Surg Neurol
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Review
Principles of neuroanesthesia in aneurysmal subarachnoid hemorrhage: The Helsinki experience.
Aneurysmal subarachnoid hemorrhage is a devastating disease that is followed by a marked stress response affecting other organs besides the brain. The aim in the management of patients with aSAH is not only to prevent rebleedings by treating the aneurysm by either microneurosurgery or endovascular surgery, but also to evacuate acute space-occupying hematomas and to treat hydrocephalus. ⋯ Multidisciplinary and professional teamwork is essential in the management of patients with cerebral aneurysms.
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The efficacy of BioGlue (CryoLife, Inc, Atlanta, Ga) surgical adhesive in transsphenoidal surgery was assessed as an adjunct in the prevention of postoperative CSF leaks. ⋯ BioGlue appears to be an effective adjunct in preventing postoperative CSF leaks after transsphenoidal surgery. However, careful attention to technical details of the repair is still required to prevent failures, especially when closing large dural and diaphragmatic defects.
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Access to tumors of the middle cranial base has traditionally required wide surgical exposures via open craniotomies. These open techniques often require the use of potentially disfiguring skin incisions and are often associated with a significant degree of brain retraction and potential morbidity. We report our experience with the use of a minimally invasive supraorbital endoscopic approach through the eyebrow for excision of middle cranial base tumors in 2 cases. ⋯ These cases demonstrate how the application of endoscopic techniques to surgery of the middle cranial base can eliminate the need for traditional open techniques without compromising surgical success.
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Case Reports
Intraoperative dynamic angiography to detect resolution of Bow Hunter's syndrome: Technical case report.
Bow Hunter's syndrome is a rare form of vertebrobasilar insufficiency that may be successfully treated by surgical intervention. Use of intraoperative dynamic transcranial Doppler ultrasound for surgical treatment of vertebrobasilar insufficiency has been described in literature. However, this technique was inconsistent and unreliable in some patients. We present a case of a patient with Bow Hunter's syndrome treated surgically and emphasize the valuable addition of intraoperative dynamic angiography to determine resolution of vertebral artery compromise. ⋯ Intraoperative dynamic angiography is a definitive test to determine hemodynamic resolution of Bow Hunter's syndrome. It offers real-time feedback of vertebral artery decompression, potentially minimizes the amount of decompression, and can be performed safely.
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Blister-like aneurysms of the internal carotid artery (ICA) are very fragile, thin-walled aneurysms. These lesions are susceptible to premature rupture intraoperatively. We describe two cases of successful arterial suturing of these blister-like aneurysms of the ICA, followed by a clip reinforcement technique and circumferential wrapping with a silastic sheet. ⋯ This technique can be a useful treatment option for these fragile aneurysms in cases where other options, such as direct clips or encircling clips, may be impossible.