New Trends in Management of Cerebro-Vascular Malformations : Proceedings of the International Conference Verona, Italy, June 8–12, 1992

Every so often a gathering of minds and experience occurs that results in an all encompassing overview in depth of such a vast subject as Cerebro-Vascular Malformations, as occurred in Verona in June 1992 and which warrants publication. Professors Da Pian and Pasqualin deserve high compliment and it is a measure of the respect in which they are held that virtually all those most knowledgeable around the world attended, presented their work and thoughts and contributed to intense discussion. Ljunggren's opening historical survey set the stage and must be the most comprehensive yet published. Subarachnoid hemorrhage from aneurysm rupture still constitutes, I dare say, the most difficult problem for neurosurgeons, in relief of the brain injury and arterial reaction and the technical perfection of aneurysm obliteration, even for small, as well as large and giant sacs. Very large high flow A VMs can be as demanding too. The bulk of the conference was devoted to subarachnoid hemorrhage, aneurysms and A VMs which were discussed under about 14 headings each. But vein of Galen malformations, dural A VMs, cavernous angiomas and venous angiomas (renamed developmental venous anomalies) came under scrutiny, not always with consensus. Trends are perceptible such as fibrinolysis of subarachnoid clot, non surgery for Galenic and dural malforma­ tions, the benignity of venous angioma, but there is still much variation in approach, pharmacologically, technically and with such as the evolving endovascular and radiosurgical stories, used alone or in conjunction. Front Matter....Pages I-XIV History and Epidemiology of SAH and Cerebrovascular Malformations....Pages 3-15 Clinical Usefulness of Magnetic Resonance Angiography in Neurosurgical Practice....Pages 16-23 Front Matter....Pages 25-25 New Evidence Pointing to Oxyhemoglobin as the Cause of Vasospasm....Pages 27-31 Recent Advances in Research of Cerebral Vasospasm — Possible Participation of Endothelin in the Genesis of Vasospasm....Pages 32-37 Cerebral Blood Flow in Middle Cerebral Ischaemia is Increased by Calcitonin Gene-Related Peptide....Pages 38-40 Anticoagulation Factors, Protein C, Protein S, and Antithrombin III in Subarachnoid Haemorrhage Patients....Pages 41-42 A Study on Cisternal CSF Levels of Endothelin-1 After Subarachnoid Haemorrhage....Pages 43-47 Early Blood-Brain Barrier Changes After Experimental Subarachnoid Haemorrhage: a Quantitative and Electron Microscopy Study....Pages 48-51 Prevention of Experimental Vasospasm with Intermittent Intracisternal rtPA....Pages 52-55 Cerebral Blood Flow Assessment Following Subarachnoid Hemorrhage....Pages 59-66 Haemodynamic Evaluation of Cerebral Perfusion After Subarachnoid Haemorrhage — a Review....Pages 67-70 Transcranial Doppler Evaluation of Cerebral Perfusion After SAH....Pages 71-75 Combined Transcranial Doppler Sonography and rCBF Measurements in the Early Stage of Subarachnoid Hemorrhage....Pages 76-81 Principles of Pharmaceutical Therapy for Vasospasm Following Subarachnoid Hemorrhage....Pages 85-89 A Calcium Antagonist in Aneurysmal SAH....Pages 90-94 Nimodipine and Cerebral Vasospasm: Review of Effects and Mechanisms....Pages 95-98 Tirilazad and Aneurysmal Subarachnoid Hemorrhage....Pages 99-101 Effect of Calcitonin Gene-Related Peptide on Outcome of Ischaemic Deficits After Subarachnoid Haemorrhage European CGRP in Subarachnoid Haemorrhage Study Group....Pages 102-106 Clinical Effects of Nimodipine in Prevention of Vasospasm After Subarachnoid Hemorrhage....Pages 107-112 Prevention of Cerebral Vasospasm — Cisternal Irrigation Therapy with Urokinase and Ascorbic Acid....Pages 113-120 Front Matter....Pages 25-25 Angioplasty of Cerebral Vasospasm....Pages 141-145 Balloon Angioplasty for the Treatment of Symptomatic Vasospasm....Pages 146-150 Intra-Arterial