Cerebral Aneurysms: Conventional Microsurgical Technique and Endovascular Method

Abstract:

Recent advances in neurosurgery and interventional neuroradiology have brought us a new aspect in the treatment of cerebral aneurysms. The present series provides a balanced overview of the treatment of aneurysms in surgical clipping and coil embolization. Between January 2004 and March 2006, a total of 119 consecutive patients with cerebral aneurysms underwent endovascular embolization or surgical clipping. Of these, 79 patients suffered an aneurysmal subarachnoid hemorrhage (SAH), whereas the remaining 40 patients had nonruptured cerebral aneurysms. Of the 32 surgically treated patients, 25 (78.1%) achieved a favorable outcome. Of the 47 patients who underwent endovascular embolization, 38 (80.9%) achieved a favorable outcome. No significant difference was observed regarding the proportion of favorable outcomes between the two treatment modalities. Four patients (5.5%) who underwent endovascular embolization required re-treatments but no re-treatments were needed in the surgically treated patients. Of the 40 cases with nonruptured aneurysms, 12 (30%) were treated using surgical clipping, whereas 28 (70%) underwent endovascular embolization. The complication rates of the two treatment modalities demonstrated no significant difference. A combined microsurgical-endovascular team approach is thus considered to provide the most effective means to achieve favorable outcomes for patients with cerebral aneurysms. A case-by-case evaluation based on the individual characteristics of each aneurysm is therefore considered to be essential.

Authors:

Yasuhiko Kaku, M.D., Hirotaka Watarai, M.D., Chief Resident; Jouji Kokuzawa, M.D., Toshiki Tanaka, M.D., Takashi Andoh, M.D., Asahi University Murakami Memorial Hospital, Gifu, Japan

Buy and download instantly for only $69!

$69.00
Order Article Copies 

For Direct IP Access please click this link

Intraoperative MRI: Technology, Systems, and Application to Pediatric Brain Tumors

Abstract:

Intraoperative magnetic resonance imaging (MRI) is a revolutionary technology that provides real-time assessment of surgical goals for the neurosurgeon. This technology has rapidly evolved over the past 15 years and currently is used for a wide variety of pathologies. These include gliomas, pituitary adenomas, epileptogenic foci, and complex hydrocephalus. Early generations of similar systems were bulky, tedious, and had marginal image quality. The next generation of systems provided improved image quality, easier surgical access, the ability to incorporate advanced imaging modalities, and integrated neuronavigation. This chapter reviews the intraoperative MRI technology, the various systems currently available, and the application of this technology to pediatric brain tumors. Continued refinements in the design of these systems will likely make them standard of care in the near future.

Authors:

Amer Samdani, M.D., Shriner's Hospital for Children, Philadelphia, Pennsylvania, USA; George I. Jallo, M.D., Johns Hopkins University, Baltimore, Maryland, USA

Buy and download instantly for only $69!

$69.00
Order Article Copies 

For Direct IP Access please click this link