Abstract:
OBJECT:Patients with fusiform aneurysms can present with subarachnoid hemorrhage (SAH), mass effect, ischemia, or unrelated symptoms. The absence of an aneurysm neck impedes the direct application of a clip and endovascular coil deployment. To evaluate the effects of their treatments, the authors retrospectively analyzed a consecutive series of patients with posterior circulation fusiform aneurysms treated at Stanford University Medical Center between 1991 and 2005. METHODS:Forty-nine patients (mean age 53 years, male/female ratio 1.2:1) treated at the authors' medical center form the basis of the analysis. Twenty-nine patients presented with an SAH. The patients presenting without SAH had cranial nerve dysfunction (five patients), symptoms of mass effect (eight patients), ischemia (six patients), or unrelated symptoms (one patient). The aneurysms were located on the vertebral artery (VA) or posterior inferior cerebellar artery (PICA) (21 patients); vertebrobasilar junction (VBJ) or basilar artery (BA) (18 patients); and posterior cerebral artery (PCA) (10 patients). Pretreatment clinical grades were determined using the Hunt and Hess scale; for patients with unruptured aneurysms (Hunt and Hess Grade 0) functional subgrades were added. Outcome was evaluated using the Glasgow Outcome Scale (GOS) score during a mean follow-up period of 33 months. Overall long-term outcome was good (GOS Score 4 or 5) in 59%, poor (GOS Score 2 or 3) in 16%, and fatal (GOS Score 1) in 24% of the patients. In a univariate analysis, poor outcome was predicted by age greater than 55 years, VBJ location, pretreatment Hunt and Hess grade in patients presenting with SAH, and incomplete aneurysm thrombosis after endovascular treatment. In a multivariate analysis, age greater than 55 years was the confounding factor predicting poor outcome. Stratification by aneurysm location removed the effect of age. Of 13 patients with residual aneurysm after treatment, five (38%) subsequently died of SAH (three patients) or progressive mass effect/brainstem ischemia (two patients). CONCLUSIONS:Certain posterior circulation aneurysm locations (PCA, VA-PICA, and BA-VBJ) represent separate disease entities affecting patients at different ages with distinct patterns of presentation, treatment options, and outcomes. Favorable overall long-term outcome can be achieved in 90% of patients with PCA aneurysms, in 60% of those with VA-PICA aneurysms, and in 39% of those with BA-VBJ aneurysms when using endovascular and surgical techniques. The natural history of the disease was poor in patients with incomplete aneurysm thrombosis after treatment.
journal_name
J Neurosurgjournal_title
Journal of neurosurgeryauthors
Coert BA,Chang SD,Do HM,Marks MP,Steinberg GKdoi
10.3171/jns.2007.106.5.855subject
Has Abstractpub_date
2007-05-01 00:00:00pages
855-65issue
5eissn
0022-3085issn
1933-0693journal_volume
106pub_type
杂志文章abstract::Neurological injury to the lumbosacral plexus associated with pelvic and sacral fractures has traditionally been treated conservatively, despite significant and often debilitating functional deficits of the lower extremities. The authors report a case of reconstruction of the lumbosacral plexus, including nerve grafti...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/ped.2005.102.1.0086
更新日期:2005-01-01 00:00:00
abstract::Iniencephaly is a rare congenital anomaly characterized by spina bifida of the cervical vertebrae, fixed retroflexion of the head on the cervical spine, and occipital bone defect. There are only five reports of surviving patients with iniencephaly. The authors report the case of a newborn who presented with iniencepha...
journal_title:Journal of neurosurgery
pub_type: 杂志文章,评审
doi:10.3171/jns.1998.89.2.0317
更新日期:1998-08-01 00:00:00
abstract:OBJECT:Subarachnoid hemorrhage (SAH) from ruptured posterior inferior cerebellar artery (PICA) aneurysms is uncommon, and long-term outcome data for patients who have suffered such hemorrhages is lacking. This study investigated in-hospital and long-term clinical data from a prospective cohort of patients with SAH from...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2014.10.JNS141079
更新日期:2015-08-01 00:00:00
abstract::The authors present a surgical case of a lipoma of the cerebellopontine angle in a 28-year-old woman. ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1977.46.4.0544
更新日期:1977-04-01 00:00:00
abstract::OBJECTIVE The presence, extent, and distribution of intraventricular hemorrhage (IVH) have been associated with negative outcomes in aneurysmal subarachnoid hemorrhage (SAH). Several qualitative scores (Fisher grade, LeRoux score, and Graeb score) have been established for evaluating SAH and IVH. However, no study has...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2016.11.JNS152839
更新日期:2018-04-01 00:00:00
abstract::The case of a 33-year-old woman with bilateral partial agenesis (type D) of the posterior arch of the atlas and recurrent transient quadriparesis due to contusion of the spinal cord after minor cervical trauma is described. At least some patients with type C or D congenital anomalies of the posterior arch of the atlas...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1996.84.4.0663
更新日期:1996-04-01 00:00:00
abstract:OBJECT:Radiosurgery and radiation therapy represent important but unique treatment paradigms for patients with certain neoplasms, vascular lesions, or functional disorders. The authors discuss their differences. METHODS:Reviewing the authors' experiences shows how the roles of these approaches vary just as their techn...
