Neurosurgery
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During external ventricular drainage (EVD) weaning, cranial computed tomography (cCT) is necessary to evaluate ventricle width. Because intrahospital transfer of critically ill patients is associated with higher mortality, bedside techniques are necessary to evaluate ventricle width. Transcranial sonography is able to show the ventricles in patients with sufficient temporal acoustic window. Contrast-enhanced ultrasound (CEUS) is able to overcome the limitations of insufficient insonation. ⋯ CEUS ventriculography is an effective bedside procedure in critically ill patients with EVD. CEUS allows measurement of ventricle width, ventricle communication, and CSF transfer to the subarachnoidal space through the cisternal foramina.
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Hemodynamics play an important role in the mechanisms of aneurysm formation, growth, and rupture. However, little is known about the hemodynamics of rupture sites. ⋯ In this case, a region with low WSS at end diastole and high pressure at peak systole was at the rupture site. A possible mechanism of rupture in this particular aneurysm is that low WSS at end diastole caused degeneration and thinning of the aneurysm wall and that high pressure at peak systole (impingement zone) resulted in rupture of the thinning wall.
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Microsurgical vascular anastomosis techniques are technically challenging and used in only a narrow spectrum of neurosurgical procedures. Opportunities for instruction and application have become increasingly rare during standard neurosurgery residencies. ⋯ Despite the decrease in frequency, indications for bypass procedures still exist in neurosurgery. The fresh tissue pressurization model offers significant benefits when training neurosurgeons to perform these technically demanding procedures.
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Upper brachial plexus injuries: grafts vs ulnar fascicle transfer to restore biceps muscle function.
Nerve transfers or graft repairs in upper brachial plexus palsies are 2 available options for elbow flexion recovery. ⋯ The results obtained from ulnar nerve fascicle transfer to the biceps branch were superior to those achieved through reconstruction with grafts.
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The middle clinoid is an osseous prominence that arises from the body of the sphenoid bone at the anterolateral margin of the sella. ⋯ Recognition of the middle clinoid and caroticoclinoidal ring on preoperative imaging is critical for surgical planning and middle clinoid removal in endonasal skull base surgery.