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L. Nelson Hopkins

S erbinenko's 1974 article titled “Balloon catheterization and occlusion of major cerebral vessels” was a fascinating review of the innovative work that he and his colleagues had performed with homemade detachable balloons and balloon-tipped catheters over the previous decade. This work laid the foundation for much of the endovascular work with aneurysms performed over the subsequent two decades. Serbinenko used balloons very cleverly for multiple purposes including test occlusions of major cervical and intracranial vessels, evaluation of collateral

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Alan S. Boulos, Eric M. Deshaies, Richard D. Fessler, Shuta Aketa, Scott Standard, Lazlo Miskolczi, Lee R. Guterman, and L. Nelson Hopkins

A nimal aneurysm models have provided insight into the hemodynamics and pathophysiological features of aneurysm formation and rupture, as well as fostering new treatment modalities; 21, 22, 26 however, the existing animal aneurysm models have several limitations. For example, in small-animal models, serial diagnostic angiography is challenging because the arterial access site must be sacrificed at the conclusion of each angiography session, making subsequent arterial access difficult. Additionally, the narrow arterial lumen complicates the course of complex

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Yiemeng Hoi, Hui Meng, Scott H. Woodward, Bernard R. Bendok, Ricardo A. Hanel, Lee R. Guterman, and L. Nelson Hopkins

S troke is the third leading cause of death in the US. Subarachnoid hemorrhage accounts for approximately 7% of stroke cases and the majority of these cases are caused by rupture of a cerebral aneurysm. 28 Approximately 50% of patients with aneurysmal SAH will die or suffer severe disability as a result of the initial hemorrhage; another 23 to 35% will die as a result of subsequent hemorrhage if the aneurysm is not treated. 13 The pathogenesis of cerebral aneurysms is significantly influenced by the local hemodynamic environment; successful treatment must

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J Mocco and L. Nelson Hopkins

In this issue of the Journal of Neurosurgery , Mitchell and colleagues present a thorough post hoc analysis of the International Subarachnoid Aneurysm Trial (ISAT) data regarding the effect of rebleeding risk on the observed benefit of coil embolization as opposed to clip ligation in patients with aneurysmal subarachnoid hemorrhage (SAH). The original ISAT data demonstrated that patients harboring aneurysms that were amenable to either coil or clip treatments and who received coil embolization had a greater likelihood of being independent at 1 year. 1

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Robert D. Ecker and L. Nelson Hopkins

Since the publication of the retrospective part of the International Study of Unruptured Intracranial Aneurysms (ISUIA) in 1998, there has been a significant focus in the neurosurgical literature on the natural history of these lesions. The prospective data from the second part of the ISUIA, which was published in 2003, provided further evidence that small, asymptomatic intracranial aneurysms may have a more benign course than previously believed. With the data from the ISUIA as a reference point, in this paper the authors strive to provide a source of practical clinical data to aid cerebrovascular physicians in the initial decision to treat or observe a patient with a small, asymptomatic intracranial aneurysm. The issues covered will include previous rupture, symptoms other than rupture, aneurysm size, site, and aspect ratio. It is the authors' goal to provide a useful practical framework on the relevant clinical issues as an aid to practitioners treating patients who present with intracranial aneurysms.

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Robert D. Ecker, Ricardo A. Hanel, Elad I. Levy, and L. Nelson Hopkins

A ccording to prospective data from the International Study of Unruptured Intracranial Aneurysms, posterior circulation aneurysms carry the highest risk of rupture and operative complications. 6 Patients in both the endovascularly treated and open surgical groups with large posterior circulation aneurysms had complication and mortality rates of in excess of 20% after 1 year; however, patients older than 50 years of age fared better after endovascular treatment. As endovascular tools and techniques improve, creative solutions for technically challenging

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Benjamin L. Brown, Demetrius Lopes, David A. Miller, Rabih G. Tawk, Leonardo B. C. Brasiliense, Andrew Ringer, Eric Sauvageau, Ciarán J. Powers, Adam Arthur, Daniel Hoit, Kenneth Snyder, Adnan Siddiqui, Elad Levy, L. Nelson Hopkins, Hugo Cuellar, Rafael Rodriguez-Mercado, Erol Veznedaroglu, Mandy Binning, J Mocco, Pedro Aguilar-Salinas, Alan Boulos, Junichi Yamamoto, and Ricardo A. Hanel

M icrosurgery remains the gold standard for decompression of cranial nerves (CNs) affected by aneurysmal mass effect. Over the past 2 decades, coil embolization has gained rapid acceptance as a viable alternative. For the treatment of large unruptured aneurysms of the proximal internal carotid artery, flow diversion has grown in popularity as an alternative to both microsurgery and coil embolization. Cranial nerve compression is not an uncommon presenting symptom for these aneurysms. For cavernous aneurysms, the presenting symptom is diplopia in about 65

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Robert A. Mericle, Ajay K. Wakhloo, Demetrius K. Lopes, Giuseppe Lanzino, Lee R. Guterman, and L. Nelson Hopkins

E ndovascular treatment using Guglielmi detachable coils (GDCs) (Target Therapeutics/Boston Scientific Corporation, Fremont, CA) of select cerebral aneurysms has become accepted as an alternative to open surgery. At most academic centers in the United States, endovascular coiling is reserved for patients with unacceptable risks associated with craniotomy and aneurysm clipping. However, there are now institutions worldwide where GDC treatment is performed as primary therapy, even when surgical risks are minimal. The long-term outcome of GDC treatment is not

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Giuseppe Lanzino, Ajay K. Wakhloo, Richard D. Fessler, Mary L. Hartney, Lee R. Guterman, and L. Nelson Hopkins

I ntracranial internal carotid artery (ICA) aneurysms located at or near the skull base and wide-necked intracranial vertebral artery (VA) and basilar artery (BA) aneurysms represent therapeutic challenges. A direct surgical approach, although feasible, is technically difficult and accompanied by significant risks. Endovascular occlusion by using Guglielmi detachable coils (GDCs; Target Therapeutics/Boston Scientific, Fremont, CA) is frequently prevented by the complexity of the wide-necked, irregularly shaped aneurysms in these locations. Thus, parent vessel

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Christopher S. Ogilvy, Xinyu Yang, Osama A. Jamil, Erik F. Hauck, L. Nelson Hopkins, Adnan H. Siddiqui, and Elad I. Levy

M anagement strategies for the treatment of unruptured intracranial aneurysms continue to evolve. 5 , 6 , 10 , 15 , 17 , 20 , 23 , 32 There is ever-increasing literature on the utilization of endovascular techniques to treat unruptured intracranial aneurysms. 8 , 24 , 28 , 30 The investigators of the International Study of Unruptured Intracranial Aneurysms (ISUIA) reported the results of endovascular strategies used to treat intracranial aneurysms. 33 The combined treatment morbidity and mortality at 1 year was 7.1% in patients without previous