Neurosurgery
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The optic strut (OS) is a candidate landmark in computed tomographic (CT) angiographic scans for the discrimination of intradural and extradural/intracavernous aneurysms involving the paraclinoid segment of the internal carotid artery. The goal of this study is to examine and confirm the qualifications of the OS as a landmark in CT angiographic scans for the preoperative evaluation of aneurysms in this region. ⋯ On CT angiographic scans, the OS is a precise identification of the proximal dural ring that forms the superior border of the cavernous sinus. The aneurysms whose necks arise obviously distal to the OS on CT angiographic scans are able to be clipped without dissection of the proximal dural ring.
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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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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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Case Reports
Endoscopic fenestration of a symptomatic cavum septum pellucidum: technical case report.
Cysts of the septum pellucidum (CSPs) may become symptomatic because of obstruction of cerebrospinal fluid flow, resulting in increased intracranial pressure and hydrocephalus requiring surgical intervention. Endoscopic fenestration may be the most effective and least invasive technique to treat this pathological condition. ⋯ Neuroendoscopic fenestration should be strongly considered as the treatment of choice for symptomatic CSPs. This procedure alone can lead to complete resolution of clinical symptoms and hydrocephalus, can reduce the size of the CSP, and can obviate the need for an implantable cerebrospinal fluid shunt.
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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.