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.
Abstract
The current research problem includes a variety of research motivations to serve the private health sector, which is witnessing a great competition from internal and external environments. In this regard, private medical clinics are increasingly seeking to attract and retain customers through the quality of their service offerings represented by health services. Innovative and effective marketing methods to improve performance and stay in competition, by relying on the physical evidence of the product as a component of the marketing mix of services and its role in particular in packaging and supporting the health service with concrete evidence that affects the customer an
... Show MoreThe consumption of fresh fruits has increased nowadays due to the lifestyle of the consumers. Maintaining the quality and nutritional value of cut fruits during storage is difficult compared to whole fruits. Deterioration of internal and external quality usually occurs in freshly harvested fruits. It is necessary to use different techniques to maintain the quality and increase the shelf life of the freshly cut product. This research studied the effect of treating apple slices with cold plasma once and with filtered water again on quality characteristics (hardness, moisture content, sugar content, carbohydrate content, and color) after being stored for five days. The best treatment was determined using two different pressures of the plasma j
... Show MoreIn this research, a study is introduced on the effect of several environmental factors on the performance of an already constructed quality inspection system, which was designed using a transfer learning approach based on convolutional neural networks. The system comprised two sets of layers, transferred layers set from an already trained model (DenseNet121) and a custom classification layers set. It was designed to discriminate between damaged and undamaged helical gears according to the configuration of the gear regardless to its dimensions, and the model showed good performance discriminating between the two products at ideal conditions of high-resolution images.
So, this study aimed at testing the system performance at poor s
... Show MoreIn this research, a study is introduced on the effect of several environmental factors on the performance of an already constructed quality inspection system, which was designed using a transfer learning approach based on convolutional neural networks. The system comprised two sets of layers, transferred layers set from an already trained model (DenseNet121) and a custom classification layers set. It was designed to discriminate between damaged and undamaged helical gears according to the configuration of the gear regardless to its dimensions, and the model showed good performance discriminating between the two products at ideal conditions of high-resolution images. So, this study aimed at testing the system performance at poo
... Show MoreThe aim of the research is to determine the impact of evaluation of investment projects after the preparation of investment budgets taking into consideration within the investment budgets the concept of competitive strategy, as the harmony between the preparation of investment budgets and competitive strategy will contribute to the success of economic unity and achieve profits well and achieve a competitive advantage. Strategies for economic units because the most important factor to them is the costs produced and the progress of the research problem is focused on "Is it possible to include a strategy of competition, especially within the investment budget when prepared The study concluded that the investment plan prepared by the
... Show MoreThe research aims to identify the impact of managing performance's employees in building intellectual capital, Because employing the practice of managing the performance of employees may acquire familiar skills to improve their performance and reflect on the construction of intellectual capital in the surveyed area, Especially that the independent dimension represented by the management of the performance of employees is one of the important topics that has received attention in the world of management in general and human resource management in particular. While the adopted dimension was represented by Intellectual capital in the important practice of human resource management in the increasing of their knowledge, to
... Show MoreThe aim of the research is to measure the length between the variable the efficiency of the tax examiner with its dimensions represented by (scientific questions, practical process (experience), training and development, impartiality and independence, ethics of the profession) and the approved variable discovering the artificial adaptation of profits, and the degree of arrangement of those dimensions its importance and priority, and the research problem has been identified In a main question that is there any effect of copying the images of the image examiner in discovering the adaptation, the financial statements and reports of the companies (X, Y) and the banks (A, B) were relied on in the interpretation of the results, t
... Show MoreThe main aim of the research is to identify the impact of the application of IFRS for SMEs on optimizing the utility of information for financial reports. To answer the questions and test the hypotheses of the research, researchers relied on the descriptive analytical approach. First, the researchers clarified the theoretical aspect through previous studies, and then they analyses d the results of the applied study by testing the hypothesis using the SPSS.
A questionnaire was distributed after evaluation and arbitration by a number of specialists on selected sample. The sample of 120 respondents consists of general managers, department directors, head of departments, accountants, auditors and financial controllers working in the
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Most of the industrial organization in the world became suffering from the problem of the pollution of the poisonous chemicals things, this urged to depend on the principle of the responsible production, because it has the positive role by dealing with these chemical things and to safe the health of the society, due to the main goal of this study is to restrict the role responsible production in accomplishing the system of the environmental management through an actual study in the northern gas company in Kirkuk province, the topic has acquired a big importance bacause there were a limited number of studies and res
... Show MoreThe exercise of citizenship behaviors and their impact on customer loyalty (An analytical study from the perspective of workers in the National Insurance Company).
The Research aims to find out the degree of customers National Insurance company for customer citizenship behavior and its impact on the level oh loyalty from the perspective of employess in the company, as well as the statement of the differences in the answers of employees according to their personality traits. To achieve the goals of research has been the use of the questionnaire as a tool for the collection and distribution of data on a sample of (90) individuals, as was the use of statistical program (SPSS) in the process of statistical analysis methods (mean, sta
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