Papaverine for the Treatment of Cerebral Vasospasm....Pages 151-153 Papaverine for the Treatment of Cerebral Vasospasm After Subarachnoid Hemorrhage....Pages 154-156 Anesthesia in Aneurysm Surgery....Pages 159-163 Special Anesthetic Considerations for Management of Cerebral Aneurysm Clipping....Pages 164-173 Total Intravenous Anesthesia Using Propofol for Burst Suppression in Cerebral Aneurysm Surgery: Preliminary Report of 44 Cases....Pages 174-175 Temporary Clipping in Aneurysm Surgery....Pages 176-179 Limits of Temporary Arterial Occlusion....Pages 180-184 Deep Hypothermic Circulatory Arrest as an Adjunct to Complex Intracranial Aneurysm Surgery....Pages 185-191 Clipping Techniques for Partially Thrombosed Giant Aneurysms....Pages 195-197 Complication Avoidance for Large and Giant Carotid Ophthalmic Aneurysms....Pages 198-202 Direct Microsurgical Approach to Giant Intracranial Aneurysms. Considerations, Technical Notes and Results in a Series of 47 Cases....Pages 203-211 Surgical Treatment of Large and Giant Carotid-ophthalmic Artery Aneurysms....Pages 212-216 Vertebrobasilar Artery Aneurysms: Current Management Techniques....Pages 219-227 The Transsylvian Approach to Basilar Aneurysms....Pages 228-230 Intracisternal Recombinant Tissue Plasminogen Activator After Aneurysmal Subarachnoid Hemorrhage: Results of a Preliminary Study....Pages 121-124 Intracisternal Therapy with Tissue Plasminogen Activator for the Prevention of Vasospasm in Patients with Aneurysmal Subarachnoid Hemorrhage. A Review....Pages 125-131 The Use of Dobutamine to Enhance Cardiac Performance and Improve Outcome in Patients Refractory to Hypervolemic Therapy for Cerebral Vasospasm: a Preliminary Study....Pages 132-135 Single Intracisternal Injection of Recombinant Tissue Type Plasminogen Activator for Prevention of Cerebral Vasospasm....Pages 136-138 Front Matter....Pages 25-25 Transclinoid-Transsellar-Transcavernous Approach to Basilar Tip Aneurysms....Pages 231-237 Combined Pterional-Subtemporal Approach to Upper Basilar Artery Aneurysms....Pages 238-243 Early Surgery for Ruptured Aneurysms of the Posterior Circulation — 60 Consecutive Cases....Pages 244-249 Retrolabyrinthine Trans-Sigmoid (RLTS) Approach to Aneurysms of the Basilar Trunk and Vertebrobasilar Junction: an Update....Pages 250-252 An Anterior Approach to Aneurysms of the Vertebro-Basilar Junction....Pages 253-254 Anterior Transpetrosal Approach for Basilar Trunk Aneurysms — Further Experience....Pages 255-260 Standard and Giant Aneurysms: the Role of Endovascular Therapy....Pages 263-268 Endovascular Treatment of Intracranial Saccular Aneurysms with GDC Platinum Detachable Coils: Small-Necked Aneurysms....Pages 269-271 Internal Carotid Artery Balloon Test Occlusion Does Require Quantitative Assessment of CBF....Pages 272-274 Endovascular Treatment of Giant Intracranial Aneurysms by Balloon Occlusion of the Parent Vessel: Clinical and Diagnostic Follow-up....Pages 275-282 Acute Medical and Surgical Management of Severely III Aneurysm Patients: a Review....Pages 285-290 Strategy of Surgical Treatment in Severely III Patients After Aneurysmal Subarachnoid Hemorrhage....Pages 291-293 Unruptured Intracranial Aneurysms — Current Concepts and Future Directions....Pages 294-295 Validity of Surgical Treatment of Unruptured Aneurysms....Pages 296-299 The Fate of Patients with Incidental Intracavernous Carotid Artery Aneurysms (ICCAA)....Pages 300-303 Surgical and Endovascular Approaches to Intracavernous Aneurysms....Pages 304-309 Aneurysm Rests in a Surgical Series of 275 Patients (Five Years): Incidence, Prognostic and Therapeutic Implications....Pages 310-315 Recurrent Subarachnoid Hemorrhage After Aneurysm Surgery....Pages 316-320 Front Matter....Pages 321-321 Classification of Arteriovenous Malformations....Pages 323-327 A New Grading System for Cerebral Arteriovenous Malformations....Pages 328-332 Front Matter....Pages 321-321 Use of the Callosal