Neurosurgery
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Case Reports
Intravascular ultrasound for intracranial angioplasty and stent placement: technical case report.
Intravascular ultrasound (IVUS) imaging has been used extensively in coronary artery interventions and has provided invaluable information for the understanding and treatment of coronary arterial disease. We present here the first description, to our knowledge, of IVUS-guided intracranial arterial interventions in the clinical setting. ⋯ IVUS of the intracranial circulation may assist the performance of intracranial angioplasty and stenting. It provides useful information that can affect clinical decisions. It may prove to be a valuable tool in clinical use and enhance our understanding of vascular disease of the intracranial circulation, as it has in the coronary circulation.
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When internal carotid artery (ICA) sacrifice is planned in the management of difficult tumors or aneurysms at the cranial base, the petrous ICA may be a useful site for anastomosis for interpositional vascular bypass. However, exposure of the artery and performing an anastomosis in this region may be technically challenging because of the narrow working corridor. The authors describe a transzygomatic extended middle fossa approach that maximizes the exposure of the petrous ICA for performing the difficult anastomosis. ⋯ The transzygomatic extended middle fossa approach provides a wide surgical corridor for maximal exposure of the petrous ICA with minimized temporal lobe retraction. This large exposure facilitates vascular anastomoses at the petrous ICA and provides working room to maneuver instruments. The middle fossa rhomboid is a key landmark to identify the petrous ICA and to avoid neuro-otologic structures.
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To introduce a method for preoperative targeting of a proper recipient artery in superficial temporal artery-to-middle cerebral artery anastomosis. ⋯ The "target bypass" method might be effective for cases with moyamoya disease or for cases requiring surgery through a small craniotomy.
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Clinical Trial
Extradural anterior clinoidectomy as an alternative approach for optic nerve decompression: anatomic study and clinical experience.
We introduce pterional craniotomy extradural anterior clinoidectomy as a new alternative approach for optic nerve decompression in patients with traumatic optic neuropathy. ⋯ Pterional craniotomy extradural anterior clinoidectomy is a promising new alternative approach for optic nerve decompression in patients with traumatic optic neuropathy.
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Periodic self-assessment is an important component of postgraduate medical education and certification. The Self-assessment in Neurological Surgery (SANS) examination has a history of usefulness for neurosurgical written and oral board examination preparation. The SANS Wired test represents a recreation of the original SANS test using an Internet-based platform. Advanced functionality and contemporary content have been added to meet the increasing requirements for demonstration of lifelong learning and self-assessment as part of the Maintenance of Certification (MOC) process. ⋯ The SANS Wired system seems to be an effective platform for neurosurgical self-assessment and is acceptable to users. The system satisfies, in part, two of the four required components of MOC, namely, periodic self-assessment and demonstration of cognitive expertise. It is endorsed by the American Board of Neurological Surgeons for MOC.