World Neurosurg
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Case Reports
Dissection of the vertebral artery fenestration limb presenting with occlusion following rupture: a case report.
Dissection of a vertebral artery (VA) fenestration is extremely rare. We herein present the first case of a patient who presented with the dissection of a VA fenestration limb accompanied by occlusion after rupture, who was treated with internal trapping of the dissected limb and the parent artery proximal to the fenestration. ⋯ The embolization length was limited and the antegrade blood flow through the other limb remained during internal trapping for the dissected VA fenestration limb; therefore careful observation of the blood flow to the dissected segment after embolization is necessary.
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Quantitative magnetic resonance angiography (qMRA) using noninvasive optimal vessel analysis (NOVA) is a novel noninvasive imaging technique that is being increasingly used to measure blood flow in extracranial and intracranial arteries. By providing important quantitative flow data, NOVA qMRA can facilitate the management of cerebrovascular disease. While the same technology can also be applied to measure flow in intracranial and extracranial veins, NOVA quantitative MRV (qMRV) is only rarely used in neurovascular practice. ⋯ To the best of our knowledge, this is the first report of successful clinical application of NOVA qMRV in adult patients with intracranial arteriovenous malformations or dural arteriovenous fistulas. We propose that NOVA qMRV is a promising technique for noninvasive measurement of intracranial and extracranial venous blood flow and for monitoring treatment effectiveness in patients with intracranial arteriovenous shunt lesions.
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Candida auris is an emerging superbug which was recently discovered and has spread widely across the world. With a steady rise in incidence involving multisystems, this presents a unique challenge to caregivers. ⋯ C. auris appears to be an emerging superbug, which is hospital-acquired. All practitioners must be aware of its existence and presentation. Given the low incidence, high mortality, and no clear guidelines of management so far, formulation of any such strategies is complicated. Further studies and research are needed for this superbug.
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Extradural anterior clinoidectomy (eAC) via the minipterional craniotomy (MPT) approach (MPT+eAC) has been recently introduced to the neurosurgical armamentarium to improve access to anterior and middle fossa skull base structures using a minimally invasive approach. However, the effect of extradural clinoidectomy on surgical exposure with the minipterional approach has not been evaluated. Moreover, the effect of eAC on surgical maneuverability has not been established for either traditional pterional or minipterional craniotomy. We sought to illustrate the microsurgical anatomy of the MPT+eAC and to evaluate the effect of eAC on surgical exposure and maneuverability. ⋯ MPT+eAC offers a larger area of exposure and greater surgical freedom and maneuverability at the paraclinoid region using this minimally invasive approach.
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Comparative Study
Comparison of conventional microscopic and exoscopic experimental bypass anastomosis - A technical analysis.
Recently, the use of digital exoscopes has been increasingly promoted as an alternative to microscopes. The aim of this study is to compare experimental bypass quality in both visualization methods. ⋯ Both methods produced equally satisfactory results in experimental bypass procedures. The exoscope has the potential for better 3-dimensional visualization and sharing the surgeon's view with others for teaching purposes.