Surg Neurol
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The purpose of this study was to call attention to the subtemporal approach directed through the petrous apex to the IAM. We studied the microsurgical anatomy of the middle floor to delineate a reliable angle between the GSPN and the IAM to precisely localize and expose the IAM from above. A new technique for the elevation of middle fossa floor in an anterior-to-posterior direction has also been examined in cadaveric dissections and performed in surgery. ⋯ The surgical technique for the middle fossa approach which includes an anterior-to-posterior elevation of middle fossa dura starting from the foramen ovale and uses the angle between the IAM and the long axis of the GSPN to localize the meatus from above may be an alternative to previously proposed surgical methods.
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Although extracranial carotid dissection with stroke is common, intracranial dissection with stroke is rare. Stenting has been used to treat extracranial carotid dissections. Intracranially, however, it is only recently that stents have become a feasible option for this disease. We present a case of a spontaneous intracranial CAD with progressive symptoms despite medical management treated with a self-expanding intracranial micronitinol stent. ⋯ This case illustrates the successful off-label use of a self-expanding intracranial nitinol stent to treat a symptomatic intracranial internal CAD in the setting of failure of traditional medical management. This is a promising application of novel endovascular technology.
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Vertebral compression fractures represent a serious health care problem. Vertebroplasty and kyphoplasty have been gaining popularity in the treatment of symptomatic compression fractures that are often secondary to osteoporosis or neoplasia. ⋯ With the continued aging of the population, VCFs represent an increasingly important health care issue. The staggering increase in the number of minimally invasive VAPs performed illustrates the continued adoption of these innovative technologies and early trends in their applications.
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Case Reports
Migration of pump for intrathecal drug delivery into the peritoneal cavity. Case report.
We report on a patient in whom a subfascially implanted pump for the intrathecal delivery of baclofen spontaneously migrated into the peritoneal cavity. ⋯ When creating a pocket for subfascial implantation, a high subcostal incision should be used so that the lower extent of the pocket will still be above the level of the linea semilunaris, hence ensuring a strong fascial layer between the pump and the peritoneum.
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Although the clinical profile of patients with PMN SAH is well documented, there are scarce data available for patients with nonaneurysmal n-PMN SAH. In the present study, the clinical characteristics of patients with n-PMN SAH were analyzed and compared with those of PMN SAH and aneurysmal SAH. ⋯ Once an aneurysm is definitely excluded, patients with n-PMN SAH have a good outcome, and like PMN SAH, have a benign clinical course. However, a second DSA is mandatory to avoid missing an aneurysm or any other vascular lesion.