World Neurosurg
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Lesions arising at the ventral thalamopeduncular junction are difficult to resect. In addition to being relatively inaccessible, these lesions are located in one of the most sensitive areas of the brain. A critical question is whether new approaches could be developed to allow surgeons to adequately resect these lesions with reasonable outcomes. In the present report, we describe our approach to resect lesions in this region of the brain using an eyebrow craniotomy approach with a trajectory through the supracarotid triangle. ⋯ Lesions arising at the ventral thalamopeduncular junction can be adequately resected with reasonable outcomes using an eyebrow, supracarotid triangle approach. This operative technique establishes another potential operative corridor by which neurosurgeons can resect lesions arising within this relatively inaccessible part of the brain.
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A 66-year-old woman had presented with a 3-month history of left trigeminal neuralgia. She had undergone successful microvascular decompression for right-sided trigeminal neuralgia 8 years previously. ⋯ We have provided preoperative and intraoperative images illustrating nicely the adapted postoperative change in venous outflow causing contralateral compression of the trigeminal nerve. Consecutive treatment effects should be carefully considered when offering and performing surgical microvascular decompression.
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Deep brain stimulation of the ventral intermediate nucleus (VIM) or caudal zona incerta (cZI) is effective for refractory essential tremor (ET). To refine stereotactic planning for lead placement, we developed a unique individualized anatomy-based planning protocol that targets both the VIM and the cZI in patients with ET. ⋯ Individualized anatomy-based VIM-cZI targeting is feasible and safe and is associated with favorable tremor outcomes.
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Case Reports
DECOMPENSATION OF A THORACIC MENINGIOMA BELOW THE OPERATED LEVEL: A DRAMATIC AND UNEXPECTED COMPLICATION.
Paraplegia after lumbar spinal surgery has been previously described. It was generally provoked by a missed thoracic compression because of degenerative processes, arachnoid cyst, and spinal cord tumor such as meningioma. We describe here a case of a patient with neurofibromatosis type 2 (NF-2) with multiple spinal meningiomas that developed postoperative paraplegia because of decompensation of spinal cord compression below and far from the operated level. ⋯ We report here the first case of acute neurologic deterioration after decompensation of a spinal cord compression below the operated level in spinal intradural surgery. Neurosurgeons must be aware of this possible complication when treating patients with multiple spinal meningiomas.