World Neurosurg
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Sacral cysts are classically divided into Tarlov cysts and meningeal diverticula. However, the pathogenesis of sacral cysts remains unclear. This study aimed to clarify a novel type of sacral extradural spinal meningeal cyst with a specific arachnoidal structure. ⋯ The clinical findings of this study illustrate a special subtype and may help explain the mechanism of sacral cyst formation.
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Internal carotid artery (ICA) injury during transsphenoidal surgery is a rare but serious complication. We analyzed a series of ICA injuries that occurred during a transsphenoidal approach to suggest an optimal management strategy. ⋯ Prompt control of bleeding, endovascular management of injured ICA, and consideration of revascularization surgery based on collateral flow may prevent catastrophic neurological sequelae.
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Studies about the transradial technique and experience with this approach abound in the neurointerventional literature, but studies focusing on patient perspectives and preferences with respect to transfemoral or transradial access are scarce. ⋯ Most patients preferred the transradial approach. Evaluating the reasons behind their preference can help operators to better understand patient perspectives and improve quality of care.
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Case Reports
Role of Extradural Clinoidectomy and Trapping in Giant Superior Hypophyseal Artery Aneurysm.
Giant paraclinoid internal carotid artery (ICA) aneurysms are surgically challenging, mainly owing to lack of adequate working space and distortion of the regional anatomy. Anterior clinoidectomy is a vital surgical technique in such cases, allowing optic nerve decompression and exposure of the proximal ICA outside the confines of the arachnoid. While clinoidectomy is generally conducted intradurally, some aneurysms, particularly unruptured and directed medially paraclinoid ICA aneurysms, can allow a completely extradural clinoidectomy. ⋯ The patient made an uneventful recovery with improvement in vision and normal visual fields. This video demonstrates the feasibility and utility of extradural clinoidectomy in adequate exposure of giant paraclinoid aneurysms and the role of aneurysm trapping for definitive aneurysm obliteration when the distal dural ring is involved. Trapping, in contrast to direct clipping, avoids manipulation of the compressed optic nerves, which is necessary for an optimal environment for postoperative visual recovery.
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Less than a quarter of the world population has access to microneurosurgical care within a range of 2 hours. We introduce a simplified exoscope system to achieve magnification, illumination, and video recording in low-resource settings. ⋯ Our low-budget exoscope offers similar image quality, magnification, and illumination like a conventional binocular microscope. It may thus help expand access to neurosurgical care worldwide. Users may face difficulty adapting to the lack of depth perception in the beginning. Prospective studies are needed to assess its usability and effectiveness compared to the microscope.