Ahead of Print: In-Stent Stenosis Following Stent-Assisted Coiling

Background: Neuroform and Enterprise are widely utilized self-expanding stents designed for the treatment of wide-necked intracranial aneurysms.

Objective: To assess the incidence, clinical significance, predictors, and outcomes of in-stent stenosis (ISS).

Methods: Angiographic studies and hospital records were retrospectively reviewed for 435 patients treated between 2005-2011 in our institution. A multivariable regression analysis was conducted to determine predictors of ISS.

Ahead of Print: Bypass for Unclippable MCA Aneurysms

Background: Giant middle cerebral artery (MCA) aneurysms pose management challenges.

Objective: To review the outcomes of patients with giant MCA aneurysms not amenable to clipping or vessel reconstruction treated with extracranial-intracranial (EC-IC) bypass and vessel sacrifice.

Methods: We retrospectively reviewed a database of aneurysms treated at our institution between 1983 and 2011.

Ahead of Print: Pterional versus Keyhole Approach

Background: Recent advancements in microsurgical techniques and instrumentation have allowed the development of the keyhole approach in aneurysm surgery.

Objective: To compare the safety, efficacy, and 1-year clinical outcome of supra-orbital keyhole and standard pterional approaches for ruptured anterior circulation aneurysms.

Methods: A total of 87 patients underwent surgical clipping, 40 through the pterional and 47 through the supra-orbital keyhole approach. Baseline demographics, operative time, procedural complications, and 1-year patient outcome were retrospectively compared.

Ahead of Print: EVD-Related Vascular Injury

Background: Placement of an external ventricular drain (EVD) is a commonly performed and often life-saving procedure. Although hemorrhage is one of the most common complications associated with the procedure, ventricular catheter-induced vascular injury is rarely reported.

Objective: We describe 9 cases of EVD-related vascular trauma: 7 arteriovenous fistulae and 2 traumatic aneurysms.

Methods: During a 3-year period, 299 patients had EVDs placed. Eight patients (2.75%), 3 male and 5 female, mean age 48 +/- 20 years, developed vascular lesions associated with EVDs. Six patients developed arteriovenous fistulae (AVFs) and 2 patients developed a traumatic aneurysm. The arterial feeders of five superficial draining fistulae arose from the middle meningeal artery, and the arterial feeder of a deep draining fistula originated from a lenticulostriate artery. One traumatic aneurysm arose from a distal branch of the anterior cerebral artery, and the second from a branch of the superficial temporal artery. Four of the superficial fistulae were treated with transarterial embolization.

Free CME Editor Choice Article: Intraoperative Angiography in Craniotomies

Background: In an era of indocyanine angiography, the routine use of intraoperative angiography (IOA) in the surgical treatment of aneurysms and vascular malformations is controversial.

Objective: To retrospectively assess the safety and efficacy of IOA and to determine predictors of surgical revision.

Methods: Between 2003 and 2011, IOA was performed during surgical treatment of 976 aneurysms, 101 arteriovenous malformations (AVMs), and 16 arteriovenous fistulas.