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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In the very elderly, their general condition and poor compliance with drug regimens can render the treatment of low back pain (LBP) difficult. We report the effectiveness of a less-invasive treatment for intractable LBP from superior cluneal nerve entrapment neuropathy (SCN-EN) and gluteus medius muscle (GMeM) pain. ⋯ Even very old patients with intractable LBP, buttock pain, and leg pain due to SCN-EN or GMeM pain can be treated successfully by peripheral block and less-invasive surgery under local anesthesia.
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Percutaneous endoscopic lumbar diskectomy and percutaneous epidural neuroplasty is a commonly used minimally invasive spinal surgery in lumbar disk herniation. But to our knowledge, there is no report about the results of percutaneous endoscopic lumbar diskectomy with percutaneous epidural neuroplasty. We did this study to evaluate the effect of percutaneous endoscopic lumbar diskectomy with percutaneous epidural neuroplasty in lumbar disk herniation. ⋯ Percutaneous endoscopic lumbar diskectomy with percutaneous epidural neuroplasty is a safe and effective surgical method in lumbar disk herniation.
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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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To report the surgical outcome of very small intracranial aneurysms (VSIAs; ≤3 mm) in a large referral neurovascular center in Southern Iran. ⋯ Surgical clipping of ruptured and unruptured VSIAs is a safe and effective modality of treatment associated with low mortality and morbidity. Age, comorbidities (hypertension, ischemic heart disease), GCS score on admission, Hunt and Hess grade, preoperative ventriculoperitoneal shunt insertion, and subarachnoid hemorrhage are important predictors of outcome in patients with VSIAs undergoing surgery.