180 degrees of the circumference of the parent vessel, present a unique therapeutic challenge, particularly in circumstances in which a decon" />
Abstract:
INTRODUCTION:Circumferential aneurysms, which incorporate >180 degrees of the circumference of the parent vessel, present a unique therapeutic challenge, particularly in circumstances in which a deconstructive treatment strategy is not feasible. We detail a novel technique for endovascular parent vessel reconstruction with aneurysm embolization. METHODS:We performed a retrospective review of the prospectively maintained databases of our two institutions to identify cases in which a balloon-in-stent technique had been used to treat circumferential aneurysms. During the first stage of this technique, a stent (Neuroform [Boston Scientific, Natick, MA], Multilink Vision [Guidant, Indianapolis, IN], or Bx Velocity [Cordis, New Brunswick, NJ]) is placed across the neck of the aneurysm to achieve parent vessel reconstruction. During the second stage, aneurysm coil embolization is performed with a compliant temporary occlusion balloon (Sentry [Boston Scientific, Natick, MA] or Hyperglide [Microtherapeutics, Irvine, CA]) placed within the stent to unambiguously demarcate and protect the parent vessel. In some cases, during the course of the embolization, coils project over and obscure the parent vessel in both working views. Before each coil detachment, the protection balloon is deflated under blank fluoroscopic roadmap visualization. The absence of shifting of any portion of the coil mass during balloon deflation indicates that the introduced coil is external to the stent-reconstructed parent vessel (i.e., within the aneurysm) and can be detached. This process is repeated until satisfactory aneurysm embolization is achieved. After embolization, the balloon catheter may be exchanged for a stent delivery system to facilitate the placement of a second stent. RESULTS:Seven patients underwent balloon-in-stent-assisted embolization over a 15-month period. Three were performed for internal carotid aneurysms, three for basilar trunk or basilar apex aneurysms, and one for a dissecting/fusiform V4 segment vertebral artery aneurysm. In three cases, the presence of the inflated balloon facilitated the manipulation of the image intensifier into a position which produced a "down-the-barrel" view of the parent vessel. In the four additional cases, for anatomic reasons, this view could not be achieved and coil mass projected over the reconstructed parent vessel in both views. Partial aneurysm occlusion (75-90%), was achieved in five cases, and near complete (>95%) occlusion was achieved in two cases. Complications included two significant retroperitoneal hematomas and two brainstem infarcts, both of which resulted in hemisensory symptoms. CONCLUSION:The balloon-in-stent technique provides a practical and safe treatment strategy for the management of circumferential aneurysms that are not amenable to deconstructive embolization.
journal_name
Neurosurgeryjournal_title
Neurosurgeryauthors
Fiorella D,Albuquerque FC,Masaryk TJ,Rasmussen PA,McDougall CGdoi
10.1227/01.neu.0000186036.35823.10subject
Has Abstractpub_date
2005-12-01 00:00:00pages
1218-27; discussion 1218-27issue
6eissn
0148-396Xissn
1524-4040pii
00006123-200512000-00018journal_volume
57pub_type
杂志文章,多中心研究相关文献
NEUROSURGERY文献大全abstract::Two patients with spinal dural arteriovenous malformations associated with intramedullary changes confirmed by the T2-weighted magnetic resonance imaging (MRI) scans are reported. The characteristics of the MRI findings for these 2 patients were as follows. 1) In the T2-weighted spin-echo image, intramedullary changes...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/00006123-198906000-00023
更新日期:1989-06-01 00:00:00
abstract::An operative repair technique for crushed sciatic nerve in the rat was used to examine whether removal of the damaged tissue could be better achieved with a low wattage CO2 laser or a blade. This approach was compared to results in rats undergoing conventional end-to-end nerve anastomosis using a microsurgical approac...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/00006123-198803000-00014
更新日期:1988-03-01 00:00:00
abstract::A new model of subacute compression of the spinal cord is described. Using an expanding epidural mass, a gradual, progressive, and highly reproducible neurological deficit was induced in rats over a 7-day period, resulting in paraplegia. Studies of spinal cord edema, disruption of the blood-spinal cord barrier, and so...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/00006123-198906000-00011
更新日期:1989-06-01 00:00:00
abstract::A silicone, dual cuffed catheter designed for the control of nasal hemorrhage was used for rectal sphincter pressure monitoring. Patients with lipomyelomeningocele and tethered spinal cord were monitored during their operative procedures to aid in distinguishing sacral nerve roots from other tissues. Stimulation of sa...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/00006123-198905000-00023
更新日期:1989-05-01 00:00:00
