World Neurosurg
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High-flow extracranial-intracranial (EC-IC) bypass followed by sacrifice of the native internal carotid artery (ICA) is a recognized treatment option for giant ICA aneurysm and skull base tumor involving the ICA. Distal clipping at the supraclinoid portion of the ICA is technically straightforward, but it can potentially compromise ophthalmic artery (OA) perfusion. Because of the extensive EC-IC anastomoses with the OA, visual symptoms are fortunately uncommon. We report a patient who developed complete blindness after distal trapping of the supraclinoid ICA; it was reversed after emergency clip removal. ⋯ OA flow following ICA trapping is complicated and precarious. Delayed onset of visual loss is possible. Prompt action by direct exploration and clip removal is needed and can be effective in reversing blindness.
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To determine whether fusion 3-dimensional (3D) angiography of both internal carotid arteries can better disclose vascular details in patients diagnosed with anterior communicating artery (ACoA) aneurysms by computed tomography angiography (CTA) or magnetic resonance angiography (MRA). ⋯ Fusion 3D angiography can significantly contribute to a better understanding of the complex anatomy of the anterior cerebral artery-ACoA complex, which is essential for successful treatment planning for ACoA aneurysms.
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The carotid web is an intraluminal shelf-like projection arising from the posterior wall of the carotid bifurcation and an uncommon etiology of ischemic strokes. We describe the feasibility of endovascular stent placement to treat this condition. ⋯ Carotid artery stent placement is a feasible option in the management of carotid webs.
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Intraoperative identification of cranial nerves is crucial for safe surgery of skull base tumors. Currently, only a small number of published papers describe the technique of trigger electromyography (t-EMG) in endoscopic endonasal removal of such tumors. ⋯ t-EMG allows surgeons to control the safety of cranial nerves both during and after skull base tumor removal.
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The objective of this pilot retrospective study is to describe the SUrface-PRojected FLuid-Attenuation-Inversion-Recovery (SUPR-FLAIR) analysis, a novel method mainly aimed at revealing cortical areas with subtle signal hyperintensity. ⋯ SUPR-FLAIR analysis is a noninvasive technique that could be helpful for the definition of the EZ, especially when MRI is negative. Its use could reduce the indications for invasive electroencephalography or could provide essential data to refine the strategy of intracerebral electrode implantation in the most challenging cases.