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Operative Neurosurgery (Hagerstown, Md.)

Ivan Radovanovic, Amir R Dehdashti, Mazda K Turel, Joao Paulo Almeida, Bruno L Godoy, Francesco Doglietto, Allan D Vescan, Gelareh Zadeh, Fred Gentili
BACKGROUND: The role of expanded endonasal endoscopic surgery for primary and recurrent craniopharyngioma is not yet fully established. OBJECTIVE: To report and evaluate our experience with the endoscopic endonasal approach (EEA) for the resection of primary and recurrent craniopharyngiomas. METHODS: This is a retrospective cohort analysis of 43 consecutive EEA procedures in 40 patients operated from September 2006 to February 2012 for suprasellar craniopharyngiomas...
February 15, 2019: Operative Neurosurgery (Hagerstown, Md.)
Elias Atallah, Hassan Saad, Jonathan Li, Ayan Kumar, Stavropoula Tjoumakaris, Nohra Chalouhi, David Hasan, Hekmat Zarzour, Nabeel Herial, Michael Reid Gooch, Robert H Rosenwasser, Pascal Jabbour
BACKGROUND: The use of the pipeline embolization device (PED; Medtronic, Dublin, Ireland) in the posterior circulation has been limited and infrequently reported compared to other off-label utilizations. Posterior inferior cerebellar artery aneurysms (PICAA) constitute 1 of the least reported posterior circulation aneurysms treated with PED. No clinical studies have addressed the treatment of these aneurysms with flow diversion exclusively. OBJECTIVE: To appraise the feasibility and the safety of PED in the treatment of PICAAs...
February 12, 2019: Operative Neurosurgery (Hagerstown, Md.)
Srikant S Chakravarthi, Amin B Kassam, Melanie B Fukui, Alejandro Monroy-Sosa, Nichelle Rothong, Joseph Cunningham, Jonathan E Jennings, Neil Guenther, Jeremy Connelly, Tobias Kaemmerer, Kenneth C Nash, Mark Lindsay, Janie Rissell, Juanita M Celix, Richard A Rovin
BACKGROUND: Endoscopic and microneurosurgical approaches to third ventricular lesions are commonly performed under general anesthesia. OBJECTIVE: To report our initial experience with awake transsulcal parafascicular corridor surgery (TPCS) of the third ventricle and its safety, feasibility, and limitations. METHODS: A total of 12 cases are reviewed: 6 colloid cysts, 2 central neurocytomas, 1 papillary craniopharyngioma, 1 basal ganglia glioblastoma, 1 thalamic glioblastoma, and 1 ependymal cyst...
February 12, 2019: Operative Neurosurgery (Hagerstown, Md.)
Kiyohiko Sakata, Nobuyuki Takeshige, Yui Nagata, Hidenobu Yoshitake, Satoru Komaki, Naohisa Miyagi, Motohiro Morioka
BACKGROUND: Tuberculum sellae meningiomas frequently extend into the optic canals, which leads to a progressive longitudinal visual loss. Therefore, in addition to tumor removal, unroofing and exploration inside the optic canal are important procedures. OBJECTIVE: To perform endoscopic endonasal tumor removal with optic canal decompression for small primary or recurrent meningiomas associated with a progressive visual loss at the inferior-medial optic canal, which corresponded to a blind corner in the ipsilateral pterional/subfrontal approach...
February 7, 2019: Operative Neurosurgery (Hagerstown, Md.)
Chad R Gordon, Amir Wolff, Gabriel F Santiago, Kenneth Liebman, Erol Veznedaroglu, Frank D Vrionis, Judy Huang, Henry Brem, Mark Luciano
BACKGROUND: Implantable shunt devices are critical and life saving for hydrocephalus patients. However, these devices are fraught with high complication rates including scalp dehiscence, exposure, and extrusion. In fact, high shunt valve profiles are correlated with increased complications compared to those with lower profiles. As such, we sought a new method for integrating shunt valves for those challenging patients presenting with scalp-related complications. OBJECTIVE: To safely implant and integrate a hydrocephalus shunt valve device within a customized cranial implant, in an effort to limit its high-profile nature as a main contributor to shunt failure and scalp breakdown, and at the same time, improve patient satisfaction by preventing contour deformity...
February 7, 2019: Operative Neurosurgery (Hagerstown, Md.)