abstract::The authors present a case of acute aggravation of subdural effusion associated with pachymeningitis carcinomatosa. Microscopic examination of a surgical specimen revealed diffuse involvement of the dura mater by a metastatic adenocarcinoma in which the tumor cells invaded venules located in the areolar layer in parti...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1097/00006123-199109000-00025
更新日期:1991-09-01 00:00:00
abstract::Evidence has accumulated that indicates that laminectomy with or without radiotherapy is not necessarily the best mode of treatment for all cases of spinal cord compression of malignant pathogenesis. Success is limited, and there is a high risk of adverse neurological developments, particularly where there is anterior...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/00006123-198905000-00009
更新日期:1989-05-01 00:00:00
abstract::A case of ulnar neuropathy at the elbow produced by spontaneous intraneural hemorrhage in a patient with acquired immunodeficiency syndrome and thrombocytopenia is reported. Intraneural hemorrhage in patients with bleeding disorders occurs infrequently. It consists of acute intrafascicular bleeding, presumably produci...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1097/00006123-199102000-00019
更新日期:1991-02-01 00:00:00
abstract:OBJECTIVE:To describe the pathological features of three very similar and unusual primary central nervous system tumors that are not readily recognized as conventional ependymomas but which, by ultrastructural examination, have an ependymomatous character. METHODS:Three distinctive tumors were found in a review of our...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/01.neu.0000079628.55729.12
更新日期:2003-09-01 00:00:00
abstract:OBJECTIVE:To analyze the incidence and impact of an intracerebral hematoma (ICH) on treatment and outcome in patients with aneurysmal subarachnoid hemorrhage. METHODS:Data of 585 consecutive patients with subarachnoid hemorrhage from June 1999 to December 2005 were prospectively entered in a database. ICH was diagnose...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/01.NEU.0000335170.76722.B9
更新日期:2008-12-01 00:00:00
abstract:OBJECTIVE AND IMPORTANCE:The coexistence of spinal arteriovenous malformation (AVM) with congenital abnormalities is relatively common. However, the association of a spinal AVM and lipoma is rare. We present an adult patient with this combined anomaly and discuss the clinical relevance of this case. CLINICAL PRESENTAT...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/01.neu.0000171028.96829.69
更新日期:2005-09-01 00:00:00
abstract:OBJECTIVE:Although endoscopic perforation of the septum pellucidum in obstruction of the foramen of Monro is well known, detailed reports on endoscopic septostomy, including surgical technique and results are lacking in the literature. METHODS:All intracranial endoscopic procedures performed between February 1993 and ...
journal_title:Neurosurgery
pub_type: 临床试验,杂志文章
doi:10.1227/01.NEU.0000338944.42411.67
更新日期:2009-03-01 00:00:00
abstract::Localization of the placental form of glutathione S-transferase (GST-pi) messenger ribonucleic acid (mRNA) in three human glioma cell lines (A172, T98G, and Tc77) was studied by in situ hybridization with digoxigenin-labeled GST-pi complementary DNA followed by immunocytochemistry with antidigoxigenin antibody. A172 g...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/00006123-199307000-00016
更新日期:1993-07-01 00:00:00
abstract::Seventy-nine patients harboring recurrent brain tumors received four cycles of infraophthalmic carotid injections of 160 mg of carmustine. Two milligrams of intravenous vincristine and 50 mg of oral procarbazine was also administered three times daily for 1 week in conjunction with each BCNU treatment. The response ra...
journal_title:Neurosurgery
pub_type: 临床试验,杂志文章
doi:10.1227/00006123-199202000-00012
更新日期:1992-02-01 00:00:00
abstract::This study analyzes the changes induced by subarachnoid hemorrhage (SAH) on the serotonin (5-hydroxytryptamine, 5-HT) uptake and release evoked in rabbit basilar arteries by tyramine. Rabbits were injected with 5 ml of autologous arterial blood into the cisterna magna to produce SAH. Tritium accumulation in basilar ar...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:
更新日期:1991-03-01 00:00:00
abstract:BACKGROUND:Markers of coagulation have shown to have important value in predicting traumatic brain injury outcome. OBJECTIVE:To externally validate and investigate the role of markers of coagulation for outcome prediction by using the International Mission for Prognosis and Analysis of Clinical Trials (IMPACT) model w...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/01.neu.0000430326.40763.ec
更新日期:2013-08-01 00:00:00
abstract::Boron neutron capture therapy (BNCT) is based on the nuclear reaction that occurs when boron-10, a stable isotope, is irradiated with low-energy thermal neutrons to yield alpha particles and recoiling lithium-7 nuclei. For BNCT to be successful, a large number of 10B atoms must be localized on or preferably within neo...
