World Neurosurg
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The anatomico-functional complexity of the ophthalmic segment aneurysms is attributable to the presence of critical neurovascular structures in the surgical field. Surgical clipping of the ophthalmic artery (OpA) aneurysms can result in postoperative visual deficit due to the complexity of the aneurysm, vasospasm, or optic nerve manipulation. In this study, we aimed to characterize the feasibility of an intracanalicular OpA (iOpA) revascularization with 2 donor vessels: an intracranial-intracranial (IC-IC) bypass using the anterior temporal artery (ATA) and an extracranial-intracranial (EC-IC) bypass using the superficial temporal artery (STA). We further discuss their potential role in "unclippable" OpA aneurysms. ⋯ This study confirms the feasibility of iOpA revascularization using IC-IC and EC-IC bypasses. These techniques could potentially be used for prophylactic or therapeutic neuroprotection from retinal ischemic injury while treating complex OpA aneurysms, infiltrative tumors, or intraoperative arterial injuries.
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To identify and reveal the sensitivity and efficiency of dynamic somatosensory evoked potentials (DSSEPs) in the diagnosis of cervical spondylotic myelopathy (CSM). ⋯ The percentage change in amplitude was obvious during cervical dynamic motion, with records from LMC2 and LUC2 being predictive of CSM diagnosis; dynamic SSEPs provided a simple, accurate, and noninvasive supplementary test for the diagnosis of complicated CSM.
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Case Reports
Severe Spinal Cord Compression by Anomalous Vertebral Arteries Treated with Gore-Tex Tape Transposition Technique.
Rare anomalous courses of vertebral arteries in the craniovertebral junction may compress the spinal cord causing myelopathy. We report here the severest form of this pathologic condition successfully treated with transposition of bilateral vertebral artery using Gore-Tex tapes. A 73-year-old man presented with progressive tetraparesis and gait disturbance. ⋯ Pinched by the vertebral artery loops on both sides, the spinal cord was severely deformed. Through the standard midline approach, we carefully transposed both vertebral arteries off the spinal cord, placing them at the optimal position using Tanaka et al's Gore-Tex tape technique originally reported for microvascular decompression. The Gore-Tex tape transposition technique proved to be versatile and useful for safe transposition of the vertebral artery in this challenging case.
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The acellular dermal matrix (ADM) and turbinate flap (TF) have been widely used in the reconstruction of skull base defects. However, owing to the lack of reported data, the therapeutic effects have been controversial. The purpose of the present study was to compare the effect of the ADM and TF on cerebrospinal fluid (CSF) rhinorrhea after nasal endoscopic resection of a skull base tumor. ⋯ The use of the ADM for patients with CSF rhinorrhea showed comparable results in terms of postoperative outcomes compared with the use of TF. ADM could serve as a safe and feasible alternative for endoscopic repair of CSF rhinorrhea after nasal endoscopic resection of skull base tumors.
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Case Reports
Anaphylactic Shock followed by Indocyanine Green Videoangiography in Cerebrovascular Surgery.
Indocyanine green (ICG) video angiography has been widely used in cerebrovascular surgery. ICG injection is generally safe, with a low incidence of complications. ICG-related anaphylactic reactions during neurosurgery have been rarely reported. We report the cases of 2 patients who had experienced anaphylactic shock in response to intravenous ICG injection (DID Indocyanine Green [Dongindang, Inc., Gyeonggi-do, Republic of Korea]) during intracranial aneurysm (IA) surgery. ⋯ Despite the rarity of ICG-related anaphylaxis, clinicians should be aware of this unexpected, but potentially life-threatening, drug reaction in patients undergoing cerebrovascular surgery.