Intrasylvian Retraction Technique to Facilitate the Sylvian Fissure Dissection: A Clinical Study of 125 Cases.

Although many authors have recommended the retractorless technique to avoid retractor-induced brain injury, others usually use brain retractors with a meticulous technique to facilitate the surgery, especially for sylvian fissure dissection. The intrasylvian retraction technique was described for sylvian fissure opening, but no clinical evidence was found. We evaluate the efficacy and safety of this technique for the distal transsylvian approach.

Frontal sinus reconstruction with overlapping sinus mucosa and vascularized pericranial flap Coverage after modified transbasal bifrontal craniotomy: Novel technique and clinical outcomes.

Background: The modified transbasal bifrontal craniotomy is a variant of the bifrontal craniotomy with a wider surgical corridor than the standard approach. There are several methods for frontal sinus repair in bifrontal craniotomy. This study reports a novel method for frontal sinus repair in the modified transbasal interhemispheric approach by precisely overlapping the frontal sinus mucosa margin (without frontal sinus mucosa exenteration) with packing the frontal sinus with povidone-soaked gel foam and covering it with a vascularized pericranial flap.

Antiplatelet Treatment in Moyamoya Disease: A Systematic Review.

Introduction: Moyamoya disease (MMD) is an uncommon cause of stroke. Antiplatelet treatment is commonly prescribed for patients with MMD despite the lack of strong evidence supporting its efficacy. We conducted a systematic review to evaluate evidence of antiplatelet treatment and clinical outcomes among patients with MMD.

Microsurgical partial trapping for the treatment of unclippable vertebral artery aneurysms: Experience from 27 patients and review of literature.

Background: The efficacy and safety of partial trapping for the treatment of unclippable vertebral artery aneurysms (UVAs) are still questionable. The partial trapping method (proximal or distal occlusion) was used in the treatment of aneurysms to simplify the surgical procedure and avoid postoperative complications.

Methods: This study included 27 patients with UVAs who underwent microsurgical partial trapping between January 2015 and August 2022, and their postoperative outcomes and complications were retrospectively reviewed and evaluated.

A randomized controlled trial: Comparing blood pressure reduction in hyperacute phase of spontaneous intracerebral hemorrhage by continuous nicardipine infusion with or without a preceding nicardipine bolus dose.

Objectives: To determine whether addition of an intravenous bolus dose before continuous nicardipine infusion would improve blood pressure reduction in the hyperacute phase in patients with spontaneous intracerebral hemorrhage (ICH).

Design: Double-blind randomized controlled trial.

Setting: One academic emergency department (ED) in Bangkok, Thailand.

Far-lateral approach without C1 laminectomy for microsurgical treatment of vertebral artery and proximal posterior inferior cerebellar artery aneurysms: Experience from 48 patients.

Background: In the endovascular era, most of vertebral artery (VA) and posterior inferior cerebellar artery (PICA) aneurysms were mainly treated with endovascular procedures. This study aimed to demonstrate the microsurgical treatment via the far-lateral approach without C1 laminectomy and its clinical outcomes.

Methods: Forty-eight patients with VA and proximal PICA aneurysms treated by microsurgery through the far-lateral approach without C1 laminectomy, between January 2016 and June 2021, were retrospectively evaluated.

Course of the V3 segment of the vertebral artery relative to the suboccipital triangle as an anatomical marker for a safe far lateral approach: A retrospective clinical study.

Background: The third segment of the vertebral artery (V3) is vulnerable during far lateral and retrosigmoid approaches. Although the suboccipital triangle (SOT) is a useful anatomical landmark, the relationship between V3 and the muscles forming the triangle is not well-described. We aimed to demonstrate the relationship between the V3, surrounding muscles, and SOT in clinical cases.

Early Exposure of the Dorsal Surface of M1 Segment via the Distal Transsylvian Approach for Clipping of Anteroinferior-Projecting Middle Cerebral Artery Bifurcation Aneurysms.

 Middle cerebral artery bifurcation (MCAB) aneurysms are common intracranial aneurysms. Anteroinferior-projecting MCAB aneurysms, with M1 segment usually embedded into the deep part of the Sylvian fissure, cause some surgical challenges. The distal transsylvian approach (DTSA) allows M1 exposure from the dorsal surface for proximal control in the early step.

Early Exposure of the Dorsal Surface of M1 Segment via the Distal Transsylvian Approach for Clipping of Anteroinferior-Projecting Middle Cerebral Artery Bifurcation Aneurysms.

Background: Middle cerebral artery bifurcation (MCAB) aneurysms are common intracranial aneurysms. Anteroinferior-projecting MCAB aneurysms, with the M1 segment usually embedded into the deep part of the Sylvian fissure, cause some surgical challenges. The distal transsylvian approach (DTSA) allows M1 exposure from the dorsal surface for proximal control in the early step.

Microsurgical Treatment of Vertebral Artery Dissection: Surgical Strategies and Treatment Outcomes.

Background: Vertebral artery dissection (VAD) is a rare cerebrovascular disease that can lead to permanent morbidity or mortality. Open surgery for VAD is challenging; therefore, most cases are managed via endovascular techniques. There are several surgical methods for VAD treatment, including trapping or proximal occlusion with or without bypass; however, the standard treatment protocol is not well established.

Suprafascial dissection for pterional craniotomy to preserve the frontotemporal branch of the facial nerve with less temporal hollowing.

