World Neurosurg
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Various modalities have been used to confirm the blood flow through parent arteries or surrounding perforating arteries during surgical aneurysm clipping, including motor-evoked potentials (MEPs), Doppler ultrasound, and indocyanine green videoangiography. Nonetheless, contralateral hemiparesis due to arterial blood flow insufficiency may arise because of false-positive or false-negative errors. By performing controlled intraoperative awakening during aneurysm clipping, we compared patients' voluntary movements with simultaneous MEP. ⋯ Intraoperative neurological assessment during aneurysmal clipping under awake craniotomy is feasible and safe, and should be valuable for the assessment of ischemia, especially in the anterior choroidal artery. From a neurophysiologic viewpoint, MEP may be insufficiently sensitive for evaluating voluntary movement under ischemia.
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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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To describe surgical management with complete resection of patients with recurrent benign or malignant lesions involving the cavernous sinus after standard therapy with an emphasis on surgical indications and surgical technique. ⋯ Complete cavernous sinus resection is an option for patients with progressive or recurrent tumors after standard therapy. Extended survival can occur in some patients. The risks of surgery are considerable, and the underlying disease, age of the patient, and associated comorbidities should be considered when making the decision to operate. Surgery should be considered for oncologic resection of malignant tumors with limited extracranial disease or in patients with recurrent or progressive benign tumors. A key decision involves whether revascularization should be used with resection. Revascularization has been used in patients with inadequate vascular reserve as measured by balloon occlusion testing and patients with benign tumors and longer life expectancy.
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To report our clinical experience with an advanced navigation protocol that provides seamless integration into the operating workflow of endoscopic transsphenoidal surgery. ⋯ The advanced navigation protocol permits continuous suction-tracked navigation guidance during endoscopic transsphenoidal surgery and optimal visualization of solid bone, fine paranasal sinus structures, soft-tissue and vascular structures. This may add to the safety of the procedure especially in cases of anatomical variations and in cases of recurrent adenomas with distorted anatomy.
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Iliac crest autograft is the historic gold standard for bone grafting, but is associated with a significant patient morbidity. Fusion rates of C1-C2 up to 88.9% using allograft and 96.7% using autologous iliac crest bone graft can be achieved when combined with rigid screw fixation. We sought to determine our fusion rate when combining allograft with recombinant human bone morphogenetic protein-2 (rh-BMP2) and rigid screw fixation. ⋯ The use of small doses of rh-BMP2 added to allograft in addition to rigid screw fixation is a safe and highly effective means of promoting a solid fusion of the atlantoaxial complex and spares the patient the morbidity of iliac crest harvest.