Neurosurgery
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Comparative Study
Through the choroidal fissure: a quantitative anatomic comparison of 2 incisions and trajectories (transsylvian transchoroidal and lateral transtemporal).
We compared the transsylvian transchoroidal (TSTC) approach with the lateral transtemporal (LTT) approach. Both approaches proceed through the choroidal fissure but through different incisions and along different trajectories. ⋯ We quantitatively described anatomic features of the TSTC approach and compared them with the LTT approach. For approaching the mesial temporal region, the TSTC approach offers an adequate surgical angle and shorter or similar distances proximal to P2-P3 and requires less temporal lobe and hippocampal retraction than the LTT approach. Such information can help surgeons select the optimal approach to the mesial temporal lobe and its surrounding structures. The TSTC approach should be considered for lesions located in the medial temporal region.
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Lateral supracerebellar-infratentorial approaches are established for lesions in ambient cistern and posterolateral midbrain, but published surgical experiences do not describe results with this approach in the sitting position. Gravity retraction of the cerebellum opens this surgical corridor and dramatically alters exposure, creating 2 variations of the lateral supracerebellar-infratentorial approach: the supracerebellar-supratrochlear approach and the infratentorial-infratrochlear approach. ⋯ Gravity retraction of the cerebellum transforms the lateral supracerebellar-infratentorial approach, enhancing exposure and approach trajectories that can be achieved with patients in prone or lateral positions. The increased upward viewing angle of the supracerebellar-supratrochlear approach accesses the posteroinferior thalamus. The increased downward-viewing angle of the infratentorial-infratrochlear approach accesses cerebellomesencephalic fissure and posterolateral midbrain. These approaches open wide corridors for safe surgical resection of symptomatic cavernous malformations and AVMs.
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We investigate an innovative and efficacious procedure for restoring wrist flexion, finger flexion, and hand sensation by passing the contralateral C7 through a subcutaneous tunnel across the anterior surface of the chest and neck. ⋯ Transfer of the contralateral C7 to the lower trunk proved to be a safe and feasible procedure. Compared with the traditional transfer of the contralateral C7 to the median nerve, it might help patients gain better restoration of wrist flexion, finger flexion, and hand sensation.
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Awake craniotomy with intraoperative electrical mapping is a reliable method to minimize the risk of permanent deficit during surgery for low-grade glioma located within eloquent areas classically considered inoperable. However, it could be argued that preservation of functional sites might lead to a lesser degree of tumor removal. To the best of our knowledge, the extent of resection has never been directly compared between traditional and awake procedures. ⋯ Our results demonstrate that awake surgery, known to preserve the quality of life in patients with low-grade glioma, is also able to significantly improve the extent of resection for lesions located in functional regions.
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Previous studies of spontaneous subarachnoid hemorrhage (SAH) have shown that global cerebral edema on the first computed tomography scan is associated with a more severe initial injury and is an independent predictor of poor outcome. Effects of secondary ischemic events also influence outcome after SAH. ⋯ Patients with global cerebral edema have higher interstitial levels of lactate and pyruvate. The edema group may have developed a cerebral hypermetabolism to meet the increased energy demand in the recovery phase after SAH. This stress would make the brain more vulnerable to secondary insults, increasing the likelihood of energy failure.