Guglielmi detachable coil embolization
Role of radiosurgery for arteriovenous malformations
Decompressive craniectomy for space-occupying supratentorial infarction: rationale, indications, and outcome
Desiree J. Lanzino and Giuseppe Lanzino
A subset of patients with ischemic cerebrovascular stroke suffer a progressive deterioration secondary to massive cerebral ischemia, edema, and increased intracranial pressure (ICP). The evolution is often fatal. In these patients, a decompressive craniectomy converts the closed, rigid cranial vault into an “open box.” The result is a dramatic decrease in ICP and a reversal of the clinical and radiological signs of herniation. For these reasons, decompressive craniectomy has been increasingly proposed as a life-saving measure in patients with large, space-occupying hemispheric infarction. The authors review the rationale, indications, and clinical experience with this procedure, which has been performed in patients who have had supratentorial ischemic stroke.
Anatomical relationships between the V2 segment of the vertebral artery and the cervical nerve roots
Sergio Paolini and Giuseppe Lanzino
During surgical procedures focused on the cervical nerve roots, the surgeon works in proximity to the V2 segment of the vertebral artery (VA). Depending on the specific surgical approach, it may be necessary to identify, expose, or mobilize the artery. In most cases, the artery may be left undisturbed. To reduce the risk of iatrogenic injury to the V2 segment during anterior and anterolateral approaches to the cervical spine, the authors analyzed the relationship between the V2 segment and the proximal segment of the C3–6 nerve roots.
Six cadaveric cervical spines (12 sides) were fixed with formalin, injected with red and blue latex, and investigated intraoperatively using different magnifications (× 3–40).
The VA rested on the anteromedial surface of the cervical nerve roots at the level of each intertransverse space. The exiting nerve roots intersected the VA at a distance ranging from 4.5 to 8.1 mm (mean 6.3 ± 1.06 mm) from the dural sac. The distance was slightly shorter at cephalad levels, suggesting that the artery is more posteriorly and medially situated at those levels. Arterial pedicles anchored the VA to the cervical nerve roots at various levels. These arteries gave rise to purely radicular, ligamentous, and medullary branches without a predictable pattern. After reaching the nerve roots on their lower margin, the nonligamentous branches pierced the radicular dural sheath within the neural foramen at a distance of 2 to 4 mm from the VA.
Proximal-to-distal dissection of a cervical nerve root may proceed with relative safety for at least 4 mm. The V2 segment of the VA gives rise to at least one radicular arterial pedicle between C-4 and C-6. These trunks give rise to purely radicular, ligamentous, and medullary branches in an unpredictable pattern.
The association of venous developmental anomalies and cavernous malformations: pathophysiological, diagnostic, and surgical considerations
Paolo Perrini and Giuseppe Lanzino
✓Developmental venous anomalies (DVAs) are often associated with intracranial cavernous malformations (CMs). The frequency of this association and the observation of de novo CMs located near a known, preexisting DVA raise speculations as to the possible etiopathogenetic relationship between the two. In this article, the authors review the recent literature dealing with the potential etiopathogenetic, prognostic, and therapeutic implications of the association between DVAs and CMs.
Introduction: Endovascular Neurosurgery video supplement
Brian Hoh and Giuseppe Lanzino
It is with great pride that we present this Neurosurgical Focus video supplement on endovascular neurosurgery. We were privileged to view a multitude of outstanding quality videos demonstrating the current state-of-the-art in endovascular neurosurgery. Careful and critical review was required to narrow down the videos to a workable volume for this supplement, though there were many more that we would have liked to have included.
This issue consists of several videos that represent modern neuroendovascular techniques for the treatment of cerebrovascular disease. The videos demonstrate the cutting-edge as well as standard endovascular therapies, which will be valuable to both the novice and the expert endovascular neurosurgeons. We are greatly honored to be involved with this project, and are very proud of its content and expert authors. We confidently believe you will enjoy the video content of this supplement.
Editorial. Curative embolization for low-grade AVMs: ready for prime time?
Giuseppe Lanzino and Lorenzo Rinaldo
Letter to the Editor. Steroid administration in Cognard type V dural arteriovenous fistula
Thomas Sorenson and Giuseppe Lanzino
Nuances of transradial approach for mechanical thombectomy in acute basilar artery occlusion
Leonardo Rangel-Castilla and Giuseppe Lanzino
In elderly patients with acute ischemic stroke, tortuosity of the proximal vertebral artery makes access from the transfemoral route challenging and time consuming. In such cases, a transradial approach (TA) offers a more direct vertebral artery (VA) access that overcomes proximal VA tortuosity. In this video the authors illustrate nuances of the TA for acute basilar artery occlusion in two patients with challenging proximal VA anatomy. Techniques, devices, and pitfalls are discussed. In both patients, mechanical clot retrieval was successful and resulted in significant recovery of function. The authors believe that the TA should be the initial approach for basilar artery (BA) occlusion management in elderly patients and should be considered for selected patients with other conditions requiring endovascular treatment.
The video can be found here: https://youtu.be/_Ym9tMKUy_4.