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Article: Management of subarachnoid haemorrhage.

Kopitnik, T A / Samson, D S

Journal of neurology, neurosurgery, and psychiatry

1993 Volume 56, Issue 9, Page(s) 947–959

MeSH term(s)	Aneurysm, Ruptured/complications ; Humans ; Intracranial Aneurysm/complications ; Subarachnoid Hemorrhage/diagnosis ; Subarachnoid Hemorrhage/etiology ; Subarachnoid Hemorrhage/therapy
Language	English
Publishing date	1993-09
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	3087-9
ISSN	1468-330X ; 0022-3050
ISSN (online)	1468-330X
ISSN	0022-3050
DOI	10.1136/jnnp.56.9.947
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Article: Thoracic fractures: classification and the relevance of instrumentation.

Haid, R W / Kopitnik, T A

Clinical neurosurgery

1992 Volume 38, Page(s) 213–233

MeSH term(s)	Fracture Fixation, Internal/instrumentation ; Humans ; Spinal Fractures/classification ; Spinal Fractures/surgery ; Spinal Fusion/instrumentation ; Surgical Instruments ; Thoracic Vertebrae/injuries ; Thoracic Vertebrae/surgery
Language	English
Publishing date	1992
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	127548-3
ISSN	0069-4827
ISSN	0069-4827
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Article: The future. Prospects of innovative treatment of intracerebral hemorrhage.

Kopitnik, T A / Kaufman, H H

Neurosurgery clinics of North America

1992 Volume 3, Issue 3, Page(s) 703–707

Abstract: Aggressive surgical as well as medical management strategies have had limited success with improving outcomes from spontaneous intracerebral hematomas. Future prospects of treatment will undoubtedly focus on less invasive, better tolerated procedures to ... ...

Abstract	Aggressive surgical as well as medical management strategies have had limited success with improving outcomes from spontaneous intracerebral hematomas. Future prospects of treatment will undoubtedly focus on less invasive, better tolerated procedures to remove hematomas in select patients. Some success has been achieved with a coupling of stereotactic technology, fibrinolytic agents, and mechanical devices, which can remove solid portions of hematoma through narrow probes. Newer technology also has involved laser endoscopic and small ultrasonic probes to facilitate morcellation and subsequent aspiration without the problems associated with a major intracranial procedure.
MeSH term(s)	Cerebral Hemorrhage/drug therapy ; Cerebral Hemorrhage/etiology ; Cerebral Hemorrhage/surgery ; Fibrinolytic Agents/administration & dosage ; Forecasting ; Humans ; Stereotaxic Techniques/instrumentation ; Suction/instrumentation
Chemical Substances	Fibrinolytic Agents
Language	English
Publishing date	1992-07
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1196855-2
ISSN	1558-1349 ; 1042-3680
ISSN (online)	1558-1349
ISSN	1042-3680
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Article: Current results of the surgical management of aneurysms of the basilar apex.

Samson, D / Batjer, H H / Kopitnik, T A

Neurosurgery

1999 Volume 44, Issue 4, Page(s) 697–702; discussion 702–4

Abstract: Objective: To provide current information regarding the expected clinical outcomes and sources of morbidity and mortality in the modern surgical management of basilar apex aneurysms.: Method: A retrospective review was conducted of 303 cases of such ... ...

