World Neurosurg
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Recent evidence has suggested a potential beneficial effect of aspirin on the risk of aneurysm rupture. This benefit must be weighed against its potential adverse effects as an antiplatelet agent in the setting of acute aneurysmal subarachnoid hemorrhage (SAH). ⋯ In the present study, patients taking aspirin had a lower rate of hemorrhagic presentation. In addition, taking aspirin did not adversely impact presenting clinical grade or radiographic grade, vasospasm, and outcome in the setting of aneurysmal SAH.
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Sylvian hematoma in subarachnoid hemorrhage (SAH) is associated with a poor prognosis. Although active bleeding can be detected by multiphase dynamic enhanced computed tomography (CT), bleeding from vessels in the Sylvian fissure has also been found in Sylvian hematoma. We investigated possible origins of Sylvian hematoma based on novel imaging findings of multiphase enhanced CT. ⋯ Sylvian hematomas may be caused secondarily by multiple bleeds from small vessels together with aneurysm rupture.
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To review our surgical experience in minimally invasive transcranial endoscope-assisted microsurgical treatment of intracranial aneurysms, using the supraorbital keyhole craniotomy. ⋯ The minimally invasive supraorbital keyhole approach allowed safe surgical treatment of intracranial aneurysms, including after subarachnoid hemorrhage. The markedly improved endoscopic visualization increased the assessment of clip placement with ideal control of surrounding vessels including perforators for identification of incorrect clip position.
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Case Reports
From craniofacial resection to endonasal endoscopic removal of malignant tumors of the anterior skull base.
To review the current literature and provide our institutional approach and opinion on the indications and limitations of traditional open craniofacial resection (CFR) and a minimally invasive pure endonasal endoscopic approach for anterior skull base tumors concentrating primarily on malignant lesions. ⋯ Both traditional CFR and the endonasal endoscopic approach offer advantages and disadvantages. Both approaches can achieve good results with appropriate patient selection. Numerous important factors, including location and the extent of tumor, should be taken into consideration when considering either approach. The most important determinant of outcome is the ability to achieve gross total resection with microscopic negative margins rather than the type of approach used. In the future, skull base surgeons will need to be familiar with and capable of offering both techniques to the patient.