neoplasms or trauma. 3 This technique has provided adequate coverage and good aesthetic results, and has resulted in establishment of well vascularized tissue under which further bone reconstruction may be performed. In certain clinical situations involving primarily soft-tissue loss, replacement by a free omental graft is, in our opinion, the procedure of choice. When the defect involves primarily subcutaneous tissue loss resulting in an abnormal contour, an omental free flap provides effective coverage and restoration of contour. In addition, the inherent capability
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Daniel L. Barrow, Foad Nahai, and George T. Tindall
Collin S. MacCarty, John D. Michenfelder, and Alfred Uihlein
circulatory arrest, but is often impossible to carry out if the aneurysm remains full of blood under normotensive or near-normotensive conditions. The third indication is an aneurysm which is difficult to expose without resort to considerable manipulation, thereby increasing the danger of rupture of the aneurysm, with the end result of sacrifice of the parent vessel. An aneurysm of this type is best manipulated and repaired under conditions of circulatory arrest. The fourth indication is an anomalous vascular configuration in which sacrifice of a parent vessel, such as
Gwang Yoon Choi, Hyuk Jai Choi, Jin Pyeong Jeon, Jin Seo Yang, Suk-Hyung Kang, and Yong-Jun Cho
Cerebral proliferative angiopathy (CPA) is a rare vascular disorder that is defined angiographically as a diffuse vascular network forming a poorly defined nidus, which is supplied by multiple similar-sized feeding vessels and transdural channels. Interspersed normal brain parenchyma differentiates CPA from classic arteriovenous malformations (AVMs). 1 Resection of the abnormal vessels can be challenging owing to the possibility of damaging the healthy tissues within. This case describes successful surgical removal of a CPA malformation in an 11-year-old patient
Kenichi Amagasaki, Hiromichi Yamazaki, Kimie Ohmori, Hidehito Koizumi, Kazuhiro Hashizume, and Nobuo Sasaguchi
lymphomatosis that demonstrated an unusual association with venous stenosis manifesting as multifocal vascular disease and rapidly progressive dementia. This disease is one of the diagnostic possibilities that must be considered in any patient with a multifocal vascular disorder and rapidly progressive dementia. Case Report This 55-year-old man presented at another neurosurgical institution with paraparesis, sensory disturbance of the lower extremities, and dysuria. Neurological examination revealed paraparesis with hypoactive reflexes of the lower extremities and sensory
Arya N. Bagherpour, Gustavo J. Rodriguez, Chetan Moorthy, Todd T. Trier, and Alberto Maud
P arkes Weber syndrome (PWS) is a rare congenital overgrowth disorder characterized by limb, axial, and visceral hypertrophy; capillary malformations of the skin; and the presence of significant arteriovenous (AV) shunting/high-flow vascular malformations. 11 , 15 , 16 It is a heterogeneous disorder and most often arises sporadically, although familial cases have been described. 2 A genetic link related to a mutation in the RASA1 gene has been reported to account for familial PWS. This variant is seen primarily in patients with multiple capillary
Patrik Gabikian, Richard E. Clatterbuck, Philippe Gailloud, and Danielle Rigamonti
B lue rubber-bleb nevus syndrome is a developmental disorder originally identified by the presence of distinctive cutaneous and gastrointestinal hemangiomas. It is now recognized that the number of affected organs is larger and that the disorder includes CNS vascular malformations. 3, 6, 7, 10, 11, 13, 14 Initially described by Bean 1 in 1958, BRBNS consists of multiple bluish hemangiomas of the skin and gastrointestinal tract. The cutaneous lesions, which are the hallmark of this syndrome, are characterized as rubbery, erectile nevi that are bluish
Alexander M. Nixon, Murat Gunel, and Bauer E. Sumpio
R esearch over the past few decades has identified numerous risk factors predisposing patients to vascular diseases such as atherosclerosis and saccular aneurysm formation. Factors that are common to both disorders include smoking, hypertension, and familial predisposition. 63 , 131 Because the entire vasculature is exposed to the same potentially harmful influences, it might be expected that pathological lesions would be seen in a random distribution throughout the arterial tree. In reality the distribution of such lesions proves to be far from random, and
Philippe Gailloud
anterior fissure into the cord; V 2 , = pial vessel. C: T-10, H & E coloration (reproduction of Frey's Fig. 3 ). a = intramural aneurysms in a dilated vessel, located in the center of the cord. Public domain. Figure is available in color online only. Vascular anomalies dominate our case's anatomopathological picture. Two different forms can be distinguished: 1) the multiplication of vessels of various calibers within the nervous substance of the cord and 2) the multiplication and hypertrophy of pial vessels. Which type of vascular disorder is our case showing
H. Lee Finney, Theodore S. Roberts, and Robert E. Anderson
elastic fiber. A simple mendelian autosomal dominant with a relatively high grade of penetrance, it is found throughout the world in equal sex distribution. Hallmarks of the disorder are aortic dilatation, dissecting aortic aneurysm, ectopia lentis, arachnodactyly, loose jointedness, and pectus excavatum. Vascular pathology consists of early Erdheim's cystic medial necrosis followed by fragmentation and sparsity of elastic fibers and increased collagenous tissue in vascular cystic spaces. The media is the only pathological area of the vessels. McKusick 9 stresses the
Current and novel practice of stereotactic radiosurgery
JNSPG 75th Anniversary Invited Review Article
Douglas Kondziolka
linear accelerator systems. Over 1 million patients have been treated with Gamma Knife radiosurgery, and it is clear that the concept has been used in large numbers of patients with intracranial disorders and a smaller number with selected extracranial tumors and vascular malformations. Over the last 40 years, most patients who have undergone stereotactic radiosurgery have done so after application of a rigid stereotactic frame. Several linear accelerator systems utilize mask fixation, which can provide acceptable precision and accuracy when done well. However, for
