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Introduction

Guglielmi detachable coil embolization

Giuseppe Lanzino

of a multicenter study on the safety of GDCs in the treatment of ruptured aneurysms. The article contains the data that eventually led to the Food and Drug Administration approval of the GDC as a valid alternative to surgery in high-risk surgical candidates. The study included 403 patients with ruptured intracranial aneurysms treated at 8 participating centers within 15 days from the original subarachnoid hemorrhage. The majority of patients were selected for endovascular treatment because of anticipated surgical difficulty. Not surprisingly, posterior circulation

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Editorial

Role of radiosurgery for arteriovenous malformations

Giuseppe Lanzino

in different situations. 1–6 How can we incorporate the information provided into our management of these challenging lesions? Simplistically, AVMs can be divided into 3 main groups. 9 There are many options for “simple” AVMs (Spetzler-Martin Grade I and II AVMs). Surgery has been traditionally considered the main and most effective therapy for these “simple” AVMs because it removes the risk of bleeding with a very low surgical risk. However, stereotactic radiosurgery is being considered more and more as a valid therapeutic alternative to microsurgical excision

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's description in 1910 of a sublabial gingival incision for the initial stage of exposure. From 1910 to 1925, Cushing, combining a number of suggestions made by previous authors, refined the transsphenoidal approach and used it to operate on 231 pituitary tumors, with a mortality rate of 5.6%. As he developed increasing expertise with transcranial surgery, however, Cushing reduced his mortality rate to 4.5%. With the transcranial approach, he was able to verify suprasellar tumors and achieve better decompression of the optic apparatus, resulting in better recovery of vision

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Giuseppe Lanzino, Kenneth Fraser, Yassine Kanaan and Anne Wagenbach

On the other hand, the ISAT has not had such a significant impact on neurosurgical vascular practices in the US. A major criticism of the ISAT is that only a minority of the patients evaluated at the participating centers were indeed enrolled in the trial. For inclusion in the study, the patient in question had to have an aneurysm judged by both a neurosurgeon and a neurointerventionalist to be equally amenable to surgery or endovascular embolization. As a result, only 2143 of the 9559 patients screened at the participating centers were actually enrolled in the

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David J. Daniels, Ananth K. Vellimana, Gregory J. Zipfel and Giuseppe Lanzino

or transvenous or both) as the first treatment option with the goal of cure or in preparation (adjunct) to other therapeutic modalities. Seven patients underwent various therapeutic combinations either as planned therapeutic strategy or because of failure of the initial therapeutic strategy to completely obliterate the DAVF. About half (43%) of the patients underwent surgery (either as initial treatment or for failed endovascular treatment), and 25% underwent combined therapy. Of the 26 patients treated, 21 patients (75% of all patients) had complete obliteration

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Giuseppe Lanzino and Edward R. Laws Jr.

been a slow but relentless process. Numerous reports and reviews have detailed the chronology and development of transsphenoidal surgery. 16, 19–21, 23, 25, 29 Nevertheless, some of the pioneers who made seminal contributions to the development of the procedure have not received adequate credit, and their merits and personalities are not necessarily known to the neurosurgical public. It is important to recognize that significant advances in surgical and scientific concepts and techniques are almost always multifactorial. Many individuals may contribute to the

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Giuseppe Lanzino

a way to improve surgery, and to minimize as much as possible any form of brain manipulation. In this respect, the senior author (Dr. Spetzler) should be commended for his continuous exploration of new technologies and search for better surgical strategies despite his clinical and technical mastery. Too often we become comfortable with our own habits, complacent and resistant to new technology and different strategies. A couple of the technical factors mentioned by the authors deserve further emphasis. For retractorless surgery, the use of the mouthpiece to

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Laligam N. Sekhar, Giuseppe Lanzino, Chandra N. Sen and Spiros Pomonis

follow-up periods ranging from 10 to 60 months (median 23 months), no tumor recurrence was observed in these patients. In one patient with partial tumor resection, tumor regrowth occurred and was completely excised at reoperation. Third Cranial Nerve In Case 1, a partial third nerve palsy was present preoperatively. At surgery, the nerve was found to be invaded by tumor. After excision of the abnormal segment and partial tumor resection, primary resuture was carried out. Partial recovery of function, equivalent to the preoperative condition, was observed and

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Chris A. Sloffer and Giuseppe Lanzino

opportunity for a hemorrhage to occur. An attempt would then be made to check this secondary hemorrhage by tying a second ligature placed at the time of the initial surgery, the so-called ligature of reserve, or ligature d’attente. There was also the risk of gangrene in the affected limb from ischemia caused by the arrest of blood flow through the affected artery. Percival Pott, a contemporary of Hunter, favored amputation to treatment of the aneurysm itself. He wrote, As far as my observation and experience go, such operation, however judiciously performed, will not be

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). Vasospasm and delayed ischemic neurological deficits were classified according to clinical findings as well as by transcranial Doppler (TCD) studies. All events classified as rebleeding were verified on CT scans or during surgery. Conclusions. More than 90% of patients reached the neurosurgical center within 12 hours of their first hospital admission after SAH; 70% of all aneurysms were clipped or coils were inserted within 24 hours of the first hospital admission. Given the protocol, only one rebleed occurred later than 24 hours after the first hospital admission