Surgical neurology international最新文献

{"title":"Anterior rotation of the temporalis muscle for prevention of temporal hollowing in cranial surgeries: Esthetic and patient-reported outcomes.","authors":"Ignacio J Barrenechea, Micaela Clerici, César Cordero Ramírez, Luis Márquez, Sabrina C Miralles, Ernesto Adrian Moretti","doi":"10.25259/SNI_895_2024","DOIUrl":"https://doi.org/10.25259/SNI_895_2024","url":null,"abstract":"<p><strong>Background: </strong>Temporal hollowing is a common cosmetic complication following pterional craniotomies. To address this issue, we evaluated the efficacy of anterior rotation of the temporalis muscle at closure. Although this technique is not new and has been generally reported, no research studies have been conducted to evaluate its objective and patient-reported outcomes in the long term.</p><p><strong>Methods: </strong>We retrospectively reviewed 22 patients treated with pterional, fronto-orbitozygomatic, or frontotemporo-zygomatic craniotomies from March 2021 to 2023. A 12-month postoperative magnetic resonance imaging was used to evaluate the degree of temporal hollowing. To quantify temporal hollowing, we measured the distance of depression at the level of the temporal fossa. This distance, or \"temporal thickness,\" was defined as the widest distance between the skull's outer cortical bone and skin surfaces at the level of the anterior clinoid process (D1) and foramen of Monro (D2). Furthermore, pre and postoperative cosmetic results were evaluated using the Rostock Functional and Cosmetic Cranioplasty (RFCC) Score. For reasons of objectivity, RFCC was tested by two independent plastic surgeons against the patient's rating.</p><p><strong>Results: </strong>After a year or more follow-up, 54.5% of patients exhibited no hollowing, while 31.8% had mild or moderate hollowing. Moreover, 91% reported good esthetic outcomes. No cases of severe hollowing were observed. Importantly, temporomandibular joint dysfunction was not observed.</p><p><strong>Conclusion: </strong>These results suggest that anterior rotation of the temporalis muscle is an effective primary strategy to mitigate cosmetic deformities without compromising masticatory function. Further studies with larger sample sizes are warranted to confirm these findings.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"90"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11980749/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do drains alter the frequency of postoperative spinal epidural hematomas (SpEH) and surgical site infections (SSI) in predominantly lumbar spine surgery? Short review/perspective.","authors":"Nancy E Epstein, Marc A Agulnick","doi":"10.25259/SNI_135_2025","DOIUrl":"https://doi.org/10.25259/SNI_135_2025","url":null,"abstract":"<p><strong>Background: </strong>In this short review/perspective, we asked what the frequencies would be for both postoperative spinal epidural hematomas (SpEH) and postoperative surgical site infections (SSI) in predominantly posterior lumbar procedures performed with or without the placement of wound drains?</p><p><strong>Methods: </strong>Many spine surgeons are trained to use wound drains to decrease the risk of postoperative SpEH, despite the potential increased risk of SSI. Alternatively, avoiding drains may increase the risk of SpEH but likely decrease the potential for SSI.</p><p><strong>Results: </strong>Performing predominantly posterior lumbar procedures with or without wound drains resulted in largely comparable frequencies of postoperative spinal epidural hematomas (SpEH; range of 0.10%-0.69%) and postoperative surgical site infections (SSI: range of 0.75%-7.3%). Notably, however, two studies documented that drains increased transfusion requirements, with one study showing a prolongation of the in-hospital length of stay. Critically, these series emphasized the importance of early/emergent diagnosis (i.e., with MR) and surgical treatment of SpEH to minimize residual neurological deficits.</p><p><strong>Conclusion: </strong>Here, we showed that patients undergoing predominantly lumbar spine surgery performed with or without wound drains demonstrated comparable frequencies of postoperative SpEH and SSI. Nevertheless, spine surgeons must assess on a case-by-case basis whether, based on their education, training, and experience, placing a wound drain is appropriate for their particular patient.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"85"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11980744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Idiopathic cerebellar hemorrhage in a patient with isolated developmental venous anomaly: A case report.","authors":"Ozan Baskurt, Tufan Hiçdönmez, Kazım Ozenç Mınarecı, Nurperi Gazioglu","doi":"10.25259/SNI_1056_2024","DOIUrl":"https://doi.org/10.25259/SNI_1056_2024","url":null,"abstract":"<p><strong>Background: </strong>Developmental venous anomalies (DVAs) are benign anatomical variations in venous angioarchitecture. They are considered low-flow malformations and are often incidental and clinically insignificant. Hemorrhagic complications from isolated DVAs are extremely rare, typically occurring due to coexisting cavernous malformation.