World Neurosurg
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To determine the clinical utility of laser speckle flow imaging (LSFI) and its comparability to (123)I-iodoamphetamine single photon emission computed tomography (IMP-SPECT), we used LSFI to monitor cerebral blood flow (CBF) during extracranial-intracranial (EC-IC) bypass surgery. ⋯ Although LSFI clearly demonstrated a decrease in CBF, the information is taken only from the surface of the brain. Combined use of LFSI with an electrophysiologic examination is required for intraoperative diagnosis of ischemia. LSFI was not sensitive enough to detect increased CBF by superficial temporal artery-to-middle cerebral artery anastomosis, because CBF changes are minimized during anesthesia, probably owing to low metabolic activity.
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Sylvian hematoma in subarachnoid hemorrhage (SAH) is associated with a poor prognosis. Although active bleeding can be detected by multiphase dynamic enhanced computed tomography (CT), bleeding from vessels in the Sylvian fissure has also been found in Sylvian hematoma. We investigated possible origins of Sylvian hematoma based on novel imaging findings of multiphase enhanced CT. ⋯ Sylvian hematomas may be caused secondarily by multiple bleeds from small vessels together with aneurysm rupture.
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The oculocardiac reflex (OCR) is a sudden decrease in heart rate resulting from mechanical manipulation of the orbit, especially due to traction on the orbital contents. The purpose of this study was to determine the incidence and clinical ramifications of OCR elicitation by the orbitozygomatic (OZ) approach. ⋯ OCR occurs in nearly one-third of patients who undergo the OZ approach. However, simple cessation of orbital manipulation is sufficient to normalize the patient's heart rate. Rarely is medical management required or does there appear to be any significant postoperative ramifications.
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Case Reports
Partial anterior petrosectomies for upper basilar artery trunk aneurysms: a cadaveric and clinical study.
Surgical clipping for upper basilar artery (BA) trunk aneurysms has become less common since the popularization of endovascular therapy. However, when endovascular therapy is not feasible, direct open surgery is still the treatment of choice. The anterior transpetrosal approach (ATP) is most often used to safely treat these aneurysms. We evaluate the feasibility of a modified partial anterior transpetrosal approach for the treatment of upper BA trunk aneurysms. ⋯ Modification and minimization of the conventional ATP provided sufficient exposure for the treatment of upper BA trunk aneurysms. Detailed anatomical knowledge obtained though cadaveric dissection facilitated development of this effective and less invasive approach.