Emergency extra-intracranial bypass surgery in a patient with neurologic deficit after an accident in carotid occlusive test: A case report.

OBJECTIVE: BTO is the procedure performed to assess the collateral circulation within the Willis circle in a giant ICA aneurysm. An ICA occlusion after BTO is very rare. We present a case of an internal carotid artery occlusion as a complication of BTO that required urgent revascularization surgery. CASE PRESENTATION: A 56-year-old female with a history of transient ischemic attacks for one year was diagnosed with multiple aneurysms: a giant aneurysm of the left supra-clinoid ICA, two small ones on left MCA and right ophthalmic. A BTO was performed to assess collateral supply and determine whether bypass surgery should be necessary. During the procedure, the balloon was detached while insufflating, and the patient had a subsequent neurological decline consistent with an MCA syndrome. EC-IC bypass surgery was performed with an end-to-side anastomosis of STA-MCA by trapping the giant aneurysm and clipping the ipsilateral MCA aneurysm. The patient had a reversal of neurological symptoms and made an uneventful recovery. DISCUSSION: We discuss the epidemiology of giant ICA aneurysms, the indications for BTO, and its complication. Emergency intracranial and extracranial bypass surgery in case of acute ICA injury is also discussed. We also highlighted the attributable factors to treatment strategies under restrictive conditions in Vietnam. CONCLUSIONS: ICA occlusion due to insufflated balloon detachment is an unreported complication in literature. Emergency bypass surgery is a potential treatment choice for this unusual iatrogenic complication

Avoiding dative overgeneralisation errors: semantics, statistics or both?

Item does not contain fulltextHow do children eventually come to avoid the production of overgeneralisation errors, in particular, those involving the dative (e.g., *I said her "no")? The present study addressed this question by obtaining from adults and children (5-6, 9-10 years) judgements of well-formed and over-general datives with 301 different verbs (44 for children). A significant effect of pre-emption - whereby the use of a verb in the prepositional-object (PO)-dative construction constitutes evidence that double-object (DO)-dative uses are not permitted - was observed for every age group. A significant effect of entrenchment - whereby the use of a verb in any construction constitutes evidence that unattested dative uses are not permitted - was also observed for every age group, with both predictors also accounting for developmental change between ages 5-6 and 9-10 years. Adults demonstrated knowledge of a morphophonological constraint that prohibits Latinate verbs from appearing in the DO-dative construction (e.g., *I suggested her the trip). Verbs' semantic properties (supplied by independent adult raters) explained additional variance for all groups and developmentally, with the relative influence of narrow- vs broad-range semantic properties increasing with age. We conclude by outlining an account of the formation and restriction of argument-structure generalisations designed to accommodate these findings.26 p

Impact of Training and Practice Environment on Academic Productivity of Early Career Academic Neurosurgeons

Background: Factors affecting academic productivity of neurosurgeons are increasingly being studied. In the current investigation, we retrospectively reviewed a cohort of early career neurosurgeons to determine if their medical education, residency training, or academic employer had the most influence on a young academician\u27s productivity. Methods: We studied early career neurosurgeons who completed residency in U.S.-based neurosurgical training programs between 2010 and 2014. The ranking of an individual subject\u27s medical school, residency, and current academic employer were analyzed for correlation with his or her current h-index. Results: The neurosurgeons with the highest h-indexes are more likely to have attended elite medical schools, have trained in high-ranking residency programs, and work for prestigious university departments (P \u3c 0.0001). Furthermore, we identified a positive correlation between the subjects’ academic productivity and the ranking of all the institutions throughout their medical education, training, and current employment. The strongest correlation was with the rank of their residency program (ρ = 0.52). Conclusions: There is a correlation between the early career academic neurosurgeons’ h-indexes and the ranking of all the institutions throughout their education, training, and current employment, but the strongest correlation was with the academic productivity of their residency program

Fertility, Pregnancy,and Prolactinoma: A Survey of Pituitary Surgeons\u27 View and Review of the Literature.

