World Neurosurg
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This video (Video 1) demonstrates bilateral posterior communicating artery (PCoA) aneurysms that were treated through a unilateral supraorbital approach. A 53-year-old woman presented with a Hunt-Hess grade I subarachnoid hemorrhage. Computed tomography scan showed subarachnoid hemorrhage in the left sylvian fissure and basal cistern. ⋯ The patient recovered well without any complications. Postoperative angiography confirmed complete obliteration of these 2 aneurysms. For selected bilateral PCoA aneurysms with non-low-lying and posteromedial projection of the contralateral aneurysm, surgical clipping of all aneurysms via a unilateral approach is a feasible alternative.
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Endoscopic third ventriculostomy (ETV) remains the mainstay of treatment for noncommunicating hydrocephalus these days. However, there has been no adequate clue for the intraoperative assessment of ETV efficacy until now. This time, we propose a newly defined finding, "folding sign," which is visible and enables us to confirm penetration of both the third ventricle floor and the Liliequist membrane (LM) during operation. In this report, we describe consecutive ETV cases and discuss the mechanism of folding sign and its clinical meanings. ⋯ The folding sign is a newly defined sign to predict the success of ETV during operation. This optimal finding appears only when the LM is sufficiently opened; therefore, it could be a good candidate for an intraoperative assessment tool.
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Nonlethal cervical spine injuries in skydiving are rare due to the associated high mortality. Here, we report an unusual pathomechanism leading to a Hangman fracture in a semiprofessional parachute athlete. ⋯ Excessive deceleration during canopy deployment may pose a risk for life-threatening cervical spine injuries in skydiving.
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The greater auricular nerve (GAN) may be used as a nerve graft during neurosurgical procedures to repair damaged nerves. There is extensive literature on localization of the GAN at the posterior triangle of the neck, but objective information on localization of the GAN at the anterior triangle of the neck close to cranial neurosurgical fields is lacking. The aim of this study was to introduce simple and reliable landmarks to localize the GAN at the anterior triangle of the neck to facilitate its harvest during neurosurgical procedures. ⋯ The AGA point and the M-A line are reliable landmarks for locating the GAN at the anterior triangle of the neck and for helping neurosurgeons expose and harvest the GAN efficiently.
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Aneurysm wall biomechanics are not yet an integral part of aneurysm rupture risk evaluation. We aimed to develop a new technique describing the biomechanical properties of aneurysm wall and correlating them to rupture status. ⋯ The indentation test of fresh aneurysm wall samples described the heterogeneity of biomechanical properties of the tissue and found increased elastic capacity in the rupture zone and increased stiffness in the remainder of the aneurysm. This study could be a basis for further research aimed at building a biomechanical-based model of aneurysm rupture risk.