Surgical neurology international
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An aneurysm of distal lenticulostriate artery is very rare. The natural course and management of this rare aneurysm are not clear. ⋯ An aneurysm at this location can show dynamic changes based on radiological findings. Close radiological observation is necessary.
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In this video abstract, we present a one burr-hole craniotomy for the standard lateral supraorbital approach (LSO) developed by Helsinki Neurosurgery. This is a more aesthetic variant of the classic pterional approach. Presently, the LSO approach is most commonly used at our institution. With the LSO technique, the temporal muscle is just minimally opened close to its superior insertion. Posterior and temporal extension of the craniotomy, furthermore, allows adequate access to the anterior skull base, the sellar and suprasellar regions, the middle cranial fossa, the anterior portion of the Sylvian fissure, and the distal Sylvian fissure. Even though the specific location and size of the lesion may vary, this approach accesses all mentioned structures with a very minimal variation. ⋯ "http://surgicalneurologyint.com/videogallery/lso-right-side/"\t"_blank" http://surgicalneurologyint.com/videogallery/lso-right-side/.
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A wide opening of the Sylvian fissure (SF) regarding the treatment of middle cerebral artery (MCA) aneurysm allows us to ensure early proximal control by the proximal start of Sylvian dissection and enough comfort for the microsurgical manipulation and aneurysm clipping. However, major mechanical manipulation of arteries associated with blood oozing into the surgical field may increase the incidence of postoperative vasospasm. The risk of Sylvian venous injury is bigger, and the damage of the superior temporal gyrus increases the risk of postoperative epilepsy as well. A focused opening of the SF based on 18 years experience of a senior author is an alternative technique we present in this video abstract. ⋯ http://surgicalneurologyint.com/videogallery/focused-opening-of-the-syvian-fissure/.
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The management of traumatic upper thoracic spine fractures (T1-T6) is complex due to the unique biomechanical/physiological characteristics of these levels and the nature of the injuries. They are commonly associated with multiple other traumatic injuries and severe spinal cord injuries. We describe the safety and efficacy of surgery for achieving stability and maintaining reduction of upper thoracic T1-T6 spine fractures. ⋯ Surgical treatment of upper thoracic spine fractures (T1-T6), although complex, is safe and effective. Reduction and fixation of these fractures decreases the risk of further neurological complications, allows for earlier mobilization, and correlates with shorter hospital LOS and improved outcomes.
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Accessory anterior cerebral artery (ACA), a type of median artery of anomalous triplicate ACA, is not rare, but aneurysms of the anterior communicating artery (ACoA) associated with accessory ACA can be a considerable challenge to treat surgically based on the morphological features of the ACoA complex. ⋯ In treating this aneurysm via the pterional approach, selection of approach side it is critical to preserve prevent the patency of the accessory ACA and to simultaneously perform aneurysm clipping without leaving a neck remnant. Selecting the optimal approach based on preoperative neuroimaging of which side will allow both these actions is important.