World Neurosurg
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Stent-assisted coiling technique has been more and more adopted in the treatment of intracranial aneurysms and has been shown to improve long-term angiographic results; however, the treatment is relatively contraindicated in acutely ruptured aneurysms for its ischemic and hemorrhagic complications. Staged stenting after conventional coiling has emerged as a potential treatment strategy for ruptured wide-neck aneurysms. This study assessed the safety and efficacy of coiling in the acute phase followed by delayed stenting for ruptured wide-neck intracranial aneurysms. ⋯ Staged treatment of ruptured wide-neck aneurysms with coiling in the acute phase followed by delayed stenting is safe and effective.
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To present a case series of blood blister-like aneurysms (BBAs) of the internal carotid artery (ICA) and an assessment of diagnosis and treatment options, attempting to identify surgical or endovascular management of BBAs with a low complication rate and a functional outcome. ⋯ Preoperative diagnosis of BBAs is essential for proper management. Once the BBA has ruptured, the emergency clipping operation should be performed with caution. Moreover, based on lessons learned from direct clipping and a literature review, interventional therapy appears to be a more physiologic and more definitive treatment option for BBAs of the ICA, with a more favorable patient outcome.
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In patients with supratentorial spontaneous intracerebral hemorrhage, intrahematomal catheter placement may allow for intraclot thrombolysis and drainage. Robotic assistance may be used for the stereotactic placement of catheters. ⋯ Frameless image-guided placement of intraparenchymal hematoma catheter using Robotic Stereotactic Assistance is safe and efficient.
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Trauma accounts for 4.7 million deaths each year, with an estimated 90% of these occurring in low- and middle-income countries (LMICs). Approximately half of trauma-related deaths are caused by central nervous system injury. Because a thorough understanding of traumatic brain injury (TBI) in LMICs is essential to mitigate TBI-related mortality, we established a clinical and radiographic database to characterize TBI in our low-income setting. ⋯ TBI represents a significant part of the global neurosurgical burden of disease. Implementation of proven in-hospital interventions for these patients is critical to attenuate TBI-related morbidity and mortality.
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Case Reports
Flexible ultrathin endoscope integrated with irrigation suction apparatus for assisting microneurosurgery.
Endoscopy can observe the anatomical components in a deeply located and/or hidden area during neurosurgical procedures under the operating microscope. We have newly developed a flexible ultrathin endoscope integrated with irrigation suction apparatus (FUEISA) to visualize deeply located and/or hidden areas for assisting microneurosurgery. ⋯ The FUEISA system can be applied with safe manipulation, which was remarkably useful for confirmation of the presence of perforators and cranial nerves behind the lesions, particularly anatomical components located in deep and/or hidden areas during clipping of cerebral aneurysms.