World Neurosurg
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During functional-based resection under awake conditions of a left frontal isocitrate dehydrogenase-wildtype glioblastoma, the initial intralesional debulking performed to alleviate mass effect unmasked the right hemibody negative motor networks that were identified on the neocortex by direct electric stimulation. As compared with preoperative evaluation, the 3-month postoperative functional magnetic resonance imaging (MRI) confirmed unmasked cortical clusters for the right hemibody that were absent preoperatively using the same functional MRI parameters; language clusters were also better seen. The glioma-induced mass effect can mask eloquent brain areas, and surgical decompression can unmask intraoperatively eloquent brain areas.
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Currently, neurosurgical vascular surgery frequently uses indocyanine green (ICG)-videography (VG) to evaluate the blood flow in brain vessels. Although ICG-VG delineates intravascular ICG fluorescence as a high-intensity signal in gray-scale with dark background, it is hard to identify anatomical structures, including vasculature or surgical devices simultaneously. This report developed combination of a near-infrared (NIR) camera with particular sensitivity and an optical filter to observe the blood-flow conditions and anatomical structures. ⋯ This study proposes a new NIR system and emphasizes simultaneous observation of anatomy and fluorescence signals during operation. It paves the way for further possibilities in the development of optical systems. To understand the natural phenomena and combination of different scientific and clinical fields, it might be important to understand and combine not only fluorescence, but also natural science, optics, and background pathology. This simple system would be available for neuroendoscope and robotic surgery.
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Case Reports
Meningocele Manqué Discovered During Filum Terminale Resection in Occult Tethered Cord Syndrome.
Meningocele manqué (MM) is characterized by tethering of the spinal cord, nerve roots, or filum terminale by fibrous attachments formed by atrophic or incomplete meningoceles. Patients with MM can present with symptoms of tethered cord syndrome (TCS). ⋯ Surgeons planning filum terminale release for occult TCS should always be aware of the possibility of associated pathological features of tethering that might be overlooked. In retrospect, the detection of MM was enabled by the high-resolution 3-dimensional constructive interference in steady state MRI sequence. This finding advocates for the use of high-resolution MRI for patients undergoing evaluation for occult TCS to detect pathological features that might otherwise be undetected.
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Hemostasis valves are commonly used in neurointerventions. We propose a novel concept for fixing hemostasis valves to the operating table during procedures. Moreover, we report our preliminary in vitro experience using these new devices created using a 3-dimensional printer. ⋯ HVHs should be more useful than conventional methods, particularly in cases requiring fine complementary control of both a microcatheter and microguidewire.
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Minimally invasive techniques have been developed to provide access to the disc with better visualization while causing less muscle trauma and its consequences. This study was aimed at evaluating the clinical outcomes and complications of the fully endoscopic lumbar discectomy interlaminar approach in a large number of patients. ⋯ Fully endoscopic interlaminar lumbar discectomy is a safe, effective option for treating lumbar disc herniation, with a long recurrence-free recovery.