Neurosurgery
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To introduce the supratonsillar approach, an approach that traverses the tonsillobiventral fissure in a trajectory over the cerebellar tonsil to the inferior cerebellar peduncle, and to demonstrate the utility of this approach for resecting peduncular cavernous malformations. ⋯ The supratonsillar approach differs from the transvermian and telovelar approaches to the fourth ventricle, with a more superolateral trajectory that leads instead to the inferior cerebellar peduncle. By splitting the tonsillobiventral fissure and mobilizing the tonsil inferomedially, the point of access to the lesion is deepened and transgression of normal cerebellar tissue is minimized. This elegant approach is ideally suited to the removal of cavernous malformations.
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To describe the surgical anatomy of the anterior, middle, and posterior portions of the medial temporal region and to present an anatomic-based classification of the approaches to this area. ⋯ Each approach to medial temporal lesions has technical or functional drawbacks that should be considered when selecting a surgical treatment for a given patient. Dividing the medial temporal region into smaller areas allows for a more precise analysis, not only of the expected anatomic relationships, but also of the possible choices for the safe resection of the lesion. The systematization used here also provides the basis for selection of a combination of approaches.
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Despite the widespread use of external ventricular drainage (EVD), the frequency of associated hemorrhagic complications remains unclear. This retrospective study examined the frequency of hemorrhagic complications of EVD and attempted to discern associated risk factors. ⋯ Hemorrhagic complications of EVD placement are more common than previously suspected. Admitting diagnosis seems to have an effect on the development of an associated hemorrhage and its size. Catheter gauge has an effect on hematoma volume. Most of the hemorrhages seen on postinsertion computed tomographic scans do not cause detectable changes in the clinical examination.
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To define the microsurgical anatomy of the central retinal artery (CRA) and to provide a guide to avoiding damage to it during surgery. ⋯ The CRA is at risk of being damaged or occluded during procedures involving a large part of the orbit. Procedures directed along the lower half of the proximal two-thirds of the optic sheath have the greatest risk of interrupting the artery.
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Clinical Trial
Intraoperative cortical surface characterization using laser range scanning: preliminary results.
To present a novel methodology that uses a laser range scanner (LRS) capable of generating textured (intensity-encoded) surface descriptions of the brain surface for use with image-to-patient registration and improved cortical feature recognition during intraoperative neurosurgical navigation. ⋯ This study demonstrates clinical deployment of an LRS capable of generating textured surfaces of the surgical field of view. Data from the LRS was registered accurately to the corresponding preoperative data. Visual inspection of the registration results was provided by overlays that put the intraoperative data within the perspective of the whole brain's surface. These visuals can be used to more readily assess the fidelity of image-to-patient registration, as well as to enhance recognition of cortical features for assistance in comparing the neurotopography between magnetic resonance image volume and physical patient. In addition, the feature-rich data presented here provides considerable motivation for using LRS scanning to measure deformation during surgery.