Neurosurgery
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Review Case Reports
Cervical dumbbell intra-extradural hemangioblastoma: total removal through the lateral approach: technical case report.
Extradural hemangioblastomas account for 8 to 12% of all spinal hemangioblastomas. Among them, intra-extradural forms with a dumbbell extension are extremely rare. We report a case of intra-extradural hemangioblastoma involving the C6 cervical nerve root. ⋯ This is the sixth reported case of a cervical dumbbell hemangioblastoma investigated by computed tomographic scanning and MRI but the first one resected via the lateral approach. The lateral approach seems appropriate for surgical resection because it provides primary control of the vascular feeders and access to the extradural and intradural components.
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Review Case Reports
Neuroendovascular interventions for intracranial posterior circulation disease via the transradial approach: technical case report.
To describe our experience with the transradial approach for posterior circulation neurointerventional procedures. To the best of our knowledge, this approach has not been described previously for intracranial neuroendovascular procedures. ⋯ The transradial approach is an alternative to the femoral approach for posterior circulation neuroendovascular intervention. This approach has several advantages over other approaches, and the vasculature can be less tortuous than that encountered during the femoral approach. These factors can result in increased device trackability and procedural ease.
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Review
Thrombotic intracranial aneurysms: classification scheme and management strategies in 68 patients.
Thrombotic aneurysms are a diverse collection of complex aneurysms characterized by organized intraluminal thrombus and solid mass. Consequently, their treatment often requires techniques other than conventional clipping, such as thrombectomy with clip reconstruction or bypass with parent artery occlusion. A single-surgeon experience with thrombotic aneurysms was analyzed to determine optimal treatment strategies. A classification scheme was devised on the basis of aneurysm, thrombus, and lumen morphology to relate these anatomic features to surgical therapy. ⋯ Despite their solid mass, one-third of thrombotic aneurysms can be treated surgically with conventional clipping. Direct clipping is associated with the best surgical results, and the proposed classification scheme identifies thrombotic aneurysms that may be clippable. Patients with unclippable thrombotic aneurysms had more favorable results when treated with bypass and aneurysm occlusion than with thrombectomy and clip reconstruction. The classification scheme may provide conceptual clarity and therapeutic guidance with preoperative and intraoperative decision making.
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Intraoperative rupture (IOR) of an aneurysm is a known risk in the surgical management of intracranial aneurysms. The purpose of this study was to determine the incidence of IOR in a modern surgical series and to assess which factors bear upon it. ⋯ The rate of significant IOR can be kept low. Aneurysm location, subarachnoid hemorrhage, and temporary arterial occlusion seem to be important factors affecting the incidence of IOR.
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In this report, we discuss the pertinent bony, arachnoid, and neurovascular anatomy of vestibular schwannomas that has an impact on the surgical technique for removal of these tumors, with the goal of facial nerve and hearing preservation. The surgical technique is described in detail starting with anesthesia, positioning, and neurophysiological monitoring and continuing with the exposure, technical nuances of tumor removal, hemostasis, and closure. Positive prognostic factors for hearing preservation are also highlighted.