World Neurosurg
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Primary elements of surgical treatment of cavernous angiomas (CAs) are precise lesion identification and optimal trajectory determination. Navigation techniques allow for better results compared to microsurgery alone. In this study, we examined the benefits of intraoperative ultrasound (IOUS) use as an adjunct to standard localization systems. ⋯ IOUS is a valid tool for the intraoperative identification of CAs. Implementation of standard localization methods with IOUS guidance was associated with complete resection in all cases, without increasing surgical time. Compared with microsurgery without IOUS guidance, long-term functional outcomes showed better trends, and the epilepsy-free rate was significantly higher.
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Persistent trigeminal artery is the most frequent embryonic communication between the vertebrobasilar and carotid systems. To the best of our knowledge, posttraumatic trigeminal-cavernous fistula is rarely reported in the literature. ⋯ Even though preservation of the parent artery is generally considered a desirable goal in fistula treatment, in special cases such as Salzmann type 2 anatomy plus a unique fistulous orifice accompanied by external carotid-cavernous fistula, it is required to embolize the persistent trigeminal artery and cavernous sinus.
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Sciatic neuralgia (SN) is a type of pain commonly associated with lumbosacral radiculopathy. May-Thurner syndrome (MTS) is a disease characterized by venous congestion in the left common iliac vein (LCIV) due to right common iliac artery compression. A case of MTS with SN as the first presenting symptom is described. ⋯ This is the first report of SN associated with MTS. MTS should be considered as one of the differential diagnoses of SN. Thus, symptoms such as pain, edema, and skin hyperpigmentation on the left leg should be closely noted.
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Case Reports
Microsurgical Clipping of Ruptured Anterosuperior-Projecting Anterior Communicating Artery Aneurysms: How We Do It.
In anterosuperior-projecting anterior communicating artery (ACoA) aneurysms, the aneurysm dome usually adheres to 1 or both proximal A2 segments, which may present technical difficulties. This video demonstrates microsurgical clipping of a ruptured anterosuperior-projecting ACoA aneurysm. A 52-year-old male presented with a Hunt-Hess grade II subarachnoid hemorrhage. ⋯ The patient recovered well without any complications. Successful treatment requires preoperative surgical planning, precise dissection, and preservation of critical structures. With adherence to these general principles, these aneurysms can be treated safely and effectively.
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The signs and pathomechanism of Miyazaki syndrome is presented through the case of a young female patient. ⋯ The article discusses the available literature suggesting the underlying cause in such cases to be the dysfunction of the Starling resistor mechanism due to an improperly adjusted ventriculoperitoneal shunt, which results in excessive cerebrospinal fluid loss accompanied by consequent cerebral venous overflow with vertebral venous engorgement and compressive cervical myelopathy.