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Robert F. Spetzler and Neil A. Martin

complete angiographic obliteration after embolization, there is no assurance that hemorrhage cannot occur in the future. In such thoroughly embolized cases, the nidus of the AVM nevertheless remains in the brain and the possibility for delayed recanalization of portions of the malformation through collateral channels exists. Stereotaxically directed radiation therapy is another technique available for the treatment of AVM's. 6, 15 Our grading system may be applied to lesions treated either by radiation therapy or by embolization for the purpose of comparing the

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Nancy McLaughlin and Neil A. Martin

angiographic outcomes from indirect revascularization surgery for Moyamoya disease in adults and children: a review of 63 procedures . Neurosurgery 68 : 34 – 43 , 2011 7 Endo M , Kawano N , Miyaska Y , Yada K : Cranial burr hole for revascularization in moyamoya disease . J Neurosurg 71 : 180 – 185 , 1989 8 Houkin K , Kamiyama H , Abe H , Takahashi A , Kuroda S : Surgical therapy for adult moyamoya disease. Can surgical revascularization prevent the recurrence of intracerebral hemorrhage? . Stroke 27 : 1342 – 1346 , 1996 9 Houkin

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Matthias Oertel, Daniel F. Kelly, Jae Hong Lee, David L. McArthur, Thomas C. Glenn, Paul Vespa, W. John Boscardin, David A. Hovda and Neil A. Martin

F or the past three decades, commonly used therapies for the reduction of ICP in a patient who has incurred head injury have included hyperventilation, ventricular drainage of cerebrospinal fluid, osmotherapy with mannitol, and metabolic suppression therapy. 6, 11, 12, 19, 21, 32, 41 More recently, maintenance of an adequate CPP, so-called CPP therapy, as described by Rosner and colleagues 46, 47 has also been used as a means of improving or stabilizing ICP. Of these five therapies, hyperventilation, metabolic suppression, and CPP therapy remain the most

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Neil A. Martin, Martha Hales and Charles B. Wilson

P ituitary adenomas characteristically grow as a mass that deforms, displaces, and compresses adjacent structures. A minority of these tumors, however, behave in a more aggressive fashion, invading surrounding structures and, rarely, metastasizing to remote areas of the central nervous system (CNS) and to extracranial sites. This case illustrates the clinical and pathological features of a cerebellar metastasis from a prolactin-secreting adenoma. It is notable, in light of recent reports of pituitary tumor regression during bromocriptine therapy, that the

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injury. J Neurosurg 87: 1–8, July, 1997). A relatively high arteriovenous oxygen difference (AVDO 2 ) following craniotomy or mannitol therapy was significantly related to the occurrence of cerebral infarction and/or unfavorable outcome, suggesting to the authors that cerebral blood flow may have been insufficient to meet the brain's metabolic needs. An alternative interpretation, however, is possible based on alterations in PaCO 2 , a variable not reported or considered in the article. An inverse relationship between PaCO 2 and AVDO 2 is well established. 3, 4

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Mark N. Hadley, Neil A. Martin, Robert F. Spetzler and Peter C. Johnson

lateral ventricle, and cerebral angiography was performed. These studies demonstrated two intracranial aneurysms, one arising from the left internal carotid artery (ICA) and the other from the distal basilar artery. Intravenous amphotericin B therapy was initiated on the day of admission, and the next day the patient was taken to the operating room for clipping of the ruptured left ICA aneurysm. Operation The aneurysm was approached via a left pterional craniotomy. The arachnoid of the sylvian fissure was opened, the left frontal lobe elevated, and the ICA

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Wesley A. King, Grant B. Hieshima and Neil A. Martin

: Intracranial cyanoacrylate: a new catheter therapy for arteriovenous malformations. Invest Radiol 10 : 536 – 538 , 1975 Kerber CW: Intracranial cyanoacrylate: a new catheter therapy for arteriovenous malformations. Invest Radiol 10: 536–538, 1975 15. Mullan S : Experiences with surgical thrombosis of intracranial berry aneurysms and carotid cavernous fistulas. J Neurosurg 41 : 657 – 670 , 1974 Mullan S: Experiences with surgical thrombosis of intracranial berry aneurysms and carotid cavernous fistulas. J Neurosurg 41

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Colin C. Buchanan, Nancy McLaughlin, Daniel C. Lu and Neil A. Martin

. Compression due to an uncovertebral osteophyte was found at the C3–4 level on the left side when the patient rotated his head to the left ( Fig. 4 ). In the setting of aberrant vertebrobasilar anatomy with the left VA terminating in the PICA, contralateral narrowing at the dural penetration, and midbasilar occlusion, there was a not negligible risk of stroke with conservative therapy (cervical immobilization). Therefore, surgical treatment was indicated. A recently published treatment algorithm for bow hunter's stroke by Cornelius et al. 7 agrees with this strategy; due to

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Nancy McLaughlin, Pooja Upadhyaya, Farzad Buxey and Neil A. Martin

regular ward. 9 , 51 , 54 F ig . 1. Simplified value stream map with identification of the most expensive activities in the surgical hospitalization for MVD. OT= occupational therapy; PACU = post–acute care unit; PO = postoperative; PT = physical therapy; PTU = pretreatment unit. Clinical Data Collection Patient hospital records from the RRMC were reviewed, including clinical notes (outpatient and inpatient), radiographic images, and operative notes. Outcome measures spanning the entire surgical care episode were collected according to the three

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Nancy McLaughlin, Farzad Buxey, Karen Chaw and Neil A. Martin

care or treatment process. The need for intraoperative blood transfusions, the occurrence of surgery-related complications, and readmission rates within 30 days of surgery were identified through the operative reports and postoperative clinical notes. Tier 3 Outcome Measures—Sustainability of Health The two dimensions of this tier include sustainability of health or its recovery as well as the nature of recurrences and long-term consequences of therapy. Given that Group 2 (2011–2012) is more recent and the average last follow-up would be shorter than that of