Advances in Open Neurovascular Surgery 2007

We have read with great interest the Advances in Stroke 2007 subsection in February’s issue of Stroke and congratulate Dr Fisher for nicely amalgamating articles addressing some of the most pressing advances and shortcomings in stroke management over the past year.1 Although advances in interventional approaches to stroke and neurovascular disease were nicely outlined,1,2 we noticed little emphasis on open neurosurgical approaches. Of particular interest to our cerebrovascular team, reviewing the success of hemicraniectomy for malignant middle cerebral artery infarction1,3 served to support the evidence that we have observed at our institution for this successful intervention for an oftentimes devastating disease. We would, however, like to further highlight more of the exciting advances in open cerebrovascular neurosurgery that have emerged over the past year for stroke and neurovascular diseases.As already acknowledged in your Advances in Stroke 2007 subsection,2 the results of the International Study of Unruptured Intracranial Aneurysms (ISUIA) continued to meet with considerable scrutiny over the past year. Promisingly, advances in both endovascular and neurosurgical approaches to aneurysm treatment continued in 2007. Kassam et al reported the first endoscopic endonasal clipping of a superior hypophyseal aneurysm.4 Kim et al presented a novel approach to the management of fusiform aneurysms, circumferentially cinching a Gore-Tex sling against an already clip-reconstructed parent vessel by clipping the free ends of the sling immediately adjacent to the vessel.5 Krisht et al presented their impressive experience with 50 complex basilar aneurysms managed through a pretemporal, transzygomatic transcavernous approach.6 These aneurysms, unamenable to endovascular coiling, were successfully clipped in 98% of cases with no procedure-related mortality and 6-month follow-up Rankin scores of 0 to 2 in 92% of patients. Given that half of the patients in this series presented …