World Neurosurg
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Treatment of ruptured internal carotid artery anterior wall (ICAW) aneurysms presents a surgical challenge because limitations and difficulties are encountered with either clipping or endovascular treatment. The present study examined clinical outcomes after aneurysmal trapping followed by radial artery grafting for management of these difficult lesions. ⋯ The long-term result was satisfactory, but there was a high rate of acute stage ischemic complications due to delayed vasospasm and low perfusion from the radial artery graft. Based on these results, the investigators recommend that, in addition to intraoperative anticoagulation therapy, in cases where the cerebral blood flow study in the early postoperative period indicates low cerebral perfusion or in cases with World Federation of Neurological Societies grade III-V, the patients should be placed under the highest level of intensive care to detect ischemic complications.
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Tanzania suffers from a severe lack of health practitioners trained in neurosurgical procedures. To address this problem, we have implemented an initiative, modeled after the experience of other pioneers in international neurosurgery, to establish cost-effective and sustainable neurosurgical care by teaching fundamental neurosurgical skills to local surgeons. In this report we describe our early experience in Northwest Tanzania and discuss the potential for this training model to improve neurosurgical care to a region in need. ⋯ Although numerous challenges remain, our experience demonstrates the potential of this teaching model in providing sustainable neurosurgical care in Northwest Tanzania.
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Increased intracranial pressure (ICP) that is refractory to medical measures and ventriculostomy placement after severe traumatic brain injury or aneurysmal rupture is associated with high mortality. In some recent reports, authors have described the use of lumbar cerebrospinal fluid drainage in these patients. We report the results of a prospective study involving the use of lumbar drainage in 15 patients with elevated ICP that was refractory to medical management and ventriculostomy placement. ⋯ This study shows the beneficial role of lumbar cerebrospinal fluid drainage as an effective and safe treatment modality for elevated ICP.
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To clarify the orientation, classification, and relationships of the greater superficial petrosal nerve (GSPN), and to provide a detailed description on the microsurgical anatomic features and some landmarks to its identification. ⋯ The relationships between the GSPN and its surrounding structures were studied. The vulnerability of the GSPN is attributed to diverse factors. We confirmed the communication branches between the GSPN and the GN. Our study is important to the understanding of the relationship of the GSPN with adjacent structures and will improve further information during skull base operations.
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Case Reports
Percutaneous balloon rhizotomy for trigeminal neuralgia using three-dimensional fluoroscopy.
Percutaneous balloon rhizotomy is one of the standard techniques for the treatment of trigeminal neuralgia. However, there have been well-reported complications from cannulating the foramen ovale (FO). We describe a novel technique for cannulating the FO using 3-dimensional (3D) rotational fluoroscopy. ⋯ Three-dimensional rotational fluoroscopy allows real-time visual guidance to cannulate the FO and determine the optimal position of the inflated balloon. We believe that this is an important adjunct for treating trigeminal neuralgia via percutaneous techniques.