Neurosurgical review
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The purpose of this study was to evaluate cases of subarachnoid hemorrhage (SAH) from ruptured anterior (dorsal) paraclinoid aneurysms. Anterior paraclinoid aneurysms are defined as aneurysms arising from the anterolateral wall of the proximal internal carotid artery without any relationship to an arterial branch. Between 1991 and 2008, a total of 159 patients with 169 paraclinoid aneurysms were treated at the Shinshu University Hospital and its affiliated hospitals. ⋯ Neck laceration or premature rupture frequently happened during the clipping surgery even though the aneurysm was saccular type. The treatment of a ruptured anterior paraclinoid aneurysm is quite difficult. Trapping and bypass would be recommended for such fragile aneurysms.
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Neurosurgical review · Jan 2011
Case ReportsThe extended retrosigmoid approach for neoplastic lesions in the posterior fossa: technique modification.
Approaches to the cerebellar-pontine angle and petroclival region can be challenging due to intervening eloquent neurovascular structures and cerebellar retraction required to view this anatomic compartment with the standard retrosigmoid technique. As previously described [11], the extended retrosigmoid provides additional access to space ventral to the brainstem through mobilization of the sigmoid sinus. We report our further experience and modifications of this approach for neoplastic pathology. ⋯ Requiring a fundamental change in the management of the venous sinuses, the extended retrosigmoid craniotomy permits mobilization of the sigmoid and transverse sinuses. In this process, the entire cerebellar-pontine angle extending from the tentorium to the foramen magnum can be visualized with minimal cerebellar retraction. This technical modification over the standard retrosigmoid approach may provide a useful advantage to neurosurgeons dealing with these complex lesions.
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Neurosurgical review · Jan 2011
ReviewRecanalization therapy for acute ischemic stroke, part 1: surgical embolectomy and chemical thrombolysis.
Cerebral revascularization approaches for acute ischemic stroke greatly expanded during the past decade. Many new revascularization strategies are currently being assessed, while others continue to gain in popularity, offering hope to those with an otherwise refractory disease. We discuss historical and current progress toward successful recanalization, as well as the efforts being made to develop a safe and efficacious method of revascularization in the treatment of acute ischemic stroke.