British journal of neurosurgery
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Review Case Reports
Surgical management of previously coiled intracranial aneurysms.
With the increased use of endovascular therapy in the treatment of ruptured intracranial aneurysms the number of incompletely coiled aneurysms presenting for further management either due to lack of universal durability of this method or due to recurrent rupture is increasing. Since 1998, seven patients with previously coiled aneurysms underwent surgical obliteration of refractory or recurrent lesions. All patients were recorded in a prospective registry. ⋯ Surgery of recurrent or residual aneurysms resulted in a good outcome in four and a moderate outcome in one patient. Despite early clipping after recurrent haemorrhage after coil occlusion one of the two patients died, the other one had a moderate outcome. Our experience indicates that good results are obtainable, although technical challenges are frequently encountered.
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The rationale for 'awake' resective brain tumour surgery and brain mapping is that the amount of tumour removed is optimized, and risks of damage to adjacent eloquent brain minimized by intraoperative patient assessments. Both goals are generally attained, but occasionally patients may have iatrogenic postoperative deficits. Five such cases (20%) are described from a consecutive series of 25 awake craniotomies. ⋯ These cases highlight both the benefits and limitations of awake craniotomy and intraoperative assessment. Although sensory-motor deficits can be recognized early, some high-level neurological functions may not be readily assessed intraoperatively and vascular catastrophes may occur without warning. The pathophysiological basis of these iatrogenic neurological deficits, and techniques to minimize such problems are discussed.