Retreatment of Residual and Recurrent Aneurysms After Embolization With the Woven EndoBridge Device: Multicenter Case Series.

Background: The Woven EndoBridge (WEB) device (Terumno Corp. [parent company of Microvention]) was approved by the U.S.

Novel use of robotics and navigation for anterior lumbar total disc replacement surgery.

The ability to navigate the anterior lumbar disc space may improve clinical outcomes and implant longevity. However, no robotic navigation systems are presently authorized by the U.S.

Endovascular Stenting of Tandem Carotid Artery Origin and Bifurcation Stenotic Lesions Using Flow Reversal.

Background: The treatment of tandem lesions involving severe stenosis of the internal carotid artery with concomitant stenosis of the ipsilateral common carotid artery (CCA) origin represents an ongoing challenge. Current options for the treatment of tandem carotid artery origin and bifurcation stenotic lesions include open surgical endarterectomy, endovascular stenting, balloon angioplasty, and hybrid procedures combining both modalities. However, these options are either associated with high peri-operative risks or not always anatomically feasible.

Treatment of iatrogenic V2 segment vertebral artery pseudoaneurysm using Pipeline flow-diverting stent.

Background: Iatrogenic injury to the vertebral artery is a rare but potential complication of cervical spine surgery. Previous authors have commented on the use of flow-diverting stents for treatment of aneurysms of the V3 segment of the vertebral artery.

Case Description: Here, we report a case in which injury occurred at the V2 segment of the vertebral artery with the development of a pseudoaneurysm, which was found on angiography.

A proposed grading system for standardizing tumor consistency of intracranial meningiomas.

Object: Tumor consistency plays an important and underrecognized role in the surgeon's ability to resect meningiomas, especially with evolving trends toward minimally invasive and keyhole surgical approaches. Aside from descriptors such as "hard" or "soft," no objective criteria exist for grading, studying, and conveying the consistency of meningiomas.

Methods: The authors designed a practical 5-point scale for intraoperative grading of meningiomas based on the surgeon's ability to internally debulk the tumor and on the subsequent resistance to folding of the tumor capsule.

Is bridging with intravenous thrombolysis of any benefit in endovascular therapy for acute ischemic stroke?

Objective: Large vessel occlusions with heavy clot burden are less likely to improve with intravenous (IV) thrombolysis alone. The purpose of this study was to show whether a combination of IV thrombolysis and endovascular therapy was superior to endovascular treatment alone.

Methods: Data for 104 patients with acute large artery occlusion treated between 2005 and 2010 were reviewed.

Feasibility, safety, and periprocedural complications associated with endovascular treatment of selected ruptured aneurysms under conscious sedation and local anesthesia.

Background: Endovascular coil embolization of ruptured aneurysms is performed under general anesthesia at most centers for perceived improved image quality and patient safety.

Objective: To report the feasibility of and outcomes associated with endovascular treatment of subarachnoid hemorrhage (SAH) patients with ruptured cerebral aneurysms performed under conscious sedation with local anesthetics.

Methods: Between January 2005 and December 2009, 187 patients with aneurysmal SAH were treated with coil embolization at the authors' hospital.

Extent of resection and early postoperative outcomes following removal of cystic vestibular schwannomas: surgical experience over a decade and review of the literature.

Object: Vestibular schwannomas (VSs) are benign tumors of the eighth cranial nerve sheath, representing approximately 6%-8% of all newly diagnosed brain tumors, with an annual incidence of 2000-2500 cases in the US. Although most of these lesions are solid, cystic vestibular schwannomas (CVSs) compose 4%-20% of all VSs and are commonly larger at the time of presentation. The authors present their experience with the operative management of CVSs, including surgical approach, extent of resection, and postoperative facial nerve outcomes.

Treatment and outcomes of acute intracranial vertebrobasilar artery occlusion: one institution's experience.

Object: The treatment of acute intracranial vertebrobasilar artery occlusion (VBO) has been described but often with poor results. The authors of this study set out to evaluate their institution's outcomes following multimodal treatment of VBO.

Methods: They retrospectively reviewed their endovascular database for all patients treated for acute intracranial VBO between December 2004 and June 2010.

Endovascular coil embolization of a very small ruptured aneurysm using a novel microangiographic technique: technical note.

Endovascular treatment of very small aneurysms is technically difficult, although recent advances with coils, microcatheters and adjunctive techniques such as balloon- or stent-assisted coiling have improved the outcomes. The microangiographic fluoroscope (MAF) is a new high-resolution x-ray detector developed for neurointerventional procedures in which superior resolution is required within a small field of view. We report the successful coil embolization of a very small ruptured anterior communicating artery aneurysm using the MAF technique.

Posterior inferior cerebellar artery to posterior inferior cerebellar artery in situ bypass for the treatment of Bow hunter's-type dynamic ischemia in holovertebral dissection.

Background: Bow hunter's syndrome is a rare cause of vertebrobasilar insufficiency arising from mechanical compression of the vertebral artery (VA) during rotation of the head. Surgical treatment usually involves direct decompression of the VA at the site of compression. We describe what is to our knowledge the first reported case of a posterior inferior cerebellar artery (PICA)-to-PICA in situ bypass for treatment of Bow hunter's-type ischemia in a patient with a VA dissection.

Perioperative safety of Hydrosoft coils.

