Neurosurgery
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Case Reports
Keyhole supracerebellar transtentorial transcollateral sulcus approach to the lateral ventricle.
Meningiomas of the lateral ventricles are commonly located in the atria. Surgical access to such tumors is challenging because of their deep location and proximity to critical neurovascular structures, particularly if situated on the dominant side. Although a number of approaches have been described in the literature, most carry the risk of postoperative neuropsychological, visual, or speech deficits, especially when operating on the dominant hemisphere. The supracerebellar transtentorial transcollateral sulcus (STTCS) approach offers the potential to circumvent functionally important structures, reducing the risk of these approach-related neurological deficits. ⋯ The STTCS approach provides good access to tumors located in the trigonal region, reducing the risk of iatrogenic language or visual field deficits. In dominant hemisphere lesions, in the hands of an experienced neurosurgeon, the STTCS approach is an effective alternative to existing techniques.
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The anterior choroidal artery (AChA) supplies important areas of the nervous system, particularly the posterior limb of the internal capsule and optic radiation. Treatment of AChA aneurysms poses particular challenges because of the complex anatomy of the aneurysm associated with the relatively small diameter of AChAs, making preservation of the parent vessel during clip ligation or endosaccular coiling challenging. ⋯ The ischemic complication rate from surgical treatment of AChA aneurysms is most closely associated with higher frequency of temporary clip applications for proximal control and may be lower than previously reported. Supplementary intraoperative tools and limitation of vessel manipulation should be used to improve outcomes.
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Carefully tailoring the transclival approach to the involved parts of the upper, middle, or lower clivus requires a precise understanding of the focal relationships of the clivus. ⋯ The transclival approach can be carefully tailored to expose focal lesions in the anterior part of the posterior fossa.
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Medically intractable epilepsy involving drop attacks can be difficult to manage and negatively affect quality of life. Most studies investigating the effect of corpus callosotomy (CC) on seizures have been limited, focusing on the pediatric population or drop seizures alone, with little attention to other factors influencing seizure outcome. ⋯ CC for medically refractory generalizing epilepsy is effective for both drop seizures and other seizure types. CC should be considered soon after a patient has been deemed medically refractory because earlier age at surgery results in lower risk and better outcome.
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In endovascular treatment for cerebral aneurysms using balloons, stents, or flow diverters, a microguidewire or microcatheter needs to be navigated distally across the neck of the aneurysm. However, this is sometimes difficult when there is a wide-neck or large aneurysm with a tortuous or atherosclerotic parent vessel. In this case report, we describe a new technique for navigating a microcatheter into a distal vessel. ⋯ This novel neck-sealing technique with a balloon for distal access may be useful in cases in which other methods are unsuccessful. In addition, this technique offers the advantages of not producing a loop in the microcatheter within an aneurysm and not requiring retraction of the microcatheter to reduce the loop.