World Neurosurg
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Posterior cerebral artery (PCA) aneurysms are often fusiform and associated with multiple intracranial aneurysms. A bypass procedure in combination with proximal occlusion or aneurysm trapping is considered to be effective for the treatment of patients with complex PCA aneurysms. Because of the deep, narrowed surgical corridor and the surrounding sensitive neuroanatomic structures, microsurgical procedures applied to the PCA are technically demanding. The authors present a technical report of a complex aneurysm formation located at the postcommunicating segment of the PCA (PCA-P2) treated via an anterior temporal approach. ⋯ The anterior temporal approach is feasible for the microsurgical management of complex postcommunicating PCA aneurysms and the application of bypass procedures.
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Sacral Tarlov cysts are rare causes of sciatic and sacrococcygeal pain and neurologic deficits. Although several microsurgical treatments have been described, the optimal treatment has yet to be determined. We describe our initial experience with symptomatic lesions combining 1) cyst fenestration and imbrication and 2) filling the epidural space using vascularized paraspinous muscle flaps rotated into the cystic cavity. ⋯ The combination of microsurgical cyst fenestration and the use of vascularized muscle pedicle flaps to fill the cystic cavity and the epidural space results in obliteration or reduction in size of the majority of cysts and is associated with initial improvement in pain in most patients. However, delayed recurrence of pain was common with this technique.
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To establish the beneficial effects of salvianolic acid and fluoxetine on the improvement of cognitive function and amelioration of depression-like symptoms of rats with chronic stress-induced depression. ⋯ Combination therapy of salvianolic acid and fluoxetine could alleviate depression-like symptoms and cognitive deficit induced by chronic stress.
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Exposure to surgical subspecialties is limited during the preclinical years of medical school. To offset this limitation, the authors created a neurosurgery elective for first- and second-year medical students. The objective was to provide each student with early exposure to neurosurgery by combining clinical experience with faculty discussions about the academic and personal realities of a career in neurosurgery. ⋯ The neurosurgery elective course significantly increased student knowledge across several areas and changed perceptions about collegiality, quality of life, and family-work balance, while not altering the students' views about the difficulty of training. Adopting a neurosurgery elective geared towards preclinical medical students can significantly change attitudes about the field of neurosurgery and has potential to increase interest in pursuing a career in neurosurgery.
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Catheter malpositioning is one of the most frequent causes of ventriculoperitoneal shunt dysfunction and revision surgery. Most intraoperative tools used to improve the accuracy of catheter insertion are time consuming and expensive or do not display the final position. We evaluate the usefulness of intraoperative fluoroscopy to decrease catheter malpositioning, and define radiological landmarks to identify the correct localization. ⋯ Intraoperative fluoroscopy is easy to perform and is a reliable method to assess correct catheter positioning. Based on its predictive value, corrections of malpositioned ventricular catheters can be performed during the same procedure. The use of intraoperative fluoroscopy decreases early surgical revisions in ventriculoperitoneal shunt treatment.