Neurosurgery
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Comparative Study
Surgical treatment of high-risk intracranial dural arteriovenous fistulae: clinical outcomes and avoidance of complications.
An increasing number of intracranial dural arteriovenous fistulae (DAVFs) are amenable to endovascular treatment. However, a subset of patients with high-risk lesions requires surgical intervention for complete obliteration. We reviewed our experience with the surgical management of high-risk intracranial DAVFs and offer recommendations to minimize complications based on fistula location and type. ⋯ Despite fulminant presenting symptoms, high-risk intracranial DAVFs can be successfully managed with good outcomes. When anatomic features prevent endovascular access, or embolization fails to obliterate the lesion, urgent surgical treatment is indicated. Patients with residual filling of the DAVF should be considered for adjuvant therapy, including further embolization or radiosurgery.
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Spontaneous acute subdural hematoma (aSDH) may be caused by aneurysm rupture. Patients can present in very poor clinical condition with anisocoria or even bilaterally dilated pupils, absent brainstem reflexes, and cardiac insufficiency. For the clinician, the question is how should these patients be treated? Large series on this subject do not exist because aSDH is a rare event. This report focuses on the prognosis and adverse prognostic factors of these patients. ⋯ Within the spectrum of aneurysmatic hemorrhage, patients with aSDH represent a distinct subgroup. Despite a very poor clinical condition on admission, recovery with only minor deficits or even without neurological deficit is possible. Mass effect and herniation induce a poor clinical condition, which is not directly related to the underlying subarachnoid hemorrhage. Hence, clinical grading systems such as the Hunt and Hess scale or World Federation of Neurosurgical Societies grading are not applicable. We suggest that whenever the medical condition allows, rapid surgical decompression should be performed even in patients who present in very poor neurological condition.
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With the recent interest in superficial temporal artery-middle cerebral artery (MCA) bypass for hemodynamic related ischemia, we performed an anatomic study to find the best possible craniotomy site that will allow finding a suitable recipient cortical artery without compromising the use of the best branch and/or segment of the donor's superficial temporal artery branches. ⋯ This study provides an anatomic and patient-independent mathematical measurement as a way to predictably find an adequate recipient temporal M4 branch for superficial temporal artery-MCA bypass in the majority of patients.
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What is known about the cerebral aqueduct is derived mainly from the legacy of classic histology and from the most recent advanced neuroimaging technologies. In fact, although this important structure is frequently glimpsed by neurosurgeons, only limited anatomic contributions have been added by microsurgery to its direct in vivo description. A review of our surgical experience in navigating the fourth ventricle prompted us to revisit the classical anatomic descriptions of the aqueduct and compare them using the novel perspective of neuroendoscopy. ⋯ Neuroendoscopy provides a novel perspective into the inner aqueductal wall and supplies an incomparable view of the intracanalicular anatomic structures.
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The aim of this study is to establish the safety and efficacy of bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) in Parkinson's disease (PD) patients with disabling motor fluctuations performed with an expedient procedure with limited intraoperative mapping. ⋯ This STN DBS surgical technique for PD is expedient with effective outcomes and low complication rates.