Key Points Patients with subtotal or complete infarction of the middle cerebral artery (MCA) territory are at high risk for space-occupying edema formation and increased intracranial pressure (ICP). The diagnosis of malignant MCA infarction is based on clinical and radiologic…
Key Points Extracranial-intracranial bypass is effective in augmenting blood flow to the middle cerebral artery. Although extracranial-intracranial bypass was originally developed as a strategy for treating cerebral ischemia related to atherosclerotic cerebrovascular occlusive disease (e.g., carotid occlusion), prospective randomized trials…
Key Points Extracranial carotid artery stenosis is the cause of approximately 8% of ischemic strokes. Modalities for diagnosing extracranial carotid artery stenosis include carotid artery duplex Doppler ultrasound, magnetic resonance angiography, computed tomography angiography, and conventional angiography. Each modality has…
Key Points Cerebral cavernous malformations (CCMs) are “mulberry-like” lesions without intervening brain tissue. CCMs present most frequently with seizure, hemorrhage, or neurologic deficit. Three gene loci have been implicated in the pathogenesis of CCMs: chromosomal arms 7q CCM1 (KRIT1), 7p…
Key Points Review of the pathophysiology, natural history, and clinical presentation of cerebral arteriovenous malformations (AVMs). Discussion of cerebral AVM classification schemes and their impact on surgical decision-making. Consideration of the unique features of cerebellar AVMs. Technical nuances for the…
Key Points Spontaneous intraventricular hemorrhages (IVHs) occur most commonly as extensions of parenchymal/deep hypertensive hemorrhages. Other causes can include aneurysmal rupture extension, most commonly from anterior communicating artery locations and fourth ventricular hemorrhages for posterior circulation aneurysmal rupture or arteriovenous…
Key Points Surgery for spontaneous supratentorial intracerebral hemorrhage (ICH) remains controversial. Surgical evacuation of cerebellar ICH is recommended for clots that are large or causing brainstem compression. There is good rationale and strong preclinical data to suggest that surgical evacuation…
Key Points Many aneurysms are not safely or completely treatable by endovascular means. Surgical clipping has a firmly established safety and durability history, with the advantages of lower recurrence and rebleeding rates compared to those associated with endovascular intervention. Surgery…
Key Points Dural arteriovenous malformations or fistulas (DAVM/F) consist of pathologic arteriovenous shunting occurring within the dural leaflet, with secondary involvement of the cerebral venous circulation. The vast majority of these lesions are acquired with possible secondary causes including hypercoagulability,…
Key Points While risk of bleeding of an unruptured brain arteriovenous malformation (AVM) is close to 2%, rupture rate of a previously ruptured AVM is considerably higher; thus, treatment of the latter is in most cases indicated whereas treatment of…