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.
Abstracts:
The Central Bank is the backbone of the banking system as a whole, and in order to maintain the banking system, one of the most important functions that the Central Bank performs is the function of supervising and controlling banks, with several tools and methods, and one of the most important of these tools is its creation of the function of a compliance observer, which obligated commercial banks to appoint a person in A bank that performs this function according to certain conditions and granting it some powers that would build a sound and compliant banking system. The function of the compliance observer is to follow up on the bank’s compliance with the instructions and decisions issued by
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First: Sacrificial anode cathodic protection (SACP) were a pipeline of steel carrying seawater using zinc as a sacrificial anode and with variable temperatures ranged (0 – 45oC) and volumetric flow rate ranged (5 – 900 lit/hr). It was found that the kd increases with increasing temperature and volumetric flow rate of seawater, where kd ranged (0.24×10-6 – 41.6×10-6 m/s).
Second: Impressed current cathodic pr
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