World Neurosurg
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In clipping surgery, it can be advantageous to dissect an adherent artery from the aneurysmal dome to achieve complete clipping. Bypass surgery can be useful to reconstruct an adherent artery when dissection of the artery is technically difficult or risky. We report the effectiveness of tailor-made intracranial (IC)-IC bypass to reconstruct an adherent artery in clipping surgery for middle cerebral artery (MCA) aneurysms. ⋯ During clipping surgery for MCA aneurysms, tailor-made IC-IC bypass is one of the useful options to reconstruct tightly adherent branch arteries, especially when an external carotid artery graft has not been prepared in advance.
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To investigate the position of the aorta relative to the spine in patients with de novo lumbar scoliosis (DLS). ⋯ Although the position of the aorta relative to the spine showed no significant difference between patients with DLS and normal subjects, great attention should still be paid to prevent DLS-induced aorta injury.
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Progressive myoclonic epilepsy (PME) is a syndrome characterized by development of progressive myoclonus, cognitive impairment, and other neurologic deficits. Despite major advances in medical treatment of epilepsy, some PME patients remain refractory to antiepileptic drugs. This may further accentuate cognitive impairment and deteriorate functional capacity. Corpus callosotomy (CC) is used in patients with drug-resistant epilepsy who are not candidates for either excisional epilepsy surgery or neurostimulation. We report the application of the standard complete callosotomy to control medically refractory status epilepticus in a patient with PME. ⋯ Inasmuch as surgery was the last resort to control severe disabling status epilepticus, because most of the epileptogenic discharges were originating from the parieto-occipital regions and profound cognitive impairment was present, we decided to perform a complete rather than just an anterior callosotomy. CC may be considered to prevent secondary generalized seizures as the most disabling attacks in patients with certain epilepsy syndromes. Nevertheless, the impact of palliative surgical intervention on the overall disease course of patients with an underlying diffuse pathologic state remains to be determined.
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Historical Article
Endoscopic Endonasal Transsphenoidal Surgery: History and Evolution.
In previous decades, extensive and disfiguring transfacial and/or transcranial approaches were used to reach the sellar and parasellar areas. However, these surgical routes were burdened by severe complications and high mortality rates. ⋯ With these techniques, surgeons have been able to overcome the visual limitations of the open surgical approaches and access areas previously hidden from view. After the contributions of the Pittsburgh duo, Carrau and Jho, pioneers of pure endoscopic surgery, our school began to implement this technique, introducing technical innovations and variations, describing the anatomical details and defining new routes, and playing a key role in its widespread clinical application.
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Stent thrombosis (ST) is a known complication after intracranial stent implantation. The pathophysiology of ST is multifactorial, and standardized treatments for ST remain uncertain. ⋯ In case of refractory ST, high-flow extracranial-to-intracranial bypass proved to be in this case a feasible and effective rescue option.