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Treatment of Spinal Arteriovenous Malformation and Fistula
With the rapid advancements in endovascular therapy over previous decades, the treatment of spinal arteriovenous malformations (AVMs) continues to evolve. The decision to use endovascular versus surgical therapy largely depends on the type of lesion and its anatomic location. Recent studies demonstrate that endovascular treatment is effective for extradural arteriovenous fistulas (AVFs), intradural ventral (perimedullary) AVMs, and intramedullary spinal AVMs. Treatment of intradural dorsal (dural) AVFs remains largely surgical because of lower recurrence rates, although recent studies demonstrate equivocal outcomes. Extrad...
Source: Neurosurgery Clinics of North America - March 26, 2022 Category: Neurosurgery Authors: Jeff Ehresman, Joshua S. Catapano, Jacob F. Baranoski, Ashutosh P. Jadhav, Andrew F. Ducruet, Felipe C. Albuquerque Source Type: research

Advances in Intraarterial Chemotherapy Delivery Strategies and Blood-Brain Barrier Disruption
Chemotherapeutics play a significant role in the management of most brain tumors. First pass effect, systemic toxicity, and more importantly, the blood-brain barrier pose significant challenges to the success of chemotherapy. Over the last 80  years, different techniques of intraarterial chemotherapy delivery have been performed in many studies but failed to become standard of care. The purpose of this article is to review the history of intraarterial drug delivery and osmotic blood-brain barrier disruption, identify the challenges for clinical translation, and identify future directions for these approaches. (Source: Neu...
Source: Neurosurgery Clinics of North America - March 26, 2022 Category: Neurosurgery Authors: Kutluay Uluc, Edward A. Neuwelt, Prakash Ambady Source Type: research

Recent Advances in Endovascular Neurosurgery
NEUROSURGERY CLINICS OF NORTH AMERICA (Source: Neurosurgery Clinics of North America)
Source: Neurosurgery Clinics of North America - March 26, 2022 Category: Neurosurgery Authors: Elad I. Levy, Azam S. Ahmed, Justin M. Cappuzzo Source Type: research

Copyright
ELSEVIER (Source: Neurosurgery Clinics of North America)
Source: Neurosurgery Clinics of North America - March 26, 2022 Category: Neurosurgery Source Type: research

Contributors
RUSSELL R. LONSER, MD (Source: Neurosurgery Clinics of North America)
Source: Neurosurgery Clinics of North America - March 26, 2022 Category: Neurosurgery Source Type: research

Contents
Elad I. Levy, Azam S. Ahmed and Justin M. Cappuzzo (Source: Neurosurgery Clinics of North America)
Source: Neurosurgery Clinics of North America - March 26, 2022 Category: Neurosurgery Source Type: research

Forthcoming Issues
Pain Management (Source: Neurosurgery Clinics of North America)
Source: Neurosurgery Clinics of North America - March 26, 2022 Category: Neurosurgery Source Type: research

Future Directions of Endovascular Neurosurgery
In the last few decades, endovascular neurosurgery has progressed from treating conventional cerebrovascular pathology to expanding outside the realm of vascular neurosurgery. As technologies, techniques, and devices are developed and refined, more patients with neurologic conditions can be treated with a less-invasive endovascular approach. For pathologies such as neurodegenerative diseases or hydrocephalus, the surgical treatment paradigm is starting to change with novel endovascular innovations. We anticipate more pathologies treatable by endovascular means, as more technological progress is made. (Source: Neurosurgery ...
Source: Neurosurgery Clinics of North America - March 3, 2022 Category: Neurosurgery Authors: Kurt Yaeger, J. Mocco Source Type: research

Transvenous Embolization Technique for Brain Arteriovenous Malformations
Transvenous embolization is potentially curative for small AVMs with favorable anatomic features, such as inaccessible arterial feeders, deep location, and/or a single draining vein. Successful embolization requires the control of arterial blood flow and successful navigation of the draining vein. This allows permeation of the embolizate into the nidus. Arterial inflow may be controlled using a hypercompliant balloon or systemic hypotension. We have described the use of transvenous rapid ventricular pacing and adenosine to achieve transient controlled hypotension. This requires a multidisciplinary approach, yet provides hi...
Source: Neurosurgery Clinics of North America - March 2, 2022 Category: Neurosurgery Authors: Muhammad Waqas, Ammad A. Baig, Elad I. Levy, Adnan H. Siddiqui Source Type: research

