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Gregory A. Helm, Nathan E. Simmons, Charles G. diPierro, and Neal F. Kassell

T he role of adjustable clamps for carotid artery occlusion in the treatment of intracranial aneurysms and cavernous sinus fistulas has decreased during the last two decades with the development of improved microvascular techniques and the advent of interventional radiology. However, in the past, many patients have been treated with various types of clamps (Poppen-Blalock, Selverstone, Crutchfield), some of whom have not been adequately monitored to ensure that the aneurysm has been completely obliterated following carotid artery occlusion. In 1965, Gurdjian

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

T raumatic carotid artery dissection is a diagnosis that has received significant discussion in the neurosurgical and trauma literature. Published series of cases have revealed a variety of clinical presentations, treatment, and results. 1, 5, 8, 13, 14, 17 Some carotid artery dissections are diagnosed fortuitously. 13 Appropriate early diagnosis and treatment of traumatic carotid artery dissection require a high index of suspicion to optimize outcome. Verneuil 16 first described this entity pathologically in 1872 in an autopsy case. Yamada, et al. , 17

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Tadashi Morimoto, Kazumi Nitta, Kiyoshi Kazekawa, and Keizo Hashizume

T he common carotid artery bifurcation usually lies at the level of the C-4 vertebra or the upper border of the thyroid cartilage, 2 but it may occur as low as the level of the T-3 vertebra 8 or as high as the hyoid bone. In a few instances the common carotid artery has been found to be absent; instead, the external and internal carotid arteries arise directly from the innominate artery or the aortic arch. It is extremely rare that the common carotid artery ascends in the neck without undergoing bifurcation. The authors present such a case in which the non

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H. Hunt Batjer, Thomas A. Kopitnik, Cole A. Giller, and Duke S. Samson

A neurysms arising from the internal carotid artery (ICA) between the site of emergence of the carotid artery from the roof of the cavernous sinus and the origin of the posterior communicating artery (PCoA) have traditionally been termed “ophthalmic artery aneurysms” since the ophthalmic artery is the chief vessel arising from this segment. 1, 3, 4, 7, 8, 11 It is clear, however, that aneurysms arising from this portion of the carotid artery are heterogeneous in terms of site of origin, projection, and relationship to the bone and dura of the skull base. It

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Jørgen Kvist Kristensen, Mogens Eiken, and Fritz von Wowern

series of patients suspected of having carotid artery disease. 10 We now report and discuss the use of the method in 325 patients. Method When an ultrasonic beam is directed toward an artery, the echoes corresponding to the artery are seen to move synchronously with the arterial pulse ( Fig. 1 ). The difference in the intraarterial pressure gives the varying diameters of the artery as well as records of small changes in the position of the artery, which are represented by a horizontal displacement of the echoes. The amount of ultrasound reflected varies with

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R. Shane Tubbs, Andrew J. DeNardo, and Aaron A. Cohen-Gadol

by arrowheads in C and E, respectively. Discussion Alexander et al. 1 identified one patient with an intercavernous carotid artery anastomosis associated with a right-sided descending aorta and unilateral agenesis of the ICA. Some authors have reported an increased incidence of intracranial aneurysms (anterior communicating artery aneurysms) in association with such intercavernous connections. 4 , 5 , 8 However, many of these aneurysms are seen in conjunction with aplasia of the ICA, which itself has a higher rate of aneurysm formation. 2 , 8 Some

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Mark J. Kotapka, Kamal K. Kalia, A. Julio Martinez, and Laligam N. Sekhar

M eningioma is the tumor most frequently involving the cavernous sinus. 12 Encasement of the carotid artery represents one of the greatest obstacles to complete removal of these meningiomas, 2 especially when the artery has been invaded by tumor. Little information exists in the literature on the frequency or extent of carotid artery invasion by meningioma, knowledge that would define the necessity for the use of reconstructive techniques, such as saphenous vein bypass grafting, 11 in such cases. This study was conducted to investigate the frequency and

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Patrick G. Ryan and Arthur L. Day

P atients with internal carotid artery (ICA) occlusion can develop neurological symptoms long after the time of the actual thrombosis. Several causes for this delayed phenomenon have been proposed, including impairment of collateral circulation from ipsilateral, contralateral, or vertebrobasilar sources, and microembolization from the stump of the ipsilateral occluded ICA. While stenosis of these collateral channels can easily be identified, documentation of embolization from the carotid artery stump is often imprecise. In this report, we describe a patient

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Intravascular streaming during carotid artery infusions

Demonstration in humans and reduction using diastole-phased pulsatile administration

Stephen C. Saris, Ronald G. Blasberg, Richard E. Carson, Hetty L. deVroom, Robert Lutz, Robert L. Dedrick, Karen Pettigrew, Richard Chang, John Doppman, Donald C. Wright, Peter Herscovitch, and Edward H. Oldfield

%) of 155 patients developed an irreversible encephalopathy and 25 (16%) of 155 developed visual loss following infusion of 200 mg/sq m of 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) into the carotid artery. This toxicity may have contributed to their observation that intracarotid treatment provided no improvement in survival time as compared to intravenous therapy. One explanation for the occurrence of focal toxicity of the retina and brain is poor mixing of the drug with blood at the infusion site, which results in heterogeneous drug delivery to brain

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Michael K. Morgan, Michael Besser, Ian Johnston, and Raymond Chaseling

T he clinical and pathological consequences of injury of the intracranial internal carotid artery (ICA) are less clearly defined than those of similar lesions of the extracranial carotid artery. Erikson, 7 in 1943, first reported a case of traumatic ICA occlusion at the skull base, and the first report of intracranial ICA dissection was published by Dratz and Woodhall in 1947. 6 There have been only 25 verified cases of intracranial ICA obstruction or occlusion secondary to trauma unrelated to neck pathology. 1, 5–13, 15, 17–23, 26, 28 We report six cases