World neurosurgery最新文献

{"title":"Use of Active Low Suction Pressure (Subgaleal) Drains in Chronic Subdural Hematoma Surgery.","authors":"Zakir H Chew, Tien M Cheong, Ji M Ling, Seyed E Saffari, Lester Lee","doi":"10.1016/j.wneu.2024.11.040","DOIUrl":"10.1016/j.wneu.2024.11.040","url":null,"abstract":"<p><strong>Background: </strong>Subdural drains are used to reduce recurrence after surgical evacuation of chronic subdural hematoma. There is a small risk of parenchymal injury. We hypothesize that using subgaleal drains with low active suction (-50 mm Hg to -100 mm Hg) may be a safer alternative and still maintain efficacy in preventing recurrence.</p><p><strong>Methods: </strong>A retrospective review of adult patients who underwent surgical drainage of chronic subdural hematoma at our institution was performed. They were classified into 2 groups: a subdural group and a subgaleal group. We collected data on patient demographics, preoperative use of antiplatelets or anticoagulants, the type of drains used, laterality of burr-hole surgery performed and postoperative complications, and recurrence. Descriptive statistics and regression analyses were used to analyze the data.</p><p><strong>Results: </strong>322 patients recruited, 172 received subgaleal drains with low active suction and 150 received passive subdural drains. There was no significant difference in the rate of recurrence; there was 11. % recurrence in the subgaleal drain group and 9.3% recurrence in the subdural drain group (P = 0.660). Patients who underwent active subgaleal drain insertion had significantly fewer complications, at 2.3% compared with 8.0% in patients who had passive subdural drains (P = 0.037).</p><p><strong>Conclusions: </strong>The use of subgaleal drains with low active suction led to significantly lower complication rates compared with the use of subdural drains and maintained its efficacy in preventing recurrence.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123457"},"PeriodicalIF":1.9,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel Checklist Approach to Reduce Time Under Anesthesia in Neurosurgery.","authors":"Asfandyar Khan, Aimen Farooq, Wissam Elfallal, Ravi Gandhi, Federico Vinas, Albert J Boquet","doi":"10.1016/j.wneu.2024.11.032","DOIUrl":"10.1016/j.wneu.2024.11.032","url":null,"abstract":"<p><strong>Background: </strong>Neurosurgical procedures require meticulous preparation, including extra measures to ensure patient safety and the appropriate setup of the operating room, which must be fully established before the surgeon can initiate the first incision. Neurosurgical delay encompasses the time from anesthesia induction start to when the neurosurgeon makes the first incision.</p><p><strong>Methods: </strong>30 neurosurgery procedures were observed randomly. Data were collected at 4 specific time intervals related to the process of 30 neurosurgery procedures in an operating room.</p><p><strong>Results: </strong>30 random observations show the bottleneck being anesthesia induction complete to the surgeon's first cut which accounts for 50% of times more than the average time (mean 33 minutes, n = 30). Minimizing the duration of anesthesia from anesthesia induction complete to surgeon first cut reduces risks, improves patient care and patient satisfaction, ensures a seamless flow of activities, and minimizes the variability in neurosurgical operating time.</p><p><strong>Conclusions: </strong>Operational neurosurgical delays can be improved using sequential checklists by constraining the variability in each phase. The article provides a conceptual novel checklist that provides a modular approach and completion of all steps in a phase reduces the variability of error to the next phase. This approach eventually reduces the patient's time under anesthesia.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123449"},"PeriodicalIF":1.9,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nonlinear Relationship Between Blood Urea Nitrogen to Albumin Ratio and 3-Month Outcomes in Patients With Acute Ischemic Stroke: A Second Analysis Based on a Prospective Cohort Study.","authors":"Pan Zhou, Xin Li, Gang-Gang Peng, Hao-Fei Hu, Zhe Deng","doi":"10.1016/j.wneu.2024.11.035","DOIUrl":"10.1016/j.wneu.2024.11.035","url":null,"abstract":"<p><strong>Objective: </strong>Patients with acute ischemic stroke (AIS) have limited evidence regarding the relationship between blood urea nitrogen and albumin. Aiming to investigate the relationship between the blood urea nitrogen to albumin ratio (BUN/ALB ratio) and poor outcomes in AIS patients at 3 months was the purpose of this study.