Surg Neurol
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Lateral approaches have traditionally been used to gain access to lesions of the infratemporal fossa (ITF). However, dysfunction of the facial nerve secondary to its translocation, conductive hearing loss, and dental malocclusion because of mandibular head resection or dislocation are significant limitations associated with some of these approaches. Although facial nerve translocation and extended maxillotomy approaches avoid some of these drawbacks, they are invasive and require extensive osteotomies and facial incisions. To avoid these potential complications and maintain an extranasal/extraoral exposure, we studied the use of a lateral and posterior extension of an anterior transmaxillary approach to the cavernous sinus. ⋯ The approach may be an alternative less invasive approach to the ITF and may be suitable for ITF lesions that have minimal lateral or intracranial extension.
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Review Case Reports
Spontaneous dissecting aneurysms of anterior and middle cerebral artery associated with brain infarction: a case report and review of the literature.
Intracranial dissecting aneurysms have been reported with increasing frequency and are recognized as a common cause of stroke. In some reviews and case reports, attempts have been made to compare the outcomes of surgical and medical treatments. However, the appropriate management of dissecting aneurysms in the anterior circulation remains controversial, especially in patients who also manifest cerebral infarction. ⋯ This is the first reported case of simultaneous idiopathic dissecting aneurysms of different major arterial branches in the anterior circulation. Our review of the literature disclosed 36 and 23 cases, respectively, of dissecting aneurysms of the ACA and MCA. Many previously reported patients with these dissecting aneurysms involving subarachnoid hemorrhage (SAH) underwent surgery, which resulted in better outcome. More than half of the patients with ACA and MCA dissecting aneurysms had cerebral infarction. All ACA dissecting aneurysms involving ischemia occurred in the A2 region. The outcomes of both surgical and conservative management were equally satisfactory. On the other hand, in patients with MCA dissecting aneurysms, the area of ischemia frequently involved the M1 region; in these patients, conservative treatment resulted in poor outcomes. Therefore, revascularization distal to the compromised artery should be considered in patients with MCA-dissecting aneurysms who have ischemia. Careful interpretation of serial angiograms and/or magnetic resonance (MR) images is necessary because of the possibility of disease progression. If the aneurysmal size increases or there is progression of ischemic symptoms in the course of conservative treatment, surgery must be urgently evaluated.
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Comparative Study
A comparative study of the treatment of chronic subdural hematoma--burr hole drainage versus burr hole irrigation.
Several surgical procedures have been reported for the treatment of chronic subdural hematoma. Whether irrigation is required is not clear. We compared the results of treatment of chronic subdural hematoma obtained with burr hole drainage and burr hole irrigation retrospectively. ⋯ For treatment of chronic subdural hematoma, postoperative hospitalization was shorter and the recurrence was less frequent with drainage than with irrigation.
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Controversy about the optimal method of performing a carotid endarterectomy (CEA) exists despite its widespread application and support from various randomized clinical trials. Many surgeons selectively or routinely use electroencephalography (EEG) monitoring as well as shunting when performing this operation. ⋯ We propose that shunting may not be necessary during CEA for high-grade stenosis with contralateral ICA occlusion, presumably because of adequate distal small vessel collaterals.
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Cerebrovascular reactivity measurements are believed to be a helpful tool for selecting patients who are at higher risk for hemodynamic strokes. The aim of this study was to compare cerebral vasoreactivity among patients suffering from internal carotid artery stenosis of different severity (asymptomatic stenosis, asymptomatic occlusion, symptomatic stenosis, symptomatic occlusion). ⋯ Although in general cerebrovascular reserve capacity is compromised in cases of hemodynamically significant carotid lesions, there is a large individual variability within the subgroups. Further randomized studies are needed to clarify whether the clinical efficiency of carotid endarterectomy and extra-intracranial bypass may be improved by selecting the patients using hemodynamic criteria.