evaluation, and prognosis of cerebral dural arteriovenous fistulas.

Dural arteriovenous fistulas are abnormal communications, within the dural leaflets, between meningeal arteries and dural venous sinuses and/or subarachnoid veins. Although many fistulas remain clinically silent and do not require treatment, presence of cortical venous reflux, intracranial bleed, and intolerable symptoms are the main indications for treatment. A thorough understanding of the natural history is of prime importance in the decision making and management of these lesions.

Venous Phase Timing Does Not Predict SPECT Results During Balloon Test Occlusion of the Internal Carotid Artery.

Introduction: The purpose of this study is to evaluate the role of venous phase timing when compared with technetium-99m Single Photon Emission Computed Tomography (SPECT) during angiographic balloon test occlusion of the internal carotid artery (ICA) and subsequent sacrifice of the ICA.

Methods: Fifty-six patients underwent formal balloon test occlusion from April 2008 to February 2014 at our institution. Venous phase timing was calculated for each patient.

Microsurgical versus endovascular interventions for blood-blister aneurysms of the internal carotid artery: systematic review of literature and meta-analysis on safety and efficacy.

OBJECTIVE Blood-blister aneurysms (BBAs) of the internal carotid artery (ICA) have a poor natural history associated with high morbidity and mortality. Currently, both surgical and endovascular techniques are employed to treat BBAs; thus, the authors sought to perform a meta-analysis to compare the efficacy and safety of these approaches. METHODS A literature search of PubMed, MEDLINE, and Google Scholar online databases was performed to include pertinent English-language studies from 2005 to 2015 that discussed the efficacy and safety of either surgical or endovascular therapies to treat BBAs.

Off-label use of the Angioseal vascular closure device for femoral arteriotomy: retrospective analysis of safety and efficacy.

Background: Angioseal, an arteriotomy closure device (ACD), functions as a collagen plug that physically closes arteriotomy sites and can simultaneously induce platelet activation and aggregation. When used 'on-label', the safety and efficacy profile of Angioseal is superior compared with those of other ACDs. However, Angioseal is sometimes deployed in less than ideal situations.

The Management of Intracranial Aneurysms During Pregnancy: A Systematic Review.

Hemodynamic changes during pregnancy may favor the formation and rupture of intracranial aneurysms. Despite this risk, guidelines for managing intracranial aneurysms during pregnancy have not been clearly defined. The objective of this review is to describe the treatment options for pregnant women with intracranial aneurysms, and to report the maternal and fetal outcomes associated with different treatment strategies.

Combined use of intraoperative indocyanine green and dynamic angiography in rotational vertebral artery occlusion.

Rotational vertebral artery occlusion, also known as bow hunter's syndrome, is a well-documented surgically amenable cause of vertebrobasilar insufficiency. Traditionally, patients have been imaged using dynamic rotational angiography. The authors sought to determine whether intraoperative indocyanine green (ICG) angiography could reliably assess the adequacy of surgical decompression of the vertebral artery (VA).

Stem Cells as a Potential Adjunctive Therapy in Aneurysmal Subarachnoid Hemorrhage.

Background: Despite advances in the management of subarachnoid hemorrhage, a considerable proportion of patients are still left with severe and disabling long-term consequences. Unfortunately, there are limited therapeutic options to counteract the sequelae following the initial insult. The role of stem cells has been studied in the treatment of various diseases.

Long-term angiographic results of endovascularly "cured" intracranial dural arteriovenous fistulas.

Objective: Dural arteriovenous fistulas (DAVFs) are complex lesions consisting of abnormal connections between meningeal arteries and dural venous sinuses and/or cerebral veins. The goal of treatment is surgical or endovascular occlusion of the fistula or fistulous nidus or at least the disconnection of the feeding vessels and the draining veins. Delayed angiographic data on previously embolized dural fistulas is lacking.