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Robert F. Spetzler, Herbert Schuster and Richard A. Roski

first reported the use of EIAB for maintaining flow in an electively ligated MCA in the management of an aneurysm. 18 Several reports have followed, further supporting this rationale. 6, 14, 15 Ferguson, et al. , 2 reported good results with the use of EIAB in “giant” intracranial aneurysms. Aneurysms greater than 2.5 cm in diameter are by convention classified as “giant aneurysms.” In a recent report of direct surgery on 24 patients, 12 the mortality rate was 20.8%, and the overall morbidity (including deaths) was 37.5%. Eight of these patients had aneurysms of

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Richard A. Roski, Robert F. Spetzler and Frank E. Nulsen

–19, 21, 26, 27 Mount 11 reported a 13.8% mortality rate in a series of 65 patients. In the large series of 220 patients reported by Odom and Tindall, 14 34 developed ischemic complications, only 12 of whom made a complete recovery after the carotid artery was opened. The incidence of permanent neurological deficit or death was 9% in their series. Numerous techniques, such as the Matas' test, the measurement of carotid stump pressure, electroencephalographic monitoring, jugular venous blood sampling, angiographic findings, gradual occlusion, and cerebral blood flow

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Mark N. Hadley, Robert F. Spetzler, Roberto Masferrer, Neil A. Martin and L. Philip Carter

should this be necessary. The decision to perform an occipital to vertebral artery bypass in this patient with a normal yet small contralateral vertebral artery instead of simply occluding the affected vertebral artery is controversial. There are limited data in the literature regarding the outcome in patients who have had surgical ligation of the vertebral artery. Shintani and Zervas 16 reviewed 100 cases of vertebral artery ligation and noted a mortality rate of 12%, yet only five patients had a documented ischemic cause of death. Three others had postoperative

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Robert F. Spetzler, Neil Martin, Mark N. Hadley, Richard A. Thompson, Elizabeth Wilkinson and Peter A. Raudzens

, Sherman DG : Stroke and mortality rate in carotid endarterectomy: 228 consecutive operations. Stroke 8 : 565 – 568 , 1977 Easton JD, Sherman DG: Stroke and mortality rate in carotid endarterectomy: 228 consecutive operations. Stroke 8: 565–568, 1977 24. Ennix CL Jr , Lawrie GM , Morris GC Jr , et al : Improved results of carotid endarterectomy in patients with symptomatic coronary disease: an analysis of 1,546 consecutive carotid operations. Stroke 10 : 122 – 125 , 1979 Ennix CL Jr, Lawrie

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Robert F. Spetzler and Neil A. Martin

than this, at least temporarily, after an AVM has bled. 4, 5 The risk of death associated with initial AVM rupture is approximately 10%, and the mortality rate increases with each subsequent hemorrhage. 5, 12 The incidence of neurological deficit is approximately 50% for each episode of hemorrhage. 16 In addition to the complications of intracranial hemorrhage, patients with AVM's face the lesser risks of developing flow-related symptoms, such as ischemic deficit due to steal. An estimation of the risk that confronts an individual patient with an AVM requires

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Vertebrobasilar insufficiency

Part 2: Microsurgical treatment of intracranial vertebrobasilar disease

Leo N. Hopkins, Neil A. Martin, Mark N. Hadley, Robert F. Spetzler, James Budny and L. Philip Carter

circulation strokes before evaluation (19 of 22) had multiple warning TIA's in the days and weeks preceding the infarction. Similarly, Fisher 19 reported that 80% of patients who experienced vertebrobasilar strokes in his series had posterior circulation TIA's over a mean period of 7 to 8 weeks before the infarction. The prognosis for patients who suffer a vertebrobasilar territory infarction is debatable. Norris and associates 39 reported more favorable morbidity and mortality rates after vertebrobasilar stroke than after anterior circulation infarction. In contrast

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The transoral approach to the superior cervical spine

A review of 53 cases of extradural cervicomedullary compression

Mark N. Hadley, Robert F. Spetzler and Volker K. H. Sonntag

deformities of the axis/skull base, or chronic traumatic dislocations of the dens. 1–3, 11, 14, 15, 19, 21–25 Extradural tumor masses have also been resected via the transoral approach with good results. 3, 4, 8, 11, 16, 17 Recent refinements in surgical techniques and intraoperative retraction have facilitated these procedures and low morbidity and mortality rates can be achieved. 3, 14, 21, 22, 24 Despite these advances, the procedure has not been widely accepted or employed. Infection and cerebrospinal fluid (CSF) fistulae remain major concerns among surgeons who

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Julian E. Bailes, Robert F. Spetzler, Mark N. Hadley and Hillel Z. Baldwin

categorized patients with SAH into grades to allow for treatment planning and prognostication. They found a 71% to 100% mortality rate among those patients who presented either with an alteration of the level of consciousness plus a major neurological deficit or in a comatose, moribund condition. In addition to the patients' initial neurological compromise, surgery was delayed and mortality and morbidity rates were increased due to rebleeding and an inability to effectively treat cerebral vasospasm. Since operation was considered dangerous in Grade IV and V SAH patients

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Robert F. Spetzler, C. Phillip Daspit and Conrad T. E. Pappas

, facial nerve injury due to surgical manipulation was the most frequent postoperative complication. There were no deaths in this series and the postoperative morbidity and mortality data compare favorably with those of previously published reports. Before the operating microscope was developed, operative mortality was more than 50% in cases of clival and petrous meningiomas. 9 With the use of the microscope, the mortality rate dropped to 11% in Mayberg and Symon's 9 series and to 9% in the patients described by Al-Mefty, et al. 1 As would be expected, there is a

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Patrick W. McCormick, Robert F. Spetzler, Julian E. Bailes, Joseph M. Zabramski and James L. Frey

T hromboendarterectomy of the internal carotid artery (ICA) has been described as a surgical therapy to improve the natural history of ICA occlusion. In the 1960's, three series of patients with ICA reopening were reported. Thompson, et al. , 19 described 118 operations with a 6.2% operative mortality rate, Murphey and Maccubbin 13 presented 50 patients with a surgical morbidity and mortality rate of 16%, and Hunter, et al. , 8 reported on 21 patients with a surgical morbidity and mortality rate of about 15%. Each of these studies demonstrated that the