World Neurosurg
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Intraoperative rupture is the most important complication of aneurysm surgery1-5 and occurs in 3 different stages: premature (before dissection), dissection, and clipping.5 We present a video of premature rupture and its management (Video 1). A 45-year-old patient presented with subarachnoid hemorrhage originating from a dorsal internal carotid artery (ICA) aneurysm of the communicating segment. Due to our sufficient experience, we preferred direct clipping in this case. ⋯ In the literature review including 10,540 cases,1 the mean incidence of IOR is 16.6%. Therefore every neurosurgeon should be prepared for this important complication and know its management well. This case reminds us once again the golden rule of aneurysm surgery: proximal control first.
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Though cage-and-plate constructs are widely used for disk height restoration in surgery for cervical disc disease, concerns over range of motion limitations and adjacent disc space violations have fueled the development of artificial disc and zero-profile constructs. This study investigated the outcomes of patients undergoing two-level cervical interventions via arthroplasty, cage-and-plate, or zero-profile constructs. ⋯ Among patients undergoing two-level interventions, cage-and-plate constructs were associated with increased odds of additional surgery within 30 months following index procedures when compared to zero-profile constructs or arthroplasty.
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Tortuosity of intracranial arteries has been proven to be associated with the risk of intracranial aneurysm development. We decided to analyze which aspects of tortuosity are correlated with hemodynamics parameters promoting intracranial aneurysm development. ⋯ Hemodynamic parameters promoting aneurysm development are correlated with larger number of smaller angles located on larger arcs.
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A retrospective cohort study was undertaken to elucidate the risk factors of loss of cervical lordosis (LCL), kyphotic deformity, and sagittal imbalance after cervical laminoplasty. ⋯ Higher preoperative C2-C7 lordosis and less preoperative cervical extension capacity were risk factors of LCL. Small preoperative C2-C7 lordosis <10.5° and younger age were risk factors of postoperative kyphosis. Furthermore, a greater K-line tilt would increase the risk of postoperative sagittal imbalance, with a cutoff value of 12.5°.
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A 65-year-old woman presented with a 2-month progressive history of forgetfulness, headaches, and decline in mobility. Imaging showed a large, enhancing pineal region tumor with triventricular hydrocephalus. She underwent an endoscopic third ventriculostomy and biopsy after appropriate consent was gained. ⋯ We speculate that these are perforating arteries from the posterior communicating artery (premamillary artery) or a branch from the first part of the posterior cerebral artery P1 (thalamoperforators). Other options include perforators from the ophthalmic segment of the internal carotid artery, the communicating segment of the internal carotid artery, the superior hypophyseal artery, or a branch of the medial posterior choroidal arteries. We look at each in turn.