World Neurosurg
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Case Reports
Mass effect due to hypertrophic pericranial flap in the reconstruction of dural defect: case report.
To present a case of symptomatic mass effect caused by engorgement of a vascularized pericranial flap in the repair of dural defect secondary to parasagittal meningioma surgical excision, in order to expose a potential complication from this reconstruction technique. ⋯ We hypothesized that pericranial flap was strangulated because of final bone flap replacement so that venous outflow was compromised. This complication can be prevented if adequate drilling of the inner table at the edge of the craniotomy and at the outer table of the bone flap is performed just at the entry zone of pericranium flap pedicle to avoid a 90° angle of entry resulting in vascular congestion.
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Cerebral vasospasm is an important cause of morbidity after subarachnoid hemorrhage, but can also occur after resection of acoustic neuroma. This study aimed to identify factors associated with postoperative cerebral vasospasm in patients with acoustic neuroma. ⋯ Younger patient age, larger tumor size, and firmer tumor consistency were independently associated with postoperative cerebral vasospasm in patients with acoustic neuroma.
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Cerebral blood volume (CBV) acquired with the use of flat-detector computed tomography with contrast media (CM) injected at the ascending aorta provides real-time brain functional information with minimized CM usage; however, unexpected asymmetric perfusion is observed for certain patients without cerebral circulatory disorders. This work tested the feasibility of left ventricle (LV) CM injection to achieve symmetric perfusion. ⋯ CBV maps acquisition with LV injection offered an approach to acquire immediate brain functional information for patients who are limited by asymmetric perfusion using ascending aorta injection and are sensitive to CM dose.
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Periprocedural stroke after carotid endarterectomy increases long-term mortality. Intraoperative monitoring with electroencephalography (EEG) and somatosensory-evoked potentials (SSEPs) helps predict perioperative stroke risk. However, the sensitivity of each technique when used independently still remains low. The aim of this study is to determine whether multimodal monitoring leads to an increase in sensitivity and diagnostic accuracy. ⋯ The odds of having a change in either EEG or SSEP are 17 times more in patients with perioperative strokes. Dual modality monitoring is more sensitive at predicting perioperative deficits than EEG or SSEP used independently.
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Case Reports
A Novel Use of Direct Platelet Application During Surgery for Clopidogrel-Associated Intracerebral Hemorrhage.
Dual antiplatelet therapy is associated with increased rates of intracerebral hemorrhage, especially in the context of subarachnoid hemorrhage. We present a case of a spontaneous hemorrhage in a patient treated with a Pipeline stent for a ruptured dissecting vertebrobasilar aneurysm and the novel use of direct application of platelets during surgery to control bleeding. ⋯ This is the first reported description of direct application of platelets to achieve intraoperative hemostasis. Platelets are activated by thrombin and collagen and the use of Floseal (a bovine-derived, gelatin matrix and human-derived thrombin) further potentiated the effectiveness of this strategy. With the increased incidence of intracerebral hemorrhage associated with dual antiplatelet therapy, this technique may provide a useful tool in the neurosurgical armamentarium.