An in vitro evaluation of sagittal alignment in the cervical spine after insertion of supraphysiologic lordotic implants.

Purpose: Cervical spine malalignment can develop as a consequence of degenerative disc disease or following spinal surgery. When normal sagittal alignment of the spine is disrupted, further degeneration may occur adjacent to the deformity. The purpose of this study was to investigate changes in lordosis and sagittal alignment in the cervical spine after insertion of supraphysiologic lordotic implants.

Safety, immediate and mid-term results of the newer generation of hydrogel coils in the treatment of ruptured aneurysms: a multicenter study.

Objective: To assess the 'real-world' performance of the newer generation of hydrogel coils in ruptured aneurysms.

Methods: A multicenter retrospective study was carried out of angiographic and clinical outcome data on consecutive patients with ruptured aneurysms treated with at least 70% of the newer generation of hydrogel coils. Demographics and data on clinical grade, smoking, use of statins, aneurysm size, location, technique used, packing density, immediate angiographic result, angiographic follow-up, rebleeding and clinical outcome were obtained and analyzed.

Cardiac standstill for cerebral aneurysms in 103 patients: an update on the experience at the Barrow Neurological Institute. Clinical article.

Object: The aim of this study was to clarify the surgical indications, risks, and long-term clinical outcomes associated with the use of deep hypothermic circulatory arrest for the surgical treatment of intracranial aneurysms.

Methods: The authors retrospectively reviewed 105 deep hypothermic circulatory arrest procedures performed in 103 patients (64 females and 39 males, with a mean age of 44.8 years) to treat 104 separate aneurysms.

Bone dowels in anterior lumbar interbody fusion.

Since the Food and Drug Administration approved the Babgy-Kuslich BAK cage for anterior lumbar interbody fusion (ALIF), various threaded interbody fusion devices have been introduced. Bone dowels offer several theoretical advantages over cages with regard to stress shielding; the purpose of this study was to assess the efficacy of bone dowels in interbody fusion. All patients undergoing ALIF performed by the senior author between 1998 and 2001 were retrospectively reviewed.

The radical transbasal approach for resection of anterior and midline skull base lesions.

Object: Craniofacial surgery can be performed to treat midline and anterior skull base lesions by creating a bicoronal scalp incision without the need for an additional transfacial procedure. Originally described as the transbasal approach, several modifications for further exposure of the skull base have been described. The authors present data on the application and outcomes of a modified transbasal approach.

Anterior communicating artery aneurysm following radiation therapy for optic glioma: report of a case and review of the literature.

A 42-year-old female presented with subarachnoid hemorrhage (SAH), presumably from a radiation-induced anterior communicating artery aneurysm. Six years earlier, she had undergone radiation treatment for an optic glioma that was diagnosed based on imaging criteria. The aneurysm was successfully clipped, and the optic glioma was biopsied to verify the diagnosis histologically.

Preserving olfactory function in anterior craniofacial surgery through cribriform plate osteotomy applied in selected patients.

Objective: Olfaction is often sacrificed to gain access to the cranial base in anterior craniofacial surgery. We describe the long-term results of olfactory function in patients who underwent anterior craniofacial surgery and a cribriform plate osteotomy to preserve olfaction.

Methods: Between 1992 and 2004, 28 patients underwent 29 cribriform plate osteotomies in an attempt to preserve olfaction during anterior craniofacial surgery performed through modified extended transbasal approaches.

Exposure of midline cranial base without a facial incision through a combined craniofacial-transfacial procedure.

Objective: A single-stage combined craniofacial-transfacial approach that exposes the midline cranial base without visible facial incisions is described.

Methods: Between 1992 and 1998, eight patients underwent surgery for five different anterior cranial base pathological findings: four angiofibromas, one mesenchymal chondrosarcoma, one esthesioneuroblastoma, one odontogenic myxoma, and one encephalocele. In all cases, the surgical exposure consisted of a bicoronal scalp incision with a bifrontal craniotomy and fronto-orbitonasal osteotomy, and then a sublabial incision for transmaxillary exposure.

Endovascular management of intracranial vertebral artery dissecting aneurysms.

Object: Intracranial vertebral artery (VA) dissecting aneurysms often present with severe subarachnoid hemorrhage (SAH) and dramatic neurological injury. The authors reviewed the management of 23 cases in an effort to evaluate treatment efficacy and outcomes.

Methods: The records of 23 patients who underwent endovascular treatment were reviewed to determine symptoms, type of therapy, complications, and clinical outcomes.

Salvage of advanced squamous cell carcinomas of the head and neck: internal carotid artery sacrifice and extracranial-intracranial revascularization.

Object: Squamous cell carcinoma (SCC) of the head and neck may involve the carotid artery (CA) in the neck or skull base. Whether tumor resection should be associated with sacrifice of the CA is debatable.

Methods: Records obtained in five consecutive patients (three men, and two women; mean age 58 years, range 47-69 years) treated for recurrent or progressive SCC involving the internal carotid artery (ICA) at the skull base were reviewed retrospectively.

