Safety of the APOLLO Onyx delivery microcatheter for embolization of brain arteriovenous malformations: results from a prospective post-market study.

Background: Catheter retention and difficulty in retrieval have been observed during embolization of brain arteriovenous malformations (bAVMs) with the Onyx liquid embolic system (Onyx). The Apollo Onyx delivery microcatheter (Apollo) is a single lumen catheter designed for controlled delivery of Onyx into the neurovasculature, with a detachable distal tip to aid catheter retrieval. This study evaluates the safety of the Apollo for delivery of Onyx during embolization of bAVMs.

Impact of Balloon Guide Catheter Use on Clinical and Angiographic Outcomes in the STRATIS Stroke Thrombectomy Registry.

Background and Purpose- Mechanical thrombectomy has been shown to improve clinical outcomes in patients with acute ischemic stroke. However, the impact of balloon guide catheter (BGC) use is not well established. Methods- STRATIS (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke) was a prospective, multicenter study of patients with large vessel occlusion treated with the Solitaire stent retriever as first-line therapy.

Interhospital Transfer Before Thrombectomy Is Associated With Delayed Treatment and Worse Outcome in the STRATIS Registry (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke).

Background: Endovascular treatment with mechanical thrombectomy (MT) is beneficial for patients with acute stroke suffering a large-vessel occlusion, although treatment efficacy is highly time-dependent. We hypothesized that interhospital transfer to endovascular-capable centers would result in treatment delays and worse clinical outcomes compared with direct presentation.

Methods: STRATIS (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke) was a prospective, multicenter, observational, single-arm study of real-world MT for acute stroke because of anterior-circulation large-vessel occlusion performed at 55 sites over 2 years, including 1000 patients with severe stroke and treated within 8 hours.

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.

Histopathological assessment of fatal ipsilateral intraparenchymal hemorrhages after the treatment of supraclinoid aneurysms with the Pipeline Embolization Device.

Object: Delayed ipsilateral intraparenchymal hemorrhage has been observed following aneurysm treatment with the Pipeline Embolization Device (PED). The relationship of this phenomenon to the device and/or procedure remains unclear. The authors present the results of histopathological analyses of the brain sections from 3 patients in whom fatal ipsilateral intracerebral hemorrhages developed several days after uneventful PED treatment of supraclinoid aneurysms.

Microsurgical treatment of pediatric intracranial aneurysms: long-term angiographic and clinical outcomes.

Background: Pediatric aneurysms are rare and complex to treat. Long-term angiographic and clinical data after microsurgical or endovascular therapies are lacking.

Objective: To study the clinical and radiographic outcomes in aneurysms in pediatric patients treated with microsurgery.

Bilateral vision, hearing impairment, and decreased level of consciousness in a patient hospitalized for new-onset seizure.

Middle-aged patients who present with new-onset visual loss, hearing impairment, or decreased level of consciousness usually represent a broad differential diagnosis. We present a 57-year-old man who developed all these symptoms a few days after hospitalization for new-onset seizures.

Cruciate paralysis secondary to traumatic atlantooccipital dislocation.

Cruciate paralysis is a clinical phenomenon thought to result from injury to decussating pyramidal tract fibers at the cervicomedullary junction, producing clinical findings of upper-extremity weakness out of proportion to the lower extremities. The authors present, to their knowledge, the first reported case of cruciate paralysis resulting from atlantooccipital dislocation.

Pleomorphic xanthoastrocytoma presenting with life-threatening hemorrhage in a child.

Pleomorphic xanthoastrocytomas are glial-based tumors that arise most frequently in young patients and usually follow a more benign and indolent clinical course than their other glial-based tumor counterparts. These tumors most frequently present with seizures, and only 3 previous case reports exist of hemorrhagic tumor as the clinical presentation. The authors present the first case of life-threatening intracerebral hemorrhage from pleomorphic xanthoastrocytoma in a child.

Resolution of mydriatic pupil after angioplasty and stenting of cervical internal carotid artery dissection: case report.

Objective: A patient with cervical internal carotid artery (ICA) dissection presented with visual loss and a mydriatic pupil that resolved after angioplasty and stenting.

Clinical Presentation: A 49-year-old woman presented with a unilateral dilated tonic pupil and transient monocular visual loss and subsequently developed speech disturbance. Angiography revealed a left cervical ICA dissection with significant luminal narrowing.

Anatomy of the mastoid emissary vein and venous system of the posterior neck region: neurosurgical implications.

Objective: The superficial venous system of the posterior neck (suboccipital venous plexus) is a potential source of complications from bleeding and air embolism. Because there is little information available about this in the literature, an anatomic study of the superficial posterior neck venous system and a morphometric analysis of the mastoid emissary vein (MEV) complex were undertaken. Both surgical and endovascular implications were considered.

Surgical treatment of high-risk intracranial dural arteriovenous fistulae: clinical outcomes and avoidance of complications.

Objective: An increasing number of intracranial dural arteriovenous fistulae (DAVFs) are amenable to endovascular treatment. However, a subset of patients with high-risk lesions requires surgical intervention for complete obliteration. We reviewed our experience with the surgical management of high-risk intracranial DAVFs and offer recommendations to minimize complications based on fistula location and type.

