Neurosurgery
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Case Reports
Sole stenting bypass for the treatment of vertebral artery aneurysms: technical case report.
Vertebrobasilar aneurysms have a risk of rupture ranging from 2.5 to 50% (especially those larger than 7 mm) and a repeat bleeding rate of between 30 and 70%. For this reason, patients with aneurysms larger than 7 mm should be treated. Considering the high complexity of surgical approaches in this area, an increasing number of reported cases are being treated with endovascular therapy. The purpose of this article is to determine the effectiveness and safety of sole stenting bypass in the treatment of three consecutive patients with vertebrobasilar aneurysms. ⋯ The sole stenting bypass technique seems to be a good alternative for the treatment of complex vertebral aneurysms by inducing thrombosis of the aneurysm with preservation of the parent vessel lumen.
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Clinical Trial
Volumetric image guidance for motor cortex stimulation: integration of three-dimensional cortical anatomy and functional imaging.
Epidural electrical stimulation of the motor cortex is a promising treatment option in patients with intractable pain. Varying rates of success in long-term pain relief have been attributed to inaccurate positioning of the electrode array, partly because the sulcal landmarks are not directly visualized. We describe an integrated protocol for precise electrode placement, combining functional image guidance and intraoperative electrical stimulation in the awake patient. ⋯ The combination of 3-D functional neuronavigation, intraoperative electrical stimulation, and continuous motor output monitoring in awake patients provides optimal information for the identification of the appropriate somatotopic area of motor cortex. This combined imaging and stimulation approach for electrode positioning offers a safe and minimal invasive strategy for the treatment of intractable chronic pain in selected patients.
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The introduction of intraoperative 1.5-T magnetic resonance imaging may provide up-to-date functional information in the surgical environment. However, feasible passive paradigms that allow the examination of anesthetized patients will be a precondition for intraoperative functional magnetic resonance imaging (fMRI). The aim of this study is to evaluate the feasibility of a recently developed passive fMRI paradigm for functional neuroimaging in anesthetized patients. ⋯ The method presented proved to be a feasible paradigm for fMRI evaluation of the sensorimotor cortex in anesthetized patients and thus forms a relevant step toward real intraoperative functional neuroimaging.
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Intraventricular surgery requires a detailed knowledge of the microanatomy of the choroid plexus vasculature. ⋯ The data obtained on the microanatomy of the intrachoroidal vasculature may have certain neurosurgical implications.
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This study had two objectives. The first was to define the ideal position of the MacCarty keyhole, a commonly used craniotomy entry site into which three of the bone cuts in orbitozygomatic craniotomy extend. The second objective was to examine the relationships in the inferior orbital fissure, a site into which two of the bone cuts in orbitozygomatic craniotomy extend. ⋯ Placing the MacCarty keyhole on the frontosphenoid suture 5 to 6 mm behind the three-suture junction results in greater preservation of the lateral wall and roof of the orbit than when the hole is placed at a more anterior site, as previously recommended. The anterolateral part of the inferior orbital fissure, which faces the temporal fossa and into which the bone cuts in the orbitozygomatic craniotomy extend, has a lower density of vascular and neural structures than the middle and posteromedial parts, which are related to the infratemporal and pterygopalatine fossa.