Neurosurgery
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Critical cerebrospinal fluid (CSF) hypovolemia may cause acute postoperative clinical deterioration in aneurysmal subarachnoid hemorrhage patients after craniotomy for microsurgical aneurysm clipping. We sought to identify risk factors for critical CSF hypovolemia and determine this syndrome's effect on clinical outcome. ⋯ Risk factors associated with an increased incidence of critical CSF hypovolemia after aneurysm surgery include the presence of global cerebral edema on admission head computed tomographic scans and prolonged operative time. In such patients, heightened suspicion of CSF hypovolemia is crucial because rapid and appropriate management obviates excess morbidity and mortality.
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Endoscopic release of carpal tunnel syndrome is still under debate. The main advantages of the technique are considered to be minor postoperative pain and a more rapid postoperative recovery. Disadvantages are thought to be the impossibility of a direct median nerve neurolysis and a higher surgical complication rate, including injury to the median nerve. ⋯ The present data prove that the endoscopic technique is a safe and reliable technique for carpal tunnel surgery. The data do not support the current discussion of a higher risk of median nerve injury with endoscopic carpal tunnel surgery. Thus, for our group, the endoscopic technique represents the therapy of choice for the primary idiopathic carpal tunnel syndrome.
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Intradural pseudoaneurysms have a malignant natural history and can be difficult to treat if parent vessel deconstruction is not feasible. These lesions often involve a long arterial segment and lack a defined saccular component that would safely accommodate the introduction of embolization coils. The current report describes the successful endovascular treatment of these lesions using a strategy of Neuroform stent reconstruction. ⋯ Endovascular Neuroform stent reconstruction represents an optimal strategy for the management of intradural pseudoaneurysms that require a constructive treatment strategy and are too small to accommodate the introduction of embolization coils. Nine out of 10 patients in the current series treated with this strategy demonstrated some degree of endovascular remodeling with either complete (n = 5) or partial (n = 4) angiographic resolution at follow-up. No rehemorrhages were encountered. Adequate antiplatelet therapy, even in the setting of acute subarachnoid hemorrhage, is prerequisite for the avoidance of thromboembolic complications.
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Ten rare cases of symptomatic septum pellucidum cysts in patients who underwent endoscopic fenestration are described. The approaches and techniques used in the management of these cysts and the endoscopic surgical indications are discussed. ⋯ Neuroendoscopic pellucidotomy could be an effective, safe, and convenient therapeutic method for symptomatic septum pellucidum cysts. This approach might provide communication between the cyst and the ventricular system, thus avoiding shunting or craniotomy. We consider that it is appropriate to use the rigid endoscope via the frontal approach. It is helpful to fill the ventricles with lactated Ringer's solution and leave an external drain after surgery.
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The surgical benefit to pseudo-occlusion of the internal carotid artery (ICA) is controversial. Because the benefit of carotid endarterectomy for pseudo-occlusion of the ICA remains uncertain, we examined the use of carotid stenting as a possible alternative treatment for this condition. ⋯ The clinical results of carotid stenting for ICA pseudo-occlusion under embolic protection were fairly good from the viewpoints of periprocedural neurological morbidity, angiographic follow-up results, and stroke prevention. Carotid stenting can be considered an alternative to carotid endarterectomy in patients with ICA pseudo-occlusion.