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Carotid-cavernous fistula

Demonstration of asymptomatic vascular “steal”

Barbara D. Barnes, Mark L. Rosenblum, Lawrence H. Pitts, David P. Winestock, Howard Parker and Mary Lou Nohr

. Philadelphia: WB Saunders, 1973, Vol. 2, pp 807–826 6. Fein JM : Reversal of intracerebral nutrient steal phenomenon after extracranial-intracranial bypass graft. Presented at the 27th Annual Meeting of the Congress of Neurological Surgery , San Francisco, California , October 13, 1977 Fein JM: Reversal of intracerebral nutrient steal phenomenon after extracranial-intracranial bypass graft. Presented at the 27th Annual Meeting of the Congress of Neurological Surgery, San Francisco, California, October 13, 1977 7. French LA

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Arthur A. Ward Jr.

useful data obtained in the Collaborative Study came from our British colleagues who participated in that study. As a result, there are still some lingering doubts in some minds that surgery for at least some aneurysms may not be any improvement over the natural history of the disease. A similar situation may be developing with respect to the extracranial-intracranial bypass graft operation for occlusive disease of intracranial vessels. The NINCDS has sponsored a controlled study to determine the efficacy of this procedure; but already the operation is becoming so

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Elizabeth A. M. Frost

may present initially with seizures, during which the patient may aspirate. Again, the diagnosis of aspiration pneumonitis is established by chest x-ray examination and arterial blood-gas analysis. Patients presenting for extracranial-intracranial bypass surgery have usually suffered strokes or transient ischemic attacks. Again, pneumonic processes aggravated by immobility are common. These patients, especially those in the younger categories, are often very heavy smokers and may have severe, superimposed chronic lung disease. In patients with vertebrobasilar

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Reconstitution of “totally” occluded internal carotid arteries

Angiographic and technical considerations

Roger W. Countee and Thurairasah Vijayanathan

✓ The authors describe their experiences with five patients with delayed transient ischemic symptoms homolateral to internal carotid artery (ICA) occlusions. In each instance, initial arteriograms were interpreted as showing irreversible occlusions of these arteries in the neck and microvascular bypass procedures were contemplated. However, after repeat arteriographic evaluations with a modified injection technique, certain angiographic features were identified that suggested the mechanism of the symptoms in these patients and that their ICA's could be reconstituted in the neck. This was successfully accomplished in each patient with complete relief of ischemic symptoms. The angiographic technique employed and the arterial flow patterns identified in these patients are discussed. The details of the operative technique are described. It is concluded that routine arteriographic techniques may be inadequate to identify the reversible carotid occlusion. This may account for some of the confusion which surrounds the surgery of these vessels as well as the failure of extracranial-intracranial bypass to relieve recurrent ischemic symptoms in these individuals.

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Frank Eggers, Robert Lukin, A. Alan Chambers, Thomas A. Tomsick and Raymond Sawaya

restoration of flow. Both latter reports advocate the use of a Fogarty catheter 3 to remove thrombus from the distal ICA during endarterectomy, as previously reported by Garamella, et al., 4 and Thompson, et al. 13 Grillo and Patterson 5 have suggested that restoration of flow in a totally occluded ICA may provide more patient benefit than an extracranial-intracranial bypass. The problem of iatrogenic carotid-cavernous fistula as a potential complication has been recognized by most authors. Upson and Raza 14 advocated use of a Fogarty catheter for progressive

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Superficial temporal-middle cerebral artery bypass

A detailed analysis of multiple pre- and postoperative angiograms in 40 consecutive patients

Richard E. Latchaw, James I. Ausman and Myoung C. Lee

was a change in the pattern of preoperative collateral circulation with a reversal of intracranial collateral filling, all confirmed that the preoperative collateral flow was, in fact, not adequate. The preoperative angiographic evaluation of the adequacy of collateral circulation is difficult at best. An accurate measure of cerebral blood flow would be of immense value in predicting those patients who would derive benefit from the extracranial-intracranial bypass; if this cannot be provided by studies using gamma-emitting radioisotopes, the method in most centers

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occlusion with pentobarbital and extracranial-intracranial bypass Pablo M. Lawner Frederick A. Simeone November 1979 51 5 710 712 10.3171/jns.1979.51.5.0710 Extradural hematoma in the neonate Glen S. Merry Gordon Stuart November 1979 51 5 713 714 10.3171/jns.1979.51.5.0713 Spontaneous regression of posterior fossa dural arteriovenous malformation Shunro Endo Keiji Koshu Jiro Suzuki November 1979 51 5 715 717 10.3171/jns.1979.51.5.0715 Posterior fossa xanthogranuloma Jesús Vaquero Guillermo Leunda

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Pablo M. Lawner and Frederick A. Simeone

cerebral artery occlusion. Fig. 2. External carotid angiogram showing patent extracranial-intracranial bypass. The patient has returned to work without evidence of new neurological deficit; the papilledema and lateral rectus muscle paresis have recovered. Discussion There is ample experimental evidence to show that barbiturates decrease neurological deficit and infarction when administered around the time of a major cerebral artery occlusion. 2, 4, 6, 7, 10 The precise mechanism of action is not understood, but some investigators believe

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Toussaint A. Leclercq and Mary W. Ambler

I nitial reports describing extracranial-intracranial bypass surgery suggest that this is an encouraging addition to the surgical treatment of transient cerebral insufficiency. The value of the procedure is enhanced by the low incidence of mortality and perioperative morbidity as the technical expertise and the criteria for case selection improve. 5 This case report describes the death of a patient who developed a subdural hematoma 25 days after superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis. The pathological findings indicate a

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Syoji Asari, Susumu Ohara, Hiroyuki Fujisawa, Toshiaki Kageyama and Keizo Matsumoto

I n 1967, operative anastomosis between the superficial temporal artery (STA) and a branch of the middle cerebral artery (MCA) to create a new extracranial-intracranial bypass was reported by Yaşargil. 5 This procedure has been used to study the effect of such a shunt on experimental acute stroke in dogs. 2, 3 The STA of the dog is small in caliber and is difficult to manipulate in overcoming distance. The patency rate with this model is low. The maxillary artery, however, has vigorous blood flow, is of large caliber, and is located close to the MCA