World Neurosurg
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Vertebral artery (VA) aneurysms comprise approximately one-third of posterior circulation aneurysms. They are morphologically variable, and located critically close to the cranial nerves and the brainstem. We aim to represent the characteristics of these aneurysms and their treatment, and to analyze the outcome. ⋯ Microsurgery is a feasible treatment for VA aneurysms, although cranial nerve deficits are more common than in endovascular surgery. Despite the challenge of an often severe hemorrhage, of challenging morphology, and risk for laryngeal palsy, most patients surviving the initial stage return to normalcy.
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The use of blood products after subarachnoid hemorrhage (SAH) is common, but not without controversy. The optimal hemoglobin level in patients with SAH is unknown, and data on perioperative need for red blood cell (RBC), fresh frozen plasma (FFP), or platelet transfusions are limited. We studied perioperative administration of RBCs, FFP, and platelets and the impact of red blood cell transfusions (RBCTs) on outcome in patients undergoing surgery for ruptured a cerebral arterial aneurysm. ⋯ Transfusion frequencies of RBCs, FFP, and platelets were relatively low. Intraoperative RBCT was strongly related to intraoperative rupture of the aneurysm in patients with poor-grade SAH. The observed association between poor outcome and RBCT in patients with SAH warrants further study.
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To explore the value of flat detector computed tomography-based vessel fusion technique for visualizing and evaluating anatomic structures and hemodynamic features of patients diagnosed with dural arteriovenous fistulas (DAVF). ⋯ The vessel fusion technique gave detailed anatomic information that enabled better understanding of the DAVF structure, and facilitated an accurate interventional or surgical planning.
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Comparative Study
Extended Endoscopic Endonasal Approach to the Third Ventricle: Multimodal Anatomical Study with Surgical Implications.
A certain interest for the extended endoscopic endonasal approach for the management of sellar-suprasellar lesions extending inside the third ventricle has been growing in recent years. The aim of this anatomical study was to evaluate the possibilities in terms of exposure and access to the different areas of the third ventricle, with the endoscopic endonasal technique, as compared with the microscopic or endoscopic view provided via different transcranial approaches. The advantages and limitations of both surgical pathways were analyzed. ⋯ This anatomical study shows that the lamina terminalis and, above all, the tuber cinereum represent two safe entry points defining possible surgical corridors to be considered for the extended endoscopic endonasal approach to the third ventricle.
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The aim of this study was to investigate the feasibility and effectiveness of endoscopic neurosurgery for patients with third ventricular colloid cysts but without ventriculomegaly. ⋯ Endoscopic resection of third ventricular colloid cyst in patients without hydrocephalus seems to be feasible, effective, and not contraindicated.