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.
Flexible paving is the most popular type of paving used in road building and one of the biggest problems facing the world's paving business is the rising demand for scarce natural resources. Uncontrolled. Numerous studies have shown that secondary materials reduce the need for traditional materials, offer efficient waste disposal technology and lower the overall cost of paving. The current study aimed to evaluate the efficiency of both fibers and dust on the sustainability and cost of flexible pavement by studying each of polyester fibers as a waste of the textile industry and fibers or rubber particles as one of the rubber waste products, in addition to studying the efficiency of using cement dust and marble dust on the paving proc
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This study aims to find the relationships between social capital (social network, social trust, shared goals) and knowledge sharing (knowledge Donating, knowledge collecting) as independent variables and their impact on improving the quality of educational services (academic staffs quality, Quality of teaching methods and study curriculums). This research is an important, because it attempts to identify the relationship between social capital and the knowledge sharing and their effect on improving the quality of educational service for universities. The study problem was determined in several questions related to the nature of the correlation relationship - the impact between the different independent variables (
... Show MoreThe research seeks to identify the proposed scenarios to predict and ward off monetary credit risks that the bank is exposed to in the future, using the banking stress tests model, and showing their impact on capital adequacy and profitability ratio,To achieve this purpose, Sumer Commercial Bank was taken as a case study, and mathematical equations were used to extract the results. Low percentage of profits and returns, strictness in the process of granting credit and financing operations in order to reduce credit risks.
Many letters and theses written on the subject of consensus, as well as in measurement,
But we tried to address a topic of consensus
Building a blind measuring guide.
We have tried to explain the meaning of convening, then the statement of consensus in language and terminology and then the statement of measurement
Also, we have shown the types of consensus mentioned by the jurists, and this is how much was in the first topic, either
The second section included the statement of the doctrines of the blind in the matter, and then the evidence of each doctrine and discussed.
We followed it with the most correct opinion statement and concluded the research with some of the conclusions we reached through
search.
The goal of this research is to find the effects of both the studying students groupwhich has various educational levels and the integration of the fragmented information through or during the study of history subjects for the female students of the fifth secondary literary section.
To achieve this study or case the researcher has chosen an experimental design or test by studying three groups: two are as mentioned above and the third is just ordinary team. In addition to that, there is a test after the experiment. The researcher chose on purpose female students of the literal section from two different secondary school Al Asil and Wahran both are secondary school for girls, and both are from directorate of education- Al Karkh 2nd dist
The Contemporary Business Environment is Surrounded by many quick and continues variable and changes which has an effect on the economic units. These variables and changes like the high competition which need many tools to help them to continue and achieve The critical success. So to achieve this they have many competitive strategies like cost leadership strategy, differentiation strategy and focus strategy.
Budget is regarded one of main tools to execute objectives polices and programs of the economic units, beside show how the economic units had execute the available economic resources.
Activity based on budgeting is regarded one of the modern technique in the m
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financial market occupy very important place in the economic activity all over the world countris, and its importance increased with considerable technological progress in the world of transportation ,communications and information where its impact have spread over the whole world, which led to link the international economy in a kind of international relations so that the open policy became the prevailing trend in national and regional economies within the framework of the new world order.
the international economy has faced the financial crisis, global, that hit all world economies although the United States is the center of the crisis and the starting spark for it w
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The research study about the empowerment as an independent variable, in which details include (training and improvement, incentives, information sharing, trust, and delegation), has also focused on the performance of the service organization as a dependent variable in all dimensions which include (improve work efficiency, building the core competencies, focus on the beneficiary of the service, increasing the feeling of satisfaction of the employees, and the organizational support commitment). The research has been based on the opinions of a chosen sample of 75 service officers of the Ministry of Interior who work at the General Directorate of Traffic. The research problem has been identified by t
... Show Moreتحتل أدوات السياسة المالية (الإنفاقية والإيرادية) مكانة مهمة بين أدوات السياسات الاقتصادية الأخرى لما تتمتع به من تأثيرات اقتصادية واجتماعية على مجمل النشاط الاقتصادي .
وفي بحثنا هذا سنركز على الآثار الاجتماعية لأدوات السياسة المالية (الإنفاق العام والإيراد العام) لما للتنمية الاجتماعية من أهمية متزايدة في عالمنا اليوم خاصة فيما يتعلق بمقوماتها غير المادية المتمثلة في خدما
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