Axial Sections of Brainstem Safe Entry Zones and Clinical Importance of Intrinsic Structures: A Review.

Brainstem surgery is more difficult and riskier than surgeries in other parts of the brain due to the high density of critical tracts and cranial nerves nuclei in this region. For this reason, some safe entry zones into the brainstem have been described. The main purpose of this article is to bring on the agenda the significance of the intrinsic structures of the safe entry zones to the brainstem.

The Nightmare of Aneurysm Surgery: Intraoperative Rupture.

Intraoperative rupture is the most important complication of aneurysm surgery and occurs in 3 different stages: premature (before dissection), dissection, and clipping. 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.

Microsurgical Treatment of Previously Coiled Giant Aneurysms: Experience with 6 Cases and Literature Review.

Objective: Surgical treatment of insufficiently embolized (coiled) or recurrent giant aneurysms has not been well established in the literature. The aim of this study is to bring up the surgical difficulties of these rare aneurysms and to offer solutions.

Methods: A database was queried for giant aneurysms that had been previously embolized and subsequently required surgical treatment.

Kissing Aneurysms: Radiological and Surgical Difficulties in 30 Operated Cases and a Proposed Classification.

Objective: The first aim of this study is to bring up the radiological and surgical difficulties of kissing aneurysms and to present solutions. The second aim is to develop a classification that can help to predict the difficulties encountered during surgery.

Methods: The records of 817 patients who were operated on for aneurysm were reviewed retrospectively to identify kissing aneurysms.

Intraoperative Aneurysm Rupture: Surgical Experience and the Rate of Intraoperative Rupture in a Series of 1000 Aneurysms Operated on by a Single Neurosurgeon.

Objective: This study aims to examine the risk factors that can cause intraoperative rupture (IOR), and especially, the role of surgical experience. To our knowledge, this is the first study to analyze the effect of the surgeon's experience on the IOR rate in 2 different perspectives.

Methods: A total of 1000 aneurysms in 775 patients were operated on by a single neurosurgeon.

The Longest Angiographic and Clinical Follow-Up of Microsurgically Treated Giant Intracranial Aneurysms: Experience with 70 Cases.

Background: Giant intracranial aneurysms (GIAs), if left untreated, have an extremely poor natural history. Despite many reports about the surgical treatment of GIAs, their long-term clinical and angiographic results are unclear. To our knowledge, this study reports the longest clinical and angiographic follow-up of microsurgically treated GIAs in the English literature.

Aneurysm Clip Compression Technique in the Surgery of Aneurysms with Hard/Calcified Neck.

Objective: One of the most important technical problems in surgery to repair aneurysms is the presence of a hard/calcified neck. In this situation, various techniques can be used for proper clipping. In addition to well-known techniques, we have used a different technique for more than 10 years.

Bilateral middle cerebral artery aneurysms: a comparative study of unilateral and bilateral approaches.

The best surgical method for the treatment of patients with bilateral middle cerebral artery (bMCA) aneurysms has not been fully determined yet. The main purpose of this study is to compare the surgical results of unilateral and bilateral approaches to bMCA aneurysms including mean operation time, mean hospital stay, and mean cost, in the experience of the same neurosurgical team. Between January 2001 and June 2010, 22 patients with bMCA aneurysms were surgically treated in our institution.

Ruptured aneurysm at the perforating artery supplying the insula: case report.

Objective: Aneurysms originating from perforating branches of the middle cerebral artery are quite rare. Most of them arise from the lenticulostriate arteries, frequently located within the basal ganglia. We report a perforating artery aneurysm that was entirely embedded within the limen insulae.

Effect of raloxifene on cerebral vasospasm following experimental subarachnoid hemorrhage in rats.

The effect of raloxifene on cerebral vasospasm following experimental subarachnoid hemorrhage (SAH) was investigated in a rat model. Seven groups of seven rats underwent no SAH, no treatment; SAH only; SAH plus vehicle; SAH plus 3 days intraperitoneal raloxifene treatment; SAH plus 4 days intraperitoneal raloxifene treatment; SAH plus 3 days intrathecal raloxifene treatment; and SAH plus 4 days intrathecal raloxifene treatment. The basilar artery cross-sectional areas were measured at 72 or 96 hours following SAH.

Thalamomesencephalic ossified cavernoma presenting with Holmes' tremor.

Background: Midbrain cavernoma associated with Holmes' tremor is a rare entity. Although there have been 4 other cases of Holmes' tremor caused by a cavernoma, this is the first case that was cured by surgical removal of the cavernoma. In addition, heavy ossification and Holmes tremor as a clinical presentation are 2 unusual features of the cavernoma.

Distal anterior choroidal artery aneurysms.

Background: Distal AChoA aneurysms are quite rare. Only 12 operated cases have been reported in the English medical literature. Treatment of these aneurysms is also difficult because of their deep location, small size, and angioarchitecture.

Treatment of a superior sagittal sinus dural arteriovenous fistula with Onyx: technical case report.

Objective: The endovascular treatment of a complex superior sagittal sinus dural arteriovenous fistula with ethylene vinyl alcohol copolymer (Onyx) in one session is described.

Clinical Presentation: A 54-year-old man presented with dizziness and a bruit. A cerebral angiogram demonstrated a superior sagittal sinus dural arteriovenous fistula with a patent superior sagittal sinus that was supplied via multiple branches of the external carotid arteries bilaterally and the left anterior and middle cerebral arteries.

Unrecognized intracerebral glass particle mimicking cavernoma: case report.

Objective And Importance: Although the presence of a foreign body in the cranium after a head injury is a well-known entity, cases of retained intracranial foreign bodies causing a delayed onset of neurological symptoms are rare. To our knowledge, an unrecognized intracerebral glass particle mimicking a cavernoma has not been previously reported in the literature.

Clinical Presentation: We report a unique case regarding an intracranial foreign body.

Comparative dural closure techniques: a safety study in rats.

Background: Some neurosurgical procedures have high morbidity and mortality rates due to cerebrospinal fluid (CSF) fistula development, particularly when dural defects are in relatively inaccessible areas or surrounded by friable dura. We used a rat model to test 4 different dural closure techniques to determine which one was significantly superior for achieving a watertight dural closure with minimal harm to brain tissue.

Methods: The rats were randomly divided into 2 groups.

Multiple aneurysms of the anterior communicating artery: radiological and surgical difficulties.

Object: Multiple aneurysms of the anterior communicating artery (ACoA) occur rarely and have not been well investigated previously. The authors report on a consecutive series of six patients who each harbored multiple ACoA aneurysms. The radiological and surgical difficulties encountered in treating these complex and uncommon aneurysms are described and the pertinent literature is reviewed.

Rare cause of subarachnoid hemorrhage: spinal meningeal carcinomatosis. Case report.

Subarachnoid hemorrhage (SAH) of spinal origin is a rare entity accounting for approximately 1% of all cases of SAH. Its most frequent causes are trauma and vascular malformations. Although primary spinal tumors, especially ependymomas, are also relatively common causes, SAH secondary to a metastatic spinal tumor arising from outside the central nervous system is an extremely rare condition; only one case has been reported in the literature.