World Neurosurg
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Randomized Controlled Trial
Retractorless surgery for anterior circulation aneurysms via pterional keyhole approach.
Brain retraction is required during many intracranial procedures to provide more working space. However, it is difficult to avoid brain retraction injury. Here, we report on retractorless surgery for anterior circulation aneurysms via a pterional keyhole approach. ⋯ Furthermore, the proportion of brain retraction injuries in group I (5.3%) was lower than that in group II (34.6%). In addition, a better prognosis was obtained in patients who underwent retractorless surgery. With the careful and accurate use of a handheld suction device and operating instruments, the retractorless technique can replace fixed retraction, reduce brain retraction injury, and is applicable to surgeries on anterior circulation aneurysms via pterional keyhole approaches.
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To describe the clinical feasibility and outcome of the endoscopic-assisted posterior intradural petrous apicectomy approach (PIPA) for petroclival meningiomas extending into the supratentorial space. ⋯ For petroclival meningiomas extending into the middle fossa, the endoscopic-assisted PIPA approach is safe and straightforward. The principal advantages of the PIPA approach are familiarity with the retrosigmoid route; the absence of temporal lobe retraction; and early control of the cranial nerves, vessels, and brainstem. However, careful patient selection regarding tumor extension is fundamental to obtaining optimal outcomes.
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Brain mapping is considered an important approach in neurosurgery to achieve better functional outcomes. The mirror neuron system (MNS) is a brain network implicated in understanding of action and imitation. No previous study has focused on identifying and monitoring the function of the MNS during the perioperative period in brain lesions. The aim of this study was to describe the application of a functional magnetic resonance imaging (fMRI) protocol to identify the MNS in a patient with a lesion in the premotor region. ⋯ The use of an fMRI protocol with observation and execution conditions based on simple intransitive finger actions allows the easy identification and preservation of the MNS. Increased activity on postoperative fMRI may be associated with improvement in motor functions.
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Case Reports
Aneurysm of the A1 segment of the anterior cerebral artery associated with the persistent primitive olfactory artery.
The persistent primitive artery constitutes the anterior cerebral artery proper. When the persistent primitive artery keeps its embryologic course along the olfactory bulb, it is called the persistent primitive olfactory artery (PPOA). ⋯ There is a high incidence of aneurysms associated with a PPOA. Follow-up studies are necessary in the present case to monitor for the development of another aneurysm at the hairpin bend.
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This report describes the technique for implanting a vagus nerve stimulator via a single low anterior cervical incision and discusses the advantages of this technique over that of the more commonly used 2-incision technique. ⋯ The single-incision technique described here for implantation of vagus nerve stimulators is technically straightforward and safe, and has significant advantages over the 2-incision technique.