World Neurosurg
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In the past, microsurgical bypass was the best option for revascularization of cerebrovascular lesions that required flow replacement or flow augmentation. Over the last 2 decades with advancements in the field of neuroendovascular surgery, especially with the revolution of flow diverting stents as well as the results of the Carotid Occlusion Surgery Study, indications for microvascular bypass have significantly decreased. The purpose of this study was to evaluate trends in cerebral revascularization over the past 8 years. ⋯ This study demonstrates the impact that both scientific inquiry and technologic advances have had on a challenging and valuable technique in cerebrovascular surgery. Indications for both flow replacement and augmentative bypass remain. However, the marked decline in indications may have an indelible impact on maintenance of surgical proficiency as well as the ability for young neurosurgeons to develop this valuable skill set.
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Stereotactic evacuation is currently accepted as a minimally invasive surgical procedure for the management of brain abscesses. Intraoperative magnetic resonance imaging (Io-MRI) is well established in neuro-oncology but its role has not been completely outlined for brain abscess surgery. The objective of this work is to analyze radiologic, clinical, and laboratory results in a cohort of patients with brain abscesses treated with an original protocol in which the minimally invasiveness of a stereotactic technique is matched with preoperative volumetric evaluation and Io-MRI. ⋯ Although this work is intended to present preliminary results of an original protocol for the management of brain abscess, the role of a precise preoperative volumetric evaluation matched with Io-MRI in the treatment of this disease seems of great benefit, as in surgical neuro-oncology.
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Knowledge of frontal sinus morphometry is important in bifrontal, pterional, orbitozygomatic, and supraorbital craniotomies. Inadvertent frontal sinus violation can lead to infection, cerebrospinal fluid fistula, and mucocele formation. In particular, knowledge of anatomy in relation to surgically relevant landmarks can help surgeons perform these procedures more precisely and safely. We performed a descriptive radiographic analysis to better understand variations in frontal sinus anatomy. ⋯ Planned surgical corridors >1.5 cm lateral to the SON and/or >3.0 cm above the HRL are most likely to avoid the frontal sinus based on our radiographic measurements of normal sinus anatomy. Careful radiographic study and appropriate planning for more medial and/or inferior corridors is suggested.
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Case Reports
Embolic stroke: a rare but probably real cause of aneurysmal-like subarachnoid hemorrhage.
Ischemic stroke is being increasingly recognized as a possible cause of spontaneous isolated convexity subarachnoid hemorrhage (SAH). However, it is a much less established cause of cisternal, aneurysmal-like SAH. Only 3 case reports of concomitant cisternal SAH and perforator infarcts exist in the literature, raising the possibility of perforating artery rupture as a potential mechanism. In contrast, embolic stroke is not recognized as a cause of aneurysmal-like SAH. ⋯ Based on these observations, embolic stroke should be included in the differential diagnosis of angiogram-negative SAH. Therefore, brain magnetic resonance imaging and vascular imaging of the neck should be part of the routine work-up of this relatively common entity.
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We investigated the complication rates of balloon-assisted coil embolization of ruptured and unruptured cerebral aneurysms dependent on their morphologic characteristics in angiography. ⋯ The risk of periprocedural complications in balloon-assisted coil embolization of ruptured and unruptured cerebral aneurysms is linked to the morphologic presentation of the aneurysm; the complication rate was significantly higher in bifurcation aneurysms.