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 MoreMany 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 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 research aimed at finding out the effect of functional rotation on the tax performance of the employees of the General Authority for Taxes through the five-meter questionnaire prepared according to the required data. The data obtained from the research sample were analyzed. The results showed a significant effect of recycling In the tax performance, and this is evident from the proportion of his contribution to the interpretation of the total variation, which is a good indicator of the impact of functional rotation in the performance of the body sample research.
The research aims to measure and analyze the reality of liquidity in the Rasheed Bank and determine their impact on risk and return in order to identify the extent of the efficiency of the management of liquidity by the Bank and how to employ them in a profitable investment areas, and analysis of the compatibility of the liquidity gap and gap the balance sheet (sensitive interest rate) and affected net interest Change prices, and through the adoption of style ladder recommended Meritassets and liabilities by the Central Bank of Iraq, as it is an important and vital aspects in commercial banks' management, when there is a commonly used optimizing the resources of the bank available, it means that there is a banking efficient management is
... Show MoreThe research seeks to identify the dimensions of creative thinking and its impact on the re-engineering of hotel service operations by analyzing the correlation and impact between research variables as well as comparing the research sample The importance of the research comes from the need to motivate managers the importance of creative thinking among workers in the researched hotels because it is an essential part in the re-engineering of hotel services. To achieve this a questionnaire was designed containing (33) items that include the independent research variables (creative thinking) and the accredited (re-engineering the hotel service) and distributed to a sample of (50) individuals represented by (Commissioner Director, Dep
... Show MoreThis experiment was conducted in the season 2001-2000 in station Ishaqi the company's general industrial crops to plant livestock Vigna radala deleted (Khadrawi) carried out the experiment design panels splinter and order in RCBD with three balls two factors are levels nitrogen fertilizer (120 and, 100.0 kg urea / ha)nitrogen ratio of 46%, which put in the main panels mAIN PLOT and Alkiavat three levels that were placed in secondary panels .....
The study area is witnessing divergence where I am North wind North East wind as we find that the north wind is getting replicated as we move from the south, The reason can be attributed to the nature of the surface of the region, with at least repeat this wind the northern region to the presence of mountain ranges, while we find that energizes the surface in the center and south helped to increase repeat this wind gusts, It also finds that the North wind East prevail in the northern region and least replicated as we move from the north to the south and to the fact that North stations are within blowing this wind sites for the circles near the display of high pressure located centers to the north-east, north and distancing itself from pa
... Show MoreInvestment in high education is considered to be most important factors of production which the return an individual and social than economic returns found by searching the growing problem of unemployment, especially among youth graduates, where the unemployment rate in 2010 (50%) of these high rates have led to increased migration of scientific minds graduate recently, "to search for job opportunities outside Iraq for not hiring functions and this is in vain" clear "in the human and financial resources lead to structural imbalances in the Iraqi economy. When calculating the correlation coefficient between the graduates and the unemployment rate where it reached (0.21) emerged from the results of
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