Neurosurgery
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Clinical Trial
Extradural anterior clinoidectomy as an alternative approach for optic nerve decompression: anatomic study and clinical experience.
We introduce pterional craniotomy extradural anterior clinoidectomy as a new alternative approach for optic nerve decompression in patients with traumatic optic neuropathy. ⋯ Pterional craniotomy extradural anterior clinoidectomy is a promising new alternative approach for optic nerve decompression in patients with traumatic optic neuropathy.
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Preoperative magnetic resonance imaging (MRI) myelography scans demonstrated a dural defect in a 50-year-old man with an epidural arachnoid cyst who had a 29-year history of untreated weakness and numbness both lower limbs. ⋯ Because the preoperative MRI myelography scan correctly identified the existence and location of the dural defect, we conclude that MRI myelography is helpful for detecting dural defects in patients with epidural arachnoid cysts.
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Pedicle subtraction osteotomy (PSO) has emerged as a powerful procedure for correcting fixed sagittal deformity. There has only been one attempt to quantify the magnitude of correction needed to restore sagittal balance; the trigonometric method for calculating the desired PSO angle is an approximation. We propose a method for calculating the exact angle required for PSO and explore how this angle differs from that obtained via the trigonometric method in illustrative cases. ⋯ The trigonometric method for calculating the PSO angle required for surgical deformity correction is an approximation, but its validity in clinical practice was confirmed by this study. The exact angle is obtained by a method centered on the apex of the PSO site. Although the difference between these angles is small, it is an important conceptual point for spine surgeons. Measurement of the exact angle is easily performed and should replace the trigonometric method for calculating the required PSO angle when standard digital measurement tools are available.
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Case Reports
Intravascular ultrasound for intracranial angioplasty and stent placement: technical case report.
Intravascular ultrasound (IVUS) imaging has been used extensively in coronary artery interventions and has provided invaluable information for the understanding and treatment of coronary arterial disease. We present here the first description, to our knowledge, of IVUS-guided intracranial arterial interventions in the clinical setting. ⋯ IVUS of the intracranial circulation may assist the performance of intracranial angioplasty and stenting. It provides useful information that can affect clinical decisions. It may prove to be a valuable tool in clinical use and enhance our understanding of vascular disease of the intracranial circulation, as it has in the coronary circulation.
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To introduce a method for preoperative targeting of a proper recipient artery in superficial temporal artery-to-middle cerebral artery anastomosis. ⋯ The "target bypass" method might be effective for cases with moyamoya disease or for cases requiring surgery through a small craniotomy.