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Mason A. Brown, Jonathan Parish, Cristian F. Guandique, Troy D. Payner, Terry Horner, Thomas Leipzig, Karishma V. Rupani, Richard Kim, Bradley N. Bohnstedt and Aaron A. Cohen-Gadol

obliteration, clip slippage/breakage, or regrowth. The efficacy of clip ligation is high, and annual recurrence rates of 0.26% to 0.53% have been reported. 19 In addition, de novo aneurysms have been reported to occur at a rate of 0.84% to 1.8% per year. 3 , 11 , 19 , 20 Long-term angiographic study of surgically treated aneurysms has been used to monitor recurrence. 1 , 3 , 4 Currently, there is no established standard protocol for the timing or length of follow-up after microsurgical treatment. The known risk factors associated with aneurysm formation include

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Charles G. Kulwin and Aaron A. Cohen-Gadol

intracranial mass effect or hydrocephalus (7%–33%). 3 , 25 , 30 An important consideration is the management of hydrocephalus. Preoperative untreated hydrocephalus has previously been connected to poorer outcomes and higher complication rates. 18 , 34 The majority of patients do not require further treatment for their hydrocephalus besides tumor resection; however, a minority do not achieve such a goal and may require postoperative ventriculoperitoneal shunting. As expected, increased tumor size is a risk factor for development of postoperative hydrocephalus. 10 If

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Aaron A. Cohen-Gadol, Michael L. DiLuna and Dennis D. Spencer

patient denied any loss of consciousness or previous convulsive experience and was quite aware of his difficulty breathing. He also denied chest pain, headache, nausea, vomiting, and incontinence. His medical history was unremarkable with respect to any epilepsy-related risk factors such as febrile seizures or head trauma. An arterial O 2 saturation level obtained during one of these episodes by using digital pulse oximetry monitoring was 82%. Arterial blood gas measurements revealed a hypoxemia level of 61 mm Hg while the patient was breathing fortified air containing

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R. Shane Tubbs, Marios Loukas, James D. Callahan and Aaron A. Cohen-Gadol

data: Tubbs. Analysis and interpretation of data: all authors. Drafting the article: Cohen-Gadol. Tubbs. Critically revising the article: all authors. Reviewed final version of the manuscript and approved it for submission: all authors. References 1 Boockvar JA , Philips MF , Telfeian AE , O'Rourke DM , Marcotte PJ : Results and risk factors for anterior cervicothoracic junction surgery . J Neurosurg 94 : 1 Suppl 12 – 17 , 2001 2 Calliauw L , Dallenga A , Caemaert J : Trans-sternal approach to intraspinal tumours in the upper

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Michael Turner, Ha Son Nguyen and Aaron A. Cohen-Gadol

surgical spinal interventions, which are risk factors for arachnoiditis. 9 Recently, a rat model for spinal cord injury demonstrated that inflammatory cells and connective tissue could occlude chronic intrathecal tubing in the setting of active inflammation. 20 , 34 Placement of the catheter within the spacious ventricle, a proximal CSF site lined by ependyma, rather than within the spinal canal and arachnoid-lined cavity, may decrease the risk of arachnoiditis. Catheter occlusions by choroid plexus or ependymal tissue have been reported. 12 , 18 , 21 The high

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Jesse D. Lawrence, Chad Tuchek, Aaron A. Cohen-Gadol and Raymond F. Sekula Jr.

showed that age and diabetes were predictors of postoperative ICU admission. 9 Furthermore, they reported that patients with no risk factors had a 2.6% likelihood of requiring the ICU. Beauregard et al., reporting on complications in 430 patients undergoing elective craniotomy, of whom 82 underwent MVD, showed that asthma, carotid stenosis, and mental illness were predictors of medical morbidity, with males having a higher complication rate. 1 Our reported data do not support these associations in MVD patients alone. As previously reported, the cost of ICU care is a

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Aaron A. Cohen-Gadol, Jeffrey T. Jacob, Diane A. Edwards and William E. Krauss

presentation, although 17 patients were noted to have progressive or episodic neurological symptoms, raising the suspicion of an increased rate of rehemorrhage in their CMs. Larger prospective studies focused on the analysis of risk factors associated with increased risk of CM growth and rehemorrhage may contribute to selection of more appropriate candidates for surgery. Management of CMs Seventy-nine percent of patients who initially present with neuropathic pain due to spinal CM hemorrhage may suffer a chronic pain due to CM hemorrhage may suffer a chronic pain

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Aaron A. Cohen-Gadol, Michael Westerveld, Juan Alvarez-Carilles and Dennis D. Spencer

–41 years). Thirty-four patients had a history of febrile convulsions in the first 5 years of life. Twenty-five patients had other epilepsy-related risk factors, including head trauma, meningitis, encephalitis, and/or perinatal injuries. Intracarotid Amobarbital Procedure Before the language and memory assessment, all patients underwent cerebral angiography, in which the cerebral hemisphere suspected to harbor the epileptogenic focus was always studied first. After angiography, a hand-directed injection of sodium Amytal was given. The dose typically ranged

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Aaron A. Cohen-Gadol, Korey Özduman, Richard A. Bronen, Jung H. Kim and Dennis D. Spencer

to compare the outcome in the patients who underwent cortical resection with the aid of ECoG guidance. Statistical significance was set at a probability value less than 0.05. Results Patient Population and EEG Findings Risk factors for epilepsy were trauma (seven patients) or meningoencephalitis (one patient); 14 patients (64%) had no obvious risk factors. Eighteen patients had complex partial, two had simple partial, and one had GTCSs as their dominating seizure types. One infant presented with infantile spasms. Ten patients experienced secondary

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William J. Kemp III, Daniel H. Fulkerson, Troy D. Payner, Thomas J. Leipzig, Terry G. Horner, Erin L. Palmer and Aaron A. Cohen-Gadol

identified female sex, history of hypertension, and smoking as risk factors for de novo aneurysm formation. 16 , 41 Although there are reports estimating the incidence of formation of de novo aneurysms, there is very little published data studying the clinical behavior of these lesions. A fundamental question is whether these aneurysms have a similar natural history to an unruptured incidentally discovered aneurysm. Our goal is to estimate the cumulative risk and risk factors for hemorrhage from these lesions in this cohort study of 37 patients. Methods The Goodman