Operative neurosurgery (Hagerstown, Md.)
-
Oper Neurosurg (Hagerstown) · Sep 2020
Case ReportsTransclival Approach for Resection of a Pontine Cavernous Malformation: 2-Dimensional Operative Video.
Cerebral cavernous malformations are common vascular anomalies consisting of a cluster of capillaries without intervening brain tissue.1 A variety of approaches for resection have been undertaken,2 and a handful of case reports have described the endoscopic, endonasal, transclival approach.3 We present a case of a 51-yr-old woman with lupus and hepatitis B-associated cirrhosis who presented with diplopia, dysphagia, and ataxia. She had a left abducens nerve palsy and magnetic resonance imaging (MRI) showed a left pontine cavernous malformation. After a repeat hemorrhage, she consented to surgical resection. ⋯ Cerebrospinal fluid (CSF) leak was ruled out using an intrathecal fluorescein injection. She was discharged home, but presented 2 wk postoperatively with aseptic meningitis, which was treated supportively. Postoperative imaging did not show residual cavernoma.
-
Oper Neurosurg (Hagerstown) · Sep 2020
Case ReportsLumbar Lateral Recess Decompression: 2-Dimensional Operative Video.
Lateral recess stenosis is a common cause of lumbar radiculopathy in adults. A lumbar nerve root travels in the lateral recess prior to exiting the spinal canal via the neural foramen. In the lateral recess, the traversing nerve root is susceptible to compression by the degenerative hypertrophy of the medial facet in addition to hypertrophied ligamentum flavum and herniated intervertebral disc.1 These degenerative changes are also typically associated with neural foraminal stenosis. ⋯ In this video, we present a case of a 64-yr-old male presenting with progressive left L5 radiculopathy refractory to conservative management, with magnetic resonance imaging (MRI) findings of left L4-5 foraminal and lateral recess stenosis. We demonstrate the operative steps to complete a left L4-5 hemilaminectomy, medial facetectomy, foraminotomy, and microdiscectomy. Appropriate patient consent was obtained.
-
Oper Neurosurg (Hagerstown) · Sep 2020
Identification of the Distal Dural Ring and Definition of Paraclinoid Aneurysms According to Bony Landmarks on 3-Dimensional Computed Tomography Angiography: A Cadaveric and Radiological Study.
Determining if paraclinoid aneurysms are intradural or extradural is critical for surgical planning. ⋯ The DDR plane method provides a useful diagnostic tool to evaluate the position of the DDR and determine the anatomic location of paraclinoid aneurysms.
-
Oper Neurosurg (Hagerstown) · Sep 2020
Ventilated Upper Airway Endoscopic Endonasal Procedure Mask: Surgical Safety in the COVID-19 Era.
COVID-19 poses a risk to the endoscopic skull base surgeon. Significant efforts to improving safety have been employed, including the use of personal protective equipment, preoperative COVID-19 testing, and recently the use of a modified surgical mask barrier. ⋯ The ventilated upper airway endoscopic procedure mask allows for a sealed surgical barrier during endoscopic skull base surgery and may play a critical role in advancing skull base surgery in the COVID-19 era. The nasal trocar may be a useful alternative in instances where 3D printing is not available. Additional studies are needed to validate these preliminary findings.
-
Oper Neurosurg (Hagerstown) · Sep 2020
A Novel Technical Refinement of Microvascular Decompression: Pain Relief and Complication Rate in a Consecutive Series of Patients With Trigeminal Neuralgia.
Microvascular decompression (MVD) represents a milestone for the treatment of trigeminal neuralgia (TN). Nevertheless, several complications still occur and may negatively affect the outcome. We recently proposed some technical nuances for complication avoidance related to MVD. ⋯ The proposed refinement of the standard MVD technique has proved effective in maintaining excellent results in terms of pain relief while minimizing the overall complication rate associated with this surgical approach.