</p><p><strong>Methods: </strong>AIS participants at a Korean hospital from January 2010 to December 2016 were included in a secondary analysis of a prospective cohort study. Logistic regression and restricted cubic splines were used to examine the relationship between BUN/ALB ratio and poor outcomes after 3 months.</p><p><strong>Results: </strong>There is a skewed distribution of BUN/ALB ratios, ranging from 0.114 to 1.250. Model II of the binary logistic regression showed that the BUN/ALB ratio was not statistically significant in predicting poor outcomes for AIS patients after 3 months. However, there was a notable nonlinear relationship between them, with the inflection point of the BUN/ALB ratio identified as 0.326. The BUN/ALB ratio on the left side of the inflection point was associated with a 42% reduction in 3-month poor outcomes (odds ratio = 0.58, 95% confidence interval: 0.40 to 0.83). Conversely, the relationship was not statistically significant on the right side of the inflection point.</p><p><strong>Conclusions: </strong>The BUN/ALB ratio and poor outcomes in AIS patients show a nonlinear correlation. For AIS patients, a BUN/ALB ratio of approximately 0.326 is associated with the lowest risk of adverse outcomes at 3 months. Specifically, for nonsmoking AIS patients, a BUN/ALB ratio of approximately 0.295 is associated with the lowest risk of adverse outcomes at 3 months.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123452"},"PeriodicalIF":1.9,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delayed screw migration following anterior cervical discectomy and fusion.","authors":"Matthew T Carr, Jeremy Steinberger, John K Houten","doi":"10.1016/j.wneu.2024.12.014","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.12.014","url":null,"abstract":"<p><strong>Objective: </strong>To identify the clinical and surgical characteristics and treatment options of patients suffering delayed (> 1 month) screw back-out after anterior cervical discectomy and fusion (ACDF).</p><p><strong>Methods: </strong>A systematic review was performed searching Embase, Medline, and Scopus for relevant case studies and case series of delayed screw back-out after ACDF.</p><p><strong>Results: </strong>25 studies encompassing 31 patients were identified and included. Average time to screw back-out was 4.6 years. 52% of patients presented with dysphagia, and 61% had a pharyngoesophageal injury. 5 patients were asymptomatic. 25 patients underwent surgery to remove hardware, 12 patients had surgical repair of the esophagus or hypopharynx, and 4 patients were managed conservatively. Antibiotic duration when given ranged from 2 weeks to 6 months. NPO duration ranged from 4 days to 3 months.</p><p><strong>Conclusions: </strong>The risk of screw back-out is low, but it can be a devastating complication. The majority of reported cases developed pharyngoesophageal injury and dysphagia. Surgery is often required to remove the hardware and repair any damage to the esophagus or hypopharynx, and may require prolonged antibiotics and NPO. Rarely, patients may be asymptomatic and treated conservatively; but in 7 patients in this series in whom back-out was initially managed conservatively there worsening back-out or injury that occurred an average of 29 months later.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142795248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ophthalmic Artery Feeders in Meningioma Reduce the Effectiveness of Transarterial Embolization With n-Butyl Cyanoacrylate.","authors":"Tomofumi Takenaka, Takeo Nishida, Masatoshi Takagaki, Yoshiko Okita, Noriyuki Kijima, Ryuichi Hirayama, Yuichi Matsui, Shuhei Yamada, Tatsumaru Fukuda, Ryota Nakagawa, Takaki Matsumura, Hajime Nakamura, Naoki Kagawa, Haruhiko Kishima","doi":"10.1016/j.wneu.2024.11.046","DOIUrl":"10.1016/j.wneu.2024.11.046","url":null,"abstract":"<p><strong>Background: </strong>N-butyl cyanoacrylate (n-BCA) is often used for preoperative transarterial embolization (TAE) of meningiomas. However, factors affecting the embolization effect with n-BCA remain unclear. This study aimed to clarify the factors associated with the embolization rate after TAE using n-BCA in meningioma, from the aspect of feeder architecture.