World Neurosurg
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Few reports have been published discussing surgical outcomes of paraclinoid aneurysms using multifarious treatments such as high-flow bypass. ⋯ Surgical treatment of unruptured paraclinoid aneurysm has high efficacy with good outcomes and a high rate of complete exclusion. However, the rate of visual disturbance is relatively high. Careful surgical techniques and intraoperative monitoring are therefore required.
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The Draf III (modified endoscopic Lothrop) procedure has been proposed to extend the endonasal transethmoidal, transfovea ethmoidalis, and transcribriform approach through the back wall of the frontal sinus. The exposure is time-consuming and increases the risk of cerebrospinal fluid leak, and the indications for use are not well described. There are few data quantifying the advantage it conveys over the approach without the Draf III procedure. ⋯ This study quantifies the increased field of view provided by the Draf III procedure during anterior skull base dissection. Recommendations for preoperative examination of radiographic evidence are provided to help identify which individuals would benefit from the additional exposure.
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Case Reports
Microvascular decompression of the optic nerve for paroxysmal phosphenes and visual field deficit.
Microvascular decompression surgery is standard neurosurgical practice for treating trigeminal neuralgia and hemifacial spasm. Most other cranial nerves have been decompressed for paroxysmal intermittent hyperactivity of the affected cranial nerve or in very long-standing compressions to treat cranial nerve hypofunctioning. ⋯ This case report adds to the few previous case reports combining 2 previously described techniques (i.e., microvascular decompression and anterior clinoidectomy plus optic canal unroofing).
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Spinal intradural tumors are usually removed with laminectomy/laminotomy with a midline dural incision. Pain, discomfort, postoperative kyphosis, and instability may be minimized with unilateral microsurgery. ⋯ Neurologic and oncologic results were good and postoperative pain and discomfort were reduced. Stability was preserved with a unilateral technique. No bracing was necessary, permitting early rehabilitation.
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The proximal segment of the anterior cerebral artery (A1) is among the most uncommon locations for occurrence of an intracranial aneurysm. These aneurysms may be missed if small or misinterpreted when they are near the internal cerebral artery bifurcation or Anterior Communicating Artery region. The association with congenital vascular anomalies and multiplicity makes them unique. ⋯ A1 aneurysms are rare, with wide anatomic variations. In this article, we discuss those variations in detail with illustrative cases and pictures. We also discussed the microsurgical and endovascular strategies to encounter them highlighting the technical challenges.