Neurosurgery
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Case Reports
The anterior subtemporal, medial transpetrosal approach to the upper basilar artery and ponto-mesencephalic junction.
To describe and anatomically analyze the amount of exposure provided by an anterior subtemporal, medial transpetrosal approach to access the upper third of the basilar artery, ventral mesencephalon, pons, and posterior cavernous sinus. ⋯ This approach combines the wide view of the subtemporal approach with the more proximal exposure afforded by a medial petrosectomy. The widened visualization of the ventral pons and mesencephalon minimizes cranial nerve morbidity, greatly facilitates dissection of low-lying aneurysms, and provides proximal basilar artery control that would otherwise be obscured by the petrous ridge.
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Biography Historical Article
Library: historical perspective. John Farquhar Fulton.
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We evaluated a combined technique designed for procedures requiring intraoperative language mapping. We planned to induce general anesthesia with endotracheal intubation and hyperventilation and then to awaken and extubate the patient for speech testing. After the latter, endotracheal reintubation and general anesthesia were planned. ⋯ The combined technique that we describe abolished the potential discomfort of surgical stimulation on a sedated patient, reduced the duration of wakefulness, and provided a secure airway and the means to hyperventilate our patients before dural opening.
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Cranial and orbitocranial penetration by organic foreign material is not infrequent. It is important to identify whether penetration has occurred and to localize and remove the organic foreign material. ⋯ Retained intracranial wood should be removed. The radiological diagnosis can be difficult, and magnetic resonance imaging is the investigation of choice. Magnetic resonance imaging may not detect some cases of organic foreign material penetration.
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This study retrospectively compares the incidence of venous air embolism (VAE) detection and morbidity in the sitting and supine positions. All patients underwent vestibular schwannoma resection via the retrosigmoid approach by a single surgical team. ⋯ Our results indicate that although there is a higher incidence of VAE detection in sitting patients, the morbidity is not statistically greater. We conclude that because morbidity from VAE is similar in either position, patient positioning should be based on surgical team preference.