World Neurosurg
-
This study aimed to compare the functional outcome at discharge for unruptured cerebral aneurysms (UCAs) between surgical clipping and endovascular coiling in total, nonelderly (<65 years), and elderly (≥65 years) patients by nonbiased analysis based on a national database in Japan. ⋯ In elderly patients with UCA, a better outcome at discharge after endovascular coiling was found. However, no significantly different functional outcome at discharge between surgical clipping and endovascular coiling for UCA in nonelderly patients was confirmed by propensity score-matched analysis from a nationwide database in Japan.
-
Despite the proven benefit of transradial access over transfemoral access in cardiac procedures, the transition for cerebrovascular procedures has only been slowly enforced. We present our experience with transradial access in cerebral diagnostic angiographies and neurointerventional procedures. ⋯ In this small retrospective series, transradial access proved to be safe and efficient. In the future, it is planned to further promote it as a standard access alternative for more patients.
-
Percutaneous endoscopic lumbar discectomy has been widely used to treat lumbar disc herniation; its advantages are less trauma, faster recovery, lower costs, and higher percentage of patient satisfaction compared with open surgery. Treatment of lumbar spinal stenosis with percutaneous full-endoscopic surgery is still challenging, especially for elderly patients with multiple comorbidities and complex pathologic factors. The aim of this study was to introduce percutaneous full-endoscopic lumbar foraminoplasty and decompression using a visualization reamer in elderly patients with lateral recess and foraminal stenosis and evaluate efficacy and safety. ⋯ Percutaneous full-endoscopic lumbar foraminoplasty and discectomy using a visualization reamer is an effective and safe treatment for elderly patients with lumbar lateral recess and foraminal stenosis. It improves safety and efficiency of decompression and reduces intraoperative fluoroscopy.
-
The treatment of giant fusiform middle cerebral artery (MCA) aneurysms remains daunting owing to their tendency to be associated with precarious end-vessel anatomy and the need for complex microsurgical techniques to appropriately address the aneurysm and the vasculature at risk. Extracranial-intracranial bypass revascularization remains a valuable tool for treating these complex lesions. In the present report, we have described a rare occurrence in which the creation of a double-barrel superficial temporal artery (STA-MCA) bypass facilitated spontaneous obliteration of the aneurysm. We have also highlighted our decision-making process, which was affected by operating in a low-to-middle income country with limited resources. ⋯ Double-barrel STA-MCA bypass is a potential salvage surgical technique to treat selected ruptured complex giant fusiform MCA aneurysms. In rare selected cases, the flow alteration induced by the bypass alone can potentially facilitate aneurysm thrombosis.