World Neurosurg
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The ventriculoatrial (VA) shunt is a surgical intervention used to manage hydrocephalus, although it is less often utilized compared to the ventriculoperitoneal (VP) shunt or endoscopic third ventriculostomy. Placement of the distal catheter typically involves the utilization of either the common facial vein (CFV) or the internal jugular vein (IJV), 2 frequently employed options for venous access. This study aims to determine whether there is a statistically significant difference between the long-term patency (2 years) of the distal end of the VA shunt of these 2 options. ⋯ In VA shunt surgery, both the CFV and IJV can be used as venous access sites for the right atrium because there is no discernible difference between their complications or long-term patency. Anatomical considerations, patient-specific characteristics, and the surgeon's preference should all be considered when choosing the venous access location for the placement of a VA shunt.
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Autologous cranioplasty has been used for decades and is the gold standard treatment in patients who underwent decompressive craniectomy (DC). One of the most common methods to store the cranial bone flap is cryopreservation at very low temperatures (-70 to -80°). The only way to achieve these low temperatures is by using special freezers which are not always available in all medical facilities, especially in low-resource centers. This paper describes our experience with the storage of cranial bone flaps in freezers of conventional refrigerators. ⋯ The use of freezers from conventional refrigerators may be an acceptable alternative for the preservation of the cranial bone flap in facilities where special freezers are not available. The rate of aseptic bone necrosis and infections observed in this paper was similar to the incidence of these complications reported in studies where ultra-low temperatures were used.
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Head trauma is considered as the main cause of chronic subdural hematoma (CSDH). However, many patients develop CSDH with no identified cause. Herein, we conduct a comparative study to investigate the differences in clinical characteristics and surgical outcomes of CSDH patients with and without a history of head trauma. ⋯ CSDH patients with a history of head trauma may be more susceptible to unfavorable outcomes; thus, they should be carefully evaluated and given more attention during hospitalization and after discharge.
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Augmented reality (AR) is an emerging technology in medicine that is underexplored in the endovascular neurosurgery arena. We describe a novel technique integrating the Hololens 2 head-mounted AR (HMAR) system for navigation of the intracranial circulation and simple coiling of an aneurysm silicone model. Computed tomography angiographies (CTAs) of the silicone models were obtained, simulating the preprocedural CTA obtained for patient treatments. ⋯ Additional refinements and fine-tuning of the registration and alignment of the hologram to the silicon model or anatomy of the patient are needed before this technology can be incorporated into clinical practice. In the meantime, the use of this tool for the training and development of endovascular skills offers valuable educational opportunities. Further advances in this direction aiming to create real 3D roadmaps are needed to decrease contrast use, radiation exposure, and navigation times.