World Neurosurg
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Acute stroke resolution via endovascular thrombectomy requires transcarotid access when transfemoral access is not possible. Although postoperative complications such as cervical hematoma and airway compression have been reported, an appropriate postprocedural management is largely unknown yet. We aim to provide new insights and learning points from our experience using the Jaw Elevation Device (JED) as a tool to facilitate recovery post surgery. ⋯ JED appears to be a reasonable option to facilitate patient recovery due to its capacity to maintain the airway, provide mild compression for hemostasis, and prevent cervical hematoma through a comfortable neck immobilization.
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We report a technique for the sphenoid ridge keyhole approach using the Lone Star (LS) retractor system as an extracranial tissue retractor in microsurgical clipping of unruptured middle cerebral artery aneurysms. ⋯ We optimized the craniotomy, manipulating the target aneurysm in the center of the keyhole. It did not interfere with conventional microsurgical techniques.
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We report a rare case of unruptured middle cerebral artery aneurysm associated with moyamoya disease. ⋯ Understanding the complexity of such process may be valuable in proper decision-making in the management of moyamoya disease patients.
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Chronic subdural hematoma associated with dural calcifications in previously pediatric shunted patients is a rare condition. The inner dural membrane opening can lead to progressive brain herniation into the subdural space due to brain reexpansion. ⋯ This case illustrates a rare complication of the treatment of a chronic subdural hematoma caused by insufficient opening of the calcified inner mambrane of the hematoma and encouraged by gradient pressure between the ventricular and subdural compartments. To avoid this complication, it is preferable to not open a thick, calcified, unelastic inner membrane. However, in case of lack of clinical and radiologic improvement, it may become necessary to open it: a wide opening should be attempted, in order to prevent brain strangulation.
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Unusual vascular anatomy can present treatment challenges as traditional approaches may be unfeasible. ⋯ This demonstrates novel use of an endovascular technique in the setting of multiple vascular pathologies.