World Neurosurg
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In case of carotid artery occlusion, the risk and extent of ischemic cerebral damage are highly dependent on the pathways of collateral flow including the anatomy of the circle of Willis. In this report, cases are presented to illustrate that 4-dimensional computed tomography angiography (4D-CTA) can be considered as a noninvasive alternative to digital subtraction angiography for the evaluation of circle of Willis collateral flow. ⋯ Temporal dynamics of collateral flow in the circle of Willis can be depicted with 4D-CTA in patients with a unilateral carotid artery occlusion.
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A pterional-orbital or subfrontal-orbital approach is recommended as a surgical treatment in cranio-orbital lesions. We describe a less invasive approach through an eyebrow incision combined supraorbital minicraniotomy and orbital osteotomy for treating some selected cranio-orbital lesions. ⋯ Some selected cranio-orbital lesions can be treated through a supraorbital eyebrow approach with orbital osteotomy. The presence of retro-ocular fat allows the orbital lesions to be classified as a lesion of the intraretro-ocular or extraretro-ocular fat. It is safe to resect the lesion of extraretro-ocular fat from the retro-ocular fat interface. However, the lesion with optic nerve and extraocular muscles involved should be removed from the intermuscular septae.
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Dural closure after intracranial procedures is considered crucial to reduce postoperative complications such as pseudomeningocele (PM), cerebrospinal fluid (CSF) leaks, hydrocephalus, and infections. However, watertight dural closure (WTDC) is often difficult to achieve, and dural substitutes often are used. We describe our experience with non-WTDC in children. ⋯ Non-WTDC after cranial surgery in children was associated with a low rate of clinically significant PM, infections, leaks, and hydrocephalus. Non-WTDC is fast and reduces the need to harvest additional tissue, thus minimizing the surgical incision.
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Transarticular screw fixation has fatal complications such as vertebral artery (VA), carotid artery, and spinal cord injuries. The landmarks for deciding the entry point for C1 lateral mass screws were clarified by using life-size 3-dimensional (3D) patient-specific spine models. ⋯ 3D models were used in surgical planning maximizing the possibility of ideal screw position and providing individualized information concerning cervical spinal anatomy. The individualized 3D printing screw insertion template was user-friendly, of moderate cost, and it enabled a radiation-free cervical screw insertion.