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Bradley A. Gross, Stefan A. Mindea, Anthony J. Pick, James P. Chandler and H. Hunt Batjer

disease because the majority of patients with this disease have pituitary microadenomas. 28 Appropriate diagnosis and management of Cushing disease is important because the mortality rate in patients with this disease is at least fourfold that in the general population matched for age and sex. 42 Control of hypercortisolism leads to gradual improvement of bruising, myopathy, central obesity, glucose intolerance and hypertension, and rapid improvement of osteoporosis. 25 Although the initial presentation of a patient with such a constellation of

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Joseph G. Adel, Bernard R. Bendok, Ziad A. Hage, Andrew M. Naidech, Jeffery W. Miller and H. Hunt Batjer

S troke is the leading cause of disability and the third most common cause of death in the US. 16 Approximately 730,000 strokes occur each year in the US. Ten to 15% of those patients who present with carotid artery territory stroke or transient ischemic attack have an occluded ICA, 12 , 13 which is associated with high morbidity and mortality rates. Patients with a good clinical endarterectomy recovery after CAO still have an increased risk of recurrent stroke. The main medical task in such cases is to control vascular risk factors and start

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Daniel L. Surdell, Ziad A. Hage, Christopher S. Eddleman, Dhanesh K. Gupta, Bernard R. Bendok and H. Hunt Batjer

precludes its use for bypass when larger flow rates are needed. The graft patency rate can be well estimated from the EC-IC bypass trial 17 conducted in 1985. This study involved 663 STA-MCA bypass procedures performed for symptomatic ICA or MCA narrowing/occlusion. The graft patency was 96%, and the mean patient follow-up was 55.8 months. Morbidity from major stroke and mortality rates following surgery were 2.5 and 0.6%, respectively, at 30 days. 17 The OA Bypass The OA diameter and flow rates are similar to those of the STA. Recipient arteries may be the PICA or

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Christopher S. Eddleman, Michael C. Hurley, Andrew M. Naidech, H. Hunt Batjer and Bernard R. Bendok

D espite the fact that the initial mortality rate from aneurysmal SAH is very high (30–70%), the secondary effects also pose a significant risk of morbidity and mortality, namely delayed cerebral ischemia due to vasospasm, the second leading cause of death and disability in patients with aneurysmal SAH. 29 , 35 , 47 Often occurring in the larger proximal arteries either involved in the circle of Willis or branching from it, this delayed, reversible narrowing of the cerebral vessels is thought to occur 3–14 days after the hemorrhagic event. 17 , 29

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Christopher S. Eddleman, Michael C. Hurley, Bernard R. Bendok and H. Hunt Batjer

therapy. In the hands of experienced neurosurgeons, open surgical management of selected CCAs can lead to good results without significant morbidity or mortality, particularly in cases of distal or transitional CCAs in which part of the aneurysm may be in the subarachnoid space. Dolenc, Heros, and others have reported combined morbidity and mortality rates of 14–25% for direct surgical approaches. 13 , 15 , 23 , 24 , 26 , 58 Despite good surgical results, microsurgical constructive strategies for CCAs are difficult due to the intimate relationship of these lesions

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Omar M. Arnaout, Bradley A. Gross, Christopher S. Eddleman, Bernard R. Bendok, Christopher C. Getch and H. Hunt Batjer

Cooperative Study, 27 7 (27%) of 26 patients died as a result of their presenting hemorrhage. Fults and Kelly 12 noted that less than half of their patients with posterior fossa AVMs survived an initial hemorrhage, and hemorrhagic mortality rates of up to 66.7% have been reported for posterior fossa AVM rupture. 34 TABLE 1: Summary of clinical presentations in patients with posterior fossa AVMs in surgical series Authors & Year No. of Posterior Fossa AVMs Hemorrhagic Presentation (%) Other Presentation (%) Perret et al., 1966 32

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Martin Pham, Bradley A. Gross, Bernard R. Bendok, Issam A. Awad and H. Hunt Batjer

measuring posttreatment hemorrhage rates as a marker of radiosurgical efficacy. We reviewed results across an accumulating, heterogeneous body of literature detailing radiosurgery for AOVMs, highlighting postradiosurgery hemorrhage, morbidity, and mortality rates; seizure control; and the potential advantages and shortcomings of radiosurgical treatment. Methods A MEDLINE search was done for all reports that used the terms “AOVM,” “angiographically occult vascular malformation,” “CM,” or “cavernous malformation” with “radiosurgery.” Surgical series and reviews

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M. Sean Grady, H. Hunt Batjer and Ralph G. Dacey

the program directors and residents in neurosurgery training programs . Neurosurgery 56 : 398 – 403 , 2005 3 Cross DT III , Tirschwell DL , Clark MA , Tuden D , Derdeyn CP , Moran CJ , : Mortality rates after subarachnoid hemorrhage: variations according hospital case volume in 18 states . J Neurosurg 99 : 810 – 817 , 2003 4 Institute of Medicine of the National Academies : Hospital Based Emergency Care: At the Breaking Point Washington DC , National Academies Press , 2007 5 Vidyarthi AR , Arora V , Schnipper JL

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Rohan R. Lall, Christopher S. Eddleman, Bernard R. Bendok and H. Hunt Batjer

intracranial aneurysms are being incidentally discovered. The optimal procedural management of these lesions is still being debated, which can carry significant risk, with morbidity and mortality rates up to 10 and 2.5%, respectively. 21 , 29 However, due to the fact that aneurysm rupture can be such a catastrophic event, preventive treatment is desirable for high-risk lesions. Many groups have sought to find conclusive data on the natural history of unruptured aneurysms. The ISUIA trial was designed and conducted to provide such information. The ISUIA concluded that

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. The average age was 69. The average stenosis as measured by DSA was 83%. The mean and median time to treatment was 2.3 and 2 days respectively. Symptoms included a hemispheric stroke (71%), hemispheric TIA (20%), or an ocular symptom (9%). The average clinical or radiographic follow up was 332 days. No patient had evidence of restenosis >50% based on US. No patient required re-treatment. The peri-procedural morbidity and mortality rate was 3.3% and 3.3% respectively. Morbidity was comprised of 3 disabling strokes and one symptomatic parenchymal hemorrhage. The 4