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Felix Umansky, Francisco B. Gomes, Manuel Dujovny, Fernando G. Diaz, James I. Ausman, Haresh G. Mirchandani, and S. Kim Berman

A lthough the perforating branches (PFB's) of the middle cerebral artery (MCA) were described by early anatomists, 17 and their role in the pathogenesis of intracerebral hemorrhage has been emphasized by Charcot and Bouchard, 11 the surgical significance of these vessels became apparent only with the introduction of the operating microscope and the development of interventional neuroradiology. The surgeon operating on aneurysms or performing vascular reconstruction procedures in the proximal segments of the MCA should be aware of the origin and course of the

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Howard A. Riina and Y. Pierre Gobin

The treatment of arteriovenous malformations (AVMs) has evolved over the last 40 years. These complex vascular lesions remain among the most difficult lesions to treat. Successful treatment of AVMs of the brain includes extensive preoperative planning, multimodality treatment options, and modern postoperative surgical care. The advent of new technologies, including interventional neuroradiology and radiosurgery, has expanded the range of malformations that can be treated effectively and has had a significant impact on those individuals who manifest this disease process. The purpose of this paper is to describe the current grading technique used by the authors and to explore the preoperative treatment and planning that leads to successful surgical obliteration of these lesions. Some description of preoperative interventions, including radiosurgery and interventional procedures will be mentioned; however, only in the context of how they impact on the surgical treatment of these lesions. In other articles in this edition of Neurosurgical Focus interventional procedures and radiosurgery as treatment adjuncts and as primary therapies will be discussed in greater detail.

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Fernando Viñuela, Jacques E. Dion, Gary Duckwiler, Neil A. Martin, Pedro Lylyk, Allan Fox, David Pelz, Charles G. Drake, John J. Girvin, and Gerard Debrun

Historical Perspectives New technical developments in the fields of vascular neurosurgery and interventional neuroradiology appear to have a positive impact in the management of complex intracranial AVM's. 1, 2, 6, 7, 12, 14, 21 The intra-arterial navigation of balloons beyond the circle of Willis using flexible microcatheters with a calibrated-leak balloon marked a new era in the field of interventional neuroradiology. This technique allowed the catheterization of individual arterial feeders, decreasing the chance of untoward embolization of normal brain arteries

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Marcelo Magaldi Ribeiro de Oliveira, Arthur Nicolato, Marcilea Santos, Joao Victor Godinho, Rafael Brito, Alexandre Alvarenga, Ana Luiza Valle Martins, André Prosdocimi, Felipe Padovani Trivelato, Abdulrahman J. Sabbagh, Augusto Barbosa Reis, and Rolando Del Maestro

physicians in the trial answered a questionnaire using a 5-point Likert-type scale to evaluate face and content validity. Construct validity was evaluated by measuring the average time to complete all proposed simulated tasks in a single HP. The results of face, content, and construct validity assessment are summarized in Tables 1 – 3 , respectively. TABLE 1. Face validity * Participant Question and Response Can HP simulate the most commonly performed interventional neuroradiology procedures? Can HP simulate interventional radiology patient

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Wesley A. King, Grant B. Hieshima, and Neil A. Martin

, Kaufmann JCE , et al : Pathology of arteriovenous malformations embolized with isobutyl-2-cyanoacrylate (bucrylate). Report of two cases. J Neurosurg 55 : 819 – 825 , 1981 Vinters HV, Debrun G, Kaufmann JCE, et al: Pathology of arteriovenous malformations embolized with isobutyl-2-cyanoacrylate (bucrylate). Report of two cases. J Neurosurg 55: 819–825, 1981 22. Viñuela F , Fox AJ : Interventional neuroradiology , in Wilkins RH , Rengachary SS (eds): Neurosurgery. New York : McGraw

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Grant B. Hieshima, Randall T. Higashida, Joseph Wapenski, Van V. Halbach, Leslie Cahan, and John R. Bentson

-portion of the basilar artery was now evident ( Fig. 2 ). The problem was discussed by personnel from the Departments of Neurosurgery, Neurology, and Interventional Neuroradiology, who believed that the source of bleeding was most likely the aneurysm at the distal segment of the basilar artery. Due to the location and size of the aneurysm as well as the risks of morbidity and mortality associated with surgical clipping, intravascular balloon embolization therapy was considered to be indicated. Fig. 2. Vertebral angiogram 10 days later showing arterial vasospasm of

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Allan J. Fox, Fernando Viñuela, David M. Pelz, Sydney J. Peerless, Gary G. Ferguson, Charles G. Drake, and Gerard Debrun

balloons. AJNR 2 : 167 – 173 , 1981 Debrun G, Fox A, Drake C, et al: Giant unclippable aneurysms: treatment with detachable balloons. AJNR 2: 167–173, 1981 3. Debrun G , Viñuela FV , Fox AJ : Aspirin and systemic heparinization in diagnostic and interventional neuroradiology. AJNR 3 : 337 – 340 , 1982 ; AJR 139: 139–142, 1982 Debrun G, Viñuela FV, Fox AJ: Aspirin and systemic heparinization in diagnostic and interventional neuroradiology. AJNR 3: 337–340, 1982; AJR 139: 139–142, 1982 4

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Aimee Lawson, Andy Molyneux, Robin Sellar, Saleh Lamin, Allan Thomas, Anil Gholkar, and Tufail Patankar

interventional neuroradiology. Adjuncts that have been developed to assist the coiling include stents, balloon remodeling, and flow diverters. 3 , 5 , 14 , 20 The Woven EndoBridge (WEB) device (Sequent Medical) provides a potential alternative to coiling as a treatment option for certain cerebral aneurysms, mainly wide-necked bifurcation aneurysms that present challenges for simple coiling. The WEB device is particularly suited to treating wide-necked aneurysms that are difficult to treat and have a high recurrence rate when treated with conventional coiling techniques. The

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Albert H. Chiu, Joost De Vries, Cian J. O'Kelly, Howard Riina, Ian McDougall, Jonathan Tippett, Martina Wan, Airton Leonardo de Oliveira Manoel, and Thomas R. Marotta

submitted version of manuscript: Marotta, Chiu, De Vries, O'Kelly, Riina, McDougall, Tippett, Wan. Approved the final version of the manuscript on behalf of all authors: Marotta. Administrative/technical/material support: McDougall, Tippett, Wan. Supplemental Information Videos Video 1. . Previous Presentations Partial data were presented at the 13th Congress of the World Federation of Therapeutic and Interventional Neuroradiology in Gold Coast, Australia. References 1 Aguilar-Pérez M , Kurre W , Fischer S , Bäzner H , Henkes H

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Ashish Sonig, Hussain Shallwani, Bennett R. Levy, Hakeem J. Shakir, and Adnan H. Siddiqui

one program to another, and thus the results of such an analysis may not reflect the true productivity of the fellowship program. Currently, few neurosurgical fellowships are accredited by a formal standardized system. Our secondary aim was to determine if a difference exists in terms of the academic productivity of fellowships with and without accreditation and with and without affiliation with a comprehensive stroke center. Methods Listings for neuroendovascular, endovascular surgical neuroradiology, neuroendovascular surgery, and interventional neuroradiology