BACKGROUND: In treating cavernous sinus dural arteriovenous fistulae (CSdAVFs), transvenous embolization of the whole affected sinus is usually performed, which may result in the disturbance of normal venous drainage or permanent cranial nerve palsy.
BACKGROUND AND IMPORTANCE: Flow diversion with the pipeline embolization device (PED) is an emerging endovascular technology allowing curative embolization of very large and giant intracranial aneurysms. Many patients with these complex aneurysms are older. The presence of a tortuous type III aortic arch reduces the chances of successful PED delivery and increases the risk of complications. We report 2 technical nuances regarding the delivery of the PED in older patients with a complex aortic arch.
BACKGROUND AND IMPORTANCE: Although medical treatment has been considered a dogma for chronic total occlusion (CTO) of the carotid artery, use of endovascular recanalization has also been reported. However, there are some difficulties in performing endovascular recanalization. We present the novel technical details and advantages of hybrid surgery for recanalization of symptomatic CTO of the internal carotid artery (ICA).
BACKGROUND: A subset of basilar apex aneurysms are unsuitable for either primary microsurgical clipping or endovascular coiling. These complex aneurysms can be treated by terminal basilar artery occlusion, but only if collateral circulation is adequate. To circumvent these complications, a high-flow vertebral artery-posterior cerebral artery or middle cerebral artery-posterior cerebral artery bypass may be performed to create an adequate collateral circulation to allow treatment of the aneurysm by basilar artery occlusion and/or clipping.
BACKGROUND AND IMPORTANCE: The use of flow-diverting stents has gained acceptance during the past few years for the treatment of numerous intracranial aneurysms, especially large or giant ones. However, successful catheterization of the distal parent artery in giant intracranial aneurysms with a microcatheter can be extremely challenging. Forming a microcatheter loop in the aneurysm sac can aid distal catheterization.
BACKGROUND AND IMPORTANCE: The safety of flow-diverting stents for the treatment of ruptured intracranial aneurysms is unknown.
BACKGROUND: The transfemoral approach is a common technique for coil embolization of cerebral aneurysms in the anterior cerebral circulation. However, it is difficult to advance a guiding catheter into the carotid artery via the femoral route in patients with a tortuous aortic arch, an unfavorable supra-aortic takeoff, aortic diseases, or occlusion of the femoral artery.
BACKGROUND: Percutaneous radiofrequency cordotomy (PRFC) involves controlled ablation of the anterolateral quadrant of the spinal cord, thereby relieving pain. Evolving from a morbid open surgery, the procedure has been modernized through the application of physiological target confirmation, well-regulated thermal ablation, and improved intraoperative imaging.
BACKGROUND: Stereotactic radiosurgery is ideal for treating small cerebral arteriovenous malformations (AVMs) that are surgically inaccessible. However, given the inherent delay of AVM obliteration and the potential for radiosurgical failure, detailed evaluation of the neurovascular architecture is necessary to monitor persistence of residual flow. Modern imaging systems such as magnetic resonance imaging (MRI) and angiography allow clinicians to assess transnidus flow after radiosurgical intervention.
BACKGROUND: Eloquent intracranial arteriovenous malformations (AVMs) located in the primary motor or somatosensory cortex (PMSC) carry a high risk of microsurgical morbidity.
BACKGROUND: The middle cerebral artery (MCA) is the most frequent location for unruptured intracranial aneurysms. Controversy remains as to which unruptured MCA aneurysms should be treated prophylactically.
BACKGROUND: Detection of procedural thromboembolism by diffusion-weighted magnetic resonance imaging (MR-DWI+) can help identify and mitigate endovascular risk factors. Data remain scant on procedural MR-DWI+ following the use of the Neuroform open-cell design stent in aneurysm embolization.
BACKGROUND: Cerebral infarction is a major contributor to poor outcome after subarachnoid hemorrhage (SAH). Although usually considered a complication of delayed cerebral ischemia, infarcts may also occur early, in relation to initial brain injury or aneurysm-securing procedures.
BACKGROUND: Technological advances have resulted in diminishing perioperative complications reported during carotid artery stenting (CAS) trials. Because trial experience lags behind technological advances, an understanding of the incidence of perioperative complications after CAS remains in flux.
BACKGROUND: Large or giant complex vertebrobasilar junction aneurysms have a dismal natural history and are often challenging to treat with standard endovascular or neurosurgical techniques.
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