Neurosurgery
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Comparative Study
Comparative analysis of anterior petrosectomy and transcavernous approaches to retrosellar and upper clival basilar artery aneurysms.
To compare two techniques, transcavernous approach (TcA) and anterior petrosectomy (AP), used to manage retrosellar and upper clival basilar artery (BA) aneurysms. ⋯ From an anatomic standpoint, the TcA offers more advantages than the AP, when approaching retrosellar BA aneurysms, except for those cases in which proximal control is the principal issue and the neck of the aneurysm is located more than 6.0 mm below the floor of the sella.
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Comparative Study
Subtemporal approach to the tentorial incisura: normative morphometric data based on magnetic resonance imaging scans.
The tentorial notch can be contained within a transversal line made in front of the cerebral peduncles and another line through the posterior border of the quadrigeminal plate into the anterior, middle and posterior parts. Different approaches to the tentorial incisura have been established. The subtemporal approach represents one of those options. Since morphometrical analyses of this approach in this region have not yet been performed, the aim of the present study was to measure the surgical corridor along these borders. ⋯ Knowledge of these distances and various contours of the path is crucial to avoid brain damage during retraction or manipulation. The curvature of the floor of the middle cranial fossa is highly variable and thus determines the surgical path chosen.
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We performed a systematic microanatomical study of the occipital artery (OA) and its branches to describe the course, diameter, and branches of this vessel as well as the presence and pattern of anastomotic channels between the OA and the vertebral artery. ⋯ Detailed knowledge of the OA anatomy is helpful in choosing this vessel as a donor for extra-intracranial bypasses. More importantly, knowledge and understanding of the type and pattern of anastomoses between the OA and the vertebral artery are critical to avoid disastrous complications (i.e., posterior circulation stroke) during embolization of vascular or neoplastic processes fed by distal OA branches.
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The use of intrathecal morphine has been effective with few complications for chronic intractable pain of both benign and malignant origins. A rare but serious problem that exists is the formation of an inflammatory mass at the catheter tip of the pain pump. ⋯ This is the first such case, to our knowledge, of a bupivacaine precipitate mimicking a spinal cord tumor.
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Intraorbital arteriovenous fistulas (AVF) of the ophthalmic veins are an extremely rare phenomenon. This article describes two such cases treated solely by transvenous occlusion and not hitherto described in the literature. ⋯ Ophthalmic vein fistulas are a rare form of AVF with presenting symptoms mimicking those of carotid cavernous fistulae. This report describes two cases of ophthalmic vein fistulas successfully treated and angiographically obliterated via transvenous embolization with resolution of the patient's presenting symptoms.