Journal of neurosurgery
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Journal of neurosurgery · Nov 2015
"Live cadavers" for training in the management of intraoperative aneurysmal rupture.
Intraoperative rupture occurs in approximately 9.2% of all cranial aneurysm surgeries. This event is not merely a surgical complication, it is also a real surgical crisis that requires swift and decisive action. Neurosurgical residents may have little exposure to this event, but they may face it in their practice. Laboratory training would be invaluable for developing competency in addressing this crisis. In this study, the authors present the "live cadaver" model, which allows repetitive training under lifelike conditions for residents and other trainees to practice managing this crisis. ⋯ The live cadaver model presents a useful simulation of the conditions of live surgery for clipping cerebral aneurysms and managing intraoperative rupture. This model provides a means of practice and promotes team management of intraoperative cerebrovascular critical events. Precise metric measurement for evaluation of training performance improvement can be applied.
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Journal of neurosurgery · Nov 2015
Case ReportsEnhancing subdural effusions mimicking acute subdural hematomas following angiography and endovascular procedures: report of 2 cases.
Hyperdense enhancing subdural effusion due to contrast extravasation has been recently described as a potential mimicker of acute subdural hematoma following a percutaneous coronary procedure. Herein, the authors report on 2 patients who presented with subarachnoid hemorrhage from ruptured cerebral aneurysms and who developed enhancing subdural effusions mimicking acute subdural hematomas after angiography and endovascular coil placement. In 1 case, the subdural effusions completely cleared but recurred after a second angiography. CT attenuation values higher than expected for blood, as well as the evolution of the effusions and density over time, allowed for differentiation of enhancing subdural effusions from acute subdural hematomas.
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Journal of neurosurgery · Nov 2015
Preparedness of neurosurgery graduates for neuroendovascular fellowship: a national survey of fellowship programs.
Endovascular interventions have become an essential part of a neurosurgeon's practice. Whether endovascular procedures have been effectively integrated into residency curricula, however, remains uncertain. The purpose of this study was to assess the preparedness of US neurosurgery graduate trainees for neuroendovascular fellowship. ⋯ The results of this study suggest potential gaps in the training of neurosurgery residents with regard to endovascular neurosurgery. In an era of minimally invasive therapies, changes in residency curricula may be needed to keep pace with the ever-changing field of neurosurgery.
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Journal of neurosurgery · Nov 2015
Anatomical considerations of fascial release in ulnar nerve transposition: a concept revisited.
Surgical transposition of the ulnar nerve to alleviate entrapment may cause otherwise normal structures to become new sources of nerve compression. Recurrent or persistent neuropathy after anterior transposition is commonly attributable to a new distal compression. The authors sought to clarify the anatomical relationship of the ulnar nerve to the common aponeurosis of the humeral head of the flexor carpi ulnaris (FCU) and flexor digitorum superficialis (FDS) muscles following anterior transposition of the nerve. ⋯ The common aponeurosis encountered between the FDS and FCU muscles represents a potential site of posttransposition entrapment, which may account for a subset of failed anterior transpositions. Exploration of this region with release of this structure is recommended to provide an unconstrained distal course for a transposed ulnar nerve.
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Journal of neurosurgery · Nov 2015
Case ReportsSuperficial siderosis of the central nervous system associated with incomplete dural closure following posterior fossa surgery: report of 3 cases.
This report reviews a series of 3 patients who developed superficial siderosis following posterior fossa operations in which dural closure was incomplete. In all 3 patients, revision surgery and complete duraplasty was performed to halt the progression of superficial siderosis. ⋯ In this paper the authors also review the etiology, pathophysiology, diagnosis, and treatment of this condition. The authors suggest that posterior fossa dural patency and pseudomeningocele are risk factors for the latent development of superficial siderosis and recommend that revision duraplasty be performed in patients with posterior fossa pseudomeningoceles and superficial siderosis to prevent progression of the disease.