Microsurgical clipping of an unruptured basilar apex aneurysm.

Unruptured posterior circulation aneurysms pose a treatment challenge. Although data supports the use of endovascular technique for select ruptured cases, in unruptured cases, there may be clinical equipoise. Furthermore, wide-necked basilar apex aneurysms commonly require the use of stents and placement of patients on dual therapy.

Brain arteriovenous malformations.

An arteriovenous malformation is a tangle of dysplastic vessels (nidus) fed by arteries and drained by veins without intervening capillaries, forming a high-flow, low-resistance shunt between the arterial and venous systems. Arteriovenous malformations in the brain have a low estimated prevalence but are an important cause of intracerebral haemorrhage in young adults. For previously unruptured malformations, bleeding rates are approximately 1% per year.

Microvascular decompression for hemifacial spasm secondary to vertebrobasilar dolichoectasia: surgical strategies, technical nuances and clinical outcomes.

Hemifacial spasm (HFS) due to direct compression of the facial nerve by a dolichoectatic vertebrobasilar artery is rare. Vessels are often non-compliant and tethered by critical brainstem perforators. We set out to determine surgical strategies and outcomes for this challenging disease.

Normal perfusion pressure breakthrough theory: a reappraisal after 35 years.

The intrinsic ability of the brain to maintain constant cerebral blood flow (CBF) is known as cerebral pressure autoregulation. This ability protects the brain against cerebral ischemia and hyperemia within a certain range of blood pressures. The normal perfusion pressure breakthrough (NPPB) theory described by Spetzler in 1978 was adopted to explain the edema and hemorrhage that sometimes occur after resection of brain arteriovenous malformations (AVMs).

Indications and results of direct cerebral revascularization in the modern era.

Background: There has been a progressive decrease in the indications for cerebral revascularization during the past 30 years, particularly with the advance of endovascular techniques. Our objective was to define indications for and evaluate outcomes of patients treated with bypass surgery in the modern endovascular era.

Methods: We retrospectively reviewed the charts of all patients who underwent direct cerebral revascularization procedures between January 2006 and March 2013.

Human placenta aneurysm model for training neurosurgeons in vascular microsurgery.

Background: Neurosurgery, a demanding specialty, involves many microsurgical procedures that require complex skills, including open surgical treatment of intracranial aneurysms. Simulation or practice models may be useful for acquiring these skills before trainees perform surgery on human patients.

Objective: To describe a human placenta model for the creation and clipping of aneurysms.

Vertebral artery transposition for revascularization of the posterior circulation: a critical assessment of temporary and permanent complications and outcomes.

Object: Despite advances in medical management and endovascular therapies, including the introduction of statins, antiplatelet agents, and drug-eluting stents, some patients experience medically refractory vertebrobasilar insufficiency and may benefit from robust surgical revascularization. The aim of this study was to evaluate such patients after surgical revascularization, emphasizing long-term outcomes and rates of complications.

Methods: The authors retrospectively identified 22 patients (5 women and 17 men) whose mean age was 69.

Validation of the supplemented Spetzler-Martin grading system for brain arteriovenous malformations in a multicenter cohort of 1009 surgical patients.

Background: The supplementary grading system for brain arteriovenous malformations (AVMs) was introduced in 2010 as a tool for improving preoperative risk prediction and selecting surgical patients.

Objective: To demonstrate in this multicenter validation study that supplemented Spetzler-Martin (SM-Supp) grades have greater predictive accuracy than Spetzler-Martin (SM) grades alone.

Methods: Data collected from 1009 AVM patients who underwent AVM resection were used to compare the predictive powers of SM and SM-Supp grades.

A hierarchical model for the development of cerebral arteriovenous malformations.

Objective: Cerebral arteriovenous malformations (AVMs) are vascular lesions whose pathogenesis, although not fully elucidated, is likely multifactorial. Recent research investigating vessel development suggests a potential hierarchical model in which capillary sprouts from higher-flow arteries give rise to lower-flow veins. It is possible that an embryologic structural vascular dysgenesis in this hierarchical development heavily contributes to the formation of AVMs.

Urgent cerebral revascularization bypass surgery for iatrogenic skull base internal carotid artery injury.

Background: When feasible, the management of iatrogenic internal carotid artery (ICA) injury during skull base surgery is mainly endovascular.

Objective: To propose a cerebral revascularization procedure as a rescue option when endovascular treatment is not feasible.

Methods: We retrospectively reviewed all extracranial-intracranial (EC-IC) bypass procedures performed between July 2007 and January 2014.

Microsurgical resection of cervical spinal arteriovenous malformation: the pial resection technique.

We present the case of a 26-year-old female patient who had two episodes of sudden, left, upper and lower extremity paresthesias and weakness, which resolved completely after 5 months. After recovery, she presented for evaluation. Imaging demonstrated a C3-C6 intra- and extra-axial arteriovenous malformation (AVM) with spinal cord compression and edema.

Contemporary management of spinal AVFs and AVMs: lessons learned from 110 cases.

Object: Spinal arteriovenous fistulas (AVFs) and arteriovenous malformations (AVMs) are rare, complex spinal vascular lesions that are challenging to manage. Recently, understanding of these lesions has increased thanks to neuroimaging technology. Published reports of surgical results and clinical outcome are limited to small series.

Molecular and cellular biology of cerebral arteriovenous malformations: a review of current concepts and future trends in treatment.

Object: Arteriovenous malformations (AVMs) are classically described as congenital static lesions. However, in addition to rupturing, AVMs can undergo growth, remodeling, and regression. These phenomena are directly related to cellular, molecular, and physiological processes.

Lateral inferior cerebellar peduncle approach to dorsolateral medullary cavernous malformation.

Object: Brainstem cavernous malformations (BSCMs) present a unique therapeutic challenge to neurosurgeons. Resection of BSCMs is typically reserved for lesions that reach pial or ependymal surfaces. The current study investigates the lateral inferior cerebellar peduncle as a corridor to dorsolateral medullary BSCMs.

Twenty-year follow-up of flow reversal and revascularization for a giant serpentine basilar artery aneurysm.

Background And Importance: Current microsurgical and endovascular therapies have offered little advancement for the treatment of complex vertebrobasilar aneurysms. The outcome of patients with these rare lesions has remained poor, despite sometimes heroic measures.

Clinical Presentation: The authors report a case of a 65-year-old man who 20 years earlier had presented with symptoms suggestive of brainstem compression.