Neurosurgery
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Review Case Reports
Flash fluorescence with indocyanine green videoangiography to identify the recipient artery for bypass with distal middle cerebral artery aneurysms: operative technique.
Distal middle cerebral artery (MCA) aneurysms frequently have nonsaccular morphology that necessitates trapping and bypass. Bypasses can be difficult because efferent arteries lie deep in the opercular cleft and may not be easily identifiable. ⋯ The flash fluorescence technique provides quick, reliable localization of an appropriate recipient artery for bypass when revascularization is needed for a distal MCA aneurysm. This technique eliminates the need for extensive dissection of the efferent artery and enables a superficial recipient site that makes the anastomosis safer, faster, and less demanding.
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Review Case Reports
Nonoverlapping Y-configuration stenting technique with dual closed-cell stents in wide-neck basilar tip aneurysms.
Stent-assisted coiling is increasingly used to treat wide-neck intracranial aneurysms to protect the lumen of the parent artery from coil protrusion. This technique is insufficient for treating some aneurysms, depending on their configurations. ⋯ The nonoverlapping Y stenting technique is a good alternative to traditional stent-assisted coiling. This technique is particularly suitable for the treatment of broad-neck bifurcation aneurysms.
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Review Case Reports
Microplate-bridge technique for watertight dural closures in the combined petrosal approach.
Although the combined petrosal approach has significant advantages for medium to large petroclival lesions, it carries the risk of a few major complications. The cerebrospinal fluid leak rate with this approach has been reported to be as high as 15%. ⋯ We recommend this safe and simple closure technique during skull base surgery.
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Review Case Reports
Facial reanimation of patients with neurofibromatosis type 2.
Neurofibromatosis type 2 (NF2) is a tumor suppressor syndrome defined by bilateral vestibular schwannomas. Facial paralysis, from either tumor growth or surgical intervention, is a devastating complication of this disorder and can contribute to disfigurement and corneal keratopathy. Historically, physicians have not attempted to treat facial paralysis in these patients. ⋯ Management of facial paralysis is often times overlooked when defining a care plan for NF2 patients who typically have multiple brain and spine tumors. The paralyzed smile may be treated successfully with single-stage free gracilis muscle transfer in the motivated patient.
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Review Case Reports
Safe resection of arteriovenous malformations in eloquent motor areas aided by functional imaging and intraoperative monitoring.
Arteriovenous malformations (AVMs) proximal to motor cortical areas or motor projection systems are challenging to manage because of the risk of severe sensory and motor impairment. Surgical indication in these cases therefore remains controversial. ⋯ Surgical resection of AVMs in eloquent motor areas can be considered a safe option for selected cases when performed in conjunction with a detailed functional assessment. Possible selection criteria for surgical treatment are discussed in light of the presented clinical data.