Background: To protect the frontotemporal branch of the facial nerve (FTFN) when performing pterional craniotomy, several reports suggest the subfascial or interfascial dissection technique. However, the reports of postoperative frontalis paralysis and temporal hollowing, which are common complications, were relatively limited. This study reports the incidence of postoperative frontalis paralysis and temporal hollowing after pterional craniotomy using the suprafascial and interfascial techniques.

The Intersection Between the Sternocleidomastoid and Splenius Capitis as the Anatomical Landmark to Facilitate Occipital Artery Harvest: A Retrospective Clinical Study.

Background: Occipital artery (OA)-posterior inferior cerebellar artery (PICA) bypass is a challenging procedure and is not frequently performed owing to the difficulty of OA harvest. To facilitate harvest, the intersection between the sternocleidomastoid and splenius capitis (the OA triangle) is used as the anatomical landmark to identify the OA segment that carries the highest risk of damage. This clinical study aimed to demonstrate efficacy and safety of OA harvest using this landmark.

Preoperative Localization of the Carotid Bifurcation for Cervical Carotid Exposure Using the Mastoid-Hyoid Line.

Background And Importance: The location of the carotid bifurcation (CB) is highly variable, which makes precise exposure of the cervical carotid artery difficult, especially in transverse incisions. The method for preoperative localization of the CB is not well established. We used the distance from the mastoid-hyoid (M-H) line to the CB, measured preoperatively with computed tomography angiography, to localize the location of the transverse skin incision.

Anterior Temporal Approach for Clipping Posterior-Projecting Supraclinoid Carotid Artery Aneurysms: A More Lateral Corridor to Better Visualize the Aneurysm Neck and Related Branches.

Background: Direct visualization of the aneurysm neck and its related branches during microsurgical clipping of supraclinoid internal carotid artery (SICA) aneurysms using a standard pterional approach may be difficult, especially when aneurysms are posteriorly projected. We evaluated the efficacy and safety of an anterior temporal approach for clipping posterior-projecting SICA aneurysms.

Methods: Between December 2017 and March 2020, 26 patients with posterior-projecting SICA aneurysms who received microsurgical clipping via an anterior temporal approach were retrospectively reviewed.

Anterior temporal approach for clipping of ruptured basilar tip aneurysms: Surgical techniques and treatment outcomes.

Background: Basilar tip (BT) aneurysms are challenging to treat with microsurgical clipping, especially in subarachnoid hemorrhage cases. The anterior temporal approach is one of the surgical approaches for the treatment of aneurysms in this area. The majority of the previous reports on this approach have described unruptured cases.

Heel Suturing on the Donor Vessel prior to Arteriotomy for End-to-side Cerebrovascular Anastomoses.

Microvascular anastomosis is a common procedure in cerebrovascular surgery. End-to-side anastomoses were the most common procedure for extracranial-to-intracranial bypass. Many techniques were used to reduce clamping time of the recipient vessel.

Interhemispheric Approach with Early A1 Exposure for Clipping Anterior Communicating Artery Aneurysms: Operative Techniques and Outcomes.

Background: The interhemispheric approach (IHA) provides an excellent surgical corridor for clipping anterior communicating artery aneurysms (AcoAAs). However, an important disadvantage of the approach is obtaining proximal control at A1 in the last stage of dissection, especially in anterior or superior projecting AcoAAs and ruptured cases. We describe and evaluate the microsurgical clipping of AcoAAs using the IHA with early A1 exposure.

Blind-Alley Formation and Occipital Artery-Posterior Inferior Cerebellar Artery Bypass for the Treatment of Unclippable Vertebral Artery Aneurysms with Posterior Inferior Cerebellar Artery Involvement.

Background And Importance: Unclippable vertebral artery aneurysms (UVAs) are difficult to treat with direct clipping, especially in cases involving the origin of the posterior inferior cerebellar artery (PICA). Bypass with trapping is the common procedure used for these conditions. The authors used the blind-alley formation technique, which is a simpler method than trapping and can avoid some complications.

Contralateral Transcondylar Fossa Approach with Bilateral V3 Segment Exposure for Clipping of Vertebral Artery Aneurysm Which Deviates Across Midline: A Case Report and Review Article.

This article reports a patient with unruptured right vertebral artery aneurysm which deviates across the midline to the left side. The contralateral (left) transcondylar fossa approach with bilateral V3 exposure is used for aneurysm clipping. The literature related to this technique is also reviewed.

Anterior Temporal Approach for Clipping of Upper Basilar Artery Aneurysms: Surgical Techniques and Treatment Outcomes.

Background: Upper basilar artery (BA) aneurysms, which consist of basilar tip and BA-superior cerebellar artery aneurysms, are challenging to treat with microsurgical clipping. The anterior temporal approach is one surgical approach used to treat aneurysms in this region. Most previous reports on this approach have consisted of unruptured cases.

Massive Epistaxis from Nontraumatic Cavernous Carotid Aneurysm Treated by High-Flow Bypass and Cervical Internal Carotid Artery Ligation: A Case Report and Review of the Literature.

Background: Epistaxis is a rare presentation of the ruptured cavernous carotid aneurysm, especially the nontraumatic type. Both endovascular therapies and open surgeries have a role in the treatment with various outcomes, but the standard procedure is not well established. We report a successful high-flow bypass with cervical internal carotid artery ligation for aneurysm repair and review the related literature.

Surgical treatment of large and giant cavernous carotid aneurysms.

Cavernous carotid aneurysms (CCAs) are uncommon pathologic entities. Extradural place and the skull base location make this type of an aneurysm different in clinical features and treatment techniques. Direct aneurysm clipping is technically difficult and results in a significant postoperative neurological deficit.