Surg Neurol
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Aneurysms of the posterior circulation are challenging lesions to neurosurgeons, despite improvements in microsurgical techniques and advances in skull base approaches. We present a rare case of a posterior cerebral artery (PCA)-posterior communicating artery (PcomA) junction aneurysm associated with bilateral internal carotid artery (ICA) occlusion successfully treated with an endovascular procedure. ⋯ We emphasize the advantages of the endovascular approach for the patient in critical condition. We believe that this is the first report of a PCA-Pcom junction aneurysm associated with bilateral ICA occlusion without moyamoya disease.
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The ongoing controversy on the certification of neurosurgery subspecialties has not been settled. There has been no detailed report on why a resident chooses to undergo further training in the form of a postgraduate fellowship. A survey was devised to investigate the reasons, as well as factors, that prompt the resident to pursue fellowship training. ⋯ A significant number of residents consider fellowship a way to further their personal interest and knowledge, as well as increase their marketability. Relatively few from the surveyed group considered their residency training experience deficient in the subspecialty areas, with the exception of peripheral nerve, endovascular, and possibly skull base neurosurgery.
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To assess the clinical features and therapeutic outcomes of gram-negative bacillary meningitis (GNBM) in adult postneurosurgical patients. ⋯ There has been an increase of GNBM in postneurosurgical patients in recent years. In addition, the emergence of strains resistant to third-generation cephalosporins in this specific group of patients has also been noted in recent years, and has become a great therapeutic challenge. We noted many prognostic factors in postneurosurgical patients in this study; however, appropriate antibiotic therapy and initial consciousness level are the most significant ones. Therefore, in cases of postneurosurgical patients with nosocomially acquired GNBM, the possibility of third-generation cephalosporin resistance should be strongly suspected. Early initiation of appropriate antibiotic therapy is needed in this potentially fatal disease.
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Primary palmar hyperhidrosis (PH) is very common, and can be disabling. Various surgical methods for endoscopic sympathectomy have been advocated. We present a simple and effective method of treating PH by means of transthoracic endoscopic sympathectomy (TES). ⋯ TES is a simple, safe, and effective method of treating PH.