Neurosurgery clinics of North America
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Neurosurg. Clin. N. Am. · Oct 1998
ReviewSurgical treatment of paraclinoid and ophthalmic aneurysms.
Paraclinoid aneurysms include those arising from the ophthalmic segment and from the distal cavernous carotid artery or clinoid segment. Three aneurysm variants originate from the ophthalmic segment: ophthalmic artery, superior hypophyseal artery, and dorsal types. Clinoidal segment aneurysms arise from the carotid artery in the interval between the carotid oculomotor membrane proximally and the dural ring distally, and include anterior-lateral and medial variants. With proper exposure and a firm understanding of the parasellar osseous, dural, and vascular anatomy, most paraclinoid aneurysms are occluded with low risk to the brain or visual apparatus.
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Neurosurg. Clin. N. Am. · Oct 1998
ReviewTemporary vascular occlusion during cerebral aneurysm surgery.
Temporary artery occlusion is an effective way to reduce the detrimental effects of intraoperative aneurysm rupture and to facilitate aneurysm dissection. The major risk incurred is of cerebral infarction. Dilemmas in the use of this technique include the amount of time that arterial flow may be interrupted safely and whether or not there is benefit to intermittent reperfusion. Protocol for the use of temporary occlusion is described.
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Neurosurg. Clin. N. Am. · Oct 1998
ReviewIntraoperative aneurysm rupture and complication avoidance.
The unexpected rupture of an intracranial aneurysm is a potentially catastrophic event. Strategies to control intraoperative aneurysm hemorrhage are based on sound surgical principles and take into consideration such variables as the timing, location, and severity of the rupture. Proven, successful techniques to prevent or control complications during aneurysm surgery are discussed in this article.
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Patients with subarachnoid hemorrhage from ruptured cerebral aneurysms frequently have systemic manifestations including hypovolemia and fluid and electrolyte disturbances in addition to neurologic symptoms. Anesthetic management therefore begins with proper preoperative evaluation and optimization. Anesthetic induction and maintenance are partly dependent on the patient's condition and seek to optimize cerebral perfusion, facilitate surgical exposure, and reduce the risk of intraoperative aneurysm rupture. Cerebroprotective strategy and adjunct monitors may be useful in some institutions.
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The endovascular management of cerebral aneurysms is undergoing revolutionary growth. Recent advances in endovascular surgery including balloon remodeling, revascularization techniques, functional cerebral rearrangement, intracranial stents, treatment for vasospasm and coil design are discussed, as are their future considerations.