111 research outputs found
Nanoparticle-Facilitated Delivery of Antioxidant Therapy following Aneurysmal Subarachnoid Hemorrhage
No full textFlow-Diverter Stent With an Incorporated Flow Sensor—The Integration of a Treatment and Diagnostic Device for Intracranial Aneurysms
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Supracerebellar Transtentorial Approach for Resection of a Basal Ganglia Thalamic Cavernous Malformation: 2-Dimensional Operative Video
No full textIn Reply: The Glossopharyngo-Cochlear Triangle-Part II: Case Series Highlighting the Clinical Application to High-Riding Posterior Inferior Cerebellar Artery Aneurysms Exposed Through the Extended Retrosigmoid Approach
No full textCerebral cavernous malformations: Review of the genetic and protein-protein interactions resulting in disease pathogenesis
No full textMutations in the genes KRIT1, CCM2, and PDCD10 are known to result in the formation of cerebral cavernous malformations (CCMs). CCMs are intracranial lesions comprised of aberrantly enlarged cavernous endothelial channels that can result in cerebral hemorrhage, seizures, and neurologic deficits. Although these genes have been known to be associated with CCMs since the 1990s, numerous discoveries have been made that better elucidate how they and their subsequent protein products are involved in CCM pathogenesis. Since our last review of the molecular genetics of CCM pathogenesis in 2012, breakthroughs include a more thorough understanding of the protein structures of the gene products, involvement with integrin proteins and MEKK3 signaling pathways, the importance of CCM2-PDCD10 interactions, and others. In this review, we highlight the advances that further our understanding of the gene to protein to disease relationships of CCMs
Resection of Quadrigeminal Midbrain Cavernous Malformation Using the Supracollicular Safe Entry Zone
No full textBrainstem cavernous malformations (BSCMs) are rare and challenging neurosurgical lesions that demand a sophisticated and nuanced strategy for resection. A key element of surgical planning for BSCM resection is brainstem safe entry zones, a set of neuroanatomically defined locations where a pial resection can be executed with minimal risk to the adjacent central nervous system tracts and nuclei. Quadrigeminal BSCMs are particularly unusual and can be accessed via the supra-, inter-, or infracollicular safe entry zones. We report a unique demonstration of the supracollicular safe entry zone for the resection of a symptomatic hemorrhagic quadrigeminal plate BSCM. A man in his early 60s presented with transient hearing loss and visual dysfunction. A right quadrigeminal midbrain cavernous malformation was identified on magnetic resonance imaging. Surgical resection was performed with the patient in the sitting position. A bipedicular suboccipital flap, torcular craniotomy, and midline supracerebellar infratentorial approach were used. The lesion itself was accessed via the supracollicular safe entry zone, where pial hemosiderin staining was also encountered, using a linear transverse incision just above the right superior colliculus. Gross total resection was achieved, and the patient recovered from surgery with no new neurologic deficits (Video 1)
Side-to-Side Superficial Temporal Artery to Middle Cerebral Artery Bypass Technique: Application of Fourth Generation Bypass in a Case of Adult Moyamoya Disease.
No full textBACKGROUND: Moyamoya disease (MMD) is a rare cause of cerebral hemorrhage and ischemia. Spontaneous development of collateral supply from the external carotid artery (ECA) may limit the use of donor arteries used in standard direct bypass techniques.
OBJECTIVE: To identify the technical feasibility of side-to-side (S-S) superficial temporal artery to middle cerebral artery (STA-MCA) bypass and demonstrate the application of fourth generational bypass techniques in the treatment of MMD.
METHODS: S-S bypass was performed in order to maintain distal outflow in the donor STA. Fourth generation bypass techniques, including atypical anastomosis construction and intraluminal suturing were utilized.
RESULTS: The novel S-S STA-MCA bypass was performed, with patent flow in both recipient MCA and endogenous ECA-ICA collaterals supplied by the distal STA. Technical nuances, including proper alignment of donor vessel, tension reduction, and S-S anastomosis construction with intraluminal suturing technique are essential for successful bypass. Unique flow properties of this bypass were identified, resulting in flow augmentation to the recipient territory compared to standard end-to-side (E-S) techniques.
CONCLUSION: Fourth generational bypass techniques can be successfully applied to MMD, allowing for novel bypass construction. S-S anastomosis can result in potentially beneficial flow properties compared to standard E-S constructions
The middle communicating artery: a novel fourth-generation bypass for revascularizing trapped middle cerebral artery bifurcation aneurysms in 2 cases
No full textThe anterior and posterior communicating arteries are natural connections between arteries that enable different adjacent circulations to redistribute blood flow instantly in response to changing supply and demand. An analogous communication does not exist in the middle cerebral circulation. A middle communicating artery (MCoA) can be created microsurgically between separate middle cerebral artery (MCA) trunks, enabling flow to redistribute in response to changing supply and demand. The MCoA would draw blood flow from an adjacent circulation such as the external carotid circulation. The MCoA requires the application of fourth-generation techniques to reconstruct bi- and trifurcations after occluding complex MCA trunk aneurysms. In this report, the authors describe two recent cases of complex MCA bi- and trifurcation aneurysms in which the occluded efferent trunks were revascularized by creating an MCoA. The first MCoA was created with a “double-barrel” superficial temporal artery-M2 segment bypass and end-to-end reimplantation of the middle and inferior MCA trunks. The second MCoA was created with an external carotid artery-radial artery graft-M2 segment interpositional bypass and end-to-side reimplantation of the inferior trunk onto the superior trunk. Both aneurysms were occluded, and both patients experienced good outcomes. This report introduces the concept of the MCoA and demonstrates two variations. Angioarchitectural and technical elements include the donation of flow from an adjacent circulation, a communicating bypass, the application of fourth-generation bypass techniques, and a minimized ischemia time. The MCoA construct is ideally suited for rebuilding bi- and trifurcated anatomy after trapping or distally occluding complex MCA aneurysms
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