Operative neurosurgery (Hagerstown, Md.)
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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.
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Oper Neurosurg (Hagerstown) · Mar 2020
Antibiotic Impregnated Catheter Coating Technique for Deep Brain Stimulation Hardware Infection: An Effective Method to Avoid Intracranial Lead Removal.
Few studies have proposed alternative salvage methods of deep brain stimulation (DBS) intracranial lead once the infection has already occurred. ⋯ The antibiotic impregnated catheter coating technique seems to be effective in avoiding intracranial lead removal in case of IPG or DBS extension-lead junction infection. This method does not require any surgical learning curve, it is safe and relatively inexpensive. Randomized, prospective, larger studies are needed to validate our results.
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Oper Neurosurg (Hagerstown) · Mar 2020
Robot-Assisted Insular Depth Electrode Implantation Through Oblique Trajectories: 3-Dimensional Anatomical Nuances, Technique, Accuracy, and Safety.
The insula is a deep cortical structure that has renewed interest in epilepsy investigation. Invasive EEG recordings of this region have been challenging. Robot-assisted stereotactic electroencephalography has improved feasibility and safety of such procedures. ⋯ Oblique trajectories are the preferred method for insular investigation at our institution, maximizing the number of contacts within insular cortex without traversing through sulci or major CSF fissures. Robot-assisted procedures are safe and efficient. 3D understanding of the insula's unique anatomical features can help the surgeon to improve targeting of this structure.
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Oper Neurosurg (Hagerstown) · Mar 2020
Transdiscal C7 Pedicle Subtraction Osteotomy With a Strut Graft and the Correction of Sagittal and Coronal Imbalance of the Cervical Spine.
Cervical spine deformity negatively affects patients' quality of life. Pedicle subtraction osteotomy (PSO) has reported to correct cervical deformity but it is challenging and carries a significant risk of morbidity. ⋯ Transdiscal C7 PSO with a strut graft placement provided a safe way of correcting sagittal and coronal imbalance simultaneously and reduced neurological complication by preventing sagittal translation, foraminal narrowing and spinal cord kinking.