World Neurosurg
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The transorbital approach (TOA) has a unique advantage to the more common lateral approaches as it provides direct access to the anterior middle fossa and medial sylvian fissure (SF) without significant dissection or retraction. However, when to use the TOA for surgical treatment of middle cerebral artery (MCA) aneurysms remains unclear. This study details the feasibility of clipping unruptured MCA aneurysms via the TOA by highlighting the anatomic features that either facilitate or hinder the approach. ⋯ Given the minimally invasive, technically challenging approach, the feasibility and safety of TOA for MCA aneurysms must be evaluated before wide clinical adoption. This study identified AOF, aneurysm width, and SF accessibility as three features that may significantly impact the possibility of clipping MCA aneurysms via TOA.
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Case Reports
Microsurgical Clipping of a Ruptured Basilar Apex Aneurysm: Contending with a Formidable Clinical Scenario.
Basilar apex aneurysms (BAAs) represent 5%-8% of cerebral aneurysms.1-3 Treating BAAs is long established in neurosurgery.4-6 The morbid and lethal characteristics of aneurysmal subarachnoid hemorrhage coupled with potential medical complications of neurointensive care contribute to poor prognosis of patients with ruptured BAAs.7,8 A 58-year-old woman presented to the emergency department with a 1-day course of intense headaches that progressed to loss of consciousness. Noncontrast computed tomography of the head revealed extensive intraventricular hemorrhage (Fisher grade 4). Computed tomography angiography revealed an 8.7 × 6.3 mm wide-neck BAA. ⋯ Nonetheless, the course of BAAs can still be poor even after adequate surgical management. This case exemplifies the burdensome nature of BAAs and the difficult clinical course of patients despite meticulous microsurgical management. Fisher grade 4, which is associated with a 31% risk of vasospasm, was a notable factor contributing to this outcome.7 Further, the patient's recovery was complicated by hospital-acquired pneumonia, which has a mortality rate of 9.7%.8 Accordingly, amid the emergent discipline of enhanced recovery after surgery, optimized protocols for postoperative management could benefit these patients.9-11.
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The study aimed to evaluate the safety, feasibility, effect on fusion, and clinical efficacy of atlas lateral mass and C2-3 transfacet screw fixation technique, serves as an alternative method to traditional posterior atlantoaxial fixation. ⋯ The atlas lateral mass and C2-3 transfacet screw fixation technique, an alternative to conventional posterior fixation, has been demonstrated to be an efficacious method for providing adequate stabilization and fusion in patients with atlantoaxial instability, even in the cases of thin C2 pedicle, high-riding vertebral artery, previous failed surgeries, or reoperation.
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To evaluate the accuracy of stereotactic coordinates to target the ansa lenticularis (AL) using 2 surgical planning methods, the conventional millimeter method (MM) and the normalized Tenths method (TM), assessed through individualized probabilistic tractography. ⋯ TM surpasses MM in identifying the structural connectivity between the AL and predefined ROIs, underscoring the advantages of coordinate normalization. However, variations in AC-PC line lengths and Euclidean distances between methods could lead to inaccuracies in the coordinate settings, potentially affecting the precision of structural connectivity and the efficacy of therapeutic outcomes.
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Dynamic functional network connectivity (dFNC) captures temporal variations in functional connectivity during magnetic resonance imaging acquisition. However, the neural mechanisms driving dFNC alterations in the brain networks of patients with acute incomplete cervical cord injury (AICCI) remain unclear. ⋯ Patients with AICCI demonstrate abnormal connectivity within dFNC states, and the temporal characteristics of dFNC are associated with sensorimotor dysfunction scores. These findings highlight the potential of dFNC as a sensitive biomarker for detecting network functional changes in AICCI patients, providing valuable insights into the dynamic alterations in brain connectivity related to sensorimotor dysfunction in this population.