</p><p><strong>Methods: </strong>We retrospectively analyzed 62 patients with meningioma who underwent preoperative TAE with n-BCA between 2016 and 2021. Patient variables, including characteristics, intraoperative findings, and outcomes, were collected. Feeder architecture was classified into 7 groups: 1) internal maxillary artery, 2) occipital artery, 3) ascending pharyngeal artery, 4) posterior meningeal artery, 5) infraclinoidal internal carotid artery, 6) ophthalmic artery (OphA), and 7) pial feeder group, based on preoperative angiography. We set primary outcome as the embolization rate, representing the reduction rate of the gadolinium-enhanced lesion volume observed on contrast-enhanced magnetic resonance imaging. Angiographic findings following n-BCA injection were classified as feeder occlusion or intratumoral embolization. We analyzed the factors associated with the embolization rate.</p><p><strong>Results: </strong>The OphA feeder group showed a decrease in the embolization rate (P = 0.008). The number of feeder groups with intratumoral embolization showed a robust positive correlation (r = 0.557). The OphA feeder group showed an increase in the number of feeder groups (P < 0.001) and larger tumor volume (P = 0.005).</p><p><strong>Conclusions: </strong>The OphA feeder group was associated with a lower embolization rate. Our study suggested that the vascular architecture in meningioma affected the efficacy of TAE with n-BCA.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123463"},"PeriodicalIF":1.9,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Bone Preservation at the Anterior Edge of the Vertebral Body Affect the Subsidence of Zero-Profile Cages After Anterior Cervical Discectomy and Fusion?","authors":"Bin Zhang, Qingquan Kong, Pin Feng, Junlin Liu, Junsong Ma","doi":"10.1016/j.wneu.2024.11.057","DOIUrl":"10.1016/j.wneu.2024.11.057","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to investigate whether the preservation of the anterior edge of the vertebral body affects the cage subsidence and clinical outcomes after anterior cervical discectomy and fusion (ACDF) using zero-profile cages.</p><p><strong>Methods: </strong>We retrospectively analyzed 86 patients who underwent 1-3 levels of ACDF using zero-profile cages between December 2017 and June 2023. According to whether the anterior edge was protected, the patients were divided into an intact group and a defect group. Cage subsidence was defined as a ≥2 mm decrease in vertebral height at follow-up compared with measurement on postoperative day 2. The patients' radiological parameters and clinical outcomes were also analyzed.</p><p><strong>Results: </strong>The subsidence rate was 17.02% (8/47) in the intact group and 41.03% (16/39) in the defect group (P = 0.014). At the last follow-up, all patients in both groups achieved complete intervertebral fusion. The cervical lordosis of the 2 groups was effectively restored after surgery, and the visual analog scale and Neck Disability Indexscores of the 2 groups were significantly improved. Multivariate logistic regression analysis showed that the protective factor for zero-profile cage subsidence was bone protection at the anterior edge of the vertebral body (odds ratio = 0.270; 95% confidence interval = 0.091-0.804), and the risk factor was related to the height of the preoperative surgical segment (odds ratio = 2.285; 95% confidence interval = 1.395-3.743).</p><p><strong>Conclusions: </strong>For patients who undergo ACDF with zero-profile cages, especially those with a higher surgical segment, bone protection at the anterior edge of the vertebral body can effectively reduce the risk of zero-profile cage subsidence, but there is no difference in the final clinical effect.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Volume Reduction Effect of Preoperative Embolization of Only the Feeding Arteries from the External Carotid Artery on Vestibular Schwannomas.","authors":"Hiroki Sakamoto, Takao Hashimoto, Yusuke Arai, Hirofumi Okada, Muneaki Kikuno, Michihiro Kohno","doi":"10.1016/j.wneu.2024.11.063","DOIUrl":"10.1016/j.wneu.2024.11.063","url":null,"abstract":"<p><strong>Background: </strong>Although there are many reports on the efficacy of preoperative embolization for meningioma, such as a reduction in intraoperative blood loss, its efficacy for vestibular schwannoma remains unclear. Feeding arteries of vestibular schwannomas include branches from the anterior inferior cerebellar artery and internal carotid artery, in addition to the branches from the external carotid artery (ECA). However, it has been reported that the embolization of feeding arteries from the anterior inferior cerebellar artery and the internal carotid artery has a high risk of complications. Therefore, we retrospectively analyzed the effects of preoperative embolization of only the feeding arteries from the ECA for vestibular schwannomas, particularly regarding its volume reduction effect.