World Neurosurg
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Although endovascular approaches for acute ischemic stroke have been developed, the appropriate selection and sequence of device application or other treatments is unclear. If information about the clot quality can be obtained before the selection of devices, fast recanalization with a suitable device and strategy can be achieved. We studied the relationship between clot quality and the configuration of a microguidewire during endovascular thrombectomy. ⋯ Our results showed that we can select a suitable device and strategy for fast recanalization according to information about clot quality obtained using the modified pigtail-shaped microguidewire.
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Subependymomas are infrequent, low-grade gliomas associated with the ventricular system and the spinal cord. Little is known about the origin and natural history of these slow-growing lesions. ⋯ Subependymomas demonstrate mixed populations of cells expressing glial lineage markers as well as putative stem cell markers, suggesting these tumors may arise from multipotent glial progenitors that reside in the subventricular zone. Definitive diagnosis requires surgical sampling. Although the clinical course of subependymomas appears benign, the inability to radiographically diagnose these lesions, and the possibility of an alternative malignant lesion support a low threshold for early and safe maximal resection.
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Various surgical techniques have been described for treating odontoid instability and achieving effective stabilization. The earliest technique to be described proposed a C1 lateral mass entry point including neurectomy of the C2 nerve roots to ensure hemostasis. Because C2 neurectomy remains controversial, preservation of the C2 nerve root as described in Goel-Harms technique can lead to intractable occipital neuralgia and significant blood loss. The aim of this study was to modify the Goel-Harms technique with a high C1 lateral mass screw entry point to enhance overall intraoperative safety. ⋯ This study confirms that changing the C1 entry point to the junction of the posterior arch and superior-posterior part of the C1 lateral mass by using intraoperative CT navigation yields a safe and effective procedure with few complications. The overall complication rate was 6%.
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There are several ways to identify donor artery patency and success of surgery after an anastomosis of the superficial temporal artery (STA) to the middle cerebral artery (MCA). The purpose of this study was to evaluate the ratio of bilateral STA mean flow rate (MFR) with the use of color Doppler ultrasonography (CDUS) after bypass surgery and to confirm the possibility of this value as a predictor of the extent of collateral flow. ⋯ We conclude that using CDUS to measure both STA MFR ratio is a potential method to predict the extent of collateral flow through an STA-MCA anastomosis.
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To evaluate efficacy and reliability of intraoperative Doppler sonography in localizing the transverse and sigmoid sinuses during lateral suboccipital craniotomy. ⋯ A combination of image-guidance and micro-Doppler enhances the accuracy in localizing the margins of the transverse and sigmoid sinuses using the retrosigmoid approach, thus preventing inadvertent injury. The method could potentially be applied during other craniotomies involving the exposure of a venous sinus.