World Neurosurg
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Among human oral bacteria, particular kinds of Streptococcus mutans (SM) known as dental caries pathogens contain a collagen-binding protein, Cnm, and show platelet aggregation inhibition and matrix metalloproteinase-9 activation. We have previously reported that these strains may be a risk factor for intracerebral hemorrhage. As a major sample-providing hospital, we report the clinical details, including intracranial aneurysms and ischemic stroke. ⋯ Specific types of oral SM can be a risk factor for cardioembolic infarct, intracerebral hemorrhage, and intracranial aneurysm rupture. Further study is needed.
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To study the prognoses of patients with subdural hematoma (SDH) who were not operated on at the time of the first diagnosis and the causes of enlarged hematomas in some patients during the follow-up period. ⋯ SDHs reveal different prognoses in different age groups. Multicomponent SDHs are within the group that shows the greatest increase in size in the follow-up period. SDHs and CSDHs cause recurrent hemorrhages by sustaining the tension on the bridging veins. The greater the hematoma volume, the greater the growth potential of the hematoma tends to be. CSDHs that do not manifest changes in volume for a long time can be monitored without surgical intervention as long as the clinical picture remains stable.
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A critical step in the far lateral approach (FLA) is exposure of the V3 segment of the vertebral artery, located deep in the suboccipital triangle (SOT). Safe exposure of the SOT is achieved by means of a plane-by-plane dissection, which carries the risk of devascularization. A suitable alternative is to lift a cutaneous muscle flap including the 3 first muscle planes and leave the deepest plane (SOT) attached to the skull base. To achieve this, it is necessary to have superficial anatomic landmarks to help identify the cleavage site. We describe the use of the nuchal lines as a safe, effective, and reproducible method to dissect the muscles to expose the SOT and vertebral artery. ⋯ The nuchal lines allow dissection of muscles in 2 groups, one superficial and the other deep (SOT), which remains attached to the skull base. The V3 segment of the vertebral artery is easily exposed.
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This report examines the usefulness of the preoperative image to orient the surgeon in the sphenoid sinus during endoscopic endonasal transsphenoidal surgery (ETSS). ⋯ Use of oblique coronal images in addition to conventional images provided good orientation of anatomic structures in the sphenoid sinus. The combination of preoperative imaging and endoscopic observation could allow safer surgery in ETSS.