Microsurgery for Upper Basilar Tip Aneurysm With Intraoperative Rupture: 3-Dimensional Operative Video

2018 ◽  
Vol 16 (2) ◽  
pp. E43-E43 ◽  
Author(s):  
Oliver Soto Granados ◽  
Marcos Devanir Silva da Costa ◽  
Bruno Lourenço Costa ◽  
Kléber González-Echeverría ◽  
Samantha Lorena Paganelli ◽  
...  
Keyword(s):  
Young Patients ◽  
3 Dimensional ◽  
Microsurgical Treatment ◽  
Fluid Analysis ◽  
Interpeduncular Cistern ◽  
Orbitozygomatic Approach ◽  
Aneurysm Occlusion ◽  
Aneurysm Dissection ◽  
Intraoperative Rupture ◽  
Spontaneous Subarachnoid Hemorrhage

Abstract In the last years, a shift from the microsurgical treatment to an endovascular therapy in patients with basilar apex aneurysm has been settled, part of this phenomenon is related to the significant tendency of vital perforators to be involved in the aneurysm dissection and clipping, which can implicate unfavorable outcomes. Nevertheless, microsurgical treatment remains the treatment that can provide the superior rates of stable and durable aneurysm occlusion, which is most important to young patients. In this video, we present the case of a 45-yr-old female patient who complained of a sudden and severe headache and presented with progressive lethargy during the following 3 d. At admission, computed tomography did not show abnormal findings. However, cerebrospinal fluid analysis showed erythrocytes and corroborated the clinical suspicion of spontaneous subarachnoid hemorrhage. The patient signed the Institutional Consent Form, which allows the use of his/her images and videos for any type of medical publications in conferences and/or scientific articles. Angiography and magnetic resonance imaging revealed a saccular basilar apex aneurysm. It showed a wide neck as well as a lobulated dome with upward and slightly left projection. The aneurysm did not involve angiographically visible thalamoperforator arteries, which allowed the microsurgical treatment by the fronto-orbitozygomatic approach. However, during the interpeduncular cistern dissection, an intraoperative rupture of the aneurysm occurred. This video exemplifies the steps required to manage an intraoperative rupture of a basilar apex aneurysm.

Combined Transpetrosal Approach With Preservation of Superior Petrosal Vein Drainage for a Cerebellopontine Angle Epidermoid Cyst Extending Into Meckel's Cave: 3-Dimensional Operative Video

2018 ◽  
Vol 16 (6) ◽  
pp. E172-E173
Author(s):  
Ken Matsushima ◽  
Michihiro Kohno ◽  
Nobuyuki Nakajima ◽  
Norio Ichimasu
Keyword(s):  
Epidermoid Cyst ◽  
Cerebellopontine Angle ◽  
Young Patients ◽  
Neurological Deficits ◽  
Meckel’S Cave ◽  
3 Dimensional ◽  
Petrosal Vein ◽  
Meckel's Cave ◽  
Superior Petrosal Sinus ◽  
Superior Petrosal Vein

Abstract The combined transpetrosal approach enables wide exposure around the petroclival region by cutting the tentorium and superior petrosal sinus. We often choose this approach for removal of tumors ventral to the facial and vestibulocochlear nerves, such as petroclival meningioma and epidermoid cyst, because complete removal of the tumor under direct visualization is required to prevent its later recurrence, especially in young patients. Recent reports revealed anatomical variations of the drainage of the superior petrosal sinus, and dural incision considering preservation of the superior petrosal vein was proposed.1-3 This 3-dimensional video shows a patient with an epidermoid cyst, which was surgically treated using the combined transpetrosal approach, with consideration of the variation of the superior petrosal sinus and preservation of the drainage route of the superior petrosal vein. The video was reproduced after informed consent of the patient. The patient is a 31-yr-old woman who presented with a left cerebellopontine angle epidermoid cyst extending into Meckel's cave. The superior petrosal sinus was of the lateral type, draining only laterally into the transverse–sigmoid junction without medial connection with the cavernous sinus.1 The combined transpetrosal approach was performed with cutting of the superior petrosal sinus medial to the entry point of the superior petrosal vein, in order to preserve its drainage into the transverse–sigmoid junction. Meckel’ cave was opened along its lateral margin, and tumor removal was accomplished, leaving only a minute part of the capsule strongly adhering to the neurovascular structures. The patient had no new permanent neurological deficits during follow-up. The figures in the video were modified from Matsushima et al1 by permission of the Congress of Neurological Surgeons.