</p><p><strong>Methods: </strong>Of the 805 patients with vestibular schwannoma who underwent tumor removal at our department between September 2013 and March 2022, a total of 15 patients who underwent preoperative embolization of only the feeding arteries from the ECA were analyzed. Tumor volume was measured based on contrast-enhanced T1-weighted imaging, and the effects of preoperative embolization on tumor volume reduction were analyzed.</p><p><strong>Results: </strong>Tumor volumes before and after embolization were 16.4 ± 9.2 mL and 14.1 ± 9.6 mL, respectively, indicating a volume reduction effect of 15.3 ± 10.3% (P < 0.001). The mean time from embolization to contrast-enhanced T1-weighted imaging was 5.1 ± 3.0 days.</p><p><strong>Conclusions: </strong>Preoperative embolization of only the feeding arteries from the ECA may be an effective adjunctive treatment for vestibular schwannomas, given the significant volume reduction effect achieved within several days after embolization, in addition to reducing intraoperative blood loss.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123480"},"PeriodicalIF":1.9,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconstructive Endovascular Treatment of Intracranial Ruptured Posterior Circulation Aneurysms Located on Small Arteries: Complications and Long-Term Results.","authors":"Jinshuo Yang, Qiaowei Wu, Chunlei Wang, Zhiyong Ji, Pei Wu, Guang Zhang, Chao Xu, Jiaxing Dai, Chunxu Li, Yujing Zhu, Shancai Xu, Huaizhang Shi","doi":"10.1016/j.wneu.2024.11.056","DOIUrl":"10.1016/j.wneu.2024.11.056","url":null,"abstract":"<p><strong>Objective: </strong>Assess the complications, clinical outcomes, and angiographic results of endovascular treatment (EVT) for ruptured intracranial posterior circulation aneurysms in small arteries, and identify their risk factors.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 79 patients with ruptured posterior circulation aneurysms in small arteries (the diameter of the parent artery was ≤2 mm) treated at our hospital between January 2014 and August 2023. All patients received EVT. The study examined risk factors associated with in-hospital complications and clinical outcomes.</p><p><strong>Results: </strong>The incidence of in-hospital complications among all patients receiving reconstructive EVT was 30.4% (24/79). The median clinical follow-up time of the patients was 45 months (interquartile range: 28-65 months). Favorable clinical outcomes were observed in 83.5% (66/79) of patients, while the overall mortality rate was 11.4% (9/79). Of the 75 survivors, 59 (78.7%) underwent angiographic follow-up, revealing a median follow-up time of 11 months (interquartile range: 6-12 months) and a complete occlusion rate of 84.7% (50/59). Residual aneurysms occurred in 6.8% (4/59) of patients. Survival analysis indicated 1- and 3-year complication-free survival rates of 70.9% and 65.5%, respectively, and overall 1- and 3-year survival rates of 89.6% and 87.6%. Multivariate analysis identified external ventricular drainage (P = 0.007) as an independent risk factor for in-hospital complications. Older age (P = 0.024) and a World Federation of Neurosurgical Societies grade of 4-5 (P < 0.001) were independent risk factors for unfavorable clinical outcomes.</p><p><strong>Conclusions: </strong>Reconstructive EVT for ruptured intracranial posterior circulation small artery aneurysms was generally safe and effective. However, the risk of complications and unfavorable clinical outcomes persisted. External ventricular drainage was a significant risk factor for in-hospital complications, whereas older age and higher World Federation of Neurosurgical Societies grades were predictors of unfavorable clinical outcomes.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123473"},"PeriodicalIF":1.9,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Endonasal Approach for Calcified Sellar/Parasellar Region Pathologies: Report of 11 Pituitary Adenoma Cases.","authors":"Aykut Gokbel, Ayse Uzuner, Atakan Emengen, Eren Yilmaz, Seda Duman Ozturk, Yonca Anik, Ihsan Anik, Savas Ceylan","doi":"10.1016/j.wneu.2024.11.066","DOIUrl":"10.1016/j.wneu.2024.11.066","url":null,"abstract":"<p><strong>Objective: </strong>Calcification in pituitary adenomas is a rare occurrence and its differential diagnosis typically includes other sellar masses. Common calcifications in pituitary adenomas are classified into 2 morphological forms: capsular (eggshell-like) and multiple small nodular calcifications located within the adenoma. Also, there is a pituitary stone term. This study aims to present the results of calcified pituitary adenoma case series who underwent endoscopic endonasal approach (EEA) and the clinical, histopathological characteristics and surgical outcomes of these cases.