World Neurosurg
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Sustainability and Green Practices in the Neurosurgical Operating Room: A Scoping Literature Review.
The healthcare sector is a significant contributor to worldwide greenhouse gas emissions. The specific environmental impacts of neurosurgical operations remain largely unexplored. ⋯ There is a paucity of literature on sustainability practices within the field of neurosurgery. Here we identify the available evidence on the environmental impact of neurosurgical care and describe some avenues to reduce this impact by exploring surgical sustainability literature more broadly.
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Moyamoya disease (MMD) is characterised by supraclinoid internal carotid artery (ICA) narrowing causing cerebral parenchyma to starve. Direct and indirect revascularisation techniques are the treatment norm. We provide a clinicoradiological comparison of single and double barrel superficial temporal artery to middle cerebral artery (STA-MCA) bypass for MMD. The perfusion in cerebral hemispheres and vessel density in DSA have been evaluated using novel algorithms. ⋯ Double barrel STA-MCA bypass clinically as well as radiologically improves perfusion in the ACA as well as MCA territories in MMD. The novel image processing algorithm is an accurate, objective tool to evaluate perfusion in MR images and vessel density in DSA images of MMD.
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Cerebral revascularization is an effective measure for dealing with complicated intracranial aneurysms and ischemic cerebro-vascular disease. Intra-operative thrombosis causing bypass occlusion is a severe issue that cause devastating consequences for complication in revascularization. We report our experiences regarding salvage maneuvers for intraoperative thrombosis in cerebral revascularization procedures and discuss the characteristics and culprits. ⋯ Various factors are responsible for intraoperative thrombosis in cerebral revascularization. Relieving the downward compression effect of the donor vessel STA on the recipient vessel M4 segment of MCA by applying gelfoam around the site of the anastomosis stoma, can be recommend to salvage the intraoperative thrombosis in cerebral revascularization.
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Trans-arterial embolization (TAE) via the ophthalmic artery and middle meningeal arterial are the common arterial routes for anterior cranial fossa (ACF) dural arteriovenous fistulas (DAVFs). However, TAE via the sphenopalatine artery (SPA) to treat ACF DAVFs is rarely reported. Here, we describe 14 cases of ACF DAVFs that were either treated solely or in conjunction with other arterial routes via the SPA. A total of 15 embolization attempts were performed via the SPA. ⋯ The SPA may be as an alternative arterial route if other appropriate arterial routes are unavailable. However, its safety and efficiency need to be confirmed further.