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Background: Microsurgical laboratory training remains the mainstay to acquire, improve, and perfect surgical abilities. Microvascular anastomotic techniques are of key importance for revascularization procedures, such as in giant cerebral aneurysms, skull base complex tumours, and symptomatic ischemic cerebrovascular diseases. Methods: We show the techniques, materials, and experience performed in a microsurgical laboratory of a neurosurgical referral center in Mexico City. Results: We describe the materials, non-specimen suture practices, specimen manipulation, and finally all the individual procedures we are capable to perform on live specimens. Conclusions: The microsurgical laboratory is an indispensable tool for the acquisition of the so needed microsurgical skills in neurosurgery, having a very special emphasis in vascular neurosurgery.

Background: Standard pterional approaches have largely been used as the first option for middle cerebral artery aneurysms. This approach presents several disadvantages when facing giant aneurysms: aneurysmatic neck cannot be adequately seen and perianeurysmatic architecture is not completely visualized, leading to inappropriate clipping techniques. Orbitocranial approaches have been described in anterior communicating aneurysms, but not in middle cerebral artery bifurcation ones. Methods: In this report, we present the case of a patient with subarachnoid hemorrhage secondary to a middle cerebral artery bifurcation aneurysm rupture which was clipped using an orbitocranial approach. We describe the surgical technique step-by-step, present a clinical report, and discuss the advantages and utility of this procedure. Results: This technique was performed successfully and uneventfully in our patient, and it proved to be a safe method of clipping these kind of aneurysms, providing adequate visualization for the surgeon and making it safer for the patient. Conclusions: We consider the orbitocranial approach as an adequate alternative to the conventional pterional approach when facing giant aneurysms of the middle cerebral artery bifurcations as it offers a much better visualization of the aneurysmatic neck, as well as that of the perianeurysmatic architecture.

Objective: Limited data on the treatment and outcomes of patients with intracranial aneurysms (ICAs) in the (coronavirus disease 2019) COVID-19 era is available. Our objective was hence to investigate the impact of the pandemic on the overall complication rate and postprocedural ischemic strokes specifically, in patients treated for ICAs. Methods: The National Inpatient sample database was used. The main outcomes were the occurrence of postprocedural ischemic strokes, as well as death, non-routine discharge, total charges (US dollars), and length of stay (days). Propensity score matching was applied to compare the pre- and COVID-19 periods. Trends were assessed using piecewise joinpoint regression with the Mann-Kendall test. Results: A total of 57,715 patients were included in the study. The mean age was 65 years, with most of the patients (69.9 %) being females. After matching, no differences in length of stay (p = 0.266), non-home discharge (p = 0.475), and in-hospital mortality rates (p = 0.305) between the two periods were found. However, the overall complication rate was significantly higher during the pandemic (31.1 % vs. 28.3 %; p