OBJECTIVE: Pituitary surgeons frequently encounter female prolactinoma patients seeking treatment to restore fertility. Current medical guidelines recommend using dopamine agonist (DA) for this, but for fetal safety, DA should stop upon pregnancy confirmation. The probability that prolactinoma may grow during pregnancy makes this last recommendation imperfect. With the advances in endoscopic surgery, we queried the potential role for surgery in these infertile patients, who may be ambivalent about both stopping and continuing DA while pregnant. METHODS: An anonymous survey was sent to pituitary surgeons to investigate how they would advise prolactinoma patients on treatment of infertility, and counsel them about pregnancy. Directories from various US-based neurosurgical societies were culled. Surgeons who designated themselves as skull base / pituitary were surveyed. RESULTS: Seventy-six surgeons responded (41%). The majority (67%) adhered to medical guidelines for microprolactinoma, but 26% recommended surgery. However, for a macroprolactinoma at diagnosis, the number of surgeons who recommended DA treatment vs. surgical treatment were almost evenly split (χ CONCLUSION: A review of the current literature shows that both medical and surgical therapy have flaws. Significant numbers of surgeons considered surgery a legitimate option for prolactinoma patients seeking to be pregnant. The divergence between these surgeons\u27 opinion and current medical guidelines warrants further investigation and discussion

Evolution of the Intracranial Approaches to Jugular Foramen Tumors: A Surgeon\u27s Personal Perspective Through Three Illustrative Cases.

Tumors of the jugular foramen remain challenging lesions despite advances in surgical technique and medical technology. Tumors with extensive extra- and intracranial components necessitate both radical neck dissection maneuvers combined with skull base approaches. We present a single surgeon\u27s perspective in managing these difficult tumors

The Use of Augmented Reality to Improve Safety of Anterior Petrosectomy: Two-Dimensional Operative Video.

An anterior petrosectomy (AP) provides access to the upper petroclival region, but approach-related complications include seizures and temporal lobe hematomas

Optimization of skull base exposure using navigation-integrated, virtual reality templates

In many skull base procedures, arriving at the optimal bone exposure is important. Whereas insufficient exposure can jeopardize the operation itself, over-doing the exposure might lead to complications. We developed a new technique, harnessing the strength of Virtual Reality (VR) technology in planning, rehearsal and navigation, to achieve the optimal skull base exposure for resection of tumors. VR models of patient-specific anatomy were used to rehearse the surgical exposure. From the altered models, the one with the ideal exposure was chosen, integrated with the navigation system in the operating suite, and used as a template to achieve the optimal exposure in surgery. The use of these VR templates is demonstrated in two cases involving skull base tumors. In both cases, over-zealous bone removal could have increased the risk of complications, and inadequate exposure would jeopardize the tumor resection. Navigation guided by the VR templates aided the creation of the “ideal” surgical exposure to reach the surgical goals. Complete resections were achieved and neither patient suffered any approach-related complications. In conclusion, virtual reality is a powerful tool to improve the safety and efficacy of neurosurgical procedures. With preoperatively-altered VR templates, the surgeon is no longer navigating just to find bearings, but to duplicate an opening designed to simultaneously provide sufficient exposure while limiting postoperative complications. Intuitively useful and successful in early application, there has been no identifiable disadvantages to date

Optimization of skull base exposure using navigation-integrated, virtual reality templates.

In many skull base procedures, arriving at the optimal bone exposure is important. Whereas insufficient exposure can jeopardize the operation itself, over-doing the exposure might lead to complications. We developed a new technique, harnessing the strength of Virtual Reality (VR) technology in planning, rehearsal and navigation, to achieve the optimal skull base exposure for resection of tumors. VR models of patient-specific anatomy were used to rehearse the surgical exposure. From the altered models, the one with the ideal exposure was chosen, integrated with the navigation system in the operating suite, and used as a template to achieve the optimal exposure in surgery. The use of these VR templates is demonstrated in two cases involving skull base tumors. In both cases, over-zealous bone removal could have increased the risk of complications, and inadequate exposure would jeopardize the tumor resection. Navigation guided by the VR templates aided the creation of the ideal surgical exposure to reach the surgical goals. Complete resections were achieved and neither patient suffered any approach-related complications. In conclusion, virtual reality is a powerful tool to improve the safety and efficacy of neurosurgical procedures. With preoperatively-altered VR templates, the surgeon is no longer navigating just to find bearings, but to duplicate an opening designed to simultaneously provide sufficient exposure while limiting postoperative complications. Intuitively useful and successful in early application, there has been no identifiable disadvantages to date