Neurosurgery
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The transfemoral approach is a common technique for coil embolization of cerebral aneurysms in the anterior cerebral circulation. However, it is difficult to advance a guiding catheter into the carotid artery via the femoral route in patients with a tortuous aortic arch, an unfavorable supra-aortic takeoff, aortic diseases, or occlusion of the femoral artery. ⋯ The sheath guide specifically designed for transbrachial carotid cannulation was useful for coil embolization of cerebral aneurysms in the anterior cerebral circulation.
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Current management of middle cerebral artery aneurysms: surgical results with a "clip first" policy.
One response to randomized trials like the International Subarachnoid Aneurysm Trial has been to adopt a "coil first" policy, whereby all aneurysms be considered for coiling, reserving surgery for unfavorable aneurysms or failed attempts. Surgical results with middle cerebral artery (MCA) aneurysms have been excellent, raising debate about the respective roles of surgical and endovascular therapy. ⋯ At present, surgery should remain the treatment of choice for MCA aneurysms. Surgical morbidity was low, and poor outcomes were due to an inclusive policy that aggressively managed poor-grade patients and complex aneurysms. This experience sets a benchmark that endovascular results should match before considering endovascular therapy an alternative for MCA aneurysms.
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Auditory brainstem implants have failed to produce consistent clinical results comparable to those with the cochlear implant, both with surface and penetrating electrodes. ⋯ In the absence of appropriate surface landmarks and imaging guidance, to gain tonotopic access to the human cochlear nucleus with surface and depth electrode remains a major challenge. Due to its location close to the surface, the dorsal cochlear nucleus is vulnerable to surgical manipulation and to tumors.
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This study proposes a 3-dimensional (3-D) template of the insula in the bicommissural reference system with posterior commissure (PC) as the center of coordinates. ⋯ This 3-D reconstruction of the insula should be useful to improve its localization and other cortical areas and allow the differentiation of insular cortex from opercular cortex.
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Dissection of the superficial temporal artery (STA) is often required in preparation for a bypass procedure. Traditionally, dissection of the STA involves a direct cutdown on the artery after marking the course of the artery on the skin with the help of a Doppler ultrasound probe. ⋯ We describe a method that takes advantage of the position of the STA superficial to the temporal fascia to allow rapid, safe, and efficacious dissection. The incision is linear and easier to manage and close. In our series, there were no technical complications related to the dissection of the STA.