Journal of neurosurgery
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Journal of neurosurgery · May 2013
Comparative StudySubclinical ischemia verified by somatosensory evoked potential amplitude reduction during carotid endarterectomy: negative effects on cognitive performance.
Although the mechanisms underlying neurocognitive changes after carotid endarterectomy (CEA) are poorly understood, intraoperative ischemia and postoperative hemodynamic changes may play a role. ⋯ Hypoperfusion during cross-clamping, as verified by SSEP amplitude reduction, plays a significant role in the subtle decline in cognition following CEA. However, this detrimental effect was small, and various confounding factors were present. Based on these observations and the group-rate analysis, the authors conclude that successful unilateral CEA with routine shunt use does not adversely affect postoperative cognitive function.
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Journal of neurosurgery · May 2013
Case ReportsIntracranial atherosclerotic disease associated with moyamoya collateral formation: histopathological findings.
Atherosclerotic disease has been suspected as a cause of moyamoya disease in some patients but has not, to the authors' knowledge, been confirmed by pathological studies. The authors present the histopathological findings in a patient with moyamoya collateral formation associated with atherosclerotic occlusive disease of the distal internal carotid artery (ICA). Typical atheromatous changes were evident in the distal ICA and proximal middle cerebral artery. ⋯ Proliferation and enlargement of the lenticulostriate arteries in the basal ganglia was also identified. Moyamoya phenomenon secondary to atherosclerotic disease has similar histopathological features to idiopathic moyamoya phenomenon, both in the affected large basal arteries and lenticulostriate collaterals. These findings support the hypothesis advanced by Peerless that moyamoya is a 2-step process involving an obliterative vasculopathy of the terminal ICA and a secondary proliferative response.
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Journal of neurosurgery · May 2013
Case ReportsSuperior cerebellar artery-posterior cerebral artery bypass: in situ bypass for posterior cerebral artery revascularization.
Iatrogenic pseudoaneurysms are rare but serious complications of transsphenoidal surgery, and an iatrogenic pseudoaneurysm of the posterior cerebral artery (PCA) has been reported just once in the literature. The authors encountered such a case with a new P1 segment PCA pseudoaneurysm after endoscopic transsphenoidal resection of a pituitary adenoma. The aneurysm proved ideal for a novel intracranial-intracranial bypass in which the superior cerebellar artery (SCA) was used as an in situ donor artery to revascularize the recipient P2 segment. ⋯ Like other in situ bypasses, it requires no dissection of extracranial arteries, no second incision for harvesting interposition grafts, and has a high likelihood of long-term patency. The SCA-PCA bypass is also applicable to fusiform SCA aneurysms requiring revascularization with trapping. This case demonstrates a dangerous complication that results from the limited view of the posterolateral surgical field through the endoscope and the imprecision of endoscopic instruments.