Neurosurgery
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Recent reports have validated the use of retrosigmoid approach extensions to deal with petroclival lesions. ⋯ Knowledge of the IICA general relationship with these landmarks (combined with a careful assessment of the preoperative imaging and with the use of intraoperative navigation and micro-Doppler) may help to enhance the inframeatal/petroclival region exposure via a retrosigmoid route, maximizing safe inframeatal and suprameatal petrous bone removal while minimizing neurovascular complications.
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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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Multicenter Study
Initial multicenter technical experience with the Apollo device for minimally invasive intracerebral hematoma evacuation.
No conventional surgical intervention has been shown to improve outcomes for patients with spontaneous intracerebral hemorrhage (ICH) compared with medical management. ⋯ Minimally invasive evacuation of ICH and intraventricular hemorrhage can be achieved with the Apollo system. Future work will be required to determine which subset of patients are most likely to benefit from this promising technology.