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.
Introduction: In recent decades, the endovascular treatment of cerebral arteriovenous malformations (AVMs) has advanced. However, it still carries risks of unanticipated complications. Coil migration is a reported complication of aneurysmal coiling procedures. Herein, we report a case of early intraprocedural coil migration during pressure cooker technique embolization of right thalamic AVM, discussing the management and potential explanations. The literature showed no report of coil migration after the pressure cooker technique in the form of coil-augmented Onyx injection technique (CAIT). Case description: An otherwise healthy 26-year-old female suddenly developed a severe headache with no loss of consciousness. Computed tomograp
... Show MoreThe goal of this study is to build an application that can be used in difficult cases and sudden circumstances during the pandemic and post-disaster state, which can be the development of digital risk management and mitigating the difficult impact of the epidemic through the improvement of IT and IoT that can be fine by finding initial solutions and make the world like a digital city that could be managed by the network. We provide this study to gain an overview of reasons for delayed and exceeded costs in a select of thirty Iraqi case projects by controlling the time and cost. The drivers of delay have been investigated in multiple countries/contexts. however, there is little country data available under the conditions that have ch
... Show Moreلقد تسبب انتشار الإرهاب في العالم وكذلك الحروب الأهلية والصراعات في أوائل القرن الحادي والعشرين في جميع أنحاء العالم في الكثير من الأضرار وخلفت ضحايا جسيمة. أدت الهجمات الإرهابية على النساء، مثل اختطاف بوكو حرام لأكثر من 270 تلميذة في نيجيريا وتقارير عن انتشار الاغتصاب والاعتداء الجنسي في المناطق التي مزقتها الحرب، إلى إنتاج العديد من العروض المسرحية في الولايات المتحدة التي تصور خواص الجناة وكذلك الضحا
... Show MoreThis article investigates the relationship between foot angle and jump stability, focusing on minimizing injury risk. Here are the key points: Importance: Understanding foot angle is crucial for improving jump stability, athletic performance, and reducing jump-related injuries like ankle sprains. Ideal Foot Angle: Research suggests a forward foot angle of around 15 degrees might be ideal for many people during jumps. This angle distributes forces evenly across the foot, lowers the center of gravity, and provides more surface area for pushing off the ground. Factors Affecting Ideal Angle: The optimal angle can vary depending on the type of jump (vertical vs. long jump), fitness level, and personal preference. Incorrect Foot Angles: Landing w
... Show MoreOften there is no well drilling without problems. The solution lies in managing and evaluating these problems and developing strategies to manage and scale them. Non-productive time (NPT) is one of the main causes of delayed drilling operations. Many events or possibilities can lead to a halt in drilling operations or a marginal decrease in the advancement of drilling, this is called (NPT). Reducing NPT has an important impact on the total expenditure, time and cost are considered one of the most important success factors in the oil industry. In other words, steps must be taken to investigate and eliminate loss of time, that is, unproductive time in the drilling rig in order to save time and cost and reduce wasted time. The data of
... Show MoreThis study aimed to find out the impact of work-life balance on employee satisfaction in five-star hotels in Amman, Jordan based on a descriptive analytical approach. The questionnaire of the survey was designed and distributed to a sample of participants in order to collect the necessary data for this study and they were analyzed later through the SPSS V22 program. The study population was the hotel sector in Jordan, while the study sample included the five-star hotels in the capital, Amman, and the sampling unit included the employees of the middle and lower levels of management in the five-star hotels in Amman. The study showed a number of results, including the existence of a good level of work-life balance by employees in top manage-me
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The research the impact of the application of some of the production system tools in the specified time, which can be adapted in the service sectors (banking sector) over the improvement and increase the quality of banking services, and highlights the research problem in the low quality of banking services provided to customers because of the reliance on traditional banking systems in the provision of services Because of the lack keep pace with global developments in the banking industry, and the goal of research is to clarify the applicability of the production system in the time specified in the service sector and th
... Show MoreThe research tackles the nature of relationship between the Orthodox Church and the state in the Russian Federation. At the beginning of the nineties of the last century, the church had been performed a different role in its relationship with the state, and it had an effect over the internal and foreign policies for the Russian Federation. In political history of Russia, the church’s existence became an evident too much in comparing with the previous historical period, starting with the educational and political system, whether through a symbolic participating roles as what happened in the inauguration ceremony to take over responsibility of the head of state or taking actual roles such as influencing on the process of holding elections d
... Show MoreThe internationalization of the Libyan crisis and its accompanying militarization of the conflict have played a vital role in hindering to reach a comprehensive political settlement solution in Libya. The increasing international greediness in the Libyan energy resources and the geopolitical importance of the Libyan State led to the involvement of many international and regional powers in this crisis and transformed the Libyan crisis into “proxy war”. Moreover, the Turkish direct military intervention in the Libyan crisis is considered as one of the main constraints facing the international and regional efforts to settle the Libyan crisis as a result of the Turkish insistence on its military existence in Libya to preserve i
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