Background: Ruptured posterior communicating artery (PCoA) aneurysms are common; they usually present with subarachnoid haemorrhage (SAH) and oculomotor nerve palsy. The aneurysmal dome projection may influence the safety access and aneurysmal neck clipping. Here, we discuss additional intraoperative steps that may be required to widen the surgical field to ensure safe surgical clipping of a rupture pure posteriorly directed PCoA aneurysm. Case description: A previously healthy 38-year-old male reported sudden severe headache and disturbed level of consciousness with a Glasgow coma scale (GCS) of 13. His initial computed tomography (CT) scan of the head showed SAH in the basal cistern. 3D-constructed CT angiography (CTA) revealed a left pure posteriorly directed PCoA aneurysm. In the surgery, through the left pterional approach, all intraoperative steps were carried out. Additional steps were performed as well. Three additional intraoperative steps were contemplated because a pure posteriorly directed PCoA aneurysm is not well appreciated and is often hidden behind the supra cliniold internal carotid artery (ICA). First, the extension of Sylvian fissure dissection to include the distal part and the proximal. Second, temporal pole mobilization is performed by cutting small anterior temporal veins. Third, a brain retractor is placed on the temporal lobe to gently tract the superficial part of the lobe. All these steps widened the surgical corridor to ensure the aneurysm's safe clipping. Conclusion: Surgical clipping is influenced by the aneurysmal dome projection. In a ruptured pure posteriorly directed PCoA aneurysm, further intraoperative steps may facilitate complete access and safe clipping of the aneurysm.
The technology and modern social communication medias have contributed to changing many of our concepts about education to a large extent; these technological advancements have created new challenges for the Instructor of course, but on the other hand it did provided him with expressive media, models and strategies that the old methods cannot fulfill, including the flipped classroom strategy, which is one of the modern technical solutions and in it's optimal use it can correct the weakness of the traditional education and can develop the communication skills as a whole among the students, in order to create a positive, active and interactive student.
The current research contained - four chapters: the first one included the methodolog
ABSTRACT
Impkact of Knowledge sharing on organizational innovation Impriscal study in Arabic company .
of Knowledge Management is the main component Knowledge sharing system, it mean the exchange if Knowledge, ideas, and good practice with another individual . Knowledge sharing between persons, then its values can growth .
It is vry important because it can provide us with the contention between virus peoples . the interaction among the people can pass all kind of Knowledge among them. the connection and interaction and interaction enabl
... Show Morethe researchers Sought to determine the impact of the customer contact (Within a client contact there are two times, first is the total time required to create a service and within it there is contact time while the second time is the time of client contact ؛ where means a time that records the physical presence of the customer during the process of service) on operations performance by concentrate attention on the cost (labor productivity) and quality (patient ratio to the doctor) and speed (cycle time) and flexibility (the flexibility range) , as well as ruling out variable of innovation because of impossibility to measure this variable in the Specialty Center for Dental in al-alwia due to the center is lacking of mechanisms t
... Show MoreThis research investigates the type and the significant relationship between roaming management and self-efficacy and its impact on excellence in providing hotel service. To achieve this, the applied approach was adopted through A questionnaire was designed and developed for the collected data. It has consisted of three parts. The firsts section included nine questions to measure the dimensions of management by roaming. The second section includes nine questions to measure the effectiveness of the two employees. The last section includes 12 questions to measure the excellence of the hotel service. The research sample included 43 employees' responding to this
... Show MoreThe research aims to show the role or extent of the impact of financing in its various forms on the municipal performance before and after the financial deficit through relying on the analytical research methodology of the research community represented by the Directorate General of Municipalities and the Directorate of Maysan municipalities as a sample of research (13) municipal institutions for a period of (8) years, Considering the completion of the final accounts of these years, which provides the necessary data for the study, in addition to the variation in the quality and amounts of grants allocated to municipal institutions during these years, which gives a clearer and more comprehensive picture of the reality of allocatio
... Show MoreAbstract
Performance evaluation is of great importance in all countries of the world, because it has a prominent and effective role in determining the efficiency and effectiveness of the optimal use of available resources, which are rare and important in achieving the desired objectives. With the continued growth of public spending and the limited resources, the State seeks to achieve its objectives through its units with minimal expenditure or deficit, rationality and wastefulness in the spending. In many countries, particularly developing countries, reforms are made in the public sector to achieve that goal through the adoption of IPSAS, which is reflected in the developmen
... Show MoreOccupy public investment spending, a great deal of attention since the thirties of the last century, to play important role in economic and social development process and therefore most of the countries are trying different degree of economic development to the completion of the largest amount of public investment, especially in infrastructure, which is one of the pillars essential to economic development, and in order to maximize utilization of the completion of public investment should focus on achieving efficiency in completion.
The current reality of public projects in Iraq, indicating the absence of several key characteristics that must be provided if these proje
This research deals with the poetic image of poets of the eighth century poetic, where they embodied the features of the religious life in which they live, and their impact on the Koranic text in the reflection of the image on their poems, where it becomes clear the ability of the poet at that stage to clarify the aesthetic components of the poetic text; Investigations, singled out the first topic: the analogy, and the second metaphorical picture, and the third: the picture.