World Neurosurg
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Posterior cervical decompression and instrumentation (PCDI) often is associated with increase in sagittal balance and loss of lordosis. Here, we propose a simple method of surgical positioning using a readily available smartphone application to optimize cervical thoracic alignment in PCDI. The intent of this optimization is to minimize losses in lordosis and increases in sagittal balance. ⋯ Positioning of the patient in preparation for PCDI can influence postoperative lordosis and sagittal balance. Using the leveling application on the smartphone (RIDGID level), is a rapid and free alternative for the maintenance of lordosis and sagittal balance during instrumentation in the operating room.
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We investigated the relationship between hemodynamic characteristics and clinical outcomes for aneurysms treated by the Derivo embolization device, a novel second-generation flow-diverter stent, using computational fluid dynamics (CFD). ⋯ Our CFD results indicate that the energy loss involved with the blood flow passing through an aneurysm and concentrated inflow into an aneurysm were the most important factors to determine whether an aneurysm will become a complete occlusion or remnant case.
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Posterior cerebral artery (PCA) aneurysms are rare, and most are giant, dissecting, or fusiform in morphology. Proximal occlusion of the PCA without revascularization causes high risk of ischemic complications. This study aimed to evaluate the safety and validity of using superficial temporal artery (STA)-PCA bypass through zygomatic anterior temporal approach in complex PCA aneurysms. ⋯ STA-PCA bypass appears to be safe and effective for the treatment of complex PCA aneurysms requiring supplementation of blood flow in the area of the PCA. We established a surgical route, allowing the procedure to be done through the zygomatic anterior temporal approach. This approach provides adequate operative field exposure and reduces retraction of temporal lobe.
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We retrospectively reviewed the institutional experience in patients who underwent microsurgical resection of cavernous malformations (CMs) or arteriovenous malformations (AVMs) using a multimodal intraoperative protocol including neuronavigation, intraoperative ultrasound (i-US), computed tomography (i-CT), and neuromonitoring. ⋯ The combination of different intraoperative real-time imaging modalities (i-CT and i-US), coupled with neuromonitoring, in the surgical management of vascular lesions, particularly if located in eloquent areas, has a positive impact on clinical outcome.
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Balloon guide catheters (BGCs) can be used during cervical carotid stenting as a proximal protection strategy to minimize thromboembolic procedural complications (Video 1). A 9-French BGC can be swiftly inflated before each embologenic step of carotid stenting (microwire crossing, prestent angioplasty, stenting, poststent angioplasty); aspirated; and deflated. We present 2 unique cases in which the impact of BGC aspiration is demonstrated on cervical carotid stenting for atherosclerotic stenoocclusive disease. ⋯ Stent self-reexpansion was documented after reversal of negative pressure from the vacuum syringe, allowing for gentler aspiration. Awareness and early recognition of this potential for vessel wall collapse with aspiration are important to prevent vessel/stent collapse, inefficient aspiration, and resultant embolization of debris. Gradual aspiration is favored.