World Neurosurg
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Giant middle cerebral artery (MCA) aneurysms are rare complex cerebrovascular lesions to treat.1 The management of those aneurysms may be very challenging, despite the introduction of refined microsurgical techniques and the rapid progress in endovascular methods, which often require bypass surgery as part of the strategy.2-4 This approach is particularly relevant to giant, dolichoectatic, and thrombotic aneurysms.5,6 This video shows the surgical strategy and stepwise depiction of the surgical treatment of a complex giant thrombosed aneurysm using a double-barrel superficial temporal artery (STA) to MCA bypass (Video 1). Informed written consent was obtained from the patient and his family. The patient was a 50-year-old man, previously healthy, who presented with headache, memory difficulty, and left-sided involuntary movements for 2 months. ⋯ The complete clipping and patency of the anastomosis was validated during surgery by indocyanine green angiography. Postoperative cerebral computed tomography angiography revealed good patency from the STA to the MCA. The patient was neurologically intact without complains.
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To analyze artificial intelligence image-assisted knee ligament injury repair and femoral nerve block analgesia after surgery. ⋯ The artificial intelligence image-assisted diagnosis system for analysis and processing of multiparametric magnetic resonance images is useful for clinical decision making, reducing physicians' labor intensity, improving efficiency, and lowering the rate of misdiagnosis.
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Tumors that take up and metabolize 5-aminolevulinic acid emit bright pink fluorescence when illuminated with blue light, aiding surgeons in identifying the margin of resection. The adoption of this method is hindered by the blue light illumination, which is too dim to safely operate under and therefore necessitates switching back and forth from white-light mode. The aim of this study was to examine the addition of an optimized secondary illuminant adapter to improve usability of blue-light mode without degrading tumor contrast. ⋯ Addition of a secondary illuminant may mitigate surgeon complaints that the operative field is too dark under the blue light illumination required for 5-aminolevulinic acid fluorescence guidance by providing improved color rendering index without completely sacrificing tumor-to-background color contrast.
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This study describes a distinct magnetic resonance imaging (MRI) feature, placing emphasis on fluid-attenuation inversion recovery (FLAIR) and contrast-enhanced T1-weighted (T1C) images for the preoperative differentiation of glioblastoma (GBM) from primary central nervous system lymphoma (PCNSL). ⋯ The SNEPGF sign is effective in identifying GBM from PCNSL, especially with high specificity.
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Vagus nerve stimulation (VNS) therapy is an increasingly popular treatment for medically intractable epilepsy. During a review of our cases, we noted that one of the senior authors give patients 1 week of antibiotic prophylaxis after VNS surgery while the other does not. We reviewed our experience with postoperative antibiotic prophylaxis after VNS surgery. ⋯ Just as with any hardware implantation, infection of the hardware can lead to significant morbidity. However, the use of postoperative oral antibiotic prophylaxis did not show benefit in reducing the infection rate.