</p><p><strong>Case description: </strong>A 33-year-old female presented with severe headaches and vertigo, progressing from balance issues and dizziness. Misdiagnosed initially as Meniere's disease, her symptoms included left oculomotor nerve palsy, left-sided hemidysmetria, dysdiadochokinesis, and positive Romberg's sign. Cranial computed tomography revealed an acute hemorrhage in the cerebellar vermis. Contrast-enhanced magnetic resonance imaging and angiography identified an isolated DVA. The absence of substantial mass effect or obstructive hydrocephalus prompted conservative management with steroids and analgesics, leading to full recovery.</p><p><strong>Conclusion: </strong>This case underscores the importance of considering isolated DVA in cerebellar hemorrhage etiology in young adults and conservative treatment is recommended to prevent secondary complications, given the DVA's role in normal venous drainage.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"82"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11980714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Morphometric analysis of the lateral mass of atlas and its clinical significance in craniovertebral junction surgeries.","authors":"Noor Us Saba, Mohd Faheem, Heena Singh, Pratibha Shakya, Navneet Kumar","doi":"10.25259/SNI_78_2025","DOIUrl":"https://doi.org/10.25259/SNI_78_2025","url":null,"abstract":"<p><strong>Background: </strong>The surgery at the craniovertebral junction (CVJ) area needs meticulous knowledge of the atlas vertebra which forms the CVJ. The screws need to be placed in the lateral mass of the atlas to stabilize the C1 and C2 joints in case of CVJ anomalies. Our study aimed to determine the dimensions of the lateral mass in dry bones for the accurate placement of screws.</p><p><strong>Methods: </strong>We have analyzed 82 dried atlas vertebrae and measurements of inferior articular facet (IAF) in terms of length, breadth, height, and angles were done.</p><p><strong>Results: </strong>The length of IAF was 17.93 ± 0.76 mm and 18.01 ± 0.75 mm on the right and left side, respectively (<i>P</i> = 0.0038). The mean width was 14.88 ± 0.85 mm on the right and 14.86 ± 0.79 mm on the left side. The mean distance measured between the posterior arch of the atlas to the anterior margin of IAF was 22.87 ± 0.60 mm on the right side and 22.79 ± 0.61 mm on the left side (<i>P</i> = 0.0247). The horizontal thickness of lateral mass on the right and left sides were 15.91 ± 1.73 mm and 15.83 ± 1.56 mm, respectively, with a <i>P</i>-value of 0.3771. The angle measured for the screw trajectory in lateral mass of the atlas was 16.61 ± 1.49 on the right side of vertebrae and 16.53 ± 1.43 on the left side.</p><p><strong>Conclusion: </strong>The study provided comprehensive data on the approximate screw length needed for the lateral mass of atlas in an adult patient. The detailed morphometric measurements provided in this study offer valuable insights that can help surgeons optimize surgical planning, potentially reducing complications and enhancing patient outcomes in craniovertebral junction procedures.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"83"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11980731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary congenital intracranial lipoma with extracranial extension in a pediatric patient: A case report and literature review.","authors":"Vikas Chandra Jha, Rahul Jain, Achintya Ajaya, Sangam Jha, Gaurav Verma, Nikhil Dhage, Anant Parashar, Vivek Sharan Sinha, Nitish Kumar","doi":"10.25259/SNI_965_2024","DOIUrl":"https://doi.org/10.25259/SNI_965_2024","url":null,"abstract":"<p><strong>Background: </strong>Congenital intracranial lipomas are rare, representing only 0.1-0.5% of brain tumors, and are typically asymptomatic. An extracranial component is exceedingly rare, usually reported in slow-growing adult cases. This report presents a unique case of a rapidly growing congenital intracranial lipoma with extracranial extension in a pediatric patient.</p><p><strong>Case description: </strong>A 3-year-old girl with a progressively enlarging forehead mass, present since birth, was found to have a large interhemispheric lipoma (12 × 10 × 9 cm) extending into the left lateral ventricle and connected to an extracranial mass (17 × 10 × 10 cm) through a frontal bone defect. Additional findings included corpus callosal agenesis and venous drainage from the scalp lesion into the superior sagittal sinus. The microsurgical intervention involved the excision of the extracranial lipoma and subtotal resection of the intracranial component, preserving critical neurovascular structures.</p><p><strong>Conclusion: </strong>This case of rapid lipoma growth in a pediatric patient is atypical, differing from slow-growing, asymptomatic presentations in adults. High-magnification microsurgery and Doppler guidance facilitated safe resection with a positive outcome. This case highlights the need for further research into developmental factors and rapid growth mechanisms in pediatric intracranial lipomas with extracranial components, potentially representing a distinct clinical entity.