Experimental saccular aneurysm models are necessary for testing novel surgical and endovascular treatment options and devices before they are introduced into clinical practice. Furthermore, experimental models are needed to elucidate the complex aneurysm biology leading to rupture of saccular aneurysms.Several different kinds of experimental models for saccular aneurysms have been established in different species. Many of them, however, require special skills, expensive equipment, or special environments, which limits their widespread use. A simple, robust, and inexpensive experimental model is needed as a standardized tool that can be used in a standardized manner in various institutions.The microsurgical rat abdominal aortic sidewall aneurysm model combines the possibility to study both novel endovascular treatment strategies and the molecular basis of aneurysm biology in a standardized and inexpensive manner. Standardized grafts by means of shape, size, and geometry are harvested from a donor rat's descending thoracic aorta and then transplanted to a syngenic recipient rat. The aneurysms are sutured end-to-side with continuous or interrupted 9-0 nylon sutures to the infrarenal abdominal aorta.We present step-by-step procedural instructions, information on necessary equipment, and discuss important anatomical and surgical details for successful microsurgical creation of an abdominal aortic sidewall aneurysm in the rat. Video LinkThe video component of this article can be found at
AIm:To raise the awareness of the appropriate management of unusual clinical presentation of cervical disc herniation. mAterIAl and methOds: Seven patients with Brown-Sequard syndrome due to cervical disc herniation presented with Brown-Sequard syndrome had been treated surgically as one of them treated with anterior cervical discectomy and three patients treated by anterior cervical discectomy and fusion while three of them have been treated by posterior laminectomy.results: Patients were 7 three of them were female and four were males and the mean age of our patients is 45.28±16.49 years ranged between 32 and 72 years. History of spinodegenerative disease in the form of chronic neck pain with or without brachialgia was found in 6/7 patients (85.7%) while history of trauma was found in 5/7 patients (71.4%). Most common affected level is C5-C6 disc Outcome after surgical treatment revealed complete recovery in 4/7 patients (57.1%) while incomplete recovery in 2 patients (28.6%) and no improvement in one patient (14.3%).COnClusIOn: Brown-Sequard syndrome is a rare presentation of cervical disc herniation but accurate diagnosis, and early anterior spinal cord decompression lead to complete recovery of these cases. KeywOrds:Cervical disc, Herniation, Brown-Sequard, Management ÖZ AmAÇ: Servikal disk herniasyonunun olağandışı klinik sunumunun uygun takibi konusunda farkındalığı arttırmak. yÖntem ve GereÇler: Servikal disk herniasyonu nedeniyle Brown-Sequard sendromu olan 7 hasta cerrahi olarak tedavi edildi. Bunların biri anterior diskektomi ile, üç hasta anterior servikal diskektomi ve füzyonla ve üç hasta posterior laminektomiyle tedavi edildi.BulGulAr: 7 hastanın üçü kadın ve dördü erkekti ve ortalama yaş 32 ile 72 aralığında olup 45,28±16,49 yıldı. Brakialji ile veya olmadan kronik boyun ağrısı şeklinde spinodejeneratif hastalık öyküsü 6/7 hastada mevcuttu (%85,7) ve travma öyküsü 5/7 hastada bulundu (%71,4). En sık etkilenen seviye C5-C6 diskti. Cerrahi tedaviden sonra 4/7 hastada tam iyileşme (%57,1), 2 hastada tam olmayan iyileşme (%28,6) oldu ve 1 hastada (%14,3) iyileşme olmadı. sOnuÇ: Brown-Sequard sendromu servikal disk herniasyonunun nadir bir sunumudur ama erken tanı ve erken anterior spinal kord dekompresyonu bu olgularda tam iyileşme sağlar.AnAhtAr sÖZCÜKler: Servikal disk, Herniasyon, Brown-Sequard, Takip
Background: The anterior skull base region can be reached through multiple corridors. The most frequently used are the pterional, bifrontal, unifrontal, and orbitozygomatic approaches. These approaches are more extensive and time consuming. The lateral supraorbital approach is a less extensive frontal modification of the classic pterional approach designed to manage tumors and aneurysms of this region. Objective: To evaluate efficacy, safety, and cosmetic results of the lateral supraorbital approach and to present some tricks to have an easy access to different pathologies at the anterior skull base through this approach. Methods: Analysis of 50 operations for anterior skull base pathologies, vascular and neoplastic, made through the lateral supraorbital approach in Neurosurgery Department, Tanta University Hospitals between January 2013 and April 2017. The basic steps in performing the procedure are described. Special tricks required in individual cases and how to identify their need from preoperative images are discussed. Results: We operated on 50 patients having 34 neoplastic and 16 vascular lesions. The mean incision length was 11 cm, mean bone flap size was 3.5 × 5.4 cm, and mean craniotomy time was 20 min. All patients were satisfied with their scars; there were no limitations to this approach regarding nature or size of the lesion. We had 8 morbidities (4 transient and 4 permanent) and 2 mortalities; all morbidities and mortalities were not related to the approach. Conclusion: The lateral supraorbital approach is simple, fast, and effective corridor to anterior skull base pathologies without significant morbidities or mortalities related to the approach.
Background: Chronic shunt-dependent hydrocephalus is still a common complication after aneurysmal SAH (aSAH) and is associated with increased morbidity. Pathology of chronic shunt-dependent hydrocephalus after aSAH is complex and multifactorial which makes its prevention challenging. We thought to evaluate whether external ventricular drainage (EVD) through fenestrated lamina terminalis would decrease the rate of chronic shunt-dependent hydrocephalus after aSAH. Methods: A retrospective analysis of 68 consecutive patients with aSAH who underwent microsurgical clipping of the ruptured aneurysm. Patients were divided into two groups: Group A included patients with lamina terminalis fenestration without insertion of ventriculostomy tube and Group B included patients with EVD through fenestrated lamina terminalis. Demographic, clinical, radiological, and outcome variables were compared between groups. Results: Group A comprised 29 patients with mean age of 47.8 years and Group B comprised 39 patients with mean age of 46.6 years. Group B patients had statistically significant (P < 0.05) lower incidence of chronic shunt- dependent hydrocephalus than Group A patients (30.8% vs. 55.2%, respectively). Conclusion: EVD through fenestrated lamina terminalis is safe and may be effective in decreasing the incidence of chronic shunt-dependent hydrocephalus after aSAH.
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