Neurosurgery
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Clinical Trial
Localized transcranial electrical motor evoked potentials for monitoring cranial nerves in cranial base surgery.
To describe a novel monitoring technique that allows "functional" assessment of cranial nerve continuity during cranial base surgery. ⋯ Facial nerve MEPs recorded intraoperatively during cranial base surgery using the proposed technique predicts immediate postoperative facial nerve outcome. This technique can also be used to monitor other motor cranial nerves in cranial base surgery.
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Wide-necked cerebral aneurysms have been particularly difficult to treat using coil embolization. The introduction of the first intracranial flexible stent (Neuroform stent; Boston Scientific/Target, Fremont, CA) has provided a great advantage to this dilemma by forming a bridge across the aneurysm neck and allowing the packing of coils. Despite this advancement, some parent vessel bifurcation aneurysms can still remain elusive to single stent and coiling technique. ⋯ Double stenting in "Y" configuration and coiling is feasible. This technique should increase the ability to endovascularly treat wide-necked aneurysms.
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Clinical Trial
Cerebral cavernous malformations associated with venous anomalies: surgical considerations.
Once thought to be rare entities, mixed cerebrovascular malformations with pathological features of more than one type of malformation within the same lesion are now being recognized with increasing frequency. Their identification generates several hypotheses about common pathogenesis or causation-evolution among different types of lesions and leads to controversial discussion on therapeutic strategies. ⋯ Our results are in favor of the hypothesis that the draining vein of a VM is the actual underlying abnormality of mixed vascular malformations. Causing flow disturbances and having the potential for hemorrhages, the VM seems to promote the development of new adjacent malformations. Thus, permanent cure of associated malformations might depend on the surgical treatment of the VM. We present a preliminary personal series and a thorough review of the literature.
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Intraventricular surgery requires a detailed knowledge of the microanatomy of the choroid plexus vasculature. ⋯ The data obtained on the microanatomy of the intrachoroidal vasculature may have certain neurosurgical implications.
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Cerebral revascularization is an important part of the treatment of complex intracranial aneurysms that require deliberate occlusion of a parent artery. In situ bypass brings together intracranial donor and recipient arteries that lie parallel and in close proximity to one another rather than using an extracranial donor artery. An experience with in situ bypasses was retrospectively reviewed. ⋯ In situ bypass is a safe and effective alternative to extracranial-intracranial bypasses and high-flow bypasses using saphenous vein or radial artery grafts. Although in situ bypasses are more demanding technically, they do not require harvesting a donor artery, can be accomplished with one anastomosis, and are less vulnerable to injury or occlusion.