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"80"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11980754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subdural hematoma complicated by seizures and prolonged neurological decline: An ethical management dilemma.","authors":"Frank M Nussbaum, Eric S Nussbaum","doi":"10.25259/SNI_1100_2024","DOIUrl":"https://doi.org/10.25259/SNI_1100_2024","url":null,"abstract":"<p><strong>Background: </strong>Neurosurgeons often face life-and-death decisions that may present serious ethical questions. Some of the most challenging situations arise when members of the care team disagree regarding the most appropriate management plan.</p><p><strong>Case description: </strong>We present the case of an older woman with a subdural hematoma and postoperative seizures resulting in prolonged neurological decline. This case highlights an ethical dilemma as part of a series of cases that will be described in coming issues of SNI.</p><p><strong>Conclusion: </strong>Readers are invited to submit comments and observations, which may be published as part of an ongoing conversation regarding such ethical concerns.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"84"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11980724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Angiographic morphologies of wide-necked cerebral aneurysms for predicting immediate incomplete occlusion after coil embolization.","authors":"Jarudetch Wichaitum, Rujimas Khumtong, Kittipong Riabroi, Tippawan Liabsuetrakul","doi":"10.25259/SNI_1079_2024","DOIUrl":"https://doi.org/10.25259/SNI_1079_2024","url":null,"abstract":"<p><strong>Background: </strong>Wide-necked cerebral aneurysms present unique challenges in endovascular treatment, with immediate incomplete occlusion posing significant risks for recurrence and mortality. However, the predictive factors of immediate incomplete occlusion after coil embolization of wide-necked aneurysms have not been identified. Thus, this study aimed to identify specific angiographic morphologies predictive of immediate incomplete occlusion after coil or stent-assisted embolization for wide-necked aneurysms.</p><p><strong>Methods: </strong>This retrospective case-control study evaluated all patients diagnosed with cerebral wide-necked aneurysms who underwent endovascular treatment between January 2009 and December 2019. The case was defined as wide-necked aneurysms with immediate incomplete occlusion, while control was defined as those with immediate complete occlusion. The cases and controls were compared in a 1:3 ratio. Angiographic morphologies as the predictors of immediate incomplete occlusion were analyzed using multivariable logistic regression with adjusted odds ratio (aOR) and 95% confidence interval (CI).</p><p><strong>Results: </strong>There were 73 and 226 cases and controls, respectively. Aneurysm height ≥5.6 mm (aOR, 8.14; 95% CI, 4.21-15.75; <i>P</i> < 0.001), absent shoulder (aOR, 4.22; 95% CI, 1.74-10.25; <i>P</i> = 0.001), one-sided shoulder (aOR, 2.54; 95% CI, 1.26-5.15; <i>P</i> = 0.009), and presence of vessel incorporation (aOR, 2.2; 95% CI, 1.02-4.73; <i>P</i> = 0.044) were independent risk factors of immediate incomplete occlusion.</p><p><strong>Conclusion: </strong>Aneurysm height ≥5.6 mm, absent two-sided shoulder, and presence of vessel incorporation significantly predict immediate incomplete occlusion after coil embolization for wide-necked aneurysms.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"81"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11980760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paroxysmal sympathetic hyperactivity and cerebral salt wasting post management of arteriovenous malformation in a pediatric patient: A case report.","authors":"Ahmed Hafez Mousa, Imad A M Abuanza, Sameera Hajijama, Yusor Al-Nuaimy, Arwa Jader, Jumana Hussain Timraz, Bushra Wadi Bin Saddiq, Mohammed Jilan Al Nahari, Ghaya Zeyad Alrais, Motaz M B Abudaqqa, Zeyad Faoor Alrais, Ameer Alyeldien","doi":"10.25259/SNI_802_2024","DOIUrl":"https://doi.org/10.25259/SNI_802_2024","url":null,"abstract":"<p><strong>Background: </strong>Spontaneous intracranial hemorrhage (ICH) is a rare presentation in healthy pediatric patients due to a myriad of conditions. Among them, arteriovenous malformations (AVMs) stand out for their potential to rupture and risk of death due to hemorrhagic strokes. A complication to consider in patients post ICH due to AVMs is the development of paroxysmal sympathetic hyperactivity (PSH) and cerebral salt wasting (CSW), as these complications further delay recovery and may lead to devastating results if left untreated.</p><p><strong>Case description: </strong>We report a rare case of a 13-year-old female who developed a nontraumatic intracerebral hemorrhage due to a rupture of left AVM. She was managed with a decompressive craniotomy and further stabilized with two sessions of embolization. Following surgical intervention, she developed PSH and CSW, recovering through medical management.</p><p><strong>Conclusion: </strong>By highlighting this unique presentation in a previously healthy patient, we aim to deepen our understanding of the complexities surrounding fewer known causes of pediatric ICH, particularly in relation to nontraumatic AVMs, and to emphasize the importance of early diagnosis and intervention. Close monitoring and prompt assessment are required to prevent further complications in patients with PSH or CSW.