Treatment of Pseudotumor Cerebri (Sinus Stenosis)
This article discusses the role of medical and surgical management and the expanding role of venous stenting. (Source: Neurosurgery Clinics of North America)
Source: Neurosurgery Clinics of North America - March 2, 2022 Category: Neurosurgery Authors: Shail Thanki, Waldo Guerrero, Maxim Mokin Source Type: research

Radial Access Techniques
Transradial access (TRA) has gained traction in neurointerventions as studies continue to demonstrate improved access site safety and equivalent end artery effectiveness when compared with traditional transfemoral techniques. Herein, we describe the technical nuances of obtaining TRA with a focus on distal TRA, left TRA, and sheathless TRA using larger bore catheters. We also discuss various strategies to avoid access site conversion if radial artery spasm or radial anomalies are encountered and offer some solutions for forming the Simmons catheter especially when it cannot be performed in the descending aorta. Lastly, we ...
Source: Neurosurgery Clinics of North America - March 2, 2022 Category: Neurosurgery Authors: Evan Luther, Joshua Burks, David J. McCarthy, Vaidya Govindarajan, Ahmed Nada, Vasu Saini, Aria Jamshidi, Hunter King, Rainya Heath, Michael Silva, Isaac Josh Abecassis, Robert M. Starke Source Type: research

Novel Innovation in Flow Diversion
Flow diversion is a mainstay of modern endovascular aneurysm treatment. Several surface-modified flow diverters have been introduced with a goal to reduce rates of in-stent thrombosis and the need for dual antiplatelet therapy. Preliminary follow-up data suggest that these now commercially available devices are noninferior with respect to rates of angiographic occlusion. These data also suggest that these devices have lower rates of stent-related ischemia. In this chapter, we explore these devices in detail and discuss clinical data regarding their efficacy. We also discuss an alternative bioactive surface modification str...
Source: Neurosurgery Clinics of North America - March 2, 2022 Category: Neurosurgery Authors: Joseph S. Hudson, Michael J. Lang, Bradley A. Gross Source Type: research

Radial Access Intervention
Leveraging from the interventional cardiology experience, the transradial access (TRA) for neurointervention has also started to become more used for both diagnostic and therapeutic procedures. A growing body of evidence is showing a superiority of the TRA compared with the conventional transfemoral access (TFA) in terms of access site complications (ACSs), patient satisfaction and preference, hospital length of stay, and cost. Outcomes via the transradial are noninferior, and at times superior, in select neuroendovascular procedures. Future advancements in technology with radial-specific catheters and further operator exp...
Source: Neurosurgery Clinics of North America - March 2, 2022 Category: Neurosurgery Authors: Andres Restrepo-Orozco, Mohamed Abouelleil, Leonard Verhey, Leah Lyons, Jenny Peih-Chir Tsai, Paul Mazaris, Justin Singer Source Type: research

Endovascular Robotic Interventions
After robotic systems were approved for peripheral vascular interventions, many centers adopted this technology in treating carotid diseases. Robotic systems provide several advantages by eliminating radiation exposure and decreasing the rate of musculoskeletal injuries among interventionalists. The main disadvantage this technology poses is the lack of haptic feedback. Based on the experience of our center and several others, robotic systems have proved to be efficient, feasible, and safe when treating carotid diseases. One of the main goals of robotic systems is their future potential in remotely treating stroke patients...
Source: Neurosurgery Clinics of North America - March 2, 2022 Category: Neurosurgery Authors: Kareem El Naamani, Rawad Abbas, Georgios S. Sioutas, Stavropoula I. Tjoumakaris, Michael R. Gooch, Nabeel A. Herial, Robert H. Rosenwasser, Pascal M. Jabbour Source Type: research

A Renaissance in Modern and Future Endovascular Stroke Care
Acute ischemic stroke continues to be a major cause of death and disability globally. Although the concept of endovascular treatment of ischemic stroke is relatively new, current evidence from high-quality randomized trials suggests a significant improvement in the clinical outcome with mechanical thrombectomy up to 24 hours from the stroke onset. There has been a paradigm shift from medical management to mechanical thrombectomy which is now considered standard of care in eligible patients. Not surprisingly, there has been a constant effort to further improve stroke care in the last few years with a common goal of ultra-ra...
Source: Neurosurgery Clinics of North America - March 2, 2022 Category: Neurosurgery Authors: Devi P. Patra, Bart M. Demaerschalk, Brian W. Chong, Chandan Krishna, Bernard R. Bendok Source Type: research