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Felipe C. Albuquerque

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Patrick P. Han, Felipe C. Albuquerque, Francisco A. Ponce, Christopher I. Mackay, Joseph M. Zabramski, Robert F. Spetzler, and Cameron G. McDougall

I ntracranial stent placement is an emerging procedure for the treatment of cerebrovascular disease. 2, 13, 14, 20, 28–30, 37, 38, 41 To date few reports on the technique and results of stent placement for nonatherosclerotic intracranial cerebrovascular disease have been published. 18, 36, 46 Gruber, et al., 15 described outcomes in the embolization of 31 very large (> 2 cm) or giant aneurysms with GDCs, without the addition of a stent. Only five of 25 aneurysms originally deemed more than 90% occluded displayed a stable degree of occlusion on angiograms

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M. Yashar S. Kalani, Ali M. Elhadi, Wyatt Ramey, Peter Nakaji, Felipe C. Albuquerque, Cameron G. McDougall, Joseph M. Zabramski, and Robert F. Spetzler

T he incidence of aneurysms in the pediatric population is not well established, but several studies suggest that between 1% and 5% of all aneurysms occur in children. 3 , 5 , 7 , 8 , 13–15 It is speculated that the etiology of aneurysm formation in children may be different than in adults, as a disproportionate number of pediatric aneurysms are large to giant and fusiform or dissecting. 5 , 8 , 14 These characteristics of pediatric aneurysms make them challenging for standard microsurgical treatment options. Although endovascular techniques are a well

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Richard W. Williamson, David A. Wilson, Adib A. Abla, Cameron G. McDougall, Peter Nakaji, Felipe C. Albuquerque, and Robert F. Spetzler

A neurysms of the posterior inferior cerebellar artery (PICA) are relatively rare, comprising approximately 0.5%–3% of all intracranial aneurysms. 10 , 11 , 14 , 15 The majority of patients with these aneurysms present with a subarachnoid hemorrhage (SAH), although patients can occasionally present with symptoms secondary to mass effect on the brainstem or lower cranial nerves. 15 The location of the PICAs next to the medulla and lower cranial nerves can make treatment challenging, especially in the face of SAH. 7 , 16 Both microsurgical and

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Yin C. Hu, Vivek R. Deshmukh, Felipe C. Albuquerque, David Fiorella, Randal R. Nixon, Donald V. Heck, Stanley L. Barnwell, and Cameron G. McDougall

T he Pipeline Embolization Device (PED) (ev3-Covidien) is an effective tool in the treatment of complex intracranial aneurysms of the anterior circulation and is generally associated with a low complication rate. 4 , 5 A recently noted phenomenon is delayed ipsilateral intraparenchymal hemorrhage (IPH) observed in patients days to weeks after the uneventful treatment of their aneurysms. 7 Although the incidence of IPH appears low, sporadic, and unpredictable, the pathophysiology of this adverse event has been difficult to elucidate. The present report

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Adib A. Abla, David A. Wilson, Richard W. Williamson, Peter Nakaji, Cameron G. McDougall, Joseph M. Zabramski, Felipe C. Albuquerque, and Robert F. Spetzler

basal cisterns or fissures. 9 We sought to further study the relationship between aneurysm location and maximum SAH burden in patients enrolled in a prospective randomized controlled trial. In addition to assessing differences in bleed thickness with different aneurysm types, we also investigated whether differences in the location of ruptured aneurysms can further influence the risk for developing symptomatic or radiographic vasospasm. Methods Study Criteria and Data Acquisition We analyzed 250 patients with SAH who had been enrolled in a prospective

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Adib A. Abla, Hasan A. Zaidi, R. Webster Crowley, Gavin W. Britz, Cameron G. McDougall, Felipe C. Albuquerque, and Robert F. Spetzler

T he Pipeline Embolization Device (PED) (ev3 Inc.) is now approved by the FDA for use in the US for internal carotid artery (ICA) aneurysms. Despite excellent results in a host of series, 1 , 6 , 8 there are still some disadvantages and caveats when the device is used for the treatment of difficult intracranial aneurysms. 2–5 , 9 , 13 , 14 , 16 We describe a case in which Pipeline embolization resulted in incomplete treatment and intraaneurysmal thrombus formation, causing mass effect on the optic chiasm and necessitating further treatment. Case

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Joshua S. Catapano, Stefan W. Koester, Visish M. Srinivasan, Mohamed A. Labib, Neil Majmundar, Candice L. Nguyen, Caleb Rutledge, Tyler S. Cole, Jacob F. Baranoski, Andrew F. Ducruet, Felipe C. Albuquerque, Robert F. Spetzler, and Michael T. Lawton

O phthalmic artery (OA) aneurysms are surgically challenging lesions surrounded by adjacent critical structures within a small subarachnoid space. 1–4 In addition to the complexity of these aneurysms, extensive drilling of the anterior clinoid and optic strut and dissection of the distal dural ring and roof of the cavernous sinus are required, as well as the occasional need for proximal control in the neck. 4 Although the intricate anatomy of this region makes microsurgical clipping more difficult, there are distinct benefits associated with clipping

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Robert F. Spetzler, Joseph M. Zabramski, Cameron G. McDougall, Felipe C. Albuquerque, Nancy K. Hills, Robert C. Wallace, and Peter Nakaji

T he 6-year results of the Barrow Ruptured Aneurysm Trial (BRAT) have been presented previously. 11 This trial used a prospective intent-to-treat design that randomized all patients who were admitted with a diagnosis of subarachnoid hemorrhage (SAH) to either a coiling or a clipping cohort. The design of the BRAT thus included patients with various types of aneurysms as well as patients who presented with a nonaneurysmal SAH. This all-inclusive patient database provides a unique opportunity to assess the frequency and treatment results of the various causes of

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Robert F. Spetzler, Felipe C. Albuquerque, Joseph M. Zabramski, and Peter Nakaji

W e thank Drs. Riina and Barker, Dr. Cockroft, and Dr. Amenta and colleagues for their remarks. We will address each in turn. We appreciate the nice summary of our publication by Drs. Riina and Barker. However, we believe that it is irrelevant whether a stent is added or whether clinicians have strong feelings about the right treatment in the absence of supporting data. We applaud Dr. Cockroft on his erudite and elegant discourse on the results of the Barrow Ruptured Aneurysm Trial (BRAT). Dr. Cockroft, arguing for a “more nuanced view of individualized care