World Neurosurg
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Three-dimensional (3D) rotational angiography (RA), a gold standard imaging tool for the evaluation of cerebral aneurysms after clipping, can currently be performed intraoperatively in a hybrid operating room (OR). However, its role in intraoperative aneurysmal surgery is unclear. We aimed to study the value of intraoperative 2-dimensional digital subtraction angiography (2D-DSA) and 3D-RA for the evaluation of aneurysms after clipping, in terms of clip repositioning. ⋯ A hybrid OR, with angiography facilities for high-resolution 2D-DSA and 3D-VR images, allows neurosurgeons to perform high-quality surgery. The routine use of intraoperative 3D-RA may not be necessary; however, it is invaluable for treating challenging aneurysms.
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Whether surgery should be performed in patients with acute onset of moyamoya disease (MMD) is controversial. This study aimed to determine optimum operative time for patients with MMD. ⋯ It seems more reasonable to opt for delayed revascularization for patients with acute-onset MMD, but the decision must take into account the morbidity of ongoing ischemic or hemorrhagic events.
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Fever is relatively common and worsens neurologic injury after aneurysmal subarachnoid hemorrhage (SAH). The aim of this study was to display the time course of body temperature, identify predictive factors of fever after SAH, and evaluate its impact on delayed cerebral ischemia (DCI) and clinical outcomes. ⋯ Predictors of fever after SAH were a worse clinical status at admission, larger SAH and intraventricular hemorrhage, anterior communicating artery aneurysm, and greater body mass index. Fever itself was an independent risk factor for DCI and unfavorable outcomes after aneurysmal SAH.
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Temporal lobe resection (TLR) including amygdalohippocampectomy (AHE) is the most frequent performed procedure in epilepsy surgery. Owing to the close anatomic relationship of the mesial temporal structures and the midbrain and choroidal fissure, the incidence of severe complications, such as postoperative stroke, is as high as 2.5%. ⋯ Our modified AHE technique is associated with a low rate of complications in TLR for medically refractory temporal lobe epilepsy, and helps avoid permanent severe neurologic complications.
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Minimally invasive transportal resection of deep intracranial lesions has become a widely accepted surgical technique. Many disposable, mountable port systems are available in the market for this purpose, like the ViewSite Brain Access System. The objective of this study was to find a cost-effective substitute for these systems. ⋯ Syringe port is a cost-effective and safe alternative to the costly disposable brain port systems, especially for neurosurgical setups in developing countries for minimally invasive transportal resection of deep brain lesions.