Giant, partially thrombosed aneurysm develops after remote angiographically negative subarachnoid hemorrhage: case report.

Objective: This is the first report of the rupture of a giant aneurysm in a patient who sustained a remote angiographically negative subarachnoid hemorrhage (SAH).

Clinical Presentation: A 62-year old woman initially presented with a Fisher Grade III SAH 9 years ago. Her evaluation, which included cerebral angiography, magnetic resonance imaging scans, and magnetic resonance angiography of the head and neck, failed to reveal the cause of the hemorrhage.

Application of a novel headrest system for odontoid screw fixation. Technical note.

The authors describe a unique headholder device adapted to facilitate the placement of anterior odontoid screws. The patient's head is affixed in the headholder equipped with an articulating arm that can be placed in a paramedian fashion. This configuration rigidly fixates the head and provides an unencumbered open-mouth view of the odontoid using radiographic images, thus making screw placement easier.

Synchronous endoscopy and microsurgery: a novel strategy to approach complex ventricular lesions. Report of three cases.

Simultaneous endoscopic and microsurgical (synchronous) approaches represent a new paradigm in the treatment of complex ventricular lesions. This technique is well suited for lesions that involve multiple ventricular or cisternal compartments, have a nonlinear axis, or adhere to critical anatomical or neurovascular structures. Two distinct operative corridors, one endoscopic and the other microsurgical, are used during synchronous approaches to address such lesions, increasing the likelihood of a safe and complete resection.

Bilateral ethmoidal dural arteriovenous fistulae: a previously unreported entity: case report.

Objective And Importance: Ethmoidal dural arteriovenous fistulas (AVFs) are rare intracranial lesions associated with a high risk of intracranial hemorrhage. Reported hemorrhage rates have ranged from 62 to 91%, and an aggressive clinical course is more likely than a benign clinical course. We describe the first case of a patient with bilateral ethmoidal dural AVFs.

An anatomical evaluation of the mini-supraorbital approach and comparison with standard craniotomies.

Objective: To compare anatomically the surgical exposure provided by pterional (PT), orbitozygomatic (OZ), and minisupraorbital (SO) craniotomies.

Methods: Seven sides of six fixed cadaver heads injected with silicone were used. The mini-SO craniotomy followed by the PT and OZ approaches were performed sequentially.

Durectomy and reconstruction for the treatment of a recurrent spinal meningioma. Case report.

The management of spinal meningiomas with extensive involvement of the dura mater is controversial. The principal difficulty in performing a resection is the potential for complications associated with this approach. The authors present the case of a pregnant 35-year-old woman in whom bilateral lower-extremity numbness, weakness, gait ataxia, and myelopathy developed.

Endovascular reconstruction with the Neuroform stent as monotherapy for the treatment of uncoilable intradural pseudoaneurysms.

Objective: Intradural pseudoaneurysms have a malignant natural history and can be difficult to treat if parent vessel deconstruction is not feasible. These lesions often involve a long arterial segment and lack a defined saccular component that would safely accommodate the introduction of embolization coils. The current report describes the successful endovascular treatment of these lesions using a strategy of Neuroform stent reconstruction.

Quantification and comparison of telovelar and transvermian approaches to the fourth ventricle.

Objective: To quantify the exposure to the fourth ventricle obtained with the telovelar and transvermian approaches.

Methods: The telovelar, with and without C1 posterior arch removal, and transvermian approaches were performed on six cadaveric heads. The area of surgical exposure was calculated from triangles formed by defined anatomic points.

Surgical management of distal coil migration and arterial perforation after attempted coil embolization of a ruptured ophthalmic artery aneurysm: technical case report.

Objective And Importance: Distal coil migration is a rare but hazardous complication of aneurysm coil embolization. Various microsnare devices have been developed to address this problem. We describe the surgical management of a case in which microsnare retrieval failed.

Long-term clinical and angiographic follow-up of unclippable wrapped intracranial aneurysms.

Objective: This is the largest contemporary series examining long-term clinical and angiographic follow-up of unclippable wrapped intracranial aneurysms.

Methods: The presentation, location and shape of aneurysm, wrapping technique, outcome at discharge and last follow-up, and change in aneurysm at last angiographic follow-up were reviewed retrospectively in 74 patients with wrapped or clip-wrapped aneurysms. Patients in whom wrapping was used in conjunction with primary clipping were excluded.

Resolution of hemifacial spasm after surgical obliteration of a tentorial arteriovenous fistula: case report.

Objective And Importance: We describe a patient with a tentorial dural arteriovenous fistula who presented with ipsilateral hemifacial spasm.

Clinical Presentation: A 50-year-old man sought treatment for left facial twitching that worsened over 6 months. Magnetic resonance imaging and catheter angiography demonstrated a left tentorial dural arteriovenous fistula.

Combined skull base approaches to the posterior fossa. Technical note.

Combined approaches to the skull base provide maximal exposure of the complex and eloquent anatomical structures contained within the posterior fossa. Common to these combined exposures are variable degrees of petrous bone removal. Understanding the advantages of each approach is critical when attempting to balance increases in operative exposure against the risk of potential complications.