Neurosurgery
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This study examined the usefulness of a surgical approach (retrosigmoid suprafloccular transhorizontal fissure approach) for resection of brainstem cavernous malformations (CMs). ⋯ The retrosigmoid suprafloccular transhorizontal fissure approach is useful for the resection of lateral pontine CMs.
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Improved educational tools for anatomic understanding and surgical simulation of the cranial base are needed because of the limited opportunities for cadaver dissection. A 3-dimensional cranial base model with retractable artificial dura mater is essential to simulate the epidural cranial base approach. ⋯ The improved 3-dimensional cranial base model provides a useful educational tool for the anatomic understanding and surgical simulation of extradural cranial base surgery.
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The International Subarachnoid Trial (ISAT), the largest prospective randomized study into endovascular and neurosurgical treatment of ruptured intracranial aneurysms, recently reported long-term follow-up in >The Lancet Neurology. In this cohort, the risk of death at 5 years was significantly lower in the coiled group, but the proportion of survivors who were independent was not statistically different between the groups, and rebleeding was higher in the coiled group. This article critically evaluates the long-term ISAT data from an evidence-based perspective and places it in the context of the overall approach to treatment of ruptured intracranial aneurysms. ⋯ Nevertheless, the evidence for the superiority in coiling in the long term should not be assumed from ISAT data alone. Potential biases of patient characteristics and national referral patterns, as well as the methodological problems already described from the original trial, contribute to the difficulty in interpreting differences in long-term outcomes. These new data should be regarded as Level 2b evidence, suitable for treatment recommendations but not guidelines.
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The Sundt clip graft is a vessel-encircling clip that can be used to repair a significant dehiscence or tear in an intracerebral vessel wall during urgent situations. ⋯ Neurosurgeons should remember that the Sundt clip graft may be used in emergent situations in which a vascular tear or blister is encountered and the vessel cannot be repaired with suturing or other techniques, including standard encircling aneurysm clips.