Abstract	Objective: To provide current information regarding the expected clinical outcomes and sources of morbidity and mortality in the modern surgical management of basilar apex aneurysms. Method: A retrospective review was conducted of 303 cases of such aneurysms that were treated surgically during 18 years at one institution. Postoperative angiography was performed in 81% of the cases. Clinical grading using the Glasgow Outcome Scale was conducted at the time of hospital discharge and for 91% of the surviving patients at 6 months after surgery. The preoperative parameters that were linked statistically to poor clinical outcome were identified through the use of single and multivariate analyses. Results: More than 80% of the patients were operated on using some modification of the trans-sylvian exposure, and temporary arterial occlusion was used routinely. Good outcomes (Glasgow Outcome Scale scores of 4 or 5) were achieved in 76% of the patients at the time of discharge and in 81% of the patients at 6 months after surgery. There was no incidence of postoperative subarachnoid hemorrhage. Residual aneurysm was revealed by postoperative angiography in 6% of the cases. Factors found to be statistically linked to poor outcome included poor admission grade (Hunt and Hess Grades IV and V), patient age older than 65 years, computed tomographic demonstration of thick basal cistern clot, aneurysm size greater than 20 mm, and symptoms attributable to brain stem compression. Conclusion: Direct microsurgical repair of basilar apex aneurysms should result in good clinical outcomes in 80 to 85% of cases, with reliable prevention of subarachnoid bleeding and routine elimination/reduction of symptoms secondary to mass effect. Those patients who are at high risk for poor outcomes can be identified by the presence of certain clinical, radiographic, and demographic features before undergoing surgery and can be considered for alternative or adjunctive modes of therapy if long-term efficacy of such treatment is demonstrated.
MeSH term(s)	Adolescent ; Adult ; Aged ; Basilar Artery ; Child ; Female ; Humans ; Intracranial Aneurysm/surgery ; Intraoperative Care ; Male ; Middle Aged ; Postoperative Complications ; Retrospective Studies ; Risk Factors ; Treatment Outcome
Language	English
Publishing date	1999-04
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	135446-2
ISSN	1524-4040 ; 0148-396X
ISSN (online)	1524-4040
ISSN	0148-396X
DOI	10.1097/00006123-199904000-00001
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Article: Subarachnoid hemorrhage during arteriovenous malformation embolization as a result of vessel wall "sandblasting".

Horowitz, M / Purdy, P / Kopitnik, T

Surgical neurology

1998 Volume 50, Issue 5, Page(s) 403–6; discussion 406–7

Abstract: Objective: Preoperative selective particulate embolization of arteriovenous malformations can make subsequent surgical resection of such lesions safer for the patient and easier for the surgeon. Nevertheless, embolization carries intrinsic risks, which ... ...

Abstract	Objective: Preoperative selective particulate embolization of arteriovenous malformations can make subsequent surgical resection of such lesions safer for the patient and easier for the surgeon. Nevertheless, embolization carries intrinsic risks, which include subarachnoid hemorrhage. We report two cases of subarachnoid hemorrhage during particulate embolization that we think was attributable to catheter positioning near a vessel curve and subsequent denudation of the vessel wall to the degree that hemorrhage was induced.
MeSH term(s)	Adult ; Arteriovenous Malformations/diagnostic imaging ; Arteriovenous Malformations/surgery ; Cerebral Angiography ; Cerebral Arteries/injuries ; Embolization, Therapeutic/adverse effects ; Female ; Humans ; Preoperative Care ; Rupture ; Subarachnoid Hemorrhage/diagnostic imaging ; Subarachnoid Hemorrhage/etiology ; Tomography, X-Ray Computed
Language	English
Publishing date	1998-11
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	221938-4
ISSN	1879-3339 ; 0090-3019
ISSN (online)	1879-3339
ISSN	0090-3019
DOI	10.1016/s0090-3019(97)00349-2
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Article: Combined transsylvian-subtemporal exposure of cerebral aneurysms involving the basilar apex.

Kopitnik, T A / Batjer, H H / Samson, D S

Microsurgery

1994 Volume 15, Issue 8, Page(s) 534–540

Abstract: The surgical repair of cerebral aneurysms involving the apex of the basilar artery continues to undergo refinement and evolution. The inherent difficulty in accessing the basilar apex as well as the complexities of the microanatomy render this area a ... ...