</p><p><strong>Methods: </strong>This study conducted a retrospective cohort analysis of patients with calcified pituitary adenoma operated on by EEA between August 1997 and February 2024. The inclusion criteria were as follows: proven radiological calcification on preoperative neuroimaging, intraoperative findings of calcification, and definitive histopathological diagnosis of calcification. Among these patients, 11 cases were included.</p><p><strong>Results: </strong>The mean follow-up duration was 51.45 ± 37.24 (6-118) months. Based on the preoperative paranasal sinus computed tomography scans of patients, 9 patients (81.8%) had intratumoral calcification, 1 (9.1%) had capsular (eggshell-like) calcification, and 1 (9.1%) had both intratumoral and capsular calcification. Moreover, stone-like calcifications were observed in 4 patients (36.4%), soft-type calcifications in 3 (27.3%), hard-type calcifications in 3 (27.3%), and soft-type and hard-type calcifications in 1 (9%). Gross total resection was achieved in 9 patients (81.8%). Pathologic subtypes included nonfunctioning (n = 4), prolactin secreting (n = 3), growth hormone-secreting adenoma (n = 2), and pituitary apoplexy (n = 2). Ten patients had psammomatous-type calcifications and 1 had extensive ossification and osteoid metaplasia.</p><p><strong>Conclusions: </strong>Preoperative radiological evaluation, intraoperative classification of calcification, and postoperative histopathological assessments are crucial in the treatment of calcified adenomas. Bases on these findings, the EEA, with its advantages, is an approach that can be effectively used in the management of these calcified adenomas.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multiple Paraclinoid Aneurysms and Basilar Tip Clipped by the Same Orbito-Zygomatic Approach: 2-Dimensional Operative Video.","authors":"Rabindranath Garcia-Lopez, Josue A Cervantes-Gonzalez, Eli Hernandez-Chavez, Maria J Arevalo-Torres, Victor Ramzes Chavez-Herrera","doi":"10.1016/j.wneu.2024.11.020","DOIUrl":"10.1016/j.wneu.2024.11.020","url":null,"abstract":"<p><p>The management of multiple intracranial aneurysms poses a significant clinical challenge.¹ Various factors, including the patient's neurologic status, age, risk factors, aneurysm morphology, location, ruptured or unruptured status, availability of equipment, the surgeon's surgical abilities, and patient preferences, influence the choice of treatment modality.² It has been observed that there is a higher risk of rupture during the perioperative period when surgical intervention is performed to treat a ruptured aneurysm.³ Additionally, it is suggested that patients with multiple aneurysms located in both the anterior and posterior circulation are less likely to be treated with a single procedure.⁴ This surgical strategy should be applied in the setting of multiple aneurysms in the anterior and posterior circulation that would, on the other hand, demand multiple interventions.⁵ In an experienced scenario, microsurgery could be a viable option. We present the case of a 58-year-old patient who presented with chronic headaches, a medical history of hypertension, and tobacco use. The patient had no neurologic deficits. During imaging, 5 incidental aneurysms were found. Bilateral ophthalmic aneurysms, one ipsilateral ventral paraclinoid aneurysm, at the bifurcation of the internal carotid artery, and another at the top of the basilar. The aneurysms were clipped with an orbito-zygomatic approach, and the patient had no postoperative neurologic deficit (Video 1). The patient consented to the procedure and publication of her image. No institutional research ethics board approval was required because only intraoperative footage was shown. No identifiable data are displayed except for 2 photographs of the patient's head without the face, which was appropriately consented to.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"224"},"PeriodicalIF":1.9,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}