British journal of neurosurgery
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Interpositional grafts are often used for extracranial to intracranial artery bypass procedures. However, donors often suffer from size mismatch and donor site morbidity. We sought a novel donor vessel that has not been used for these procedures. ⋯ The AIA is more than long enough to graft the superficial temporal artery at the root of the zygoma to the vessels of the anterior and posterior circulations. This obviates the possibility of ischemic complications following radial artery harvest and graft size mismatch when using other grafts. Indications for the potential use of the AIA may be limited, but they include special situations such as second craniotomy with a previously damaged superficial temporal artery.
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Retroclival haematomas are rare entity and they are mostly caused by trauma. There has been only one case published to have a retroclival haematoma following pituitary apoplexy. We present a patient diagnosed with pituitary apoplexy who was found to have acute subdural retroclival haematoma on the MRI.
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Review Case Reports
Remote site intracranial haemorrhage: a clinical series of five patients with review of literature.
Post-operative haematoma is a well-known complication following the intracranial surgery, the surgical site itself being the most frequent and usually results from inadequate haemostasis. Remote site intracranial haemorrhage, that is, haemorrhage occurring at a distant site from the site of craniotomy, is relatively rare and may occasionally cause significant morbidity or even mortality. Authors report a clinical series of five patients who developed remote site haemorrhage following intracranial surgery. ⋯ All the patients were diagnosed by CT scan in the post-operative period. Four patients were operated and made a good recovery while one patient with cerebellar haematoma rapidly deteriorated and developed brain death and hence was not operated. The pertinent literature is reviewed regarding pathophysiology and management of this rare condition.
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Haemangioblastomas are hypervascularized tumours. Their surgical management requires a complete resectioning and a prompt handling of the vascular inlets and outlets. The use of intraoperative indocyanine green video angiography (ICG-VAG) depicts the precise vascular pattern for the surgeon. ⋯ Here we present a case of spinal haemangioblastoma treated with the aid of intraoperative ICG-VAG and the Flow 800 software. The use of the Flow 800 allowed the surgeon to detect, at a glance, minimal changes in the vascular supply during the dissection. The colour-coded images generated by the Flow 800 increase the ICG-CAG sensitivity, improving the capability to detect changes in vascular patterns.
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Following retromastoid craniectomy for microvascular decompression of the fifth or seventh cranial nerve, the preferred method and value of cranioplasty remains disputed. ⋯ Although this technique is unlikely to affect the rates of infection and postoperative pain, we believe that the low rate of CSF leak provides a unique advantage over other currently used methods of closing retromastoid craniectomies.