World Neurosurg
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Case Reports
Fully endoscopic transforaminal-transchoroidal approach for tectal area tumors removal.
The surgical approaches to lesions located in the tectal area have remained controversial. The essential functions in the surrounding areas and the difficulties in obtaining a good surgical view during tumor removal have made these procedures risky and challenging. Endoscopic transforaminal approaches have been previously described for biopsy and intraventricular tumor removal. However, the endoscopic transforaminal-transchoroidal gross resection technique for such cases has barely been described. ⋯ In our experience, a fully endoscopic transforaminal-transchoroidal approach was a suitable treatment for this complex pathological entity. Opening of the choroidal fissure added an extra angle of work and improved the exposure of the upper posterior part of the third ventricle.
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Case Reports
Tuberculoma of the peripheral nerve: Illustrative case and systematic review of literature.
Tuberculomas affecting the peripheral nerve are exceedingly rare. As such, little has been reported about their clinical features, treatment, and outcomes. ⋯ Tuberculoma of the peripheral nerve is a rare manifestation of tuberculous disease, with a predilection for the ulnar nerve. Current management includes nerve exploration, lesion resection, and antitubercular treatment, which often results in good neurologic recovery.
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Trigeminal neuralgia is featured by episodic and severe unilateral facial pain triggered usually by innocuous cutaneous stimuli.1-4 Microvascular decompression (MVD) is a safe and effective treatment for cases refractory to medical treatment caused by neurovascular conflicts.1,5-7 This Video 1 demonstrates MVD using arachnoid membrane and petrosal dura to transpose dual offending arteries. Informed consent was obtained from the patient for publication of this operative video. The patient was a 64-year-old woman with refractory right trigeminal neuralgia (V2 territory). ⋯ Postoperative imaging demonstrated no signs of cerebellar contusion or hemorrhage. The patient presented complete resolution of her pain, and no neurologic deficits were observed. We demonstrate MVD with 2 different transposition techniques that can be considered for trigeminal neuralgia with dual offending arteries (AICA, SCA).
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Many medical students find neurosurgery interesting, but few pursue it as a career. Reasons for this mismatch include lack of exposure and poor perceptions of its career demands, work-life balance, personalities, and patient outcomes. It is imperative to recruit promising students early in medical school to build a pipeline of future neurosurgeons. We aimed to recruit medical students to neurosurgery and improve perceptions of the field by hosting an optional cadaver laboratory event (Neuroanatomy Lab Initiative [NLI]) during first-year students' gross anatomy course. ⋯ An NLI during first-year medical students' anatomy course was an effective, relatively low-resource means of engaging students and improving their perceptions of neurosurgery. We provide a framework for scaling this initiative to other institutions to help recruit the next generation of neurosurgeons.
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Chronic midline low back pain is the number one reason for disability in the United States despite the prolific use of medical and surgical interventions. Notwithstanding the widespread use of epidural spinal cord stimulators (SCSs), there remains a large portion of the population with inadequate pain control thought to be because of the limited volume of stimulated neural tissue. Intradural SCSs represent an underexplored alternative strategy with the potential to improve selectivity, power efficiency, and efficacy. We studied and carried out development of an intradural form of an SCS. Herein we present the findings of in vivo testing of a prototype intradural SCS in a porcine model. ⋯ Chronically implanted intradural device in the porcine model demonstrated safety and feasibility for translation into humans.