World Neurosurg
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The internal maxillary artery (IMA) is a reliable donor for extracranial-intracranial high-flow bypasses. However, previously described landmarks and techniques to harvest the IMA are complex and confusing and require extensive bone drilling, carrying significant neurovascular risk. The objective of our study was to describe a minimally invasive technique for exposing the IMA and to assess the feasibility of using the IMA as a donor for anterior-circulation recipient vessels using 2 different local interposition vessels. ⋯ This study confirmed the technical feasibility of IMA as a donor for an extracranial-intracranial bypass to the second segment of the anterior cerebral artery, M2, and the supraclinoid internal carotid artery. However, IMA-STA-M2 was observed to be the most suitable bypass model.
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Three-dimensional images have become an important tool in understanding surgical anatomy. This paper describes a simple method for obtaining endoscopic 3-dimensional anatomic images for teaching purposes. ⋯ Images produced in this way may aid in the understanding of the depth of different structures and ease of learning curve for the use of the endoscopy in neurosurgery.
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Nearly 9.2% of vestibular schwannomas (VS) recur. We evaluate the association of cell proliferative markers like MIB with recurrence in VS. ⋯ MIB index ≥3.5% is associated with recurrence in VS. Maximal diameter of the tumor and extent of resection are perhaps not associated with recurrence of VS.
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To explore influence of reduction of slippage on radiologic parameters, clinical outcomes, and perioperative complications in treatment of grade II/III lumbar isthmic spondylolisthesis. ⋯ In patients with grade II/III lumbar isthmic spondylolisthesis, if postoperative slippage was grade I or less, pelvic tilt and sacral slope could be corrected more effectively, and better clinical outcomes would be obtained for cases with preoperative unbalanced pelvis. In cases with balanced pelvis, lumbar lordosis could be better corrected by the same degree of reduction, although clinical outcomes would not be influenced significantly. Perioperative complications would not be influenced by reduction of slippage.
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Case Reports
Transtubular Evacuation of Hypertensive Intracerebral Hemorrhage with limited equipment.
Hypertensive intracerebral hemorrhage is common in developing countries, where many patients with hypertension are not detected and well treated. The tubular retractor system provides the opportunity for surgeons to evacuate the clot and achieve hemostasis under direct vision. We showed a transtubular surgery performed in a developing country with limited equipment (Video 1). ⋯ This minimally invasive transtubular approach provides a new option for reducing the mass effect of the hematoma without aggressive manipulation of the normal brain tissue. We showed our experience of performing the surgery with limited equipment. This technique could be used in more rural areas to help local patients there.