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"79"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11980737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparative meta-analysis between mini-transverse and longitudinal techniques in the management of carpal tunnel syndrome.","authors":"Abdulsalam M Aleid, Hassan A Al-Ghanim, Saud N Aldanyowi, Loai Saleh Albinsaad, Mohammed Yousef Alessa, Abdulmonem Ali Alhussain","doi":"10.25259/SNI_520_2024","DOIUrl":"https://doi.org/10.25259/SNI_520_2024","url":null,"abstract":"<p><strong>Background: </strong>Due to the gap and the controversy regarding whether to use the traditional open technique or the minimally invasive technique in carpal tunnel syndrome, we carried out this systematic review and meta-analysis to compare the two techniques regarding their outcomes.</p><p><strong>Methods: </strong>A systemic computer-based search was carried out to find relevant articles. We searched the following databases: PubMed, Scopus, and Web of Science. The search was carried out from inception until April 2024 using the following search terms: \"Transverse\" OR \"Mini-transverse\" AND \"Carpal tunnel syndrome\" AND \"Longitudinal.\" No filters were applied and reference lists of included papers were searched to try and include further relevant papers that were not identified during the search.</p><p><strong>Results: </strong>The mini-transverse technique was associated with a lower functional status scale (FSS) and symptoms severity scale (SSS) compared to the longitudinal technique with mean difference [MD] of -0.32 (95% confidence interval [CI]: -0.52, -0.12, <i>P</i> = 0.002), and -0.43 (95% CI: -0.6, -0.25, <i>P</i> < 0.00001), respectively. Furthermore, the mini-transverse technique was associated with a lower pain score with MD of -0.5 (95% CI: -0.71, -0.3, <i>P</i> < 0.00001). Moreover, the time needed to return to work was statistically significantly lower in the mini-transverse group compared to the longitudinal group with an MD of -9.34 (95% CI: -13.55, -3.13, <i>P</i> = 0.002). No significant difference was observed between either group regarding the duration of operation (MD: -6.96, [95% CI: -16.66, 2.74, <i>P</i> = 0.16]) and the incidence of complications (odds ratio: 0.46, [95% CI: 0.15, 1.4, <i>P</i> = 0.17]).</p><p><strong>Conclusion: </strong>The efficacy and safety outcome measures of the mini-transverse and longitudinal surgical approaches utilized on carpal tunnel syndrome patients were compared in the current study. Mini-transverse procedures yielded superior results in this study than longitudinal techniques, as they were statistically significant in relation to decreased FSS, SSS, pain score, and time required to return to work. However, in terms of the length of the procedure and the frequency of complications, both methods were similar.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"78"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11980740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Y-stent-assisted coiling for large wide-neck dysplastic middle cerebral artery bifurcation aneurysm: An update to procedural technique.","authors":"Anqi Luo, Justin Mascitelli, Lee Birnbaum, Nohra Chalouhi, Fadi Al Saiegh","doi":"10.25259/SNI_877_2024","DOIUrl":"10.25259/SNI_877_2024","url":null,"abstract":"<p><strong>Background: </strong>The endovascular treatment of complex middle cerebral artery (MCA) aneurysms, particularly dysplastic large MCA bifurcation aneurysms, can pose significant technical challenges. We aim to present three cases illustrating the technical nuances and challenges often encountered in Y-stent-assisted coiling (Y-SAC) for such aneurysms and provide an update on technical nuances.</p><p><strong>Methods: </strong>We present three consecutive cases of dysplastic MCA aneurysms, each >10 mm with a wide neck. We successfully performed Y-SAC in all cases on the first attempt using the \"around the world\" technique and used Neuroform Atlas Stent (Stryker Neurovascular, California, USA) as a distal anchor to reduce the microcatheter loop. Immediate final digital subtraction angiography showed adequate occlusion of all aneurysms.</p><p><strong>Results: </strong>All patients tolerated the procedure well and were discharged home on postoperative day (POD) 1 in all cases. The first patient required a second coiling at the aneurysm neck 6 months after initial treatment, with complete protection of the dome. The second patient's 6-month follow-up angiogram showed complete occlusion of the aneurysm with patency of all MCA branches. Unfortunately, the third patient failed to comply with dual antiplatelet therapy after discharge and developed stent thrombosis 3 months postprocedure and passed away.</p><p><strong>Conclusion: </strong>Y-SAC is a reasonable option for large, wide-neck, MCA bifurcation aneurysms in patients who are not fit for microsurgical clipping and/or bypass surgery. Complex endovascular techniques, including aneurysm encircling and the \"Atlas Stent Anchor\" technique, may be necessary to complete the procedure successfully.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"71"},"PeriodicalIF":0.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}