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Omar M. Qahwash, Ali Alaraj, Victor Aletich, Fady T. Charbel and Sepideh Amin-Hanjani

multiple relatively atraumatic endovascular commercial products, vessel dissection or rupture is a possibility and must be kept in mind, as exemplified by the previous case reports referenced above. 13 , 20 Our preference in treating vasospasm is to use a compliant balloon capable of vessel expansion at much lower atmospheric pressures. The visualization of expansion is used to limit inflation, as opposed to the predetermined pressure or volume of injection suggested by the manufacturer. We believe that this reduces the risk of vessel rupture even when the balloon is

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Ali Alaraj, Troy Munson, Sebastian R. Herrera, Victor Aletich, Fady T. Charbel and Sepideh Amin-Hanjani

Fisher Grade 3 SAH and Hunt and Hess Grade II underwent EVD placement and surgical clipping of an ACoA aneurysm. During surgery, the lumbar drain and EVD were allowed to drain; however, the volume of CSF was not documented. Postoperatively, the patient was neurologically intact until POD 4 when he became somnolent, not opening his eyes or following commands. Intracranial pressure before deterioration was 0–5 cm H 2 O. Emergent CT scanning showed significant pneumocephalus and a “skinny,” oblong midbrain. The patient was placed in the Trendelenburg position, and an

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Oral Presentations

2010 AANS Annual Meeting Philadelphia, Pennsylvania May 1–5, 2010

patient was unaccounted. The median preoperative tumor volume was 57.0 cm 3 and most tumors (N = 206) occupied eloquent territories. All patients underwent resection followed by chemotherapy and radiation therapy. The median postoperative tumor volume was 1.4 cm 3 , equating to a 98% EOR. The median overall survival was 12.2 months. Using Cox proportional hazards analysis, the following were predictive of survival: patient age, KPS, and EOR (p less than 0.0001). A significant survival advantage was seen with as little as 70% EOR, and stepwise improvement in survival

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acute clinical state according to Glasgow Coma Scale (GCS) in non-intubated patients and outcome in all patients after 12 months as assessed by the Rankin Stroke Score (RSS) Results Ninety seven patients were included in the study. The only management modality that differed between the two treatment groups was the volume of CSF drainage during the first week. Both the mean ICP and mean ICP wave amplitude were significantly lower during this week in the MWA group. The GCS during weeks 1–3 was nearly significantly higher in the MWA group (P=0.065). RSS in all

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equipment and personnel are outlined. Patient response to the program is documented. Results: The analysis of our telemedicine program indicates that patient satisfaction, cost containment, and surgical case volume all benefit from the provision of neurosurgical tele-services. Conclusion: Utilization of telemedicine can expand the reach of neurosurgical expertise, locally, regionally, nationally and internationally. The experience of one program in metropolitan Washington, D. C. provides an example of how telemedicine in neurosurgery may be successful

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some patients showed viral protein, DNA, and RNA including CD, but with viral genes only detected in limited amounts and not in all samples (up to 2000 DNA copies/μg tissue). MRI immediately after injecting Toca 511 plus gadolinium showed imprecise delivery. Therefore, realtime MRI-guided CED was implemented. In 7 patients at a single center (average tumor volume = 10.5 cm3, range=2.6–25.0 cm3) 12–70% of tumor volume (mean=45%) was infused. A 14-gauge cannula allowed flow rates up to 50 microL/min without reflux, and 3.1 mL was delivered to 1–3 targets with improved