Objective: Hydrosoft coils were developed to serve as finishing coils to prevent aneurysmal recurrence at the neck. Initial animal studies were encouraging since some studies showed endothelial healing across the neck without recurrence over time. However, theoretical concerns exist regarding the potential threat to parent vessels as the Hydrosoft coils at the neck expand, as well as whether such coils can be adequately supple to safely serve as a true finishing coil.

Horizontal deployment of an intracranial stent via an antegrade approach for coil embolization of a basilar apex aneurysm: technical note.

The treatment of basilar apex aneurysms has progressively become more minimalistic in nature. Although initial coil embolizations were geared towards those aneurysms with a favorable neck to dome ratio, wide necked aneurysms have also been increasingly treated by the endovascular route. Several techniques have been described in the stent assisted coiling of basilar apex aneurysms, including the Y stent formation, waffle cone technique and horizontal stenting.

Use of the Outreach Distal Access Catheter for microcatheter stabilization during intracranial arteriovenous malformation embolization.

The Outreach DAC is an intermediate-sized catheter designed for use with the Merci clot retriever in acute stroke. We investigated its utility as an adjunctive device during AVM pedicle embolization. In the authors' opinion, the DAC provided additional guide-catheter and microcatheter support, improved selective angiographic visualization of AVM angioarchitecture, aided microcatheter removal from its embedded position in the AVM Onyx cast, and enhanced local microcatheter control and safety, compared with embolization with the guide and microcatheter alone.

Cerebral arteriovenous malformations: issues of the interplay between stereotactic radiosurgery and endovascular surgical therapy.

Intracranial arteriovenous malformations (AVMs) are congenital lesions frequently diagnosed as a result of hemorrhage or other neurological symptoms. Prevention of such devastating neurological injury has promoted a variety of treatment strategies. The rich history of multimodal therapy in the treatment of AVMs includes microsurgery, endovascular embolization, and stereotactic radiosurgery (SRS).

Use of the microangiographic fluoroscope for coiling of intracranial aneurysms.

Background: Neurointervention is an ever-evolving specialty with tools including microcatheters, microwires, and coils that allow treatment of pathological conditions in increasingly smaller intracranial arteries, requiring increasing accuracy. As endovascular tools evolve, so too should the imaging.

Objective: To detail the use of microangiography performed with a novel fluoroscope during coiling of intracranial aneurysms in 2 separate patients and discuss the benefits and potential limitations of the technology.

Utility of CT perfusion scanning in patient selection for acute stroke intervention: experience at University at Buffalo Neurosurgery-Millard Fillmore Gates Circle Hospital.

Computed tomography perfusion scanning generates physiological flow parameters of the brain parenchyma, allowing differentiation of ischemic penumbra and core infarct. Perfusion maps, along with the National Institutes of Health Stroke Scale score, are used as the bases for endovascular stroke intervention at the authors' institute, regardless of the time interval from stroke onset. With case examples, the authors illustrate their perfusion-based imaging guidelines in patient selection for endovascular treatment in the setting of acute stroke.

Intra-arterial thrombolysis and thrombectomy for acute ischemic stroke: technique and results.

Endovascular intraarterial (IA) strategies have emerged as important treatment options for patients with acute ischemic stroke who are ineligible for intravenous (IV) tissue plasminogen activator (tPA) or in whom such therapy has failed. The goal of this article is to provide a comprehensive review of percutaneous IA endovascular techniques aimed at revascularization in the setting of acute ischemic stroke from IA thrombolysis, mechanical thrombectomy, and primary intracranial stenting to retrievable-stent technology. For each modality, we focus on the existing clinical data, including our institutional experience and techniques.

Endovascular management of spinal dural arteriovenous fistulas. A review.

Object: Spinal dural arteriovenous fistulas (DAVFs) are the most common spinal vascular malformations and can be a significant cause of myelopathy, yet remain inefficiently diagnosed lesions. Over the last several decades, the treatment of spinal DAVFs has improved tremendously due to improvements in neuroimaging, microsurgical, and endovascular techniques. The aim of this paper was to review the existing literature regarding the clinical characteristics, classification, and endovascular management of spinal DAVFs.

HoxD10 gene delivery using adenovirus/adeno-associate hybrid virus inhibits the proliferation and tumorigenicity of GH4 pituitary lactotrope tumor cells.

Prolactinoma is one of the most common types of pituitary adenoma. It has been reported that a variety of growth factors and cytokines regulating cell growth and angiogenesis play an important role in the growth of prolactinoma. HoxD10 has been shown to impair endothelial cell migration, block angiogenesis, and maintain a differentiated phenotype of cells.

Waldenström's macroglobulinemia and large B-cell central nervous system lymphoma: a case report.

Background: Waldenström's macroglobulinemia is a low-grade B-cell lymphoma characterized by monoclonal synthesis and secretion of IgM antibodies [3]. The classic symptoms of WM result from blood hyperviscosity. Neurologic symptoms, such as fatigue, dizziness, and blurred vision, are common.

Islet cell differentiation in liver by combinatorial expression of transcription factors neurogenin-3, BETA2, and RIPE3b1.

Transcription factors, such as PDX-1, that normally mediate pancreatic development are capable of inducing hepatic progenitor cells to differentiate into cells with pancreatic islet characteristics. We hypothesized that simultaneous expression of multiple transcription factors involved in islet development might enhance the differentiation of hepatic progenitor cells. Bi- or tri-cistronic constructs were generated in hybrid adenovirus/adeno-associated virus (Ad/AAV) vectors containing neurogenin 3 (NGN3), BETA2 (NeuroD), and RIPE3b1 (MafA), each of which plays a role in islet cell differentiation.