World Neurosurg
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Case Reports
Stent assisted coiling of aneurysm in a persistent primitive lateral vertebro basilar system.
Fenestrations of cerebral arteries are relatively common. Knowledge of their structure has recently gained clinical significance with increasing awareness of fenestration aneurysms. Persistent primitive lateral vertebrobasilar (PPLVB) anastomoses are an extreme end of the embryologic mishaps causing these fenestrations, and their occurrence has only been reported twice. ⋯ The unique anatomy of these aneurysms and relation with important perforators and brainstem make surgery extremely difficult and require advanced endovascular techniques like balloon remodeling and stent assistance. Three-dimensional rotational angiography can help in providing clarity to the aneurysmal anatomy and planning treatment. The purpose of this case report is to bring to notice the possibility of such aneurysms and use the unique anatomy to understand various tools available in the endovascular surgeon's armamentarium.
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Case Reports
Encountering a basal vein of Rosenthal variant during the anterior transpetrosal approach.
The basal vein of Rosenthal (BVR) is important in intracranial surgery, including skull base surgery. We report a case of petroclival meningioma in which a BVR variant drained into the tentorial sinus. ⋯ To our knowledge, this is the first study to describe surgery using the ATPA and involving a BVR variant, in which the vein was imaged successfully preoperatively using sliding-thin-slab MIP.
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During brain surgery, there are difficulties associated with identifying subcortical fibers with no clear landmarks. We evaluated the usefulness of cortical evoked potentials with subcortical stimuli (subcortico-cortical evoked potential [SCEP]) in identifying subcortical fibers intraoperatively. ⋯ SCEP was useful for identifying subcortical fibers and confirmed the preservation of these fibers. This technique is expected to contribute to the effectiveness and safety of resective surgery in patients with lesions close to eloquent areas.
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The potential for radiation exposure during neurosurgical training has increased dramatically in the last decade. Incorporation of instrumented and minimally invasive spinal surgery and neuroendovascular procedures into the curriculum has led to increased potential for exposure to ionizing radiation. Contemporary neurosurgery residents' exposure to radiation has not been previously reported. ⋯ To our knowledge, this study is the first to quantify radiation exposure for neurosurgery residents in the current era of training. From this work, efforts may be initiated to increase awareness and safety with regard to radiation exposure. Although the total dose is not high, a better understanding of the impact of radiation exposure on practitioners may help to drive institutional policies to reduce occupational exposure.
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Box trainers are ideal simulators, given they are inexpensive, accessible, and use appropriate fidelity. ⋯ The NET, a face and construct valid open-source partial task neuroendoscopic trainer, was designed. Presimulation novice neurosurgeons and neurosurgical residents were described as having insufficient skills and preparation to practice neuro-endoscopy. Plate tilt and endoscope angle were shown to be important factors in participant performance. The NET was found to be a useful partial-task trainer for skill building in neuro-endoscopy.