Abstract	The surgical repair of cerebral aneurysms involving the apex of the basilar artery continues to undergo refinement and evolution. The inherent difficulty in accessing the basilar apex as well as the complexities of the microanatomy render this area a notoriously hazardous and technically challenging region in which to perform microsurgical clipping of cerebral aneurysms. Several operative approaches have been described and are constantly undergoing a state of evolution in the hopes of optimizing the exposure of the distal basilar artery and minimizing the inherent risks of surgery. The consistent decline in operative morbidity has paralleled improved understanding of the microvascular anatomy, both in this region and along the various corridors of approach. No single operative approach is universally superior, considering the wide variability of individual patient anatomy and vascular configurations. Each approach has strengths, weaknesses, and potential complications that must be considered in the though process of planning an operative attack on a basilar apex aneurysm. Intimate familiarity with the microvasculature and the microsurgical anatomy of the region is an imperative prerequisite for the application of any surgical approach to this region. This paper outlines a detailed review of the microsurgical anatomy that is pertinent to microsurgery of aneurysms in this region, and describes an approach referred to as the combined transsylvian-subtemporal approach. We have found this operative approach particularly useful in aneurysm surgery of the basilar apex but do not mean to imply that this single approach is suitable for all surgeons or all patients.(ABSTRACT TRUNCATED AT 250 WORDS)
MeSH term(s)	Basilar Artery/surgery ; Cerebral Arteries/anatomy & histology ; Craniotomy/methods ; Humans ; Intracranial Aneurysm/surgery ; Microsurgery/methods ; Vascular Surgical Procedures/methods
Language	English
Publishing date	1994
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	605524-2
ISSN	1098-2752 ; 0738-1085
ISSN (online)	1098-2752
ISSN	0738-1085
DOI	10.1002/micr.1920150804
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Article: Central nervous system monitoring. What helps, what does not.

Unwin, D H / Giller, C A / Kopitnik, T A

The Surgical clinics of North America

1991 Volume 71, Issue 4, Page(s) 733–747

Abstract: The ICU monitoring of CNS function can make a difference in the clinical outcome. No single technique addresses the multiple issues that arise in the ICU setting, especially for the polytrauma patient. Multimodality approaches combining assessment of ... ...

Abstract	The ICU monitoring of CNS function can make a difference in the clinical outcome. No single technique addresses the multiple issues that arise in the ICU setting, especially for the polytrauma patient. Multimodality approaches combining assessment of cerebral blood flow, electrophysiologic parameters, and intracranial pressure, when appropriate, with cardiac and respiratory monitors are being developed at a number of traumatology centers world wide. Experience needs to be gained to establish the best combination of these modalities. Pending this, selected use of intracranial pressure monitoring combined with EEG and transcranial Doppler ultrasound provides reliable immediate assessment and ongoing monitoring of CNS structures.
MeSH term(s)	Arterial Occlusive Diseases/physiopathology ; Blood Pressure ; Brain/physiopathology ; Brain Death/physiopathology ; Brain Injuries/physiopathology ; Carbon Dioxide/physiology ; Carotid Artery Diseases/physiopathology ; Cerebrovascular Circulation ; Echoencephalography ; Electroencephalography ; Evoked Potentials ; Humans ; Intracranial Pressure ; Ischemic Attack, Transient/diagnostic imaging ; Ischemic Attack, Transient/physiopathology ; Monitoring, Physiologic/methods
Chemical Substances	Carbon Dioxide (142M471B3J)
Language	English
Publishing date	1991-08
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	215713-5
ISSN	1558-3171 ; 0039-6109
ISSN (online)	1558-3171
ISSN	0039-6109
DOI	10.1016/s0039-6109(16)45483-6
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Article: Aneurysm retreatment after Guglielmi detachable coil and nondetachable coil embolization: report of nine cases and review of the literature.

Horowitz, M / Purdy, P / Kopitnik, T / Dutton, K / Samson, D

Neurosurgery

1999 Volume 44, Issue 4, Page(s) 712–9; discussion 719–20

Abstract: Objective: Guglielmi detachable coil embolization of cerebral aneurysms is becoming increasingly used to manage certain intracranial lesions based on aneurysm geometry, patient condition, and patient and surgeon preferences. Aneurysm recurrences or ... ...

