World Neurosurg
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Case Reports Comparative Study
Treatment and outcomes among 102 posterior inferior cerebellar artery aneurysms: a comparison of endovascular and microsurgical clip ligation.
The vicinity of brainstem and cranial nerves as well as the limited operative working space make clip ligation of posterior inferior cerebellar artery (PICA) aneurysms challenging. The small caliber of the PICA and the broad neck often associated with these aneurysms also create challenges in preserving this artery during treatment. Few data exist to compare the 2 treatment approaches for aneurysms in this location. ⋯ PICA aneurysms are challenging and require a multimodality treatment paradigm. Although microsurgery is associated with more short-term postoperative complications, presenting grade and patient's age remain the primary predictors of long-term outcome.
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Surgery for the treatment of cervical spondylotic myelopathy is typically accompanied by complication rates between 11% and 38%. By determining clinical and surgical predictors of complications, clinicians can identify high-risk patients and plan accordingly. We conducted a survey of the AOSpine community to identify key predictors of postoperative complications. ⋯ This survey summarizes surgeons' perceptions of the most important clinical, imaging, and surgical risk factors for postoperative complications. Knowledge of these predictors allows clinicians to identify high-risk patients and institute prevention plans.
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Fractional anisotropy (FA) of the high cervical cord (C1-C2), rostral to the injury site, correlates with upper limb function in patients with chronic cervical spinal cord injury (SCI). In acute cervical SCI, this relationship has not been investigated. The objective of this study was to identify functional correlates of FA of the high cervical cord in a series of patients with acute cervical SCI. ⋯ FA of the whole cervical cord as well as the CST, rostral to the injury site, is associated with preserved upper limb motor function as well as superior ASIA grades after acute cervical SCI. FA of the high cervical cord is a potential biomarker of neural injury after acute cervical SCI.
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A challenging step of the paramedian supracerebellar-transtentorial approach is to expose the anterior portion of the mediobasal-temporal region (MTR), a step that seems most affected by the steepness of the tentorium. The objective of this study was to define magnetic resonance imaging measurements that can predict the level of challenge in exposing the anterior portion of the MTR. ⋯ The results provide strong evidence proving that the lesser the tentorial and occipital angles, the easier the exposure of the anterior portion of the MTR during the paramedian supracerebellar-transtentorial approach. The tendency of the cranial shape toward dolichocephaly seems to have the same practical value in choosing the approach. It is easier to expose the anterior portion of the MTR in these individuals.
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Aneurysms of the posterior cerebral artery (PCA) are rare, and therefore the individual and institutional experience of their microsurgical management is usually limited. In the present article, we describe our experience with the subtemporal approach to aneurysms arising from the PCA. ⋯ The subtemporal approach is a suitable approach to aneurysms of the segments P1, P1-P2 junction, and P2, as well as the anterior P3 segment of the PCA. Using the subtemporal approach, the cerebrospinal fluid is released before retraction is necessary to prevent temporal lobe injury. The subtemporal approach can provide enough space for revascularization procedures. The most encountered complications were not related to the subtemporal approach but to the specific nature of PCA aneurysms.