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23 results

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  • Chapter 13 - Combined Retrosigmoid and Orbitozygomatic Approach

  • from Section II - Open Combined Approaches
  • Edited by Vijay Agarwal
  • Book:
    Integrated Management of Complex Intracranial Lesions
    Published online:
    05 October 2021
    Print publication:
    21 October 2021, pp 140-149

  • Summary

    Neurosurgical lesions that span the supratentorial and infratentorial compartments can pose a significant challenge. Although these lesions are traditionally addressed using transpetrosal approaches, skull base principles can be maintained and successful resection achieved with the combination of less extensive surgical approaches. Through the combination of the orbitozygomatic and retrosigmoid approaches, the vast majority of anterior, middle, and posterior fossa pathology can be successfully resected. Over the past two decades at our institution, the orbitozygomatic and retrosigmoid approaches have largely replaced the more traditional transpetrosal approaches, with the combined two-stage orbitozygomatic-plus-retrosigmoid approach being utilized when necessary.

Comprehensive Management of Arteriovenous Malformations of the Brain and Spine
  • Edited by Robert F. Spetzler, Douglas S. Kondziolka, Randall T. Higashida, M. Yashar S. Kalani
  • Published online:
    05 January 2015
    Print publication:
    08 January 2015
  • Vascular malformations of the brain and spine pose many management challenges. This text provides a comprehensive, state-of-the-art review of the natural history, treatment options, and outcomes of patients with these conditions. Despite their relative rarity, these lesions are responsible for devastating injury to individuals and can cause an enduring physical, psychological, and economic burden on patients and families. Many new therapeutic options are now available with the advent of novel surgical, endovascular, and radiosurgical techniques. The basic sciences have fuelled development of small molecule and biologic therapies targeting the molecular basis of disease. Authored by international experts in the fields of neurosurgery, neurology, radiology, and radiation oncology, this book provides state-of-the-art treatment plans and discussions of ideal therapy. This text is aimed at practitioners in the fields of neurology, neurosurgery, neuroradiology, radiation oncology, rehabilitation medicine and allied fields who care for patients with brain and spinal vascular malformations.

  • Carotid Dissection: Technical Factors Affecting Endovascular Therapy

  • Felipe C. Albuquerque, Patrick P. Han, Robert F. Spetzler, Joseph M. Zabramski, Cameron G. McDougall
  • Journal:
    Canadian Journal of Neurological Sciences / Volume 29 / Issue 1 / February 2002
    Published online by Cambridge University Press:
    02 December 2014, pp. 54-60
    • Article
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  • Background and Purpose:

    To delineate factors associated with the successful endovascular treatment of extracranial carotid dissections, the authors review their management of 13 cases.

    Methods:

    The records of 12 patients with 13 dissections were assessed with reference to mechanism of dissection, preoperative symptoms, presence of a pseudoaneurysm, treatment success, and etiology of treatment failure. Patients were followed prospectively and included six men and six women, ranging in age from 27 to 62 years.

    Results:

    Angioplasty and stenting were performed successfully in 11 of 13 procedures (10 of 12 patients). Follow-up in these 10 patients demonstrated excellent patency through the stented segment in nine of the 11 treated vessels. Two patients, both of whom suffered their original dissection as a result of endarterectomy, required further angioplasty and stenting for stenosis outside the previously treated arterial segment. Regarding the treatment failures, a stent deployment device could not navigate a tortuous loop in one, while a microwire could not be advanced beyond a pseudoaneurysm in the second. Six patients had pseudoaneurysms, four of which were treated only with stenting across the dissected arterial segment. All pseudoaneurysms treated in this fashion resolved. No permanent complications occurred as a result of endovascular therapy.

    Conclusions:

    Angioplasty and stenting can be performed safely to manage carotid dissection. A pseudoaneurysm or tortuous anatomy can preclude therapy although the former typically resolves if angioplasty and stenting are feasible. Dissections secondary to endarterectomy may be associated with a higher rate of restenosis after stenting and may require further treatment.

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