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Fredric B. Meyer, Michael J. Ebersold and David F. Reese

distribution, lower cranial nerve involvement, nystagmus, and by the radicular pain pattern of a ruptured disc. The presence of occipital neuralgia, when associated with other neurological signs or symptoms, mandates proper radiographic evaluation. Also, vertebral aneurysms, odontoid separation, and hysteria may produce findings similar to foramen magnum tumors. Prognosis The follow-up period in this series ranged from 1 to 40 years. The operative mortality rate was 5.0%. All deaths occurred in patients with large tumors anterior to the spinal cord, except in one

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Fredric B. Meyer, David G. Piepgras, Thoralf M. Sundt Jr. and Takehiko Yanagihara

. Discussion Natural History The natural history of acute occlusion of the MCA, either embolic or thrombotic, is difficult to define. Review of the literature gives a wide spectrum of information. In 1965, Carter 10 reviewed 34 patients and noted a 33% mortality rate with this disease. Of the surviving patients, eight (29%) made good recoveries, three (8.8%) had moderate recoveries, and 13 (38.2%) were totally disabled. Burrows and Lascelles 9 reported on 59 patients. One-third succumbed to the initial stroke, and one-half of the remainder had severe deficits. Bladin

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Fredric B. Meyer, Thoralf M. Sundt Jr. and Bruce W. Pearson

Currently, there are approximately 600 case reports of these tumors in the literature. 8, 10, 11, 14, 16, 18, 21, 25, 27, 29, 31, 33, 35–37, 44, 50, 53, 56 Most large series quote mortality rates ranging from 5% to 15%, significant cerebrovascular sequelae in 8% to 20% of cases, and cranial nerve injuries in 32% to 44% of patients. However, these reports reflect early experience without the benefits of modern techniques such as intraoperative cerebral blood flow (CBF) monitoring, shunts, or interposition saphenous vein grafts. More recent case reports demonstrate low

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Fredric B. Meyer, Daniela Lombardi, Bernd Scheithauer and Douglas A. Nichols

mortality rates. Therefore, despite similar pathological diagnosis, intra- and extra-axial cavernous hemangiomas are in fact distinct clinical entities. There are approximately 22 published surgical reports of attempted resection of extra-axial cavernous hemangiomas, with a reported perioperative mortality rate of 38%. 5 The small number of reported cases has prompted this analysis of our experience with eight extra-axial cavernous hemangiomas. The clinical characteristics of these lesions are defined, and an operative approach to expose the intracavernous

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Daniela Lombardi, Bernd W. Scheithauer, Fredric B. Meyer, Glenn S. Forbes, Edward G. Shaw, Donna J. Gibney and Jerry A. Katzmann

patients required postoperative tracheostomy. The overall perioperative mortality rate in this group was 25%. The second group consisted of 13 patients operated on between 1975 and 1989. In these, five tumors occurred in the lateral, one in the third, and seven in the fourth ventricle. Six patients underwent subtotal tumor resection, and gross total removal was achieved in seven. Intraoperative alteration of vital signs was observed in three patients, two of whom required postoperative tracheostomy. No perioperative deaths occurred in this group. Follow-up review

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Marc S. Goldman, Robert E. Anderson and Fredric B. Meyer

ischemic episodes at hourly intervals in the gerbil and found that there was greater histological damage, more ischemic edema formation, and a higher mortality rate at 24 hours in animals undergoing repetitive ischemia than in animals undergoing a single ischemic episode of equal duration. Other investigators have reported contrary data. Rehncrona, et al. , 28 found that mitochondrial function returns to normal in rats upon reperfusion after 30 minutes of complete ischemia. Matsumoto, et al. , 17 produced four consecutive 3-minute episodes of global cerebral

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Douglas A. Nichols, Robert D. Brown Jr., Kent R. Thielen, Fredric B. Meyer, John L. D. Atkinson and David G. Piepgras

secondary to sequelae of severe SAH and vasospasm despite aggressive medical and endovascular intervention. Therefore, in this group of 26 patients, the short-term (30-day) treatment-related serious neurological morbidity rate was 0%, treatment-related mortality rate was 3.8%, the mortality rate unrelated to treatment was 3.8%, and the overall combined morbidity and mortality rate was 7.6%. Long-Term Mortality Rate and Poor Functional Outcomes Four patients did not survive to the 6-month follow up. In addition to the two patients described in the previous section

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Fredric B. Meyer and Wanda L. Windschitl

might be a source of embolism. Results In the 290 operations included in our series, the 30-day major neurological morbidity and mortality rate was 1.7%. There were two significant strokes (0.7%), both of which occurred during exposure of the carotid artery in patients classified as Sundt Grade 3, 30 as evidenced by acute attenuation in the intraoperative electroencephalogram. There were two cerebral hemorrhages, one caused by hyperperfusion in a patient with Sundt Grade 3 and the other by a documented heparin-induced consumptive coagulopathy in a patient

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Jonathan A. Friedman, Mark A. Pichelmann, David G. Piepgras, John L. D. Atkinson, Cormac O. Maher, Fredric B. Meyer and Kristine K. Hansen

obtained. Thus, cerebral peduncle infarction may have occurred undetected in some patients. Accidental occlusion of the AChA by Cooper, 3 and its beneficial contralateral motor effects in a patient with PD, led to a series of procedures to deliberately occlude the artery in patients with advanced PD of either idiopathic or postencephalitic type. In his classic publication, Cooper reported on 34 patients with 40 deliberate occlusions of the AChA who had a 10% operative mortality rate, but the most remarkable finding was the paucity of induced hemiplegia (two patients

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Alejandro A. Rabinstein, Mark A. Pichelmann, Jonathan A. Friedman, David G. Piepgras, Douglas A. Nichols, Jon I. McIver, L. Gerard Toussaint III, Robyn L. McClelland, Jimmy R. Fulgham, Fredric B. Meyer, John L. D. Atkinson and Eelco F. M. Wijdicks

. Discussion Summary of Findings This report details our experience in the treatment of more than 400 patients with ruptured intracranial aneurysms over a recent 10-year period. Regardless of the treatment selected to secure the ruptured aneurysm, the morbidity and mortality rates from SAH and cerebral vasospasm were high. Nearly one third of our patients experienced symptomatic cerebral vasospasm, and this incidence is consistent with those of previously reported series. 2, 5, 7 In approximately 15% of all patients, the clinical manifestation of vasospasm was severe