Neurosurgery
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The transoral approach is the most direct and commonly used method to access the ventral craniocervical junction. Recently, an endonasal, endoscopic approach to the craniovertebral junction was proposed. We reasoned that the coupling of the endoscope with the direct transoral approach and image guidance could result in a minimally invasive, simple approach to the ventral craniovertebral junction. We investigated the potential usefulness of such an approach in a cadaver model. ⋯ With the aid of the endoscope and image guidance, it is possible to approach the ventral craniovertebral junction transorally with minimal tissue dissection, no palatal splitting, and no compromise of surgical freedom. In addition, the use of an angled-lens endoscope can significantly improve the exposure of the clivus without splitting the soft palate. An endoscope-assisted transoral approach is a direct and powerful tool for the treatment of surgical pathology at the craniovertebral junction.
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Case Reports
Large distal anterior cerebral artery aneurysm treated with resection and interposition graft: case report.
Distal anterior cerebral artery (DACA) aneurysms are rare, representing only 2% to 6.7% of all intracranial aneurysms. Most of them are small. Large and giant aneurysms are even rarer in this location. Only 26 giant pericallosal (PC) aneurysms have been reported thus far. Various surgical techniques have been used to treat these aneurysms, including direct aneurysm neck clipping, aneurysm trapping, proximal occlusion of the anterior cerebral artery, or a combination of clipping with coiling or a bypass procedure. The report presents an unusual case of a complex DACA aneurysm managed by resection and interposition arterial graft. ⋯ Surgical treatment of a large DACA aneurysm may be difficult due to a complex neck and the involvement of the branch vessels. Resection and interposition grafting and A3-A3 or A4-A4 anastomoses are treatment options for such patients.
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In vitro characterization of a targeted, dye-loaded nanodevice for intraoperative tumor delineation.
To synthesize and complete in vitro characterization of a novel, tumor-targeted nanodevice for visible intraoperative delineation of brain tumors. ⋯ F3-targeted dye-loaded NPs efficiently cause definitive color change in glioma cells. This report represents the first use of targeted NPs to cause a visible color change in tumor cell lines. Similar nanodevices may be used in the future to enable visible intraoperative tumor delineation during tumor resection.
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With the growing volume of aneurysms treated with endovascular methods and the unavoidable risks of incomplete coiling or recurrence, the volume of coiled aneurysms requiring surgical management is growing. We present a consecutive surgical experience with previously coiled aneurysms to examine clinical trends, the phenomenon of coil extrusion, microsurgical techniques, and morphological features affecting clippability. ⋯ This study demonstrated a sharp increase in the incidence of coiled aneurysms requiring surgery, reflecting the increasing numbers of patients opting for endovascular therapy initially. Coil extrusion occurs more often than expected, is often misdiagnosed on angiography as simply compaction, and seems to be a time-dependent process not seen acutely. Direct clipping is the preferred microsurgical treatment of coiled aneurysms and may be predicted by the relationship between coil width and compaction height (C/H < 2.5, or a wedge angle < 90 degrees). We recommend a bypass strategy for unclippable coiled aneurysms because it can be executed methodically; has predictable ischemia times; and is associated with more favorable results than thrombectomy, coil extraction, and clip reconstruction.
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Restoration of lumbar lordosis is a critical factor in long-term success after lumbar fusions. Transforaminal lumbar interbody fusion (TLIF) is a popular surgical technique in the lumbar spine, but few data exist on change in spinal alignment after the procedure. ⋯ The TLIF operation is highly effective in improving spinal alignment in patients with degenerative spinal disorders when the appropriate surgical technique is implemented.