Combined endovascular and microsurgical management of giant and complex unruptured aneurysms.

Object: The purpose of this study was to assess the efficacy and describe the technical features of combined endovascular and microsurgical treatments for complex and giant unruptured intracranial aneurysms.

Methods: A prospectively maintained database was reviewed to identify all patients with unruptured intracranial aneurysms who were treated with combined techniques. Twenty-one lesions were treated in as many patients: six lesions involved the posterior cerebral artery (PCA); seven the cavernous portion of the internal carotid artery (ICA); two the basilar apex; two the basilar trunk; and one each the anterior communicating artery, anterior cerebral artery, petrous ICA, and cervical ICA.

Bilateral locked facets of the lumbosacral spine: treatment with open reduction and transpedicular fixation.

Background: A 23-year-old man was involved in a motor vehicle crash and found to have bilateral locked facets at L5-S1. His neurologic examination, radiographic workup, surgical management, postoperative care, and the relevant literature are discussed.

Design: Case report and literature review.

Comparison of routine and selective use of intraoperative angiography during aneurysm surgery: a prospective assessment.

Object: Whether routine intraoperative angiography is necessary for cerebral aneurysm surgery is currently under debate. In this study the authors prospectively assessed the cerebrovascular surgeon's accuracy in predicting the need for intraoperative angiography.

Methods: Between January 2002 and January 2003, 200 consecutive patients (141 female and 59 male patients, mean age 52.

Recurrence of a vertebral artery dissecting pseudoaneurysm after successful stent-supported coil embolization: case report.

Objective And Importance: Dissecting aneurysms of the intracranial vertebral artery are increasingly recognized as a cause of subarachnoid hemorrhage. We present a case involving technical success of the stent-supported coil embolization but with recurrence of the dissecting pseudoaneurysm of the intracranial vertebral artery. The implications for the endovascular management of ruptured dissecting pseudoaneurysms of the intracranial vertebral artery are discussed.

Percutaneous intracranial stent placement for aneurysms.

Object: Intracranial stent placement combined with coil embolization is an emerging procedure for the treatment of intracranial aneurysms. The authors report their results using intracranial stents for the treatment of intracranial aneurysms.

Methods: A prospectively maintained database was reviewed to identify all patients with intracranial aneurysms that were treated with intracranial stents.

Intention-to-treat analysis of Spetzler-Martin grades IV and V arteriovenous malformations: natural history and treatment paradigm.

Object: In this study the authors quantified a subgroup of patients with Spetzler-Martin Grades IV and V arteriovenous malformations (AVMs) recommended for complete, partial, or no treatment, and calculated the retrospective hemorrhage rate for these lesions.

Methods: Between July 1997 and May 2000, 73 consecutive patients with Grades IV and V AVMs were evaluated prospectively by the cerebrovascular team at Barrow Neurological Institute. Treatment recommendations given to the patients or referring physicians were classified as complete treatment, partial treatment, and no treatment.

Thoracoscopic approaches to the thoracic spine: experience with 241 surgical procedures.

Introduction: Microsurgical thoracoscopic approaches to the thoracic spine allow access to the spinal cord, spinal nerves, disc spaces, vertebral bodies, paravertebral soft tissues, and sympathetic chain with minimal invasiveness.

Methods: Between January 1994 and January 2000, 241 thoracoscopic procedures were performed: 164 thoracic sympathectomies, 60 discectomies, 5 neurogenic tumor resections, 8 corpectomies and spinal reconstructions, 2 anterior releases, and 2 biopsies. Cases were reviewed to evaluate the efficacy, surgical results, and complications of the thoracoscopic procedures.

Thoracoscopic resection of thoracic neurogenic tumors.

Object: The authors describe the treatment and results of thoracoscopic resection performed in patients with neurogenic tumors.

Methods: Seven patients with large intrathoracic paraspinal neurogenic tumors underwent a thoracoscopic procedure to achieve gross-total resection. All tumors were entirely intrathoracic and treated thoracoscopically except in one patient whose tumor had an intraspinal extension.

Carotid dissection: technical factors affecting endovascular therapy.

Background And Purpose: To delineate factors associated with the successful endovascular treatment of extracranial carotid dissections, the authors review their management of 13 cases.

Methods: The records of 12 patients with 13 dissections were assessed with reference to mechanism of dissection, preoperative symptoms, presence of a pseudoaneurysm, treatment success, and etiology of treatment failure. Patients were followed prospectively and included six men and six women, ranging in age from 27 to 62 years.

Biportal thoracoscopic sympathectomy: surgical techniques and clinical results for the treatment of hyperhidrosis.

Objective: To describe a bilateral thoracoscopic sympathectomy procedure, using a biportal approach, for the treatment of severe hyperhidrosis.

Methods: Between May 1996 and September 2000, 103 consecutive patients underwent thoracoscopic sympathectomy procedures to treat bilateral hyperhidrosis (206 procedures). Operative results, complications, and patient satisfaction were determined by reviews of hospital and office charts and by follow-up assessments in the outpatient clinic.