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Robert F. Spetzler, Robert S. Rhodes, Richard A. Roski and Matt J. Likavec

. We had one fatality (Case 3), in a patient who died suddenly 3 days after surgery from an unrecognized subdural hematoma. We believe this may well have been from a technical error and was probably avoidable. The risk of postoperative bleeding is obviously higher than from an STA-MCA bypass, since the volume of blood delivered through the venous bypass is so much greater. Furthermore, in patients with recent insults to their blood-brain barrier, the large flow through the subclavian-MCA bypass could conceivably lead to a normal perfusion pressure breakthrough with

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Mark C. Preul, Patrick K. Campbell, David S. Garlick and Robert F. Spetzler

. Two methods of application of this hydrogel were also assessed. Optimal delivery of such hydrogels requires investigations of mode of application in terms of speed of application, accuracy, aerosolization, and thickness of coat. To determine if volume or method of application of the hydrogel was of significance, we used a conventional 2-chamber syringe sprayer (Dual Liquid applicator) driven by hand pressure on the dual syringes, and a gas-assisted sprayer (MicroMyst applicator) designed to improve the control of application in areas of limited access. Methods

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Richard Kerr and Andrew Molyneux

UK rates of coiling and clipping by center after ISAT recruitment stopped (May 2002–December 2002) based on returns to the Royal College of Surgeons categorized according to high-recruiting centers (> 50 patients: 12 centers, 530 patients) and low-recruiting centers (< 50 patients: 9 centers, 298 patients). Five non-ISAT centers treated 150 patients. The total number of patients treated in all centers over 8 months was 1153. This pattern continued between January and September 2003, with large recruiting centers using coils in 83% of patients, low-volume

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Thomas M. Wascher, Robert F. Spetzler and Joseph M. Zabramski

French Fogarty arterial embolectomy catheter * can be inserted extra-arterially (between the outer wall of the vessel and the bony wall of the carotid canal) 5 to 10 mm proximal into the carotid canal. The distal end of the catheter is connected to a three-way stopcock attached to a syringe filled with normal saline. The balloon of the catheter can be inflated with the saline to the appropriate volume (0.2 ml) and the stopcock closed to provide a safe temporary occlusion of the petrous ICA ( Fig. 2 ). The authors have used this simple but effective modification for

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Robert F. Spetzler, Paul W. Detwiler, Howard A. Riina and Randall W. Porter

Spetzler RF, Koos WT (eds): Color Atlas of Microneurosurgery, ed 2. Volume III: Cerebral Revascularization, Extracranial Vascular Disease, and Intraspinal Pathology. Stuttgart: Georg Thieme Verlag, 1999, p 413. With permission from Georg Thieme Verlag Medical, Stuttgart. Lower Right: Axial T 1 -weighted MR images obtained in a 10-year-old boy with severe progressive thoracolumbar pain, demonstrating a large, circular flow void in the anterior spinal canal that is indenting the cord. Selective angiography demonstrated a large ventral AVF (Type C). The lesion was

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Karl A. Greene, John A. Anson and Robert F. Spetzler

volumetric analysis. The volume of the aneurysm was calculated to be 186.8 ml. Fig. 3. Left: Axial T 2 -weighted magnetic resonance (MR) images demonstrating the large, partially thrombosed aneurysm. Right: Axial MR angiogram showing the two distal branches (arrows) arising from the lateral aspect of the aneurysm. Operations In the first of the two planned operations, a large pterional-type craniotomy was performed while the patient was under barbiturate electroencephalography burst suppression 14 following dissection of the superficial temporal

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Daniel D. Cavalcanti, Mark C. Preul, M. Yashar S. Kalani and Robert F. Spetzler

. Lesions surfacing anteriorly on the peduncle, pontomesencephalic junction, or upper pons can be managed through these approaches. The anterior mesencephalic zone can also be nicely exposed when neither color nor volume alteration is visible on the pial surface. We currently use keyhole approaches rather than extensive dissections and large craniotomies whenever possible. The mini-modified orbitozygomatic (mini-OZ) approach generally replaces full orbitozygomatic craniotomies. The mini-OZ requires a significantly smaller skin incision, just behind the hairline, and the

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Michael T. Lawton, Ronald Jacobowitz and Robert F. Spetzler

53. Rekate HL : Circuit diagram of the circulation of cerebrospinal fluid. Pediatr Neurosurg 21 : 248 – 253 , 1994 Rekate HL: Circuit diagram of the circulation of cerebrospinal fluid. Pediatr Neurosurg 21: 248–253, 1994 54. Rekate HL , Brodkey JA , Chizeck HJ , et al : Ventricular volume regulation: a mathematical model and computer simulation. Pediatr Neurosci 14 : 77 – 84 , 1988 Rekate HL, Brodkey JA, Chizeck HJ, et al: Ventricular volume regulation: a mathematical model and

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Patrick P. Han, Francisco A. Ponce and Robert F. Spetzler

can be treated with partial embolization to reduce blood flow through the AVM. 17, 19 These patients manifest progressive, often insidious loss of neurological function without evidence of hemorrhage from the AVM. Angiography also shows evidence of vascular steal from the surrounding normal brain: a rapid and high-volume flow to the AVM immediately during the arterial phase with delayed filling of the MCA or the anterior cerebral artery. Our seven patients fit this profile, and endovascular embolization was recommended to palliate the steal-induced progressive loss

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Robert W. Ryan, Robert F. Spetzler and Mark C. Preul

Investigators also began to take advantage of the fundamental properties of different types of lasers. The long wavelength of the CO 2 laser (10.6 μm) was found to have high absorption in tissue and water, with rapid conversion of light energy into heat in a small volume of tissue. 16 This profile makes the CO 2 laser an excellent cutting tool, as it causes minimal thermal damage to adjacent tissue but limits its ability to coagulate large vessels. Extensive experiments on the lesion characteristics produced by CO 2 laser beams were conducted by Stellar et al. 32 and