Neurosurgery
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Surgery within the insula carries significant risk of morbidity, particularly hemiparesis, because of the difficulty in detecting the internal capsule boundaries. ⋯ The posterosuperior part of the insula forms the region at greatest risk to corticospinal tract injury. The PIIP and UCIP are crucial to understanding the relationship of the insula with the posterior limb of the internal capsule including the corticospinal tract.
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Various techniques of cerebral bypasses are used to treat aneurysms and tumors. ⋯ The EC-IC and local bypasses have higher long-term patency rates (91% and 100%) compared with IC-IC bypasses (66%, 0% long graft). Some EC-IC bypasses may occlude asymptomatically (9%) or develop graft stenosis (13%) over the long term. Microsurgical and endovascular surgical techniques have been developed to treat graft stenosis.
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Central fever is common after aneurysmal subarachnoid hemorrhage (aSAH) and may delay ventriculoperitoneal shunt (VPS) placement. ⋯ aSAH patients with central fever or persistent fever after treatment of fever of identifiable etiology are not at an increased risk of infectious VPS failure.
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Despite a high mortality and morbidity of subarachnoid hemorrhage due to an intracranial aneurysm (IA), there is no effective medical treatment to prevent the rupture of IAs. Recent studies have revealed the involvement of the transactivation of proinflammatory genes by nuclear factor-κB (NF-κB) and Ets-1 in the pathogenesis of IA formation and enlargement. ⋯ The results suggest the possibility of a minimally invasive molecular therapy targeting the inhibition of NF-κB and ets-1 for IAs in humans.
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Intravascular ultrasonography (IVUS) has been used for guiding intravascular stent placement in interventional cardiology. ⋯ IVUS guidance during aneurysm embolization may improve the procedure by providing intravascular aneurysmal measurements and visualization of devices used in the procedure.