World Neurosurg
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Quantifying the clinical neurological impairment of individuals with traumatic spinal cord injury (SCI) is of great importance in managing the population. The current gold standard is the International Standards for Neurological Classification of SCI (ISNCSCI). Administered in isolation, this measure is not sensitive or specific enough to quantify impairment for the whole SCI population with the detail required for clinical trials and interventional studies. ⋯ The use of impairment measures alone will not provide clinicians with enough information regarding ability. Thus, the use of functional outcomes, such as the Spinal Cord Independence Measure, Functional Independence Measure, and other functional tests in addition to the neurological impairment measures, such as the ISNCSCI and the electrophysiologic measures, are required for adequate characterization of the deficits and abilities in the traumatic SCI population.
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The introduction of extended endoscopic endonasal approaches for the management of midline skull base lesions has brought again the focus on the problem of postoperative cerebrospinal fluid (CSF) leak management. Notwithstanding the improvements in reconstruction techniques that have reduced the rate of postoperative CSF leakage, no technique has proven to be thoroughly effective. ⋯ An endoscope-guided sealant technique with fibrin glue used while the patient is awake has proven, in our experience, to be effective in reducing the rate of reoperations in the management of postoperative CSF leaking after endoscopic endonasal approaches for the treatment of intradural skull base lesions. This technique, which needs larger case series to be validated, could be considered in the spectrum of possibilities to manage selected postoperative CSF leakages.
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Review Case Reports
Usefulness of tumor blood flow imaging by intraoperative indocyanine green videoangiography in hemangioblastoma surgery.
Hemangioblastomas remain a surgical challenge because of their arteriovenous malformation-like character. Recently, indocyanine green (ICG) videoangiography has been applied to neurosurgical vascular surgery. The aim of this study was to evaluate the usefulness of tumor blood flow imaging by intraoperative ICG videoangiography in surgery for hemangioblastomas. ⋯ In surgery for hemangioblastomas, careful interpretation of dynamic ICG images can provide useful information on transit feeders and unexposed hidden vessels that cannot be directly visualized by ICG.
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Review Historical Article
The carotid siphon: a historic radiographic sign, not an anatomic classification.
After the term carotid siphon was introduced by Moniz in 1927 to describe the radiographic appearance of the intracranial internal carotid artery (ICA), the concept gained popularity in decades following in both the anatomic and the medical literature. However, as conflicting definitions persist in the delineation of proximal and distal sites, does the term carotid siphon provide the precision needed for current anatomic and clinical studies? ⋯ Tracing the origin and usage of the term carotid siphon during 6 decades in the medical literature shows continued discrepancy rather than consensus. The term carotid siphon is historically relevant but can now be supplanted by definitive ICA classification systems, which continue to evolve in contemporary medical and anatomic communications.
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The occipital artery (OA) is an important donor artery for posterior fossa revascularization. Harvesting the OA is believed to be difficult and time consuming due to its 3-dimensional course through different suboccipital tissue layers. We propose a safe and effective means of dissecting the OA. ⋯ This segmentation provided a safe and effective procedure for harvesting the OA, in which dissection of the transitional segment is a critical step. Although the course of the OA is complex, precise anatomical knowledge of the suboccipital muscles and a stepwise dissection make harvesting the OA relatively simple.