World Neurosurg
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To review notable aneurysm cases that required complex decision making from a single institution and to examine available literature when relevant to highlight evidence-based paradigms for treatment of complex aneurysms. ⋯ Innovations in both arms of the cerebrovascular field will continue to advance the field and provide novel approaches to these complex lesions.
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The Japanese Society of Neurotraumatology announced guidelines for management of severe traumatic brain injury (TBI) in 2000. To evaluate subsequent implementation of these guidelines, we investigated current severe TBI practices in Japan. ⋯ Neurosurgeons in Japan are positively involved in management of severe TBI, but few medical centers monitor TBI patients. Many medical centers find it difficult to conform to the guidelines due to lack of neurosurgeons and equipment. These problems can be addressed by consolidation of neurosurgeons into centralized centers and improvement of the medical insurance system.
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Direct surgery for complex internal carotid artery (ICA) aneurysms can be difficult. In certain situations, sacrificing the parent artery is a unique way to obliterate the aneurysm and extracranial-to-intracranial (EC-IC) bypass is indispensable to prevent postoperative cerebral ischemia. This article discusses the indications for direct ICA occlusion, and the strategies, techniques, and outcomes in a series of patients treated for complex ICA aneurysms in a single institution. ⋯ Balloon occlusion test combined with computed tomographic perfusion can be an efficient way to evaluate the compromised cerebrovascular reserve in patients with complex ICA aneurysms after ICA occlusion. In conjunction with EC-IC bypass, ICA proximal occlusion or trapping can be an effective treatment strategy.