Jakub Godzik, Corey T Walker, Cory Hartman, Bernardo de Andrada, Clinton D Morgan, George Mastorakos, Steven Chang, Jay Turner, Randall W Porter, Laura Snyder, Juan Uribe
BACKGROUND: Minimally invasive surgery (MIS) and anterior (ALIF), transforaminal (TLIF), or lateral lumbar interbody fusion (LLIF) often require percutaneous pedicle screw fixation (PSF) to achieve circumferential fusion. Robotic guidance technology may augment workflow to improve screw placement and decrease operative time. OBJECTIVE: To report surgical experience with robotically assisted percutaneous screw placement following LLIF. METHODS: Data from fusions with robotically assisted PSF in prone or lateral decubitus positions was reviewed...
February 6, 2019: Operative Neurosurgery (Hagerstown, Md.)
Subum Lee, Jin Hoon Park
BACKGROUND AND IMPORTANCE: Although many studies have demonstrated the biomechanical superiority of cervical pedicle screw (CPS) placement with sufficient safety and accuracy, it also has an inevitable major drawback in that an extensive posterior neck muscle dissection results in immediate postoperative neck pain. To avoid this disadvantage and highlight the several biomechanical advantages of CPS, we conducted the first minimally invasive surgery using both a tubular retractor through the posterolateral approach and a freehand placement technique...
February 5, 2019: Operative Neurosurgery (Hagerstown, Md.)
Guillermo Aldave, Pascal Zinn, William E Whitehead
Craniopharyngioma constitutes one of the most challenging tumors. The surgery may be the definitive treatment and multiple approaches have been described based on different anatomical considerations. The choice of the right approach is the key to optimize the resection and minimize the risks. Besides, the presentation of this tumor in the pediatric population can carry additional challenges that are not present in adults, like the absence of pneumatization of the sphenoid bone for an endoscopic endonasal approach...
February 5, 2019: Operative Neurosurgery (Hagerstown, Md.)
Gabriel Liu, Muhammed Yaser Hasan
BACKGROUND AND IMPORTANCE: Dual iliac-screw and dual-rod fixation provides additional stability to lumbopelvic constructs and can be employed in management of neoplastic disease with extensive osseous involvement. Optimal iliac-screw positioning is vital to achieve the desired dual iliac-screw and dual-rod linkage. CLINICAL PRESENTATION: In this report, we describe our technique with particular focus on subcrestal iliac-screw entry point position using a 4-quadrant teardrop radiological view concept in a case of minimally invasive L3-iliac spinopelvic fixation using dual iliac-screw and dual-rod for a patient with pathological sacral fracture...
February 5, 2019: Operative Neurosurgery (Hagerstown, Md.)
Jiri Fiedler, Svatopluk Ostry, Martin Bombic, Ludek Sterba, Petr Kostal
This video shows an urgent microsurgical embolectomy of the inferior division of the left middle cerebral artery in a patient treated by intravenous thrombolysis (IVT). Patient was eligible for endovascular mechanical thrombectomy1; however, the interventional radiologist was not comfortable performing the procedure given prior unsuccessful attempts to remove a calcified cerebral embolus.2 A 75-yr-old female presented with an acute ischemic stroke with isolated aphasia (NIHSS 9). Using the drip-and-ship concept, IVT (0...
February 4, 2019: Operative Neurosurgery (Hagerstown, Md.)
Sirin Gandhi, Ruth Lau Rodriguez, Halima Tabani, Jan-Karl Burkhardt, Arnau Benet, Michael T Lawton
A dolichoectatic intracranial vessel with multiple fusiform aneurysms on the same vessel segment is rare, and usually managed with a bypass with aneurysm trapping. This video demonstrates trapping and a double-barrel superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass to treat two fusiform aneurysms in a left dolichoectatic superior MCA trunk. A 46-year-old man with AIDS presented with aphasia and hemiparesis. IRB approval and patient consent were obtained. Both STA branches (frontal and parietal) were harvested...
January 30, 2019: Operative Neurosurgery (Hagerstown, Md.)
Devi Prasad Patra, Amey Rajan Savardekar, Rimal H Dossani, Nasser Mohammed, Vinayak Narayan, Maria-Magdalena Georgescu, Anil Nanda
Peritrigonal lesions are deeply seated and are surrounded by critical neurovascular structures. Traditional transcortical approaches carry the risk of damage to important surrounding white matter tracts. In this regard, a posterior interhemispheric approach gives a more direct and less invasive route and therefore is a reasonable alternative to transcortical approaches. The 3-dimensional video includes illustrations and animations showing the anatomy of the white matter tracts around the trigone and explains the physiological basis of posterior interhemispheric precuneal approach to this complex region...
