Summary:We discuss the usefulness of a distal transsylvian (DTS) approach for microsurgical training of young neurosurgeons and assess the safety of this procedure by evaluating the complication ratio in our institute. In this procedure, residents learn the vulnerability of the pia mater, pial capillary vessels and small superficial sylvian veins and acquire the skill to avoid bleeding from these structures. In addition, if these vulnerable structures bleed, they learn how to keep the field dry by using suction or hemostatic materials without bipolar coagulation. These represent basic skills for dissecting the neck of an aneurysm safely and preserving critical perforators and nerves, which are the most vulnerable structures in aneurysmal surgery. From 1993 to 2008, this approach was used by 17 residents in 225 procedures. No morbidity or mortality caused by this procedure was observed.For young neurosurgeons, the DTS approach is one of the best training methods to acquire delicate microsurgical skills that cannot be acquired in conventional off-the-job training.
Summary: Cerebral aneurysms of the proximal middle cerebral artery (M1) are a relatively rare condition. We report 14 cases of such aneurysms that were treated by direct surgery. There were 9 men and 5 women. Ages ranged from 5 to 70 years old (average of 50). Ten aneurysms were unruptured and 4 were ruptured. The size of the aneurysms ranged from 2 mm to 13 mm (average of 6 mm).Ten aneurysms arose from the superior wall, 3 from the inferior wall and 1 from the posterior wall of the M1 segment. The aneurysms were exposed through the pterional craniotomy and transsylvian approach. Neck clipping was accomplished successfully in 13 cases using straight or bayonet-shaped clips. A dissecting aneurysm arising from the posterior wall was clipped with a right-angle ring clip. Careful dissection of the lenticulostriate arteries from the aneurysm is important to prevent ischemic complications, especially in aneurysms arising from the superior wall.
Dissection of the interhemispheric fissure via a basal interhemispheric approach (BIHA) is one of the most difficult skills for young neurosurgeons to acquire. We reviewed operative videos of 30 BIHAs performed by 4 residents in our institute, and investigated how the pia mater or pial
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