Neurosurgery
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Although the lateral condylar vein has been encountered in some skull base approaches and used as a route to access the anterior condylar venous confluence, few descriptions can be found in the literature regarding its morphology. ⋯ The lateral condylar vein may be encountered in exposing the jugular bulb, hypoglossal canal, or foramen magnum. This vein has been reported to be a main draining route of dural arteriovenous fistulas, in which case it can be utilized as a transvenous route for endovascular treatment, or obliterated. An understanding of the anatomy of this vein may prove useful in planning skull base and endovascular procedures.
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Case Reports
Surgical distal outflow occlusion for the treatment of complex intracranial aneurysms: experience with 18 cases.
Selected intracranial aneurysms still require parent artery occlusion. Although such occlusion is usually performed proximal to the aneurysm, in rare instances, it may be difficult or impossible to access the proximal parent artery. ⋯ We describe our experience with distal outflow occlusion in the treatment of complex aneurysms not amenable to primary clip reconstruction or endovascular therapy. This technique has been described in very limited fashion in the past and may be particularly useful for patients requiring parent artery occlusion when proximal occlusion is challenging or impossible.
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Significant hemorrhage may occur from the cerebral venous sinuses during the dural separation from the bone flap, particularly in elderly patients. It is important to achieve an urgent hemostatic control. ⋯ We report our experience with a new hemostasis technique to manage bleeding from iatrogenic lacerations of cerebral venous sinuses.
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Once considered inoperable lesions in inviolable territory, brainstem cavernous malformations (BSCM) are now surgically curable with acceptable operative morbidity. Recommending surgery is a difficult decision that would be facilitated by a grading system designed specifically for BSCMs that predicted surgical outcomes. ⋯ Rather than developing a grading system for all cerebral cavernous malformations that is weak with BSCMs, we propose a system for the patients who need it most. The BSCM grading system differentiates patients who might expect favorable surgical outcomes and offers guidance to neurosurgeons forced to select these patients.
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Bilateral anterior cingulotomy is well described for certain pain and psychiatric disorders. Typically, stereotactic frame-based radiofrequency ablation is used. We report the feasibility of a frameless approach using magnetic resonance imaging-guided laser induced thermal therapy (MRgLITT). ⋯ MRgLITT cingulotomy is well tolerated for treatment of cancer pain and can be easily performed framelessly for appropriate candidates.