Neurosurgery
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Case Reports
Revision of vagal nerve stimulator electrodes through a posterior cervical triangle approach: technical note.
We describe an approach to vagal nerve stimulator (VNS) lead replacement through the posterior cervical triangle. Scar around the structures of the carotid sheath is avoided and new leads are placed on a pristine section of the vagus nerve proximal to the original site. ⋯ The posterior cervical triangle approach provides a virgin dissection plane for VNS revision.
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Visual field defects are a common side effect after mesial temporal resections such as selective amygdalohippocampectomy (SelAH). ⋯ DTT and intraoperative visualization of the Meyer loop is a helpful tool for preoperative planning and during surgery to find a safe trajectory to mesial temporal structures while avoiding the optic radiation. This technique in combination with a basal approach seems to be a promising strategy to prevent postoperative visual field deficits in most patients.
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Surgical correction of adult degenerative scoliosis is a technically demanding procedure with a considerable complication rate. Extensive blood loss has been identified as a significant factor linked to unfavorable outcome. ⋯ Less invasive image-guided correction of degenerative scoliosis in elderly patients with significant comorbidity yields a favorable complication profile. Significant improvements in spinal balance, pain, and functional scores mirrored expedited ambulation and early resumption of daily activities. Less invasive techniques appear suitable to reduce periprocedural morbidity, especially in elderly patients and individuals with significant medical risk factors.
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Case Reports
Targeted extracranial-intracranial bypass with intra-aneurysmal administration of indocyanine green: case report.
Early origin of the middle cerebral artery M2 segment is a normal variant. When such a vessel is occluded proximally, the parenchyma distal to the vessel may become ischemic. Targeted extracranial to intracranial bypass to such a specific branch may preserve perfusion to the end organ. We describe the use of intra-aneurysmal injection of indocyanine green to identify a target middle cerebral artery branch (MCA) for bypass, immediately followed by proximal parent vessel sacrifice via endovascular embolization. ⋯ Targeted bypass to distal branches is feasible with intra-arterial and intra-aneurysmal injection of indocyanine green, allowing confident preservation of blood supply to areas distal to the sacrificed vessel.
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The Pipeline embolization device (PED; Covidien Vascular Therapies, Mansfield, Massachusetts) is a promising, yet experimental, vascular reconstruction device for the treatment of complex intracranial aneurysms. We present a PED-related complication and describe a salvage strategy. ⋯ Maintaining distal access is critical until the entire parent vessel is reconstructed, especially when multiple PEDs are required. The salvage technique described may help regain distal access if it is lost during the procedure.