World Neurosurg
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The innominate artery, also known as the brachiocephalic artery, is the first vessel off the aortic arch and provides blood to the right arm, neck, and head. Occlusion of the innominate artery can be treated with endarterectomy, angioplasty, stenting, and bypass grafting. Bypass grafting describes a surgical procedure during which a bypass from the ascending aorta to the innominate artery is created. Our case depicts a patient post innominate artery bypass graft with a less commonly encountered postsurgical anatomy.
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Although gun-related penetrating traumatic brain injuries make up the majority of cranial missile injuries, low-velocity penetrating injuries present significant clinical difficulties that cannot necessarily be identically managed. Bow hunting is an increasingly popular pastime, and a crossbow allows a unique mechanism to cause a self-inflicted cranial injury with a large, low-velocity projectile. Historically, arrow removal is described in an operating room setting, which provides limited knowledge of the location of vascular injury in the setting of postremoval hemorrhage, and may represent an inefficient use of operating room availability. ⋯ We describe a novel approach to retained cranial arrow removal in a radiologic, rather than operative, setting and describe its relative benefits over traditional removal in the operating room.
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Case Reports Historical Article
Linear Cutting Trepanation in Italy: A Unique Case from Hellenistic Sicily (Third Century BC).
During the archaeological excavations conducted in the Hellenistic necropolis discovered in Messina (Sicily, Italy) dating back to the 3rd century BC., a skeleton showing evidence of cranial traumas and surgical intervention was found. The skull, belonging to a young adult male, presented signs of 4 head injuries produced by both blunt and sharp-edged instruments. The first 2 lesions, located on the frontal bone, were produced by blunt blows and showed signs of long-term survival. ⋯ The trepanation is likely related to the multiple head injuries exhibited by the patient, who unfortunately did not survive the surgical intervention. Trepanation in Italy has been largely attested since Prehistoric times, but the case from Messina represents the first evidence of neurosurgical intervention performed through the linear cutting technique in the Italian context and the second case in the whole of Europe. This technique might have been imported in Sicily during the Hellenistic period from the Near East, where it is clearly attested.
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Case Reports
Microsurgical Clipping of Ruptured Anterosuperior-Projecting Anterior Communicating Artery Aneurysms: How We Do It.
In anterosuperior-projecting anterior communicating artery (ACoA) aneurysms, the aneurysm dome usually adheres to 1 or both proximal A2 segments, which may present technical difficulties. This video demonstrates microsurgical clipping of a ruptured anterosuperior-projecting ACoA aneurysm. A 52-year-old male presented with a Hunt-Hess grade II subarachnoid hemorrhage. ⋯ The patient recovered well without any complications. Successful treatment requires preoperative surgical planning, precise dissection, and preservation of critical structures. With adherence to these general principles, these aneurysms can be treated safely and effectively.
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Case Reports Comparative Study
A Comparative Report on Intracranial Tumor-to-Tumor Metastasis and Collision Tumors.
The incidence of 2 distinct tumor types occupying the same anatomic location is rarely observed and may be accounted for by 2 separate mechanisms: tumor-to-tumor metastasis and collision tumors, where 2 adjacent tumors invade one another. These rare phenomena arise from distinct mechanisms, which may affect their preoperative recognition, surgical approach, and postoperative care. We review 2 cases, highlighting their identification and perioperative management. ⋯ Preoperative recognition of collision tumor and tumor-to-tumor metastasis is imperative for surgical planning, including selecting regions for tissue biopsy and goals of care. Meticulous evaluation of history and imaging and thorough pathologic analysis allow for effective diagnosis and optimal patient outcomes.