World Neurosurg
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We performed a fine white fiber dissection to demonstrate the extensive connections of the corpus callosum. ⋯ The corpus callosum was found to have intricate connections with all the lobes of the cerebral hemispheres, including the insular region and the limbic and paralimbic areas. Based on the course and traverse of the callosal fibers, a transverse incision in the corpus callosum should be preferred when performing a callosotomy to access intraventricular lesions as this splits the callosal fibers instead of transecting them. The analysis of the course of the callosal radiations enhances understanding of the growth pattern of primary corpus callosal gliomas and helps to design a safe surgical strategy.
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Basilar artery occlusion (BAO) is a severe condition with high mortality. However, surgical procedures and outcomes of BAO with different pathologic subtypes have not been fully clarified. This study compared the surgical procedures and clinical outcomes of mechanical thrombectomy in different subtypes of BAO. ⋯ The outcome of endovascular treatment for BAO varies among patients with different pathologic mechanisms. Patients with embolism from tandem vertebral artery steno-occlusion achieved the best outcomes. Rescue treatment was more common in patients with embolic BAO with tandem vertebral artery steno-occlusion and BAO with in situ atherosclerotic thrombosis.
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Due to the increasing age of patients, the evaluation of bone density is crucial, especially in preparation for spinal surgery. The aim of this study was to determine bone density using a computed tomography (CT) and to correlate Hounsfield units (HU) with bone density values of a quantitative computed tomography (QCT). ⋯ The equation allows calculating bone density values without the need for an additional QCT and without further radiation exposure or costs. With this measuring method it is possible to obtain additional information from a computed tomography.
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The occipital transtentorial approach (OTA) is a very useful but challenging approach to expose the pineal region because the deep-seated arachnoid membranes usually fold and extend over the great vein of Galen (GVG), leading to dense and poor visibility. In addition, the practical aspects of arachnoid anatomy are not well understood. We aimed to develop a safe surgical procedure for the OTA according to the practical aspects of arachnoid anatomy. ⋯ A 2-layered arachnoid structure interposes the GVG from above and below the tentorium. The arachnoid membrane below the tentorium can be peeled off bluntly from the GVG to the attachment bundle limited by the penetrating veins. This detachment technique is useful for safe enlargement of the surgical field for the OTA.
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The demand of thrombectomy treatment for acute ischemic stroke increased dramatically in the United States after the publication of 5 pivotal trials in 2015. The impact of call burden on career satisfaction and burnout in neurointerventionalists has not been explored. ⋯ The burden of stroke call has strong implications for career satisfaction and burnout in neurointerventionalists. This model can be used by hospitals, departments, and physician groups to better conceptualize conditions that facilitate burnout and attrition. Changes to hospital management practices and culture may be the most productive focal areas for intervention.