Neurosurg Focus
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Greater extent of resection (EOR) of low-grade gliomas is associated with improved survival. Proximity to eloquent cortical regions often limits resectability and elevates the risk of surgery-related deficits. ⋯ Intraoperative monitoring with direct cortical stimulation and subcortical stimulation enables surgeons to preserve essential functional tissue during surgery. Through tailored pre- and intraoperative mapping and monitoring the EOR can be maximized, with reduced rates of surgery-related deficits.
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Case Reports
Clip reconstruction of an 8 cm giant internal carotid artery bifurcation aneurysm: microsurgical technique.
Thrombosed giant intracranial aneurysms usually present with symptoms and signs from their mass effect. Although multiple treatment options are available, direct clip reconstruction with thromboendarterectomy remains the gold standard. Here we present a 66-year-old man with seizure, aphasia and hemiparesis. ⋯ Although we prepared for bypass with the radial artery and/or the superficial temporal artery, we were able to clip-reconstruct the aneurysm without bypass. The patient improved upon his pre-morbid state after surgery and made an excellent recovery. The video can be found here: http://youtu.be/P_10hRQFuPo .
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This video demonstrates combined two separate craniotomies for two difficult unruptured cerebral aneurysms. The anterior communicating artery (ACOM) aneurysm existed at a high position, projected posteriorly, and thus necessitated an interhemispheric approach. ⋯ Meticulous micro-cisternal opening under high magnification enabled safe and effective exposure of both aneurysms with minimal brain retraction, which alleviated brain damage as shown in postoperative images. The video can be found here: http://youtu.be/mBYsaAVekCA .
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Giant cerebral aneurysms may be treated through a variety of options, including aneurysm trapping with concurrent bypass. This video describes the case of a large, recurrent, left middle cerebral artery aneurysm that was treated using a high flow, radial artery bypass graft, from the external carotid artery to the left temporal M2 branch. A step-by-step operative description, with emphasis on proper microsurgical technique, is included. The video can be found here: http://youtu.be/9xTMC6InivQ .
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Case Reports
Clip ligation of contralateral P1 aneurysm: extending the working depth of microsurgery along the skull base.
Clip ligation of posterior circulation aneurysms can be challenging because of limited operative working space and angles. Certain proximal posterior cerebral (P1) aneurysms are especially challenging because of their locations within the lateral anterior interpeduncular fossa. We present a 52-year-old woman who had previously undergone coil embolization of a ruptured right-sided posterior communicating artery aneurysm. ⋯ She underwent clip ligation of the latter two unruptured aneurysms through a left-sided pterional craniotomy. The microsurgical techniques to clip ligate a contralateral P1 aneurysm are discussed in the video. The video can be found here: http://youtu.be/YBE7FcFGlpQ .