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Shinichiro Miyazaki, Takanori Fukushima and Takamitsu Fujimaki

with giant aneurysms and advanced occlusive disease in both the anterior and posterior circulation. Their distal bypass grafting site was the proximal posterior cerebral artery or a major branch of the middle cerebral artery. Skull Base Surgery In the past 10 years, new surgical approaches have been reported which permit more aggressive management of tumors and aneurysms involving the skull base. 2, 4, 9, 16 Fish, et al. , 4 described their lateral approach to radical surgery of skull base lesions with carotid artery bypass in five cases, including three

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Apostolos Mintelis, Tetsuro Sameshima, Ketan R. Bulsara, Linda Gray, Allan H. Friedman and Takanori Fukushima

, Milwaukee, WI) were obtained in 10 cases without skull base lesions. Scans (0.8- to 1-mm-thick slices) of the circle of Willis were acquired in approximately 1 minute, with a pitch of 1. The technical parameters included 140 kVp at a 0-second scan time with a tube current of 210 mA. Scanning data were transferred to an independent workstation with 3D visualization software (Silicon Graphics; Vitrea, Minneapolis, MN). Measurements (20 measurements) similar to the bone measurements—JT length, thickness, and width—were obtained on axial and coronal scans ( Figs. 3 and 4

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Ketan R. Bulsara, Toral Patel and Takanori Fukushima

C erebral bypass surgery indications have undergone significant modifications. Despite the revolution in endovascular neurosurgery, cerebral bypass surgery remains an essential component in the management of some skull base lesions. In this paper, we describe our cerebral bypass surgery techniques, incorporating lessons learned over 2 decades. Clinical Materials and Methods Between 1986 and 2006, the senior author treated 100 skull base lesions with adjunctive bypass surgery. Saphenous vein grafts were used in all cases. During the bypass procedures

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Mari Kusumi, Takanori Fukushima, Ankit I. Mehta, Hamidreza Aliabadi, Yoichi Nonaka, Allan H. Friedman and Kiyotaka Fujii

. Neurosurgery 59 : 4 Suppl 2 ONS270 – ONS278 , 2006 27 Zhao JC , Liu JK : Transzygomatic extended middle fossa approach for upper petroclival skull base lesions . Neurosurg Focus 25 : 6 E5 , 2008

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Peter M. Grossi, Yoichi Nonaka, Kentaro Watanabe and Takanori Fukushima

F or more than a century, surgeons have been trying to develop and define safe surgical approaches to large skull base lesions of the CPA and ventrolateral brainstem and clivus. Anterior approaches through the anterior petrous bone or subtemporal region provide some exposure, but often require significant elevation of the temporal lobe. Traditional posterior suboccipital approaches provide access to the CPA, but exposure of the ventral brainstem and clivus are extremely limited unless the cerebellum is retracted significantly or the posterior dural sinuses