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Giovanni Muscas, Christiaan Hendrik Bas van Niftrik, Jorn Fierstra, Marco Piccirelli, Martina Sebök, Jan-Karl Burkhardt, Antonios Valavanis, Athina Pangalu, Luca Regli and Oliver Bozinov

, 23 or cerebrovascular reactivity (CVR). 11 , 15 The application of intraoperative high-field MRI may deliver such information directly after the bypass anastomosis. By obtaining functional MRI blood oxygenation level–dependent (BOLD) volumes during repeated cycles of apnea, CVR can be measured at the brain tissue level. We previously reported the feasibility of intraoperative 3-T MRI BOLD-CVR and its preliminary application for neurovascular surgery. 6 The purpose of this study was to assess whether intraoperative BOLD-CVR can offer hemodynamic information at the

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Ranjith Babu, Steven Thomas, Matthew A. Hazzard, Allan H. Friedman, John H. Sampson, Cory Adamson, Ali R. Zomorodi, Michael M. Haglund, Chirag G. Patil, Maxwell Boakye and Shivanand P. Lad

-hour restrictions have increased the number of resident handoffs and reduced clinical experience due to decreased working hours, it is feared that the number of medical errors and complications may increase, resulting in worse patient outcomes. 15 , 18 , 19 , 25 , 27 In this study, we evaluated the effect of duty-hour restrictions on morbidity and mortality rates in patients who underwent brain tumor and cerebrovascular procedures. Additionally, we also examined the effect on length of stay (LOS) and health care costs to determine whether work hour restrictions have not only

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Suzanne M. Michalak, John D. Rolston and Michael T. Lawton

concluded that errors were the eighth leading cause of death in the United States, causing almost 100,000 deaths per year. 10 Other studies have estimated that operative adverse events comprise 48%–66% of all adverse events and that 54%–74% of these are due to preventable errors. 2 , 6 , 7 There is a particular need for error characterization in high-risk subspecialties, such as cerebrovascular surgery, where success is critically dependent on teamwork, advanced technology, and technical skills. A perfect surgery without delays would require flawless communication

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Peter Weinstock, Sanjay P. Prabhu, Katie Flynn, Darren B. Orbach and Edward Smith

technique in the context of pediatric cerebrovascular disease. Given the uniquely complex anatomy of lesions such as brain arteriovenous malformations (AVMs) and vein of Galen malformations (VOGMs), we describe our initial experience with printing patient-specific 3D models of these conditions with the novel approach of printing “in situ” lesions. While this is a proof-of-principle study, it provides feasibility data, demonstrating, for the first time, intraoperative validation of model fidelity and evidence that simulation with 3D models may have the potential to reduce

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Avital Perry, Christopher S. Graffeo, Lucas P. Carlstrom, William J. Anding, Michael J. Link and Leonardo Rangel-Castilla

T he landscape of neurosurgical cerebrovascular training is shifting dynamically, as a number of forces have collectively resulted in decreased microsurgical operative experience, including duty-hour restrictions, improvements in endovascular and radiosurgical technology and experience, and trends in litigation. 5 , 10 , 11 , 17 , 20 , 23 In order to increase training efficiency and decrease the risk of compromising patient safety, numerous avenues have been explored for the development of neurosurgical simulators, including models based on large and small

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John R. Taylor, William E. Bell and Carl J. Graf

cerebrovascular malformation on the heart. The complexities of surgical removal of a highly vascular lesion from the brain of a patient with impending cardiac decompensation are evident. In the child described, cardiomegaly and a high-output flow murmur were the first diagnostic hints of a cerebrovascular anomaly. Case Report This 4-year-old boy was referred to the cardiology clinic, University Hospitals, because of a cardiac murmur. Previous history revealed the length of gestation to have been 32 to 33 weeks, and the birth weight 1810 gm. Delivery was complicated by a

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Neurosurgical Forum: Letters to the Editor To The Editor Julio Cruz , M.D., Ph.D. Medical College of Pennsylvania and Hahnemann University Philadelphia, Pennsylvania 306 308 One of the most undesirable features of performing clinical research is addressing potential misinformation. Even though mathematically elegant, the paper by Yoshihara, et al. (Yoshihara M, Bandoh K, Marmarou A: Cerebrovascular carbon dioxide reactivity assessed by intracranial pressure dynamics in severely head injured patients. J

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Gabriele Wurm, Berndt Tomancok, Peter Pogady, Kurt Holl and Johannes Trenkler

microsurgery through a comparison of the biomodel with the intraoperative video. Modeling Method Construction of the SL cerebrovascular models included acquisition of imaging data, postprocessing with object segmentation, and creation of a solid model. Three-dimensional CT scanning was used as the imaging source in the first three patients, who were treated in 1999. Three-dimensional rotational angiography was used as the imaging source in the other 10 patients, who were treated between 2001 and 2003, according to the following established protocol. The 3D

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Shouri Lahiri, Mani Nezhad, Konrad H. Schlick, Brenda Rinsky, Axel Rosengart, Stephan A. Mayer and Patrick D. Lyden

N icardipine is commonly used for blood pressure reduction in patients with acute stroke. It is a dihydropyridine calcium channel antagonist that acts on vascular smooth muscle and reduces systemic vascular resistance and blood pressure. 3 , 9 In addition, nicardipine is a potent vasodilator of the systemic venous circulation, which contains approximately 70% of total blood volume. 3 , 5 , 9 Few studies have described the effect of nicardipine on cerebrovascular hemodynamics when the drug is administered intravenously. Under standard conditions, measured

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Berkley L. Rish

stroke resolution pattern with the help of progressive rehabilitation therapy. Eight months following the cerebrovascular accident he has recovered his ability to walk independently with one cane. His speech is minimally dysphasic. He has returned to restricted employment; however, he has a mild, spastic left hemiparesis. His tic pain has not recurred. Discussion Because of the proximity of the internal carotid artery in the foramen lacerum to the trigeminal ganglion in Meckel's cave there is a danger of possible arterial injury when percutaneous radiofrequency