Operative neurosurgery (Hagerstown, Md.)
-
Oper Neurosurg (Hagerstown) · Mar 2020
Biplane Fluoroscopic-Guided Balloon Rhizotomy for Trigeminal Neuralgia: A Technical Note.
The classic percutaneous technique used to cannulate the foramen ovale for the treatment of trigeminal neuralgia can place important anatomic structures, such as the distal cervical internal carotid artery, at risk. ⋯ Balloon rhizotomy is a commonly used treatment option for trigeminal neuralgia. Direct visualization of the foramen ovale can reliably be achieved on AP fluoroscopy using specific anatomic landmarks. This technique can be utilized to increase the accuracy and safety of the procedure.
-
Oper Neurosurg (Hagerstown) · Feb 2020
Case ReportsPterional Craniotomy for Resection of Clinoidal Meningioma Associated With an Aerated Anterior Clinoid Process: 2-Dimensional Operative Video.
Extradural removal of the clinoid performed prior to resection of clinoidal meningiomas has been advocated as a way to facilitate devascularization of the tumor and provide early identification and/or decompression of adjacent neurovascular structures. A small number of video publications exist in the literature that provides useful guidance to surgeons preparing for resection of clinoidal region meningiomas.1-3 However, none of these videos portray the variable anatomy associated with an aerated clinoid process. This known anatomical variant can increase the risk profile associated with resection of clinoidal meningomas-especially with regards to postoperative cerebrospinal fluid (CSF) fistula. In this video publication, we discuss the care of a 54 yr-old male who presented with visual deterioration in the right eye. ⋯ Following resection, MRI obtained in the early postoperative period demonstrated gross total resection of the neoplasm without untoward finding. The patient noted marked improvement in his vision following surgery and did not suffer any complications relating to postoperative CSF fistula. Full patient consent for photography and/or recording of other forms of video/imaging was obtained in the preoperative period.
-
Oper Neurosurg (Hagerstown) · Jan 2020
Multimodal Management of a Ruptured Right Medial Parietal Arteriovenous Malformation: 2-Dimensional Operative Video.
Arteriovenous malformations (AVM) of the medial surface of the cerebral hemispheres are challenging because of the limited access to the interhemispheric fissure, the presence of the bridging veins, and the difficult control of arterial feeders and deep venous drainage. We present a 20-yr-old patient with a grade 3 Spetzler Martin ruptured right medial parietal AVM revealed by headaches, left hemiparesis, and ataxia. We highlight the importance of a detailed and selective study of AVM angioarchitecture with new sequences as XperCT (Philips Medical) viewing which permits a better understanding of the anatomy and pathology and a better therapeutical planning. ⋯ At the last follow-up, the patient had only slight left ataxia. Multimodal management with planned selective embolization may facilitate microsurgical resection of AVMs. Given the retrospective nature of this report, informed consent was not required.
-
Oper Neurosurg (Hagerstown) · Jan 2020
Thoracic 11-Lumbar 1 Laminoplasty for Resection of Conus Arteriovenous Malformation: 2-Dimensional Operative Video.
Conus medullaris spinal arteriovenous malformations are uniquely classified by the Spetzler classification. They possess a glomus (type II) nidus in either or both the intra- and extramedullary compartments, with multiple feeding arteries and niduses resulting in complex venous drainage patterns. These characteristics make resection of these lesions challenging, and these lesions are associated with a high risk for recurrence. ⋯ 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.
-
Oper Neurosurg (Hagerstown) · Jan 2020
Case ReportsMedial Temporal Encephalocele and Medically Intractable Epilepsy: A Tailored Inferior Temporal Lobectomy and Case Report.
Temporal lobe encephaloceles are increasingly recognized as a potential cause of medically refractory epilepsy and surgical treatment has proven effective. Resection of the encephalocele and associated cortex is often sufficient to provide seizure control. However, it is difficult to determine the extent of adjacent temporal lobe that should be resected. We present a case report and our technique of a tailored inferior temporal pole resection. ⋯ Resection of temporal encephalocele and adjacent cortex is safe and effective procedure for select patients with medically refractory epilepsy. This video demonstrates our technique which provides a more standardized approach to the resection.