Abstract	Objective: Guglielmi detachable coil embolization of cerebral aneurysms is becoming increasingly used to manage certain intracranial lesions based on aneurysm geometry, patient condition, and patient and surgeon preferences. Aneurysm recurrences or incomplete initial treatments are not uncommon, making repeat treatment necessary using either surgical or endovascular techniques. Methods: Between January 1993 and June 1998, 1025 cerebral aneurysms were managed by the authors at a single hospital. One hundred twenty-four of these lesions were treated using Guglielmi detachable coils, and one was managed with nondetachable coils. During the follow-up period, eight patients who underwent embolization at our institution and one who underwent embolization elsewhere received repeat treatment. Five were approached surgically, and four underwent re-embolization. All charts and films were reviewed retrospectively to determine patient outcome and clinical success. Results: No patient in the subgroup of this clinical study suffered a permanent complication from initial aneurysm coiling, no episodes of subsequent bleeding occurred, and no complications resulted from any subsequent therapies. The anatomic results were excellent, and all aneurysms were totally or near totally obliterated. Conclusion: Subtotal initial coil embolization of aneurysms can be managed safely using a variety of surgical and endovascular techniques. Our approach to this predicament, lessons we have learned, and a review of the literature are herein discussed.
MeSH term(s)	Adult ; Aged ; Embolization, Therapeutic/instrumentation ; Female ; Humans ; Intracranial Aneurysm/therapy ; Male ; Middle Aged ; Retreatment
Language	English
Publishing date	1999-04
Publishing country	United States
Document type	Case Reports ; Journal Article ; Review
ZDB-ID	135446-2
ISSN	1524-4040 ; 0148-396X
ISSN (online)	1524-4040
ISSN	0148-396X
DOI	10.1097/00006123-199904000-00013
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Article: An unusual transcranial Doppler waveform associated with vessel distortion in giant intracranial aneurysms.

Giller, C A / Giller, A M / Batjer, H H / Kopitnik, T A

Neurosurgery

1994 Volume 34, Issue 6, Page(s) 1068–70; discussion 1070–1

Abstract: Although the shapes of velocity waveforms obtained with transcranial Doppler examination can indicate such abnormalities as increased intracranial pressure and proximal arterial compromise, the significance of unusual waveform morphologies is often ... ...

Abstract	Although the shapes of velocity waveforms obtained with transcranial Doppler examination can indicate such abnormalities as increased intracranial pressure and proximal arterial compromise, the significance of unusual waveform morphologies is often obscure. In this report, we describe four cases in which an unusual waveform morphology was obtained from vessels distorted and narrowed by intracranial masses. The appearance of this unusual morphology as an isolated signal within a transcranial Doppler examination should, therefore, suggest a structural deformation of the insonated vessel to those who interpret transcranial Doppler studies.
MeSH term(s)	Adult ; Blood Flow Velocity/physiology ; Cerebral Angiography ; Diagnosis, Differential ; Female ; Humans ; Intracranial Aneurysm/diagnostic imaging ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Ultrasonography, Doppler, Transcranial
Language	English
Publishing date	1994-06
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	135446-2
ISSN	1524-4040 ; 0148-396X
ISSN (online)	1524-4040
ISSN	0148-396X
DOI	10.1227/00006123-199406000-00018
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Article: Surgical management of proximal carotid artery aneurysms.

Batjer, H H / Kopitnik, T A / Giller, C A / Samson, D S

Clinical neurosurgery

1994 Volume 41, Page(s) 21–38

MeSH term(s)	Carotid Artery Diseases/diagnostic imaging ; Carotid Artery Diseases/surgery ; Carotid Artery, Internal/diagnostic imaging ; Carotid Artery, Internal/surgery ; Cerebral Angiography ; Humans ; Intracranial Aneurysm/diagnostic imaging ; Intracranial Aneurysm/surgery ; Subarachnoid Hemorrhage/diagnostic imaging ; Subarachnoid Hemorrhage/surgery
Language	English
Publishing date	1994
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	127548-3
ISSN	0069-4827
ISSN	0069-4827
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