World Neurosurg
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Neovascularization (NV) plays an important role in plaque progression and plaque vulnerability. However, visualization of NV is difficult using standard imaging tools. Recently, optical frequency domain imaging (OFDI) has provided images of intraplaque microstructure that could not be visualized by previous imaging modalities. Here we report a rare case of NV in the carotid plaque detected both before carotid artery stenting (CAS) and in an in-stent restenotic lesion using OFDI. ⋯ In carotid artery plaque, NV might correlate with plaque progression and in-stent restenosis. OFDI enables advanced evaluation of NVs in the carotid artery plaque.
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Recently, the lateral supraorbital (LSO) keyhole variant of the standard pterional (PT) approach has been popularized for anterior skull base surgery, because it provides good anatomic exposition, reduced complications, and better aesthetic and functional results. However, these aspects have been formally compared only by a limited number of studies. We reviewed our experience with 50 consecutive anterior communicating artery (AComA) and A1/A2 aneurysms. Of these 50 patients, 25 had undergone the standard PT approach and 25, the LSO variant. We report the results in terms of exclusion of the aneurysm, postoperative complications, functional/masticatory outcomes, and aesthetic and patient satisfaction. ⋯ The LSO approach demonstrated a lower rate of early clinical minor complications, with a reduction in hospitalization. The LSO approach provides better results for patient satisfaction, masticatory comfort, and cosmetic results. In our experience, the LSO approach is a safe and effective substitute to the standard PT craniotomy to treat unruptured AComA and A1/A2 aneurysms.
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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.
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Titanium mesh implants (TMIs) are used for various purposes in craniotomy. Although delayed implant exposure and thinning of the overlying skin are well-known complications, the mechanism has not yet been elucidated. We reviewed our cases and propose a mechanism for TMI exposure. ⋯ We believe that the key factor resulting in delayed titanium mesh exposure is the pressure gradient between the atmosphere and the intracranial space. Fluctuation of this gradient exerts dynamic stress on the tissue in the mesh holes and the adjacent tissue, resulting in tissue damage and implant exposure.