Walter Dandy at the Johns Hopkins Hospital was the first to describe an aneurysm clipping. In 1938 a patient presented to him with complete palsy of the third cranial nerve along with periorbital headaches. Through clip application, Dandy achieved complete…
The portion of the proximal intradural internal carotid artery (ICA) adjacent to the anterior clinoid process (ACP) is called the paraclinoid segment. Aneurysms arising from the ICA between the roof of the cavernous sinus and the origin of the posterior…
Introduction Moyamoya disease is a chronic, occlusive cerebrovascular disease with unknown etiology characterized by steno-occlusive changes at the terminal portion of the internal carotid artery (ICA) and an abnormal vascular network at the base of the brain. These vessels are…
Introduction The clinical manifestations of supratentorial stroke, ischemic or hemorrhagic, are usually diagnosed in a timely fashion. However, infratentorial stroke can be indolent, and its diagnosis is often delayed until severe clinical symptoms are evident. The posterior fossa tolerates very…
Epidemiology Hemorrhagic infarction, or intracerebral hemorrhages (ICHs), make up approximately 14% of all strokes. Within the United States, ICH occurs with an incidence estimated to range from 15 to 35 cases per 100,000 people per 1 year. Each year, approximately…
Subarachnoid hemorrhage, when caused by the rupture of an intracranial aneurysm, has a mortality rate near 50% at 30 days, and approximately half of the survivors sustain irreversible brain damage. To avoid such a catastrophic event, it is important to…
Introduction Cervicocerebral arterial dissection is an important cause of stroke; however, the majority of dissections are asymptomatic and do not warrant invasive therapy. The treatment of carotid and vertebral artery dissections has evolved significantly since the early diagnosis and management…
Since the first description of a carotid endarterectomy (CEA) for the prevention of stroke, the operation has been widely debated and often criticized; yet the number of endarterectomy procedures performed annually has steadily increased. Early studies suggested that medical management…
Introduction The many advantages of endovascular treatment of cerebral aneurysms are well documented. Acceptance and use of endovascular techniques have steadily increased and has been bolstered by publication of the results of the International Subarachnoid Aneurysm Trial (ISAT) in 2005.…
Introduction Surgical treatment of cerebrovascular disorders with cerebral revascularization procedures has remained a formidable task for neurosurgeons for centuries. Despite remarkable advances in medical management and noninvasive procedures, cerebrovascular revascularization with extracranial-intracranial (EC-IC) bypass procedures has withstood the test of…