Operative neurosurgery (Hagerstown, Md.)
-
Oper Neurosurg (Hagerstown) · Mar 2019
Supracerebellar Infratentorial and Occipital Transtentorial Approaches to the Pulvinar: Ipsilateral Versus Contralateral Corridors.
Due to the critical neurovascular structures that surround the pulvinar, deciding the best surgical approach can be challenging, with multiple options available. ⋯ Multiple approaches to the pulvinar have been described, modified, and improved. Based on this anatomic study we believe that although the corridor distance with a contralateral approach is longer, the surgical view and access can be better. We recommend the use of a PSCI contralateral approach especially when a significant protrusion of the posterior parahippocampal gyrus is present.
-
Oper Neurosurg (Hagerstown) · Mar 2019
Hybrid Therapy for Metastatic Epidural Spinal Cord Compression: Technique for Separation Surgery and Spine Radiosurgery.
Despite major advances in radiation and systemic treatments, surgery remains a critical step in the multidisciplinary treatment of metastatic spinal cord tumors. ⋯ Separation surgery is an effective, well-tolerated, and reproducible surgery. It provides safe margins for concomitant SRS. Combined, this "Hybrid Therapy" allows durable local control, maintenance of spinal stability, and palliation of symptoms, while minimizing operative morbidity.
-
Oper Neurosurg (Hagerstown) · Mar 2019
Microsurgical Resection of a Ventral Pontine Cavernoma via Supratrigeminal Zone by Anterior Transpetrosal Approach: 2-Dimensional Operative Video.
Brainstem cavernomas with recurrent bleeding and gradual neurological deterioration should be considered an indication for surgical treatment. However, surgery is challenging for cavernous hemangiomas located in the ventral part of the pons. In such cases, safe surgical access to the brainstem is limited and obtaining a good surgical field, regardless of the approach selected, is often difficult. ⋯ In the extradural bone removal, Sonopet Ultrasonic Aspirator (Stryker Ltd, Portage, Michigan) is a very excellent surgical tool for avoiding the injury of the internal carotid artery. As demonstrated by Cavalcanti DD2, ATPA is particularly useful for accessing lesions located in the upper ventral pons via the supratrigeminal zone because it provides a wide and shallow surgical field above the trigeminal nerve without requiring retraction of the cerebellum. We received written informed consent from the patient for this publication.
-
Oper Neurosurg (Hagerstown) · Mar 2019
Transtentorial Approach for Parahippocampal Gyrus Arteriovenous Malformation Resection: 3-Dimensional Operative Video.
Medial temporal basal arteriovenous malformations (AVMs) have complex anatomy. They usually drain to the basal vein of Rosenthal, and arterial feeders can arise from the anterior choroidal artery and its branches, or from the posterior cerebral artery. If the AVM is more posterior in the parahippocampal gyrus, there is a predominance of arterial feeders arising from P2P or P3 segments of the posterior cerebral artery. ⋯ The patient underwent microsurgical treatment in semi-sitting position using a supracerebellar and infratentorial approach with transtentorial resection. The AVM was completely removed, and the patient recovered without neurological deficits. The authors present a 3-dimensional video of the microsurgical steps required to perform a transtentorial approach for AVM resection in the parahippocampal gyrus. The patient signed the Institutional Consent Form, which allows the use of his/her images and videos for any type of medical publications in conferences and/or scientific articles.
-
Oper Neurosurg (Hagerstown) · Feb 2019
Endoscopic Endonasal Transclival Approach to the Ventral Brainstem: Anatomic Study of the Safe Entry Zones Combining Fiber Dissection Technique with 7 Tesla Magnetic Resonance Guided Neuronavigation.
Treatment of intrinsic lesions of the ventral brainstem is a surgical challenge that requires complex skull base antero- and posterolateral approaches. More recently, endoscopic endonasal transclival approach (EETA) has been reported in the treatment of selected ventral brainstem lesions. ⋯ Exposure of the ventral brainstem with EETA requires mastering surgical maneuvers, including pituitary transposition and extradural petrosectomy. The correlation of fiber dissection with 7T-MRI neuronavigation significantly improves the understanding of the brainstem anatomy.