Neurosurgery
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Clipping is an important technique for cerebral aneurysm surgery. Although clip mechanisms and features have been refined, little attention has been paid to clip appliers. Clip closure is traditionally achieved by opening the grip of the clip applier. We reconsidered this motion and identified an important drawback, namely that the standard applier holding power decreased at the moment of clip release, which could lead to unstable clip application. ⋯ This clip applier can improve clipping surgery safety because it offers additional stability during clip release.
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The time required to perform an anastomosis in extra-intracranial bypass is approximately 20 to 60 minutes. The search for alternative methods to reduce the ischemic time remains vital. ⋯ Coupler devices are helpful to perform the anastomoses, because they significantly reduce ischemia time. Their use is easier at the M1 segment, just before the bifurcation and after takeoff of the lenticulostriate arteries, and in the M2 segment. It would be advisable to have a smaller coupling system, allowing maneuverability in the deeper areas where space is limited.
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Intraoperative quantitative flow measurement by a microvascular ultrasonic flow probe is an established methodology in aneurysm surgery. ⋯ Multistage intraoperative quantitative flow measurement proved to be a feasible, safe, repeatable, and reliable methodology to assist surgery in different phases of AVM resection. Further studies are needed to assess the impact of this approach on AVM patient outcomes.VA, indocyanine green videoangiographymRS, modified Rankin ScaleSM, Spetzler Martin.
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Auditory brainstem implantation at the cochlear nuclei used mainly for neurofibromatosis type 2 patients with bilateral loss of the cochlear nerves has more recently been extended to the inferior colliculus. ⋯ The translabyrinthine or retrosigmoid approaches provide access to the cochlear nuclei for implantation and also to the inferior colliculus through the translabyrinthine or retrosigmoid infratentorial supracerebellar route. The endoscope may aid in exposing either site.