journal_title:Journal of neurosurgery
pub_type: 杂志文章,评审
doi:10.3171/jns.2004.101.4.0585
更新日期:2004-10-01 00:00:00
abstract:OBJECT:Stereotactic radiosurgery (SRS) is an important treatment option for patients with cavernous sinus meningiomas (CSM). To analyze factors associated with local tumor control and complications after single-fraction SRS, the authors reviewed cases involving patients treated with Gamma Knife SRS between 1990 and 200...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2013.5.JNS13206
更新日期:2013-09-01 00:00:00
abstract:OBJECT:Outcomes of 1019 brachial plexus lesions in patients who underwent surgery at Louisiana State University Health Sciences Center during a 30-year period are reviewed in this paper to provide management guidelines. METHODS:Causes of brachial plexus lesions included 509 stretches/contusions (50%), 161 plexus tumor...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2003.98.5.1005
更新日期:2003-05-01 00:00:00
abstract:OBJECT:An increasing number of patients with vestibular schwannomas (VSs) are being treated with radiosurgery. Treatment failure or secondary regrowth after radiosurgery, however, has been observed in 2%-9% of patients. In large tumors that compress the brainstem and in patients who experience rapid neurological deteri...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2011.12.JNS111682
更新日期:2012-04-01 00:00:00
abstract::The effect of suppression of postischemic reactive hyperemia on the blood-brain barrier (BBB) and ischemic brain edema after temporary focal cerebral ischemia was studied in cats under ketamine and alpha-chloralose anesthesia. Regional cerebral blood flow (rCBF) was measured by a thermal diffusion method and a hydroge...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1989.70.1.0073
更新日期:1989-01-01 00:00:00
abstract::Tenascin is an extracellular matrix glycoprotein expressed during both normal development and neoplastic growth in both neural and nonneural tissues. During development of the central nervous system (CNS), tenascin is synthesized by glial cells, in particular by immature astrocytes, and is concentrated in transient bo...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1995.82.1.0106
更新日期:1995-01-01 00:00:00
abstract:OBJECT:Subarachnoid hemorrhage (SAH) with simultaneous acute subdural hematoma (SDH) is a severe disease. The authors' objective was to analyze the incidence, prognosis, and clinical outcome of patients suffering from aneurysm-related SAH and space-occupying acute SDH. METHODS:Between June 1999 and June 2011, data fro...
journal_title:Journal of neurosurgery
pub_type: 杂志文章,评审
doi:10.3171/2012.11.JNS121435
更新日期:2013-05-01 00:00:00
abstract::The use of a serum-free culture system for assessing the growth factor responsiveness of malignant glial cells is described. The mitogenic properties of epidermal growth factor (EGF) and platelet-derived growth factor (PDGF) were examined in three human malignant glioma cell lines (T98G, U87, and U138). Each of the th...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1990.73.1.0106
更新日期:1990-07-01 00:00:00
abstract:OBJECT:Shock waves have been experimentally applied to various neurosurgical treatments including fragmentation of cerebral emboli, perforation of cyst walls or tissue, and delivery of drugs into cells. Nevertheless, the application of shock waves to clinical neurosurgery remains challenging because the threshold for s...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2007.106.4.667
更新日期:2007-04-01 00:00:00
abstract:OBJECT:To establish a new method for the diagnosis of central nervous system diseases, the authors visualized the cerebral cisterns and ventricles via a percutaneous lumbosacral route by using newly developed fine, flexible fiberscopes. METHODS:Fine, flexible fiberscopes, 0.9 and 1.4 mm in diameter, were introduced up...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2007.12.17287
更新日期:2009-02-01 00:00:00
abstract::The angiographic appearance of an intracranial arterial occlusion is typically distinct from that of a saccular aneurysm, with only a few reported cases of occlusion simulating aneurysm. At the same time, a small percentage of symptomatic intracranial aneurysms present with a stroke. Accurate diagnosis of these condit...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/JNS.2008.109.12.1123
更新日期:2008-12-01 00:00:00
abstract::Endolymphatic sac tumors (ELSTs) are locally invasive neoplasms that arise in the posterior petrous bone and are associated with von Hippel-Lindau (VHL) disease. These tumors cause symptoms even when microscopic in size (below the threshold for detectability on imaging studies) and can lead to symptoms such as hearing...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/JNS-07/08/0421
更新日期:2007-08-01 00:00:00
abstract::The fibrinolytic activity in cerebrospinal fluid has been monitored by determination of levels of fibrin split products (FSP) in 23 patients with ruptured intracranial aneurysms. In 20 of these 23, FSP was found in the cerebrospinal fluid (CSF), with levels ranging from 10 to 80 micrograms/ml. Eleven of the 23 patient...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1980.52.4.0453
更新日期:1980-04-01 00:00:00
abstract:OBJECT:The authors investigated whether skull base resection and primary free-flap reconstruction in a single-stage surgery is oncologically effective for treating advanced stages of recurrent skin cancer (RSC) of the head. METHODS:Eighteen consecutive patients were surgically treated. Twelve of them underwent an ante...
