Neurosurgery
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Review Case Reports
Multiple aneurysms of thoracic spinal cord arteries presenting with spinal infarction and subarachnoid hemorrhage: case report and literature review.
Arterial aneurysms of the spinal cord are rare. Their pathogenesis is variable, and the therapeutic strategies remain controversial, because their natural history is unclear. We report a case of multiple dissecting aneurysms of radiculomedullary and radiculopial arteries presenting with spinal infarction and subarachnoid hemorrhage, which spontaneously resolved. ⋯ Arterial dissections of spinal radicular arteries can resolve spontaneously and be managed conservatively. We propose a classification of the pathogenesis of spinal arterial aneurysm to clarify appropriate treatment strategies by a literature review.
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The removal of brain tumors in perieloquent or eloquent cortex risks causing new neurological deficits in patients. The assessment of the functionality of perilesional tissue is essential to avoid postoperative neurological morbidity. ⋯ Magnetoencephalography connectivity analysis gives a valuable preoperative evaluation of the functionality of the tissue surrounding tumors in perieloquent and eloquent areas. These data may be used to optimize preoperative patient counseling and surgical strategy.
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Comparative Study
Trends in neurosurgical complication rates at teaching vs nonteaching hospitals following duty-hour restrictions.
In 2003 the Accreditation Council for Graduate Medical Education implemented duty-hour restrictions for residents, with an unclear impact on patient care. ⋯ In patients undergoing craniotomy for meningioma, postoperative complication rates increased at teaching hospitals, but not at nonteaching hospitals over the 5-year epochs before and after 2003.
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Comparative Study
Comparison of indocyanine green angiography and laser speckle contrast imaging for the assessment of vasculature perfusion.
Assessment of the vasculature is critical for overall success in cranial vascular neurological surgery procedures. Although several methods of monitoring cortical perfusion intraoperatively are available, not all are appropriate or convenient in a surgical environment. Recently, 2 optical methods of care have emerged that are able to obtain high spatial resolution images with easily implemented instrumentation: indocyanine green (ICG) angiography and laser speckle contrast imaging (LSCI). ⋯ These 2 methods should be used together to obtain a complete understanding of tissue perfusion.
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Comparative Study
Cost comparison of endovascular treatment of anterior circulation aneurysms with the pipeline embolization device and stent-assisted coiling.
The Pipeline embolization device (PED) is a new endovascular option for wide-necked or fusiform anterior circulation aneurysms that were classically treated by coil embolization with adjunctive use of a stent. However, stent-coiling incurs significant equipment and implant costs. ⋯ Treatment of anterior circulation aneurysms by flow diversion with the PED has lower procedure costs compared with treatment with traditional stent-assisted coiling.