World Neurosurg
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The authors report a case of lateral posterior choroidal artery pseudoaneurysm that caused a spontaneous thalamic hemorrhage. The case supports obtaining computed tomographic angiography (CTA) even in seemingly routine cases of hypertensive hemorrhage and demonstrates a possibly unreported type of aneurysm causing thalamic hemorrhage. ⋯ The case shows the need to carefully review CTA after ICH, even in cases of seemingly typical hypertensive ICH.
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To describe a technique to approach the anterior inferior basal ganglia. ⋯ The approach described here is a novel alternative to transsylvian or supracarotid approaches to the anterior inferior basal ganglia and in this patient provided a well-tolerated surgical corridor that allowed complete resection of his cavernoma. We discuss several advantages and disadvantages of the various approaches to the anterior inferior basal ganglia.
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Venous thrombembolism is a significant cause of mortality in patients after subarachnoid hemorrhage (SAH). After screening a cohort of SAH for this complication, we proposed a refinement for risk stratification of venous thromboembolism. ⋯ Finding our SAH patients to be the largest group screened for DVT on the basis of our literature review, we confirmed many known risk factors for DVT and observed that smokers who abruptly quit lowered their risk of DVT. Our findings may be used for risk stratification when determining DVT chemoprophylaxis after SAH.
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Neurological surgery is historically among one of the most competitive residency matches, but data suggest a downward trend in neurosurgical residency applicants in the United States. In 2002, our department, in conjunction with our institution, began an initiative to increase exposure to and interest in neurological surgery, targeting both undergraduate and medical students. This study outlines and assesses the factors used by our institution to successfully prepare and recruit medical students for residency in the field of neurological surgery. ⋯ An earlier, organized involvement of the neurosurgical department in medical student education can result in an improved understanding of the role of neurosurgeons among other practitioners as well as a greater number of well-qualified residency applicants into neurological surgery.
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Sphenoid wing region dural arteriovenous fistulas (DAVFs) are rare lesions that are typically fed by middle meningeal artery feeders and that drain via the sphenoparietal sinus or middle cerebral vein. We describe a unique case of a medial sphenoid wing fistula draining exclusively via the basal vein of Rosenthal. ⋯ Sphenoid wing DAVFs may drain via the deep venous system and have a complex arterial feeding network. Key features of the fistula, including deep venous drainage, presence of venous varices, and retrograde leptomeningeal venous drainage, make this an aggressive lesion with a high risk of rupture based on the available natural history data.