journal_title:Journal of neurosurgery
pub_type: 临床试验,杂志文章
doi:10.3171/jns.2004.100.4.0652
更新日期:2004-04-01 00:00:00
abstract:OBJECT:Neurocognitive performance is used to assess multiple cognitive domains, including motor coordination, before and after carotid endarterectomy (CEA). Although gross motor strength is impaired with ischemia of large cortical areas or of the internal capsule, the authors hypothesize that patients undergoing CEA de...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2014.8.JNS1459
更新日期:2015-01-01 00:00:00
abstract::Although posterior plates are increasingly used to manage cervical spinal instability, long-term follow-up evaluation of patients with a critical analysis of efficacy and complications has not been reported. The authors have retrospectively analyzed the outcome in 44 consecutive patients (37 males and seven females, a...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1994.81.3.0341
更新日期:1994-09-01 00:00:00
abstract::The results of treatment of neoplastic spinal cord compression by vertebral body resection and immediate stabilization in 101 consecutive patients over a 5-year period have been analyzed. Sites of primary cancer included the lung (25 patients), kidney (15 patients), breast (14 patients), connective tissue (12 patients...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1985.63.5.0676
更新日期:1985-11-01 00:00:00
abstract:OBJECT:Chronic subdural hematomas (CSDHs) recur in 7 to 18% of cases. The present study was conducted to determine whether serum or lesion concentrations of coagulofibrinolytic and angiogenic factors, which have been reported to be potential markers of CSDH development, might predict such recurrences. METHODS:Sixty co...
journal_title:Journal of neurosurgery
pub_type: 临床试验,杂志文章
doi:10.3171/jns.2006.104.1.79
更新日期:2006-01-01 00:00:00
abstract::OBJECTIVECerebral cavernous malformations (CCMs) are frequently diagnosed vascular malformations of the brain. Although most CCMs are asymptomatic, some can be responsible for intracerebral hemorrhage or seizures. In selected cases, microsurgical resection is the preferred treatment option. Treatment with the unselect...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2017.12.JNS172404
更新日期:2018-06-15 00:00:00
abstract:OBJECT:The authors performed a study to review outcomes following Gamma Knife radiosurgery for cerebral arteriovenous malformations (AVMs) and to create a practical scale to predict long-term outcome. METHODS:Outcomes were reviewed in 1012 patients who were followed up for more than 2 years. Favorable outcome was defi...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2013.5.JNS1311
更新日期:2013-10-01 00:00:00
abstract::Rhombencephalosynapsis (RS) is a relatively rare developmental disorder of the cerebellum in which the cerebellar hemispheres are fused across the midline without being separated by a cleft or the vermis. The condition may be associated with hydrocephalus and other intracranial and extracranial abnormalities. The auth...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2000.93.2.0323
更新日期:2000-08-01 00:00:00
abstract:OBJECT:Meningoencephaloceles are congenital malformations that have a high incidence in the population of Southeast Asia. Frontoethmoidal meningoencephaloceles, the most common variety, require surgical treatment. The authors combined neurosurgical and craniofacial approaches for the development of a simple technique t...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/ped.2006.104.5.326
更新日期:2006-05-01 00:00:00
abstract::OBJECTIVE Dysfunction of distributed neural networks underlies many brain disorders. The development of neuromodulation therapies depends on a better understanding of these networks. Invasive human brain recordings have a favorable temporal and spatial resolution for the analysis of network phenomena but have generall...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2016.11.JNS161162
更新日期:2018-02-01 00:00:00
abstract::A case is reported of a patient in whom an intracranial extracerebral melanoma developed in association with a life-long nevus of Ota. Melanotic pigmentation of the skull, periosteum, and meninges beneath the nevus was found at operation. ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1983.58.2.0280
更新日期:1983-02-01 00:00:00