World Neurosurg
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It is estimated within the western population that 10%-13% of patients possess multiple intracranial aneurysms1 and are linked to certain risk factors. Thrombotic aneurysms are a rare subgroup of complex aneurysms characterized by an organized intraluminal thrombus.2,3 They differ from typical saccular aneurysms in terms of morphology, natural history, symptomatology, and difficulty in treatment with conventional strategies.2,4 The risk of rupture is poorly characterized and assumed to be comparable with that of nonthrombotic aneurysms.2 A subset of thrombotic aneurysms can be treated surgically with conventional clipping, and direct clipping has been associated with the best surgical outcome.2 Despite its safety, endovascular treatment is associated with a high risk of recurrence and retreatment compared with surgical treatment,5 with recanalization rates up to 5× higher compared with nonthrombosed aneurysms.6,7 A 64-year-old male presented with headaches and dizziness for 6 months. He was neurologically intact. ⋯ Achieving adequate proximal control and meticulous dissection of the branches is necessary before reconstruction. We present a 2-dimensional video demonstrating the surgical steps of clipping and reconstruction of the giant thrombosed middle cerebral artery aneurysm. Complete occlusion was achieved, and the patient tolerated the operation well with an uneventful postoperative course.
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The lateral supraorbital (LSO) approach is a minimally invasive modification of the standard pterional approach to anterior circulation aneurysms. This study aimed to describe a dual-trained cerebrovascular neurosurgeon's first 18-month experience with the LSO approach, including decision-making criteria and lessons learned. ⋯ The LSO approach can safely and effectively treat anterior circulation aneurysms and should be considered a viable minimally invasive option for aneurysm clipping. Further studies comparing the LSO approach with other cranial approaches are needed.
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The Pipeline Embolization Device (PED) has been the only flow-diverting device (FDD) approved by the Food and Drug Administration (FDA) in the U.S. market for nearly a decade, with more FDD choices in the United States following recent FDA approval of the Flow Redirection Endoluminal Device and Surpass. We sought to explore the integration patterns of these devices into practice by U.S. neurointerventionalists. ⋯ The results of this survey identify common themes in FDD choices among neurointerventionalists in the U.S. market, along with their integration patterns of the newly introduced devices into clinical practice.
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The anterior petrosectomy, also known as the Kawase approach, and the retrosigmoid intradural suprameatal approach (RISA) have both been used to reduce the petrous apex and access the petroclival region. Our goal was to compare the volumes and 3-dimensional shapes of bony resection obtained through each approach while trying to resemble realistic surgical settings. ⋯ The Kawase approach invariably results in larger volumes of bony removal than the RISA operative variant, and the volume of petrosectomy that is spatially congruent is only partially identical. The Kawase corridor is best suited for middle fossa lesions that extend into the posterior fossa, while the RISA is suitable for pathologies mainly residing in the posterior fossa and extending into the Meckel cave.
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Computer-assisted neuronavigation (CAN) during spine fusions has increasingly been utilized in the United States. The aim of this study was to analyze the trends, health care utilization, and clinical outcomes associated with CAN use. ⋯ CAN is increasing being used for spine fusions primarily for thoracolumbar procedures. No difference in complications, discharge disposition, and LOS were noted across the cohorts at index hospitalization, with higher index payments with CAN use. CAN was associated with lower rates of repeat fusions and corresponding health care utilization for up to 24 months.