Grid System for Cortical Localization....Pages 333-338 Hemodynamics of Cerebral Angiomas: Perioperative Angiography, Transcranial and Intraoperative Doppler Studies....Pages 341-349 Cerebrovascular Reserve Capacity in AVM Patients....Pages 350-351 Vasodilatory Challenge with rCBF Measurement in Patients with Cerebral AVMs: a Preliminary Report....Pages 352-355 Clinical Evaluation of Cerebral Perfusion in AVM Patients....Pages 356-363 The Role of Hemodynamic Assessment in Patients with Cerebral AVMs....Pages 364-372 Selective Flow Modulation of Proximal Feeding Arteries in Surgery of High-Flow Cerebral Arteriovenous Malformations....Pages 373-376 Perioperative Management of High-Flow Arteriovenous Malformations: Hemodynamic Monitoring and Anesthetic Considerations....Pages 377-381 Deep Barbiturate Anesthesia in the Multi-Staged Treatment of Large Deep AVMs....Pages 382-389 Medial Hemisphere and Tentorial Ring AVMs....Pages 390-392 Surgical Experience with Callosal-Cingular and Inferior Limbic AVMs....Pages 395-398 Stereotactic Uses in the Treatment of Deep “Inaccessible” AVMs and a Comparison with Radiosurgery....Pages 399-409 Surgical Removal of Thalamic Arteriovenous Malformation — Transventricular Approach, Sitting Position, Intraoperative Angiography....Pages 410-413 Treatment of Deep Basal Cerebral Arteriovenous Malformations....Pages 414-421 The Surgery of Posterior Fossa Arteriovenous Malformations....Pages 422-425 Surgical Experience with Cerebellar AVMs....Pages 426-429 Overview of Embolic Materials and Clinical Use of EVAL....Pages 430-437 Use of Ethanol in Preoperative AVM Embolization....Pages 441-445 Embolization of Cerebral AVMs with Polylene Threads: Technical Procedure, Results and Complications....Pages 446-451 Front Matter....Pages 452-462 The Role of Embolization in the Surgical Resection of AVMs....Pages 321-321 Further Experience in the Treatment of Cerebral Arteriovenous Malformations with Embolization Plus Surgery....Pages 489-494 The Team Approach to Combined Embolization and Resection of Arteriovenous Malformations....Pages 495-502 Staged Occlusion of Arteriovenous Malformations....Pages 503-506 Outcome from Multimodality Treatment of Arteriovenous Malformations....Pages 507-511 Therapeutic Strategies for Brain AVMs. An Assessment of Benefits and Risks of Surgical and Endovascular Therapy....Pages 512-514 Transcranial Doppler Sonography After Embolization and Staged Operation of AVMs and Balloon Occlusion of Carotid-Cavernous Sinus Fistula....Pages 515-521 Cavernous Malformations of the Brain Stem....Pages 463-470 Cavernomas of the Basal Ganglia, Brain Stem and Spinal Cord. Surgical Strategy and Results....Pages 525-532 Sellar and Parasellar Extra-Axial Cavernous Hemangiomas....Pages 533-537 Intracranial Cavernous Angiomas: a Simple Method for Their Surgical Approach....Pages 538-541 Auditory Evoked Responses and Blink Reflex in Brain-Stem Cavernous Angiomas. Report of 7 Cases....Pages 542-545 Endovascular Management of Vein of Galen Malformations....Pages 546-549 Dural Arteriovenous Fistulas: the Role of Endovascular Therapy....Pages 553-558 Treatment of 23 Dural AVMs Located at the Transverse and Sigmoid Sinuses....Pages 559-565 Diagnosis and Management of Venous Angiomas....Pages 565-569 Management of Venous Angiomas of the Brain....Pages 570-573 Gamma Knife Radiosurgery in Cerebral Vascular Malformations....Pages 574-580 Back Matter....Pages 473-485 ....Pages 581-585 When dealing with aneurysms, the initial subarachnoid hemorrhage can be devastating - creating difficulties in management - and cerebral vasospasm still has to be solved. The hemodynamic consequences of the occlusion of large AVMs are difficult to predict and combined or alternative treatments may be preferable to surgical removal of these lesions. For less common malformations - such as dural fistulas, cavernomas and venous angiomas - the indications for treatment have still to be established