World Neurosurg
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The main access route for middle cerebral artery (MCA) aneurysms is the transsylvian approach. Although Sylvian fissure (SF) variations have been assessed, none have examined how this affects MCA aneurysm surgery. The objective of this study is to investigate how SF variants affect clinical and radiological outcomes for surgically-treated unruptured MCA aneurysms. ⋯ Sylvian fissure variants may impact intraoperative complications during aneurysm surgery. Thus, presurgical determination of SF variants can predict surgical difficulties, thereby potentially reducing morbidity for patients with MCA aneurysms and other pathologies requiring SF dissection.
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Historically, depressed skull fractures that warranted surgery were treated in 2 stages: the first stage involved debridement and craniectomy, followed by the second stage of delayed cranioplasty. More recently, single-stage autologous cranioplasty has been proven to be safe. However, there is a paucity of literature regarding single-stage titanium mesh cranioplasty when autologous repair is not possible. ⋯ Autologous cranioplasty for depressed skull fractures is not always possible especially in cases of significant comminution. From our case series, single-stage titanium mesh cranioplasty appears to be a safe option.
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Intracranial aneurysms (IAs) are common cerebrovascular diseases with high rates of mortality and disability. With the development of endovascular treatment technologies, the treatment of IAs has gradually turned to endovascular methods. However, because of the complex disease characteristics and technical challenges of IA treatment, surgical clipping still plays an important role. However, no summary has been performed of the research status and future trends in IA clipping. ⋯ The results from our bibliometric study have clarified the global research status of IA clipping between 2001 and 2021. The United States contributed the most publications and citations, and World Neurosurgery and Journal of Neurosurgery can be considered landmark journals in this field. Studies regarding occlusion, experience, management, and subarachnoid hemorrhage will be the research hotspots related to IA clipping in the future.
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Using a cadaveric model, we compared endoscope-assisted retrosigmoid (EAR) and endoscope-assisted retrolabyrinthine posterior petrosal (EARPP) approaches towards the petroclival area, regarding surgical exposure and instrument maneuverability, also verifying how some petroclival morphometric parameters correlate with these variables. ⋯ Endoscopic techniques can spare the need for additional steps of greater morbidity when approaching the petroclival area in both routes. A simpler and faster approach as EAR was favored over EARPP in this standardized quantitative assessment. The petroclival angle and clival depth may interfere with maneuverability, but not with surgical exposure in both endoscope-assisted approaches.
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Anatomical studies of the tentorial sinuses (TS) are scant, and to our knowledge, histological studies of this structure have not been reported. Therefore, we aim to better elucidate this anatomy. ⋯ We identified novel findings for the TS which can be considered surgically and when diagnosing pathology involves these venous sinuses.