Surgery for angiographically occult cerebral aneurysms

1993 ◽  
Vol 79 (5) ◽  
pp. 674-679 ◽  
Author(s):  
Jafar J. Jafar ◽  
Howard L. Weiner
Keyword(s):  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Sylvian Fissure ◽  
Ct Scans ◽  
Anterior Communicating Artery ◽  
Content Type ◽  
Excellent Outcome ◽  
Interpeduncular Cistern ◽  
Spontaneous Subarachnoid Hemorrhage ◽  
Exploratory Surgery

✓ In 15% of patients with spontaneous subarachnoid hemorrhage (SAH), the source of bleeding cannot be determined despite repeated cerebral angiography. However, some patients diagnosed as having “SAH of unknown cause” actually harbor undetected aneurysms. The authors report six patients with SAH who, despite multiple negative cerebral angiograms, underwent exploratory surgery due to a high clinical and radiographic suspicion for the presence of an aneurysm. Brain computerized tomography (CT) scans revealed blood located mainly in the basal frontal interhemispheric fissure in four patients, in the sylvian fissure in one patient, and in the interpeduncular cistern in one patient. The patients were evaluated as Hunt and Hess Grades I to III, and had undergone at least two high-quality cerebral angiograms that did not reveal an aneurysm. Vasospasm was visualized in two patients. Three patients rebled while in the hospital. Exploratory surgery was performed at an average of 12 days post-SAH. Five aneurysms were discovered at surgery and were successfully clipped. All four patients with interhemispheric blood were found to have an anterior communicating artery (ACoA) aneurysm. The patient with blood in the sylvian fissure was found to have a middle cerebral artery aneurysm. These aneurysms were partially thrombosed. No aneurysm was detected in the patient with interpeduncular SAH, despite extensive basilar artery exploration. Five patients had an excellent outcome and one patient developed diabetes insipidus. These results show that exploratory aneurysm surgery is warranted, despite repeated negative cerebral angiograms, if the patient manifests the classical signs of SAH with CT scans localizing blood to a specific cerebral blood vessel (particularly the ACoA) and if a second SAH is documented at the same site.

scholarly journals Intraoperative Rerupture and Surgical Clipping of a Small Superiorly Projecting Anterior Communicating Artery Aneurysm: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (3) ◽  
pp. E288-E288
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Video Recording ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Surgical Clipping ◽  
Institutional Review ◽  
Clip Application ◽  
Interhemispheric Fissure ◽  
Aneurysm Occlusion ◽  
Intraoperative Rupture ◽  
Temporary Clip

Abstract Anterior communicating artery (ACoA) aneurysms are prone to rupture even at smaller sizes. The surgical management of ACoA aneurysms is highly dependent on the spatial orientation of the saccular projection, categorized as inferior, superior, anterior, or posterior. Superior projecting aneurysms constitute approximately one-third of all aneurysms involving the ACoA. These aneurysms commonly project within the interhemispheric fissure; however, if the aneurysm is not high-riding, it can often be approached via a transsylvian trajectory. The patient presented after subarachnoid hemorrhage with a 3-mm superiorly projecting ACoA aneurysm. The lesion was approached via a right modified orbitozygomatic craniotomy with a transsylvian trajectory. The aneurysm reruptured after minimal manipulation of the dome. Mitigation of the intraoperative rupture was achieved through temporary clip application to bilateral A1 vessels. Bipolar coagulation and placement of 2 permanent clips facilitated final aneurysm occlusion. Postoperative imaging demonstrated patent bilateral A2 flow and no residual aneurysm filling. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Heat Transfer and Fluid Flow Analysis on Microchannel Heat Sink with Varying Plenum Size

2019 ◽  
Vol 8 (2) ◽  
pp. 1878-1889
Keyword(s):  
Heat Sink ◽  
Flow Analysis ◽  
Outlet Temperature ◽  
Microchannel Heat Sink ◽  
Liquid Stream ◽  
3 Dimensional ◽  
Fluid Analysis ◽  
Weight Drop ◽  
Set Up ◽  
Fluid Flow Analysis

Computational fluid analysis study has been carried out to find a better prospect of perfect design, shape and plenum size microchannel heat sink (MCHS). Distinctive structure parameters were chosen to plan microchannel heat sink with shifting channel planum sizes of 10 mm, 20 mm and 30 mm. The material taken of circle type heat sink is taken as copper. The liquid taken is plane fluid. Amid liquid stream distinctive speed stream states of significant worth 0.25 lpm, 0.50 lpm and 0.75 lpm were chosen. In computational liquid examination changing weight, temperature and speed conditions impacts were additionally contemplated. Huge weight drop is recorded in the speed rating of 0.25 lpm. Speed readings were recorded high en 30 mm plenum estimate with 0.75 lpm speed stream. Investigation gives thought of an ideal structure fit as a fiddle with stream of liquid at 0.75 speed stream. The stream space were understood utilizing ANSYS programming as economically accessible for CFD examination. A special plan is set up from the examination which can exchange extensive measure of warmth in the state of microchannel heat sinks with microchannel length of 48 mm long and with other chose structure paramters. To accomplish more warmth expulsion from the MCHS the microchannel estimate upgrade is done diagnostically. For ordinary convective warmth trade coefficient, outlet temperature, grinding and weight drop, siphoning power and warm impediment have been plotted against Nusselt number qualities for various stream conditions. By settling the correct control of the liquid stream and warmth exchange propensity of a 3- dimensional MCHS has been accomplished computationally.

