Remarkable Clinical Improvement Following Microsurgical Resection of Left Lingual Gyrus Cerebral Cavernous Malformation: A Case Report

Moyamoya disease is a chronic and unusual cerebrovascular disorder characterized by progressive stenosis and occlusion of the distal portions of internal carotid arteries and its main branches within the circle of Willis. Posterior circulation (vertebral and basilar arteries) may also be affected; however, this presentation is uncommon. As well as stenosis of the terminal portion of intracranial arteries, it is seen the development of a network of collateral vessels abnormally dilated at the base of the brain with an aspect of a "puff of smoke," whose term in Japanese is described as "moyamoya." The present study aims to report two consecutive cases of patients who presented to our service with different clinical manifestations. Further investigation with digital subtraction angiography showed a moyamoya pattern.

Ruptured giant aneurysm of a cortical middle cerebral artery: A case report.

BACKGROUND: Aneurysms of the cortical branches of the middle cerebral artery (MCA) are rare. They usually are secondary to traumatic or infectious etiologies and are rarely idiopathic. The specific characteristics of idiopathic aneurysms in such location are not well defined in the literature. The authors report a rare case of a ruptured giant idiopathic cortical MCA aneurysm with review of the available literature on this clinical entity. CASE DESCRIPTION: A 24-year-old female presented with headache, disturbed level of consciousness, and right-sided weakness. Imaging studies showed a left frontoparietal intracerebral hematoma and a giant saccular aneurysm in the posterior parietal cortical branch of the MCA. The patient had no history of head trauma or active infection; therefore, the aneurysm was considered idiopathic. A microsurgical clipping of the aneurysm with evacuation of the hematoma was performed. There were no surgical complications, and the patient achieved a good outcome modified Rankin Scale of 1 with no neurological deficits. CONCLUSION: Idiopathic aneurysms of the cortical branches of the MCA are rare, and usually present with intraparenchymal hemorrhage due to rupture. There is no clear consensus regarding the optimal management strategy. This case shows that timely management can lead to good outcomes.

Transposition of Vessels for Microvascular Decompression of Posterior Fossa Cranial Nerves: Review of Literature and Intraoperative Decision-Making Scheme.

INTRODUCTION: Microvascular decompression with transposition of the involved vessels provides good surgical outcomes in cases of complex and recurrent neurovascular compression syndromes. We conducted a literature review to illustrate the variations in the surgical techniques used for transposition and to provide a practical decision-making scheme for transposition of the involved vessel. METHODS: A PubMed Medline database record search was conducted using the following algorithm ("Microvascular Decompression Surgery"[Mesh]) OR (((Microvascular) OR (Macrovascular)) AND decompression AND surgery) AND (transposition). Only articles that detailed the intraoperative techniques were included. RESULTS: A total of 48 articles were included. The adjacent anatomical walls to which the compressing vessel can be anchored were divided into 4 groups; A: roof (tentorium cerebelli), B: anterior wall (posterior surface of petrous bone and clivus), C: posterior wall (petrosal surface of the cerebellum), and D: "no wall" required. A new decision-making scheme based on the following 2 questions was designed: 1) is the conflicting vessel amenable to transposition to a nearby wall in the cerebello-brainstem space? 2) what is the closest wall to secure the transposed vessel? CONCLUSIONS: Transposition of the involved vessel is a valuable procedure for microvascular decompression of the posterior fossa cranial nerves. Anchoring the vessel to the adjacent anatomical wall ensures secure transposition. The proposed algorithm provides a systemic scheme to identify the optimal anatomical wall, and to determine the technique and material that can be used to anchor involved vessel. This scheme is an efficient method to inform the intraoperative decision-making process.

The use of non-living animals as simulation models for cranial neurosurgical procedures: a literature review.

Simulation plays a pivotal role in neurosurgical training by allowing trainees to develop the requisite expertise to enhance patient safety. Several models have been used for simulation purposes. Non-living animal models offer a range of benefits, including affordability, availability, biological texture, and a comparable similarity to human anatomy. In this paper, we review the available literature on the use of non-living animals in neurosurgical simulation training. We aim to answer the following questions: (1) what animals have been used so far, (2) what neurosurgical approaches have been simulated, (3) what were the trainee tasks, and (4) what was the experience of the authors with these models. A search of the PubMed Medline database was performed to identify studies that examined the use of non-living animals in cranial neurosurgical simulation between 1990 and 2020. Our initial search yielded a total of 70 results. After careful screening, we included 22 articles for qualitative analysis. We compared the reports in terms of the (1) animal used, (2) type of surgery, and (3) trainee tasks. All articles were published between 2003 and 2019. These simulations were performed on three types of animals, namely sheep, cow, and swine. All authors designed specific, task-oriented approaches and concluded that the models used were adequate for replicating the surgical approaches. Simulation on non-living animal heads has recently gained popularity in the field of neurosurgical training. Non-living animal models are an increasingly attractive option for cranial neurosurgical simulation training. These models enable the acquisition and refinement of surgical skills, with the added benefits of accessibility and cost-effectiveness. To date, 16 different microneurosurgical cranial approaches have been replicated on three non-living animal models, including sheep, cows, and swine. This review summarizes the experience reported with the use of non-living animal models as alternative laboratory tools for cranial neurosurgical training, with particular attention to the set of tasks that could be performed on them.

The History and Current Status of Neurosurgery in Iraq.

The roots of modern neurosurgery in Iraq can be traced back to the dawn of civilization, the Mesopotamian culture. Archaeological evidence has provided us with new insights regarding Mesopotamian medical practices. Back then, 2 forms of medicine coexisted: therapeutic and divinatory, which were practiced by the Asu and Asipu physicians, respectively. Despite their lack of knowledge of the human anatomy and physiology, our ancestors performed elementary surgical procedures that were strictly regulated by the Code of Hammurabi. In present-day Iraq, neurosurgery is facing many challenges; the specialty is limping with an inadequate number of neurosurgeons who strive to perform under conditions of political, social, and economic instability. Nevertheless, nondismissible progress has been made in recent years propelled by the efforts of our local neurosurgeons.