authors note, introduction of CNS gene therapy is a promising future treatment for diseases such as glioma and degenerative disorders. The adeno-associated virus (AAV) type 2 has been considered for some time as an attractive viral vector. One of the downsides of this virus has been that the potential effect is local at the site of injection. Convection therapy may be a useful delivery adjunct to enhance distribution. Another option as explored in this paper is the additive use of AAV serotypes. The researchers convection-infused recombinant AAV serotypes into the
Fredric B. Meyer
Fredric B. Meyer and Donald A. Muzzi
flow velocities on transcranial Doppler ultrasound studies were treated with aggressive hypervolemic hypertensive therapy. Results In this group of six patients, aneurysms were found at the basilar caput in two, the middle cerebral artery in one, the anterior cerebral artery in one, and the internal carotid artery in two. These patients were selected for the study based on preoperative angiography which suggested that these lesions would be technically difficult to repair and in all likelihood would require temporary proximal vessel occlusion. For example
Jonathan A. Friedman, Fredric B. Meyer, Douglas A. Nichols, Robert J. Coffey, L. Nelson Hopkins, Cormac O. Maher, Irene D. Meissner and Bruce E. Pollock
endovascular therapy. 27 Aggressive clinical behavior of DAVFs is unusual. We report a case of a 31-year-old man with fulminant progression of multiple DAVFs that developed after he had experienced minor head trauma. Case Report History A previously healthy 31-year-old man was playing basketball when he was struck on the vertex by the palm of another player's hand. The man experienced a stinging sensation at the site of the impact that resolved over 3 minutes. There was no loss of consciousness and he continued to play without difficulty. Over the following 6
Akio Morita, Fredric B. Meyer and Edward R. Laws Jr.
surgery. Treatment Options and Indications Surgical exploration was performed in 21 cases in which there was significant mass effect and/or uncertainty surrounding the diagnosis. Transsphenoidal surgery was performed in 16 cases. In five cases, transcranial removal was performed because the tumor mass had significant extension in the suprasellar or cavernous sinus region. Radiation therapy was administered as adjunctive treatment in 17 cases. The dose of radiation ranged from 900 to 6000 cGy (median 3600 cGy). Adjunctive chemotherapy was administered in 19
Philipp Taussky, Ricardo A. Hanel and Fredric B. Meyer
, 1988 3 Brott TG , Hobson RW II , Howard G , Roubin GS , Clark WM , Brooks W , : Stenting versus endarterectomy for treatment of carotid-artery stenosis . N Engl J Med 363 : 11 – 23 , 2010 4 CASANOVA Study Group : Carotid surgery versus medical therapy in asymptomatic carotid stenosis . Stroke 22 : 1229 – 1235 , 1991 5 Chambers BR , Norris JW : Outcome in patients with asymptomatic neck bruits . N Engl J Med 315 : 860 – 865 , 1986 6 Cina CS , Clase CM , Haynes RB : Carotid endarterectomy for symptomatic carotid
Cormac O. Maher, James A. Garrity and Fredric B. Meyer
Ventriculoperitoneal (VP) shunts have not been widely used for idiopathic intracranial hypertension (IIH) because of the difficulty of placing a shunt into normal or small-sized ventricles. The authors report their experience with stereotactic placement of VP shunts for IIH.
The authors reviewed the clinical records of all patients in whom stereotaxis was used to guide the placement of a VP shunt for IIH at their institution. All shunts were placed using stereotactic guidance to target the frontal horn of the lateral ventricle. Patients were contacted at a mean postoperative interval of 15.1 months. No patients were lost to follow up.
The authors identified 13 patients who underwent placement of a stereotactically guided VP shunt for IIH over a 6-year period. A trial of either acetazolamide or steroid therapy had failed in all patients. Prior surgical treatments included optic nerve sheath fenestrations in seven patients and cerebrospinal fluid diversionary procedures, other than stereotactic VP shunt procedures, in nine patients. Twelve patients reported excellent or good durable symptomatic relief at the time of follow up. No patient suffered progression of visual deficits. Four patients experienced persistent headaches following the procedure. Three patients required a revision of the VP shunt for technical failure.
Stereotactically guided VP shunt placement is an effective and durable treatment option in many cases of IIH that are refractory to more traditional medical and surgical approaches.
Fredric B. Meyer
vasospasm when used to enhance systolic blood pressure in hypervolemia-hypertension or hypervolemia-hypertension-hemodilution therapy regimens. 2 There has also been interest in the neurokinin system, including substance P, calcitonin gene–related peptide, and capsaicin, with some experiments demonstrating amelioration of vasospasm with antagonists and antibodies. It has been theorized that one potential mechanism underlying the effect of neurokinin receptor blockade might be suppression of the locus coeruleus resulting in a decrease in sympathetic activation. Albeit
Ryan T. Merrell, S. Keith Anderson, Fredric B. Meyer and Daniel H. Lachance
with glioma, incomplete seizure control is a frequent concern. 21 First-generation AEDs such as phenytoin, carbamazepine, valproic acid, and phenobarbital have been used to treat seizures in patients with glioma. These agents are known to cause a higher incidence of side effects in patients with glioma than in other patients with seizures. 3 , 14 Phenytoin has been a traditional first-line therapy, but it can be associated with intolerable side effects, and importantly, may alter the metabolism of chemotherapeutic agents, corticosteroids, and several other
Fredric B. Meyer, W. Richard Marsh, Edward R. Laws Jr. and Frank W. Sharbrough
Walker, 43, 44 and Rasmussen. 36–38 Certainly, it has been demonstrated that temporal lobectomy is a viable treatment for patients with temporal lobe seizures refractory to medical therapy. Falconer 5, 6 first emphasized the importance of early surgery in medically refractory patients. Despite the proven therapeutic results in appropriately selected patients, 24, 37, 38 there remains a reluctance to consider a surgical option. A debate still persists in terms of the indications for surgery and the timing of the operation. Relatively few series analyze the results
Jamie J. Van Gompel, Todd B. Nippoldt, Dominique M. Higgins and Fredric B. Meyer
inclusion criteria with the exception of pathology. Weight Recordings All patients were reviewed for height (cm) and weight (kg). Height was measured using a stadiometer. Body mass index was calculated with the following formula (BMI = [kg weight]/[height in meters] 2 ) for the initial visit. Weights were recorded for all visits available, but data acquired at 3-, 6-, 9-, and 12-month follow-up were used for analysis. Weights up to 24 months were recorded. After this point, the assumption was that recurrence or adjuvant therapy effects might interfere with this