Operative neurosurgery (Hagerstown, Md.)
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Oper Neurosurg (Hagerstown) · Aug 2020
Transylvian Clip Occlusion of an Enlarging High-Flow Tentorial Arteriovenous Fistula: 2-Dimensional Operative Video.
Endovascular therapy is the primary treatment for the majority of tentorial dural arteriovenous fistulas (dAVF). Surgical occlusion is an effective alternative when embolization is not possible. This video demonstrates microsugical occlusion of a right-sided tentorial dAVF in a symptomatic 45-yr-old male. ⋯ Immediate angiography demonstrates complete occlusion of the dAVF. This video demonstrates the surgical access obtained through a transylvian approach for this tentorial dAVF. Occlusion of the draining vein, with or without resection of the fistula, is enough to permanently treat these lesions.
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Oper Neurosurg (Hagerstown) · Aug 2020
Anterior Inferior Cerebellar Artery Bypasses: The 7-Bypass Framework Applied to Ischemia and Aneurysms in the Cerebellopontine Angle.
Aneurysms of the anterior inferior cerebellar artery (AICA) are rare. Primary clip reconstruction of these lesions is a challenge because of the limited surgical exposure and frequent nonsaccular aneurysm morphology. Endovascular treatment options exist, but outcomes are equivalent to those for open surgery. Historically, AICA aneurysms not amenable to clipping or primary coiling have been treated with parent vessel sacrifice. ⋯ All 7 AICA bypasses are feasible for application to AICA aneurysms and ischemic disease. Our experience with the 7-bypass framework demonstrates the utility of the framework as a decision-making tool and the breadth of bypass innovation possible in this anatomically challenging region.
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Oper Neurosurg (Hagerstown) · Aug 2020
Long-Term Outcomes of Endoscopic Third Ventricle Colloid Cyst Resection: Case Series With a Proposed Grading System.
Endoscopic resection of colloid cysts has gained recent widespread practice. However, reported complication and recurrence rates are variable, possibly, in part, because of a lack of consistency with reporting of the extent of cyst capsule removal. ⋯ Endoscopic resection of third ventricle colloid cysts without emphasizing complete capsule removal is a viable option for successfully treating colloid cysts of the third ventricle. Long-term follow-up demonstrates that it is associated with low risks of complications, morbidity, mortality, and recurrence. The proposed extent of the resection grading scheme will permit comparison between the different surgical approaches and facilitate the establishment of treatment guidelines for colloid cysts.
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Oper Neurosurg (Hagerstown) · Jul 2020
Magnetic Resonance-Guided Focused Ultrasound Capsulotomy for Treatment-Resistant Psychiatric Disorders.
Psychiatric surgery is an important domain of functional neurosurgery and involves deep brain stimulation (DBS) or lesional procedures performed for treatment-resistant psychiatric illness. It has recently become possible to use magnetic-guided focused ultrasound (MRgFUS) to perform bilateral capsulotomy, a lesional technique commonly carried out with surgical radiofrequency ablation or stereotactic radiosurgery. MRgFUS offers several advantages, including improved safety and real-time imaging of the lesions. ⋯ MRgFUS allows for a safe, less invasive technique for performing a well-studied psychiatric surgery procedure-the anterior capsulotomy.
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Oper Neurosurg (Hagerstown) · Jul 2020
Surgical Resection of a Complex Spetzler-Martin Grade IV Medial Sylvian Arteriovenous Malformation: 3-Dimensional Operative Video.
Sylvian arteriovenous malformations (AVMs) are challenging lesions for surgical management. They are classified according to the Sugita classification based on the location of the nidus in the sylvian fissure: pure, lateral, medial, and deep. Resection of these lesions are fraught with risks, as it requires extensive arachnoid dissection in the sylvian fissure in close proximity to surrounding eloquent tissue, and the presence of en passage arteries can resemble feeding arteries. ⋯ The detail of the AVM resection is described in the video clip. Postoperative digital subtraction angiography showed complete excision of the lesion, and the patient was discharged to home on postoperative day 6 without any neurological deficit. In 1-yr follow-up angiogram, beside complete obliteration of the AVM, the flow-related MCA bifurcation aneurysm as well as the M1 and M2 vessels have decreased in size and are much less prominent in comparison to the pretreatment angiography.