World Neurosurg
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Spinal intramedullary arteriovenous malformations (AVMs) can present with spinal hemorrhage. However, some of them occasionally can be the cause of angiographically negative intracranial subarachnoid hemorrhage, thus requiring a more comprehensive diagnostic approach to detect the possible source of bleeding. Nidal or arterial feeder aneurysms are widely considered high-risk rupture portions of the spinal AVM and recognized as a major cause of bleeding. ⋯ The case of a 25-year-old man with acute cerebral subarachnoid hemorrhage caused by intranidal aneurysm rupture of cervical glomus-type AVM is presented here. The patient was surgically treated by C3-C4 laminectomy and AVM excision by pial resection technique. Thereby, the pial resection technique helps in providing subtotal AVM nidus resection, minimizing parenchymal dissection but effectively devascularizing glomus AVMs with satisfactory long-term results.
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Patients with complex shunt-related problems and varying diagnoses of cerebrospinal fluid (CSF) disturbance can present with headache and clinical symptoms that may be difficult to relate to underdrainage or overdrainage. Telemetric intracranial pressure (ICP) monitoring may assist in evaluating individual patients and assessing shunt function and adjustment. We report a case series of patients receiving a Miethke M.scio sensor. ⋯ The Miethke M.scio is a safe and valuable device to use in shunt-treated patients, in particular those expected to need assessment of ICP monitoring postoperatively. Repeated ICP measurements can also assist in personalized adjustment of the shunt setting to optimize CSF flow in this diverse patient group. Future studies should include a standardized protocol with ICP measurements correlated to the symptoms and cause of CSF disturbances to provide better understanding of the dynamics of the ICP in each patient.
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Rotational angiography, often referred to as a "spin", is typically presented in 2D. Since rotational angiograms are composed of images acquired from multiple angles, we took advantage of this property to develop a method for converting any rotational angiogram into a 3 dimensional (3D) video. ⋯ Our solution is an inexpensive and rapid method for generating stereoscopic videos from existing angiograms. It does not require any additional hardware and is readily deployable in low-resource settings. Because the videos are in anaglyph format, they are viewable on any 2 dimensional (2D) display in the interventional suite or operating room, on a mobile device, or at home.
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According to the World Federation of Neurosurgical Societies (WFNS), a minimum neurosurgery workforce density should be 1 per 200,000 population for optimum access to neurosurgical care. Pakistan lags behind in the number of neurosurgeons, and disproportionate geographical distribution further increases disparity. Our objective was to geographically map the density of neurosurgeons and emergency neurosurgical services (ENS) in Pakistan. ⋯ The geographical mapping of neurosurgeons and neurosurgical facilities is highly skewed towards urban centers, increasing disparity in access to timely neurosurgical emergency services. Four times more neurosurgeons are required in Pakistan to bridge the gap in neurosurgical workforce.
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This study was conducted to evaluate the anatomical and clinical features of Trautman's triangle (TT) and to better understand the possible surgical corridor for other surgical approaches involving the petroclival region, especially the presigmoid retrolabyrinthine approach. ⋯ The relationship between TT and SS, petroclival angle, mastoid aeration, and subarcuate fossa has a very dynamic structure. Understanding the variations and clinical significance of these structures in the petroclival region is critical in determining the surgical approaches to be applied and understanding the etiology of vestibular system diseases.