journal_title:Neurosurgery
pub_type: 杂志文章,评审
doi:10.1097/00006123-199903000-00001
更新日期:1999-03-01 00:00:00
abstract:OBJECTIVE:We sought to determine the risk of adverse outcome after contemporary surgical treatment of patients with unruptured intracranial aneurysms in the United States. Patient, surgeon, and hospital characteristics were tested as potential outcome predictors, with particular attention to the surgeon's and hospital'...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:
更新日期:2003-05-01 00:00:00
abstract:OBJECTIVE:A quantitative analysis of intraoperative cortical shift and deformation was performed to gain a better understanding of the nature and extent of this problem and the resultant loss of spatial accuracy in surgical procedures coregistered to preoperative imaging studies. METHODS:Three-dimensional feature trac...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1097/00006123-199810000-00010
更新日期:1998-10-01 00:00:00
abstract::The authors present a review of published experience with intracranial-extracranial arterial bypass grafting. The procedure is technically feasible and has a relatively low morbidity and mortality when performed by experienced microvascular surgeons. However, its therapeutic value is still unproven. ...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/00006123-197807000-00014
更新日期:1978-07-01 00:00:00
abstract:OBJECTIVE:To review the natural history and determine the rates of intra- and extralesional hemorrhaging of brainstem cavernous malformations (cavernomas) monitored by one neuro-ophthalmology service. METHODS:A record review of all patients with brainstem cavernomas who were evaluated by a neuroophthalmology service b...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1097/00006123-200101000-00007
更新日期:2001-01-01 00:00:00
abstract:BACKGROUND:Improved training in the socioeconomic aspects of medicine is a priority of the Accreditation Council for Graduate Medical Education and the American Board of Neurological Surgeons. There is evidence that young neurosurgeons feel ill equipped in these areas and that additional education would improve patient...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/NEU.0000000000001126
更新日期:2016-09-01 00:00:00
abstract:OBJECTIVE:Carotid endarterectomy with a patch graft (Patch CEA) has been our standard treatment for patients with carotid artery stenosis, but carotid artery stenting (CAS) has emerged as an alternative. The purpose of this study was to compare the postoperative changes in the configurations and the flow velocities of ...
journal_title:Neurosurgery
pub_type: 临床试验,杂志文章
doi:10.1227/01.NEU.0000358952.12917.DF
更新日期:2009-11-01 00:00:00
abstract:BACKGROUND:Spine stereotactic body radiotherapy (sSBRT) is commonly limited to 1 or 2 vertebral levels given a paucity of efficacy and toxicity data when more than 2 levels are treated. OBJECTIVE:To prove our hypothesis that multilevel sSBRT could provide similar rates of local control (LC) (primary endpoint) and toxi...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1093/neuros/nyz348
更新日期:2020-02-01 00:00:00
abstract::Clinical problems are often complex. Problems of great complexity are usually associated with a commensurately greater degree of difficulty with respect to the decision making process. This is most certainly true regarding the management of cervical spondylosis. Usually, clinicians make clinically appropriate decision...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/01.NEU.0000249279.79686.E3
更新日期:2007-01-01 00:00:00
abstract::A consecutive series of 100 individuals with aneurysmal subarachnoid hemorrhage were subjected to early aneurysm operation followed by subsequent intravenous administration of the calcium antagonist nimodipine during the critical period for symptomatic vasospasm. A total of 85 patients were in Hunt and Hess neurologic...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/00006123-198602000-00005
更新日期:1986-02-01 00:00:00
abstract:BACKGROUND:There are no established variables that predict the success of curative resective epilepsy surgery in children with tuberous sclerosis complex (TSC). OBJECTIVE:We performed a multicenter observational study to identify preoperative factors associated with seizure outcome in children with TSC undergoing rese...
journal_title:Neurosurgery
pub_type: 杂志文章,多中心研究
doi:10.1227/NEU.0000000000000875
更新日期:2015-10-01 00:00:00
abstract::A very rare case of Petriellidium boydii pachymeningitis is described. Rarer still is the stabilization of this case for a prolonged period. Miconazole and ketaconazole both seemed useful in the treatment, and their role is discussed. ...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/00006123-198402000-00019
更新日期:1984-02-01 00:00:00
abstract::The paraclinoid area is investigated anatomically for possible microneurosurgical approaches to the C3 segment of the internal carotid artery and to structures in the vicinity of the anterior siphon knee. Removal of the anterior clinoid process reveals a tight connective tissue ring that fixes the internal carotid art...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:
更新日期:1988-05-01 00:00:00
abstract::The authors report a case of cranial plasmacytoma with multiple myelomas and palsy of the lower cranial nerves. The osteolytic lesion adjacent to the jugular foramen was demonstrated by an angiogram to be exceedingly hypervascular, with arteriovenous shunting resembling that seen in paragangliomas. Forty-five cases of...
journal_title:Neurosurgery
pub_type: 杂志文章,评审
doi:10.1097/00006123-199012000-00018
更新日期:1990-12-01 00:00:00
abstract:BACKGROUND:Spinal surgery costs vary significantly across hospitals and regions, but there is insufficient understanding of what drives this variation. OBJECTIVE:To examine the factors underlying the cost variation for lumbar laminectomy/discectomy and lumbar fusions. METHODS:We obtained patient information (age, gen...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1093/neuros/nyx047
更新日期:2017-08-01 00:00:00