British journal of neurosurgery
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Case Reports
An unusual case of spontaneous subarachnoid haemorrhage - a ruptured aneurysm of a basilar perforator artery.
A 51-year-old gentleman with no significant past medical history presented with a WFNS grade 1 subarachnoid haemorrhage. Initial angiographic investigations revealed no cause, but repeat tests showed a small basilar perforator aneurysm. ⋯ Post-operatively the patient made a good recovery. This case highlights the importance of delayed repeat catheter angiography in selected patients with suspicious initial CT head results.
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The evolving face of neurosurgery with emphasis in subspecialisation along with the introduction of European Working Time Directives has led an increasing number of trainees to wish to pursue a fellowship either at home or abroad after they finish their training. Information about fellowship programs is not always widely available and fellowships can be highly competitive. This article aims to provide some useful tips on how to pursue an international neurosurgical fellowship in Canada.
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The authors have undertaken a study of their intraoperative experience with indocyanine green fluorescence videoangiography (ICGFV). In particular, the intuitiveness, image quality and clinical utility of this technology have been assessed. ⋯ ICGFV is safe, intuitive and provides neurosurgeons with high quality, valuable, real-time imaging of cerebrovascular anatomy. It can assist in intraoperative surgical management and/or stroke prevention particularly during aneurysm clipping, EC-IC bypass and AVM/DAVF surgery.
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Subarachnoid hemorrhage (SAH) is a significant health care problem. One of the major determinants of outcome following surgery of intracranial aneurysms is development of intracranial infarcts. All patients underwent clipping for aneurysms in one year in the department of neurosurgery, PGIMER, Chandigarh were studied. ⋯ Infarcts that occur early after surgery may be related to surgical factors whereas the late infarcts were probably as results of delayed ischemic deficits. Anatomical distribution of infarcts also showed two different patterns, infarcts limited to one vascular territory (more commonly seen in early onset infarcts) or multiple, cortical, bilateral infarcts (more commonly seen in late onset infarct). Patients with poor H&H grade, higher Fisher's grade, intraoperative rupture and prolonged temporary clipping had more chances of developing an intracranial infarct.
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Adhesion formation between dura mater and cortex, and the overlying temporalis muscle and galea following decompressive craniectomy, can make subsequent cranioplasty difficult and adds to the risks of the procedure. We describe the implantation of sterile silicone sheeting at decompressive craniectomy to prevent adhesion formation and facilitate subsequent cranioplasty, potentially reducing surgical time, improving outcome and reducing risk.