World Neurosurg
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Case Reports
Management of Previously Failed Coiling and Clipping of a Middle Cerebral Artery Aneurysm.
Endovascular coiling techniques have emerged as an alternative and effective approach for treating intracranial aneurysms. However, in some cases, previously coiled aneurysms may require secondary treatment with surgical clipping, presenting a more complex challenge compared with the initial intervention.1,2 We present the case of a 39-year-old man with a residual class III Raymond-Roy occlusion partially coiled aneurysm at the left middle cerebral artery bifurcation (Video 1). Faced with the risks of rerupture, the patient underwent microsurgical treatment after providing consent. ⋯ The patient had no neurological deficit on follow-up. When planning microsurgical clipping of an aneurysm previously treated with coils, it is critical to consider coil placement, as there is a risk of prolapse if the coil is in the neck of the aneurysm. Thrombosis of the cerebral arteries is a potential complication of microsurgical clipping of partially coiled intracranial aneurysms, and injection of a fibrinolytic agent into thrombosed arterial branches may be an effective intraoperative method for treating intra-arterial thrombosis.3 This case illustrates the challenges associated with treating partially coiled aneurysms, highlighting the significance of careful planning when considering microsurgical treatment.
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Hyponatremia is a common complication following endoscopic endonasal resection (EER) of pituitary adenomas. We report a single-center, multisurgeon study detailing baseline clinical data, outcomes, and factors associated with postoperative hyponatremia. ⋯ Hyponatremia is a common postoperative complication of EER for pituitary lesions that can cause significant morbidity, increased readmissions, and increased healthcare costs.
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Currently, there is a unanimous opinion that the first line of the treatment of insular gliomas is microsurgical removal.1-3 At the same time, surgery of insular glial tumors remains a challenge because of the complex anatomy of the insular region. Among the most crucial anatomical structures are branches of the middle cerebral artery (MCA), lenticulostriate arteries (LSAs), and corticospinal tract.4 Surgery of the insular glioma becomes much more complicated in cases when the tumor extends to the anterior perforated substance, which, according to our data, occurs in 29,1% of cases.5 We present a 33-year-old woman with a history of generalized seizures (Video1). ⋯ The video demonstrates the technique of a Sylvian fissure dissection, manipulations with MCA branches and LSA, removal of the tumor from the region of the anterior perforated substance, and a discussion of surgical nuances and safety aspects. The most challenging part of the operation was to identify and protect the LSAs.6 Advanced microsurgical techniques, and the correct patient selection for surgical treatment, are cornerstones for a successful outcome and provide an acceptable frequency of postoperative neurologic deficits in patients who undergo surgery of insular gliomas through the transsylvian approach.
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To establish a predictive model to evaluate the risk of adjacent vertebral refracture (VRF) after percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fracture (OVCF) based on perioperative imaging data. ⋯ The prediction model obtained in this study can predict refracture after PKP for OVCF early and effectively. It has an excellent predictive effect which is suitable for clinicians.
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Navigated pedicle screw placement can be particularly challenging for cervical and upper thoracic levels in obese patients. This technical challenge can be compounded by smaller-diameter tools, which can be flexible and therefore confound navigation. It is imperative to avoid excessive manipulation of surrounding tissues to maintain navigation accuracy in the mobile cervical spine.1 Robotic-assisted spinal approaches use firm guides to aid drilling and screw placement but are hindered by high costs with equipment acquisition.2,3 Here, we propose a technical nuance that combines robotic surgical principles with tools that are more readily available in many surgical departments (Video 1). ⋯ Imaging showed multilevel degenerative disease and a solid prior C5-7 anterior cervical diskectomy and fusion with grade I anterolisthesis at C7-T1 due to severe facet degeneration with severe left-sided foraminal stenosis. Given failure of conservative management, the patient was brought to the operating room for left C7-T1 foraminotomy and C7-T1 posterior instrumented fusion. Here, we show the use of a tubular retractor fixed to the surgical bed for solid and reproducible trajectory for all tools to minimize the risk of surrounding tissue manipulation and its effect on navigation accuracy.