World Neurosurg
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The standard combined transpetrosal approach (CTPA) is fundamentally an epidural approach that has been quite successfully practiced for many decades. However, it has some disadvantages, such as cosmetic problems, difficulties with custom-tailored petrosectomy, and cerebrospinal fluid leakage, as it is a complicated epidural procedure. We describe here a case of primary pontine hemorrhage via intradural CTPA (iCTPA), which is a modified technique of CTPA and includes intradural anterior petrosectomy and partial posterior petrosectomy without mastoidectomy and skeletonization of the sigmoid sinus. ⋯ The intradural approach allows for custom-tailored petrosectomy and is more straightforward than the epidural route, although it can injure the vein of Labbé. Moreover, it can also reduce cosmetic problems and cerebrospinal fluid leakage. iCTPA could provide enough working space for the frontolateral surface of pontine and petroclival lesions without the need for mastoidectomy and skeletonization of the sigmoid sinus.
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Flow diverter stents are often used in the treatment of giant aneurysms at carotid arteries. Although these stents promise to decrease blood flow into the aneurysm sac, little is known about hemodynamics inside the aneurysm once the stent is planted into the aneurysm neck. To further explore this, computational fluid dynamics and Lagrangian coherent structure (LCS) techniques were used to evaluate the time evolution mechanism of stagnation regions inside an aneurysm. The purpose of this work is to provide a quantitative effectiveness comparison of 2 different flow diverter stents placed into the aneurysm neck based on their stagnation zone formations in the sac. ⋯ Finite time Lyapunov exponent fields obtained from the LCS techniques demonstrated a good agreement with the patient's digital subtraction angiography images obtained just after treatment.
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Triventricular hydrocephalus is caused by an obstruction of cerebrospinal fluid flow causing increased intracranial pressure (ICP). Common treatment options include ventricular shunting or endoscopic third ventriculocisternostomy. Spontaneous third ventriculocisternostomy is a rare phenomenon in patients with obstructive triventricular hydrocephalus. We present the case of a patient with triventricular hydrocephalus and evidence of spontaneous third ventriculocisternostomy. ⋯ Spontaneous third ventriculocisternostomy is seen in patients with chronic hydrocephalus. MRI sensitive to flow artefacts can be useful in the diagnosis of patients with apparent compensated hydrocephalus, and phase-contrast imaging can prove cerebrospinal fluid flow across the stoma. Resolution of symptoms owing to elevated ICP is regularly observed in patients with a spontaneous ventriculocisternostomy.
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Hypertensive cerebral hemorrhage leads to greater mortality and worse functional outcomes at high altitudes. Experimental studies have suggested that hemoglobin can lead to increased perihemorrhagic edema after intracerebral hemorrhage. ⋯ The hemoglobin concentration affects the mortality and morbidity from hypertensive cerebral hemorrhage in high-altitude regions, and a linear relationship exists between hemoglobin concentration and neurological recovery in the H-H group.
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To analyze the probable causes of failed craniovertebral junction stabilization procedures, and to evaluate the advantages of the Goel technique in revision surgery and the positive factors that lead to reduction of the instability and achieve ultimate arthrodesis. ⋯ Although relatively difficult, when indicated, reoperation and direct stabilization of the atlantoaxial joint can result in significant and enduring clinical recovery.