CASE REPORT: ACUTE MYOCARDITIS MIMICKING ACUTE MYOCARDIAL INFARCTION

2011 ◽  
pp. 77-83
Author(s):  
Thi Ngoc Thu Hoang ◽  
Anh Vu Nguyen
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Pulmonary Embolism ◽  
Acute Myocarditis ◽  
Young Patients ◽  
Central Hospital ◽  
Severe Chest Pain ◽  
Coronary Syndrome ◽  
Cardiovascular Center ◽  
Aneurysm Dissection

Myocarditis- pericarditis is one of the causes of severe chest pain with difficult positive diagnosis, mainly diagnosed after excluding other causes such as acute coronary syndrome, aortic aneurysm dissection, pneumonia, pulmonary embolism ... We present the case of myocarditis-pericarditis, the diagnosis should be thought of in young patients with angina at Cardiovascular Center -Hue Central Hospital.

High-Fidelity Anthropometric Facial Measurements Can Be Obtained From a Single Stereophotograph From the Vectra H1 3-Dimensional Camera

2019 ◽  
Vol 56 (9) ◽  
pp. 1164-1170 ◽  
Author(s):  
Diana S. Jodeh ◽  
S. Alex Rottgers
Keyword(s):  
Intraclass Correlation ◽  
Three Dimensional ◽  
Young Patients ◽  
Correlation Coefficients ◽  
Anthropometric Measurements ◽  
3D Analysis ◽  
Facial Morphology ◽  
Anthropometric Measures ◽  
3D Images ◽  
3 Dimensional

Background: Anthropometry is a well-established means of measuring facial morphology. Although reliable, direct anthropometry can be time-consuming and not conducive to a busy clinical practice. The Vectra H1 handheld stereophotogrammetric system requires 3 stereophotographs taken from different perspectives to generate a three-dimensional (3D) surface. The time needed to take the 3 stereophotographs can increase the possibility of involuntary movements, precluding its use to assess young patients. To overcome this limitation, we evaluated if accurate linear facial measurements can be obtained from a single stereophotograph and compare these to the measurements taken by direct anthropometry. Methods: Twenty pediatric patients, aged 0 to 10 years, who were undergoing minor surgical procedures at Johns Hopkins All Children’s Hospital were recruited. Fourteen linear facial distances were obtained from each participant using direct anthropometry under general anesthesia. These same distances were measured using Mirror 3D analysis. Intraclass correlation was used to determine intrarater reliability on duplicate 3D images. Results: Correlation coefficients between 3D imaging in frontal view and direct anthropometric measurements were excellent for 13 measures taken, ranging from 0.8 (subnasale to columella and subnasale to stomion superius) to 0.98 (nasion to subnasale and subnasale to labiale superius). Correlation coefficients between submental view and direct anthropometric measurements were excellent for 13 measures as well, ranging from 0.77 (subnasale to columella) to 0.98 (nasion to subnasale). Conclusions: Linear anthropometric measurements taken from 3D surfaces generated from a single stereophotograph correlate closely with direct anthropometric measures. This improves workflow and applicability of anthropometric studies to our youngest patients.

scholarly journals Left Modified Orbitozygomatic Approach for Clipping of Multilobulated Middle Cerebral Artery Bifurcation Aneurysm: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (4) ◽  
pp. E386-E386 ◽  
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Video Recording ◽  
Parent Vessel ◽  
Microsurgical Treatment ◽  
Institutional Review ◽  
Bifurcation Aneurysm ◽  
Orbitozygomatic Approach ◽  
Clip Application ◽  
Clip Occlusion

Abstract Middle cerebral artery (MCA) aneurysms are associated with one of the most favorable approaches for microsurgical treatment; however, aneurysm geometrics can pose challenges during clip application. The surgeon must be mindful of the clip configuration options available during the planning of ideal clip occlusion for irregular or multilobulated aneurysm domes. This patient had an incidental multilobulated MCA bifurcation aneurysm and underwent an orbitozygomatic approach for microsurgical treatment. Proximal and distal control of the aneurysm were achieved, and complete clip occlusion was achieved following the placement of a single permanent clip. Flow within the parent vessel was well preserved, and complete aneurysm occlusion was achieved. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

Microsurgical Treatment for a Ruptured PICA Aneurysm. A 3-Dimensional Surgical Video and Anatomical Landmarks Review.

2021 ◽  
Author(s):  
José Ernesto Chang M. ◽  
Guilherme Salemi Riechelmann ◽  
Sebastián Aníbal Alejandro ◽  
Samantha Lorena Paganelli ◽  
Evelyn Judith Vela Rojas ◽  
...  
Keyword(s):  
Anatomical Landmarks ◽  
3 Dimensional ◽  
Microsurgical Treatment ◽  
Surgical Video
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