Turk Neurosurg
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Unexpected bleeding from the dural sinus can sometimes occur when performing a dural opening during microvascular decompression. We conducted dural opening safely by performing indocyanine green (ICG) videoangiography before making a dural incision. We introduce two specific cases in which surgery was performed to treat a trigeminal neuralgia. ⋯ Using a microscope equipped with fluorescent filters, real-time flow assessment of the underlying veins was done. ICG videoangiography allowed for a clear confirmation of the margins of the dural sinus as well as the vascular structures at the surface of the cerebellum, which were clearly seen through the dura mater. Performing ICG videoangiography prior to dural opening makes it possible to safely perform dural opening.
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Remote intraparenchymal hemorrhage after clipping of a ruptured aneurysm is rare. The pathogenesis is variable, and the therapeutic strategies remain controversial, because the natural history is unclear. Here we report a woman with subarachnoid hemorrhage (SAH), who had an aneurysm of the anterior communicating artery identified by computed tomography angiography (CTA). ⋯ CT images performed immediately after surgery showed that two intraparenchymal hemorrhages were present contralateral to the site of the operation. After conservative treatment, the patient recovered, but still displayed a movement disorder in the left limb. SAH induced-vasospasm, defective vascular autoregulation, excessive drainage of the cerebrospinal fluid, a change in the intracranial pressure after craniotomy, and brain shift may contribute to the pathogenesis of remote hemorrhage after surgery.
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Cervical spine is the most kinetic segment of the whole vertebrae. The radiologic imaging methods concern with the morphologic changes but give no functional data. At flexion, spinal cord strains, anterior osteophytic compression increases. At extension, spinal canal gets narrower, cord shortens and gets thicker, compression of posterior ligament gets abberant and cord compression increases. ⋯ The changes of the cord compression and the transvers area of cord which is the most important prognostic indicator in spinal diseases and also the area of spinal cord and subarachnoid space can be detected via dynamic axial sections of MRI. Dynamic MR images may be helpfull in the decision making for the surgical treatment of CSM.
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Transforaminal approach in lumbar disc herniations: transforaminal microdiscectomy (TFMD) technique.
The endoscopic foraminal approach in foraminal, lateral and far-lateral disc hernias, is a contemporary minimal invasive approach. This study was performed to show that the approach is possible with using the microscope without an endoscope, and even intervention on the discs within the spinal canal is possible by having access through the foramen. ⋯ Transforaminal microdiscectomy is a method that can be performed in any clinic with standard neurosurgical instruments. It does not require additional equipment or a high amount of investment. Application of transforaminal inter-body fusion is possible when required.
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To describe the origin, the course, and relationships of the labyrinthine artery (LA). ⋯ The implication of these anatomic findings for cerebello-pontine angle tumors surgery and neurovascular pathology such as infarction, aneurysm of the LA or the AICA are reviewed and discussed.