Operative neurosurgery (Hagerstown, Md.)
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Oper Neurosurg (Hagerstown) · Apr 2020
Advanced Techniques for Endoscopic Intracerebral Hemorrhage Evacuation: A Technical Report With Case Examples.
Multiple surgical techniques to perform minimally invasive intracerebral hemorrhage (ICH) evacuation are currently under investigation. The use of an adjunctive aspiration device permits controlled suction through an endoscope, minimizing collateral damage from the access tract. As with increased experience with any new procedure, performance of endoscopic minimally invasive ICH evacuation requires development of a unique set of operative tenets and techniques. ⋯ As experience builds with endoscopic minimally invasive ICH evacuation, academic discussion of specific surgical techniques will be critical to maximizing its safety and efficacy.
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Oper Neurosurg (Hagerstown) · Apr 2020
Subdural Pneumocephalus Aspiration Reduces Recurrence of Chronic Subdural Hematoma.
Chronic subdural hematoma (cSDH) is a common neurosurgical condition, with symptoms ranging from headaches to coma. Operative evacuation is the treatment of choice. Subdural reaccumulation leading to reoperation is a vexing postoperative complication. ⋯ Intraoperative aspiration of cSDH cavity is a safe technique that may enhance cerebral expansion and reduce likelihood of cSDH recurrence.
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Oper Neurosurg (Hagerstown) · Apr 2020
Gross Total Resection of a Grade IV Astrocytoma Adjacent to the Precentral Gyrus With Nonawake Motor Mapping and Motor-Evoked Potential Monitoring: 3-Dimensional Operative Video.
Surgical treatment of the gliomas located in or adjacent to the eloquent areas poses significant challenge to neurosurgeons. The main goal of the surgery is to achieve maximal safe resection while preserving the neurological function. This might be possible with utilizing pre- and intraoperative adjuncts such as functional magnetic resonance imaging (MRI), image guidance, mapping of the function of interest, intraoperative MRI, and neurophysiological monitoring. ⋯ Nonawake motor mapping and MEP monitoring enabled us to perform gross total resection. Because it has been shown that supratotal resection may provide improved survival outcome,1,2 we extended the white matter resection beyond the contrast enhancing area in noneloquent parts of the tumor. Surgical steps in dealing with vascular anatomy as well as utilizing intraoperative adjuncts such as motor mapping and MEP monitoring to enhance the extent of resection while preserving the function are demonstrated in this 3-dimensional surgical video. The patient consented to publication of her operative video.
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Oper Neurosurg (Hagerstown) · Apr 2020
Left Occipital Craniotomy for Resection of Arteriovenous Malformation: 2-Dimensional Operative Video.
Medial parieto-occipital arteriovenous malformations (AVMs) are fed by distal cortical posterior cerebral artery branches and are generally considered eloquent given the proximity to the calcarine fissure and paracentral lobule. This patient was a neurologically intact 12-yr-old girl with an incidentally discovered left occipital AVM. The patient underwent preoperative angiographic evaluation with embolization of a dominant posterior cerebral artery feeding vessel. ⋯ The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.