World Neurosurg
-
Case Reports
Clip reconstruction of fusiform A1 segment aneurysm using lateral supraorbital approach.
Fusiform aneurysms of the anterior cerebral artery are a surgical rarity encountered only occasionally by a neurosurgeon.1,2 Seen most commonly in the vertebrobasilar territory, these aneurysms differ in pathophysiology and clinical presentation from their saccular counterparts. Arterial dissections and atherosclerosis are the leading causes of these aneurysms in young and elderly patients, respectively.3 Patients can present with symptoms related to mass effect/compression of adjacent structures or with ischemic symptoms apart from aneurysm rupture. Management of these aneurysms remains challenging owing to the lack of a distinct neck. ⋯ In Video 1, we present a case of fusiform A1 segment aneurysm in a 34-year-old gentleman and demonstrate how the aneurysm was clipped using a lateral supraorbital approach. He made an uneventful recovery with subtle right lower limb weakness. This video shows the technique and utility of a minimally invasive skull base approach for dealing with a fusiform anterior circulation aneurysm.
-
Endoscopic Discectomy of Rostrally and Caudally Migrated Lumbar Disc Herniations; A Technique Video.
Surgical treatment of extremely migrated caudal and rostral lumbar disk herniations is technically challenging. Traditional open technique often requires more bone resection, which can lead to rare but significant complications such as pars fracture or instability requiring fusion surgery. Endoscopic diskectomy is a safe alternative to traditional open surgery with acceptable complication rates.1-4 Endoscopic diskectomy provides the advantage of excellent visualization and maneuverability while minimizing soft tissue trauma and bony resection, which can result in less postoperative pain, less opioid consumption, and quicker recovery.5 We present a surgical technique guide (Video 1) for endoscopic diskectomy of 2 patients with very high rostral (grade 1) and caudal (grade 6) lumbar disk herniations as graded by Ahn's modification of the Lee-Kim grading classification.6,7 Risks, benefits, and alternatives to surgery were discussed with the patients, and they consented to the procedure. This video is not a replacement for hands-on training.
-
In the literature, degenerative cervical disc herniation is considered to occur more frequently at the C5-C6 and C6-C7 levels. This study aimed to evaluate the operated cervical level prevalence among patients with degenerative cervical disc herniation in a Hispanic Puerto Rico population. ⋯ In a Hispanic Puerto Rico population, the most prevalent operated degenerative cervical disc levels were C5-C6 and C4-C5.
-
Falcotentorial meningiomas involve the tentorial apex and straight sinus, posing challenges when encasing the galenic venous system.1 Microneurosurgery is considered the best treatment option for large falcotentorial meningiomas because it provides a definitive cure.2 In contrast, Gamma Knife surgery mainly allows the control of smaller or residual tumors after microsurgical resection.3 Approach selection between interhemispheric supratentorial versa supracerebellar transtentorial is dictated by the displacement of the Galen vein.1,4-8Video 1 describes the critical surgical steps of the supracerebellar "flyover" approach for a Bassiouni type II dumbbell falcotentorial meningiomas encasing the galenic venous system. Preoperative embolization was ruled out due to potential additional morbidity and mortality risks.9,10 A perimedian supracerebellar infratentorial transtentorial approach was performed with the patient in ¾ prone Concorde position. After early devascularization and division of the tentorium, the meningioma was internally debulked while preserving the arachnoid plane. ⋯ Pathology revealed a grade 2 meningioma. The patient remained asymptomatic with no recurrence at a 10-year follow-up. The reported case demonstrates that the most critical factor in the choice of approach to midline dumbbell falcotentorial meningiomas is the relationship of the tumor to the galenic venous system and its tributaries.