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M. Stephen Mahalley Jr. and Stephan C. Boone

an unusual and previously undescribed contribution from the occipital artery, treated by arterial embolization. Case Report This 31-year-old woman was first seen at Duke Hospital on July 21, 1967, because of headache and dizziness. She had fallen from an automobile traveling at approximately 10 mph on July 12, and had struck the left temporal area of the skull but did not lose consciousness. Skull films revealed a linear fracture of the left parietotemporal bones. No neurological abnormality was noted. She was 6 months pregnant at this time and proceeded to

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Robin G. Rushworth, William A. Sorby and Sarah F. Smith

✓ A child is described who presented with a large right vascular acoustic neuroma causing raised intracranial pressure and brain-stem compression. Ventriculoperitoneal shunting and arterial embolization were performed prior to total tumor excision. Acoustic neuromas are a rarity in childhood, and preoperative arterial embolization has infrequently been described as an adjunct to acoustic neuroma surgery.

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Andrew P. Carlson, Christopher L. Taylor and Howard Yonas

catheter technique was used. For arterial embolization, Onyx was delivered via a Marathon or an UltraFlow microcatheter (both ev3 Neurovascular). The Marathon catheter was used preferentially because of the durability of its nitinol-braided tip; however, this catheter proved too inflexible to maneuver in several vessels prompting use of the UltraFlow. When the fistula involved more than one major feeding artery, the artery with the largest caliber and least amount of tortuosity was chosen as the initial target vessel. Prior to Onyx injection, effort was made to position

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David C. Hemmy, David M. McGee, Frederick H. Armbrust and Sanford J. Larson

dysfunction, although uncommon, may be caused by any of the following: 1) extension of the tumor into the epidural space, 2) angiomatous hypertrophy of the vertebral arch, or 3) collapse of the vertebral body, frequently with kyphosis. 2 Laminectomy is an effective treatment for hypertrophy of the vertebral arch, but is not suitable when the vertebral body is affected. While both arterial embolization and radiation therapy have been reported to provide relief of symptoms in some cases, neither can be expected to correct spinal deformity. Furthermore, radiation therapy adds

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Robert D. Pugatch and Samuel M. Wolpert

. Arch Neurol 7 : 264 – 274 , 1962 Luessenhop AJ, Gibbs M, Velasquez AC: Cerebrovascular response to emboli. Observations in patients with arteriovenous malformations. Arch Neurol 7: 264–274, 1962 11. Mahaley MS Jr , Boone SC : External carotid-cavernous fistula treated by arterial embolization. Case report. J Neurosurg 40 : 110 – 114 , 1974 Mahaley MS Jr, Boone SC: External carotid-cavernous fistula treated by arterial embolization. Case report. J Neurosurg 40: 110–114, 1974 12

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Clarence B. Watridge, Michael S. Muhlbauer and Robbie D. Lowery

deficits and normal CT scans of the brain should not be designated as having focal contusions, concussions, brain-stem injuries, or peripheral nerve stretch injuries unless cerebral arteriography has ruled out a traumatic carotid artery dissection. Urgent cerebral arteriography should be utilized when this diagnosis is entertained. Treatment is directed toward arresting the propagation of thrombus, thereby reducing or preventing distal arterial embolization and/or occlusion. It is considered that early diagnosis and early intervention with anticoagulation are likely to

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Vinodh T. Doss, Jason Weaver, Scott Didier and Adam S. Arthur

neurological compromise. They may occur de novo, but as many as 25% may be secondary to another bone tumor. Although some ABCs can be managed conservatively, many will need treatment. Surgical treatment is the standard but can carry significant risk in cases in which the lesion is difficult to access. 4 , 7 Most spine surgeons advocate a gross-total, or en bloc, resection. Adjuvant therapy with phenol or liquid nitrogen may be used to avoid recurrence. 10 Selective arterial embolization (SAE) has been used more recently, but little is known of its efficacy because of the

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Daniel L. Barrow, Robert H. Spector, Ira F. Braun, Jeffrey A. Landman, Suzie C. Tindall and George T. Tindall

Literature. Amsterdam: Excerpta Medica, 1968 16. Mahaley MS Jr , Boone SC : External carotid-cavernous fistula treated by arterial embolization. Case report. J Neurosurg 40 : 110 – 114 , 1974 Mahaley MS Jr, Boone SC: External carotid-cavernous fistula treated by arterial embolization. Case report. J Neurosurg 40: 110–114, 1974 17. Miller JD , Jawad K , Jennett B : Safety of carotid ligation and its role in the management of intracranial aneurysms. J Neurol Neurosurg Psychiatry 40 : 64

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Massimo Collice, Giuseppe D'Aliberti, Giuseppe Talamonti, Vincenzo Branca, Edoardo Boccardi, Giuseppe Scialfa and Pietro P. Versari

= superior; trans = transverse. † Combined = preoperative arterial embolization and surgery. Angiographic Findings All patients underwent transfemoral angiography of both internal carotid arteries (ICAs), both external carotid arteries (ECAs), and the vertebrobasilar (VB) complex. The meningeal feeding arteries came from one or more of these arteries. In all cases but one, the ECA contributed to the arterial supply of the fistula. In one patient (Case 13), an aneurysm was also present on the left posterior inferior cerebellar artery (PICA) that was

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Georgios Zenonos, Osama Jamil, Lance S. Governale, Sarah Jernigan, Daniel Hedequist and Mark R. Proctor

, a posterior approach provided an adequate exposure in all but 1 of our cases due to the large corridor access provided by the large expansile lesion. Role of SAE Selective arterial embolization of spinal ABCs has been proposed as both a preoperative adjunct to surgery 2 , 5 , 13 , 30 , 32 as well as definitive treatment. 3 , 34 In our practice SAE was used in selected cases preoperatively to decrease intraoperative bleeding. A number of groups expressed concerns and were generally conservative in attempting SAE. 2 , 3 , 30 , 32 Shared collaterals between