Neurosurgery
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Case Reports
Ruptured internal carotid artery anterior wall aneurysm identified during vasospasm: case report.
Aneurysms of the paraclinoid segment arising from the anterolateral wall of the proximal internal carotid artery (ICA) are usually located in the intradural space, and the proximal neck of the aneurysm is closely adjacent to the dural ring. Although most of these aneurysms can be identified by cerebral angiography, the top of the aneurysm can be flattened because of its relationship to the undersurface of the clinoid process. We report a rare case of a ruptured ICA anterolateral wall aneurysm that was not identified by initial angiography but was clearly observed at the time of vasospasm. ⋯ The presented case suggests that this type of aneurysm may be missed by routine angiography performed before and after vasospasm. If initial angiography fails to reveal the origin of the subarachnoid hemorrhage but computed tomography still discloses hemorrhage from an ICA aneurysm, repeated angiography should be considered within 14 days after the onset of subarachnoid hemorrhage to confirm whether the aneurysm has arisen from the anterior clinoid segment of the ICA.
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In strictly selected cases of middle cerebral artery (MCA) occlusion, revascularization by extracranial-intracranial (EC-IC) bypass can be considered. The interventional recanalization of the occlusion under direct surgical control has not been reported in the literature so far. ⋯ On the basis of our experience, in nonatherosclerotic occlusions, intravascular intervention may be considered.
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Comparative Study Clinical Trial
Intraoperative optical spectroscopy identifies infiltrating glioma margins with high sensitivity.
Adult gliomas have indistinct borders. As the ratio of neoplastic cells to normal cells becomes lower, the ability to detect these cells diminishes. We describe a device designed to augment intraoperative identification of both solid tumor and infiltrating tumor margins. ⋯ We have developed a handheld, optical spectroscopic device that may be used rapidly and in near real time with high sensitivity and reproducibility as an optical tissue discrimination tool in glioma surgery.
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We identify radiographic imaging similarities found on head computed tomographic (CT) scans of patients with through-and-through gunshot wounds to the head with fatal outcomes. ⋯ We confirm that GCS score and diabetes insipidus correlated with fatal outcome. In the setting of low-velocity gunshot wounds, fatal outcome and low GCS score were associated with a tram-track sign on CT scans. Bullet passage through a particular supra-dorsum sellar transventricular zone was associated with fatal outcome.
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Comparative Study
Techniques for aspirating bone marrow for use in spinal surgery.
The osteogenicity of bone marrow has been well documented in the literature. The use of bone marrow as a source of osteoprogenitor cells for spinal fusion surgery is increasing. Improper aspiration technique can lead to dilution of bone marrow and a subsequent reduction in osteoprogenitor cells. Therefore, correct aspiration technique is imperative to the successful use of bone marrow with various grafting combinations. ⋯ Clinical studies currently under way will answer the question of bone marrow efficacy in spinal fusion surgery.