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Staged microsurgical resection of supra-/parasellar meningioma with cavernous sinus exenteration and carotid-to-middle cerebral artery bypass.
Atypical skull base meningiomas are characterized by aggressive growth and neurovascular invasion, which complicate resection and predispose to high recurrence rates. Lesions encasing major vessels and cranial nerves or refractory to surger…
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Comparative outcomes of microsurgical and endovascular treatment for ruptured and unruptured anterior communicating artery aneurysms.
Anterior communicating artery (AComA) aneurysms remain challenging because of their complex anatomy, rupture risk, and proximity to vital structures. This study compared the long-term durability, retreatment rates, complications, and outcom…
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Anterolateral, lateral, and posterior corridors to complex skull base lesions in sphenocavernous and petroclival regions: microsurgical anatomy with three-dimensional reconstructions and illustrative cases.
[OBJECTIVE] Access to complex lesions in the sphenocavernous and petroclival regions are challenging due to their deep location and proximity to critical neurovascular structures. This study aims to re-evaluate the microsurgical anatomy of …
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Spetzler-martin grade IV cerebral arteriovenous malformations in adult patients: a propensity-score matched analysis of resection and stereotactic radiosurgery.
Spetzler-Martin Grade IV arteriovenous malformations (AVMs) are challenging due to high risks associated with both treatment and natural progression. This study compares the outcomes of microsurgical resection and stereotactic radiosurgery …
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Efficacy and safety of preoperative embolization in surgical treatment of brain arteriovenous malformations: a multicentre study with propensity score matching.
[BACKGROUND] Brain arteriovenous malformations (AVMs) are abnormal connections between feeding arteries and draining veins, associated with significant risks of haemorrhage, seizures and other neurological deficits. Preoperative embolizatio…
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Madison Objective Self-Assessment Tool: A Reliable and User-Friendly Approach for Objective Self-Assessment in Microvascular Anastomosis Training.
[BACKGROUND AND OBJECTIVES] Thorough and objective assessment is of utmost importance for any microsurgical laboratory training, allowing trainees to identify areas needing further improvement. The ideal assessment tool should be objective,…
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Contemporary adverse event profile of microsurgery for intracranial unruptured aneurysms in high-volume microsurgical centers: the international PRAEMIUM study.
[OBJECTIVE] Objective values on procedural risk are essential to facilitate informed consent and optimize clinical decision-making in patients with unruptured intracranial aneurysms (UIAs). While robust heuristics, such as the PHASES (popul…
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Techniques and outcomes for microsurgical treatment of large and giant cerebral aneurysms in the endovascular era.
[OBJECTIVE] Large and giant intracranial aneurysms (LGIA) pose significant surgical challenges due to their complex anatomy, high risk of rupture, and severe morbidity and mortality rates. The aim of this study was to evaluate microsurgical…
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Risk Models for Adverse Events in Microsurgery for Intracranial Unruptured Aneurysms.
[BACKGROUND AND OBJECTIVES] Preventive treatment of unruptured intracranial aneurysms (UIAs) requires assessment of treatment risks vs expected benefit. Although established scores exist to estimate rupture and growth risk, currently, no ex…
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A new classification of parasagittal bridging veins based on their configurations and drainage routes pertinent to interhemispheric approaches: a surgical anatomical study.
[OBJECTIVE] Opening the roof of the interhemispheric microsurgical corridor to access various neurooncological or neurovascular lesions can be demanding because of the multiple bridging veins that drain into the sinus with their highly vari…
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A Novel Approach for Free, Affordable, and Sustainable Microsurgery Laboratory Training for Low- and Middle-Income Countries: University of Wisconsin-Madison Microneurosurgery Laboratory Experience.
[BACKGROUND AND OBJECTIVES] In low- and middle-income countries (LMICs), approximately 5 million essential neurosurgical operations per year remain unaddressed. When compared with high-income countries, one of the reasons for this disparity…
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Establishing Microsurgery Skills Laboratories in Low- and Middle-income Countries with Integrated Remote Teaching: A Novel Approach.
Microneurosurgical techniques remain crucial for managing neurosurgical diseases, especially in low- and middle-income countries (LMICs) where other advanced treatment modalities are not available. The global distribution of these technique…
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Microsurgical anatomy and approaches to thalamic gliomas. Part 2: Maximal safe resection of thalamic gliomas improves outcomes. A single-center experience.
[OBJECTIVE] As presented in Part 1 of this series, thalamic gliomas (TGs) are deep-seated, difficult-to-access tumors surrounded by vital neurovascular structures. Given their high operative morbidity, TGs have historically been considered …
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Microsurgical Obliteration of Craniocervical Junction Dural Arteriovenous Fistulas: Multicenter Experience.
[BACKGROUND] Dural arteriovenous fistulas (dAVFs) located at craniocervical junction are extremely rare (1%-2% of intracranial/spinal dAVFs). Their angio-architectural complexity renders endovascular embolization to be challenging given mul…
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Posterior Circulation Aneurysms.
Posterior circulation aneurysms have a higher tendency to rupture and become symptomatic in comparison to anterior circulation aneurysms. Current treatment modalities for aneurysms in these locations vary widely including microsurgical clip…
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The role of microsurgery for poor-grade aneurysmal subarachnoid hemorrhages in the endovascular era.
[BACKGROUND] Poor-grade aneurysmal subarachnoid hemorrhage (PGASAH) is associated with high mortality and morbidity regardless of treatment. Herein, we re-evaluate the safety and efficacy of microsurgical treatment for managing PGASAH patie…
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Combined Transcavernous and Kawase's Approach for Gross Total Resection of a Cavernous Sinus Meningioma.
Microsurgery of cavernous sinus (CS) lesions is generally considered to be associated with a high rate of morbidity and cranial nerve deficits. The success for surgical removal of CS meningiomas is debatable and achieving a good functional …
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Transcavernous Resection of a Giant Extensive Chondrosarcoma with Endoscopic Assistance.
Chondrosarcomas are one of the major malignant neoplasms which occur at the skull base. These tumors are locally invasive. Gross total resection of chondrosarcomas is associated with longer progression-free survival rates. The patient is a …
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Safety and efficacy of microsurgery for complex cranial pathologies in the ultra-geriatric population.
[OBJECTIVE] The global increase in the "ultra-geriatric" population (aged 80 years and older) has led to higher demand for neurosurgical procedures in this vulnerable population. The objective was to evaluate the safety and efficacy of adva…
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Demonstration of Microsurgical Technique and Nuances for the Obliteration of Complex Intracranial Dural Arteriovenous Fistulas in Three Consecutive Cases: Operative Video.
An intracranial dural arteriovenous fistula (DAVF) is an uncommon acquired dural shunt between an artery and a vein without a parenchymal nidus. DAVF occlusion may be achieved using either endovascular or open surgical means. Combining both…
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Grapefruit Training Model for Distal Anterior Cerebral Artery Side-to-Side Bypass.
[OBJECTIVE] Simulation models enable trainees to master microsurgical skills before performing surgeries. Vascular bypass is a critical component of cerebrovascular and many nonneurologic procedures. However, most available bypass training …