January 30, 2019: Operative Neurosurgery (Hagerstown, Md.)
Andrei F Joaquim, Eberval Gadelha Figueiredo
No abstract text is available yet for this article.
January 28, 2019: Operative Neurosurgery (Hagerstown, Md.)
Grigor Grigoryan, Serkan Inceoglu, Olumide A Danisa, Wayne Cheng
BACKGROUND: Cortical bone trajectory is a relatively new alternative for instrumentation of the lumbar spine. When performing lumbosacral instrumentation, a novel S1 endplate penetrating screw (EPS) has been recently shown to have higher insertional torque than the traditional trajectory screw, but the biomechanical properties of this new trajectory are yet to be verified with the cadaveric studies. OBJECTIVE: To evaluate 2 screw trajectories in sacra using cyclic loading and pullout tests, and to determine whether bone quality had different effects on the 2 trajectories...
January 28, 2019: Operative Neurosurgery (Hagerstown, Md.)
Pär Asplund, Bengt Linderoth, Göran Lind, Jaleh Winter, A Tommy Bergenheim
BACKGROUND: Trigeminal neuralgia associated with multiple sclerosis (MS-TN) is comparatively rare and larger series of percutaneous balloon compression (PBC) in such cases are few in the literature. OBJECTIVE: To evaluate the results after PBC for MS-TN with regards to therapeutic effect, side effects, and complications. METHODS: One hundred eleven procedures with PBC performed in 66 cases of MS-TN were analyzed. Therapeutic effect was measured as postoperative time to pain recurrence without medication...
January 23, 2019: Operative Neurosurgery (Hagerstown, Md.)
Robert F Heary, Nitin Agarwal, Prateek Agarwal, Ira M Goldstein
BACKGROUND: While recent data has demonstrated the utility of lumbar pedicle screws for the treatment of vertebral osteomyelitis, the data are limited for thoracic pedicle screws. OBJECTIVE: To investigate the effectiveness of thoracic pedicle screws for the surgical treatment of vertebral osteomyelitis. METHODS: A retrospective review of all operations performed by 2 spinal neurosurgeons from 1999 to 2012 yielded 30 cases of vertebral osteomyelitis that were treated with thoracic pedicle screws...
January 23, 2019: Operative Neurosurgery (Hagerstown, Md.)
William J Ares, Daniel A Tonetti, Stephanie Greene, Mahesh S Sharma, Frederico Xavier, Brian T Jankowitz, Ashutosh Jadhav
BACKGROUND AND IMPORTANCE: Flow diversion of intracranial aneurysms has been rarely described in the pediatric population. Here we discuss the technical and perioperative complexities inherent in the flow diversion of an infectious basilar apex aneurysm in a 2-yr-old child with significant medical comorbidities. CLINICAL PRESENTATION: Following judicious oral administration of dual anti-platelet agents and intra-arterial administration of calcium channel blockers to treat vasospasm, standard endovascular procedures were used to place a flow diverting stent across the neck of a rapidly enlarging infectious aneurysm of the basilar apex...
January 23, 2019: Operative Neurosurgery (Hagerstown, Md.)
Gregory D Arnone, Ziad A Hage, Fady T Charbel
BACKGROUND: A double anastomosis using a single superficial temporal artery (STA) donor branch for both a proximal side-to-side (S2S) and a distal end-to-side anastomosis is a novel direct bypass technique for use in selected patients necessitating flow augmentation. OBJECTIVE: To describe the single-vessel double anastomosis (SVDA) technique, including its indications, advantages, and limitations, in addition to reporting our cases series of patients who underwent a SVDA bypass surgery...
January 23, 2019: Operative Neurosurgery (Hagerstown, Md.)
Kristen E Jones, Matthew A Hunt, Christopher T Martin, David W Polly
BACKGROUND AND IMPORTANCE: Pedicle subtraction osteotomy (PSO) is a 3-column osteotomy used to correct rigid, large magnitude sagittal spinal deformity. PSO is an inherently destabilizing procedure intraoperatively, with high risk of neurological deficits from vertebral body subluxation or translation during osteotomy closure. Traditionally, PSO closure has been performed utilizing compression or cantilevering forces across adjacent level instrumentation. Such forces can loosen the instrumentation or cause abrupt subluxation or translation due to the magnitude of force required for PSO closure, resulting in neurological injury...
January 23, 2019: Operative Neurosurgery (Hagerstown, Md.)
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