World Neurosurg
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The aim of the study is to report the feasibility, safety, and outcomes associated with endovascular treatment (EVT) of unruptured intracranial aneurysms (UIAs) under local anesthesia. ⋯ Local anesthesia in the EVT of UIA is feasible and safe. It could be considered as an alternative for the patients with high risk of general anesthesia.
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Cerebral hydatid cyst is among the rare presentations of echinococcosis. Almost all the reported cases of intracranial hydatid cysts are in the cortical regions (parietal lobe in the territory of the middle cerebral artery), and all have been removed surgically using the water jet dissection technique. However, in locations in which there are several neuronal structures, such as the cerebellopontine angle, this method might not be applicable. ⋯ The Meckel cave and cerebellopontine angle are rare locations for hydatid cysts, and the surgical technique is different due to adhesion of the cyst to several neuronal structures (lower cranial nerve, brainstem, and cerebellum). Needle aspiration along with dissection of the cyst microsurgically is recommended in similar cases.
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Central sensitization is abnormal and intense enhancement of pain mechanism by the central nervous system. Patients with central sensitization may be at higher risk of poor outcomes after spinal fusion. The Central Sensitivity Inventory (CSI) was developed to identify and quantify key symptoms related to central sensitization. ⋯ Preoperative CSI was associated with worse quality of life outcomes and increased length of stay after spinal fusions. CSI may be an additional measure in evaluating patients preoperatively to better predict successful spinal fusion outcomes.
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Temporary arterial occlusion (TAO) is valuable for minimizing intraoperative rupture risk during intracranial aneurysm microsurgery; however, it may be associated with ischemic injury. This study aims to identify surgical and intraoperative neurophysiologic monitoring factors that predict perioperative stroke risk after TAO. ⋯ SSEP changes and increased single-episode TAO duration are independently associated with increased perioperative stroke risk. SSEP changes are most predictive for perioperative stroke in unruptured cases.
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Intracranial-intracranial bypass is a valuable cerebral revascularization option. Despite several advantages, one of the main shortcomings of the intracranial-intracranial bypass is the possibility of ischemic complications of the donor artery. However, when sacrificed, the temporopolar artery (TPA) is not associated with major neurologic deficits. We sought to define the role of TPA as a donor for revascularization of the middle cerebral artery (MCA). ⋯ When of favorable diameter, the TPA is a competent donor for intracranial-intracranial bypass to MCA branches at the anterior insula, and anterior frontal and middle temporal opercula (arteries anterior to the precentral gyrus coronal plane).