Pub Date : 2011-10-01Epub Date: 2012-01-25DOI: 10.1055/s-0031-1287775
D Reddy, T Gunnarsson, K Scheinemann, J P Provias, S K Singh
Background: Choroid plexus papillomas of the third ventricle in newborn infants are quite rare and present a significant surgical challenge. This case report illustrates the utility of endoscopy in facilitating tumor resection.
Patient: A 6-week-old boy, born prematurely at a gestational age of 35 weeks, presented with hydrocephalus secondary to a choroid plexus papilloma in the third ventricle, extending to the aqueduct of Sylvius and into the fourth ventricle. On admission, he was found to have clinical signs of raised intracranial pressure. MRI revealed a homogeneously enhancing mass primarily in the third ventricle. The initial surgical procedure was insertion of a ventriculo-peritoneal shunt, followed by an endoscopic biopsy, which allowed the surgeons to mobilize the tumor into the right lateral ventricle. This facilitated a subsequent transcortical approach to completely remove the tumour.
Result and conclusion: The authors present a case of choroid plexus papilloma in an uncommon location with a unique surgical approach and a successful outcome with no neurological deficits. We detail our surgical approach and the complexity of approaching a tumor located in the third ventricle of an infant.
{"title":"Combined staged endoscopic and microsurgical approach of a third ventricular choroid plexus papilloma in an infant.","authors":"D Reddy, T Gunnarsson, K Scheinemann, J P Provias, S K Singh","doi":"10.1055/s-0031-1287775","DOIUrl":"https://doi.org/10.1055/s-0031-1287775","url":null,"abstract":"<p><strong>Background: </strong>Choroid plexus papillomas of the third ventricle in newborn infants are quite rare and present a significant surgical challenge. This case report illustrates the utility of endoscopy in facilitating tumor resection.</p><p><strong>Patient: </strong>A 6-week-old boy, born prematurely at a gestational age of 35 weeks, presented with hydrocephalus secondary to a choroid plexus papilloma in the third ventricle, extending to the aqueduct of Sylvius and into the fourth ventricle. On admission, he was found to have clinical signs of raised intracranial pressure. MRI revealed a homogeneously enhancing mass primarily in the third ventricle. The initial surgical procedure was insertion of a ventriculo-peritoneal shunt, followed by an endoscopic biopsy, which allowed the surgeons to mobilize the tumor into the right lateral ventricle. This facilitated a subsequent transcortical approach to completely remove the tumour.</p><p><strong>Result and conclusion: </strong>The authors present a case of choroid plexus papilloma in an uncommon location with a unique surgical approach and a successful outcome with no neurological deficits. We detail our surgical approach and the complexity of approaching a tumor located in the third ventricle of an infant.</p>","PeriodicalId":49808,"journal":{"name":"Minimally Invasive Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0031-1287775","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30414192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-10-01Epub Date: 2012-01-25DOI: 10.1055/s-0031-1297987
M Hayashi, M Chernov, N Tamura, M Tamura, M Izawa, Y Muragaki, H Iseki, Y Okada
Background: Radiosurgical management of large cystic metastatic brain tumors represents a significant challenge. Nevertheless, modified dose planning has shown beneficial results in such cases.
Method and results: "Donut's shape" radiosurgical treatment planning is based on the chain-like application of multiple, small-sized isocenters for selective coverage of the contrast-enhancing tumor capsule and minimal irradiation of the central cystic area. Such an approach was used for the management of large cystic intracranial metastases, which were not accompanied by a significant mass effect and did not require immediate volume reduction. Treatment was done using Leksell Gamma Knife model C with automatic positioning system. The majority of treated lesions showed significant shrinkage after radiosurgery and no major complications were met.
Conclusion: Large cystic metastatic brain tumors may be successfully treated with gamma knife radiosurgery alone using the proposed "donut's shape" dose planning with coverage of the contrast-enhancing tumor capsule by multiple small-sized isocenters.
{"title":"\"Donut's shape\" radiosurgical treatment planning for large cystic metastatic brain tumors.","authors":"M Hayashi, M Chernov, N Tamura, M Tamura, M Izawa, Y Muragaki, H Iseki, Y Okada","doi":"10.1055/s-0031-1297987","DOIUrl":"https://doi.org/10.1055/s-0031-1297987","url":null,"abstract":"<p><strong>Background: </strong>Radiosurgical management of large cystic metastatic brain tumors represents a significant challenge. Nevertheless, modified dose planning has shown beneficial results in such cases.</p><p><strong>Method and results: </strong>\"Donut's shape\" radiosurgical treatment planning is based on the chain-like application of multiple, small-sized isocenters for selective coverage of the contrast-enhancing tumor capsule and minimal irradiation of the central cystic area. Such an approach was used for the management of large cystic intracranial metastases, which were not accompanied by a significant mass effect and did not require immediate volume reduction. Treatment was done using Leksell Gamma Knife model C with automatic positioning system. The majority of treated lesions showed significant shrinkage after radiosurgery and no major complications were met.</p><p><strong>Conclusion: </strong>Large cystic metastatic brain tumors may be successfully treated with gamma knife radiosurgery alone using the proposed \"donut's shape\" dose planning with coverage of the contrast-enhancing tumor capsule by multiple small-sized isocenters.</p>","PeriodicalId":49808,"journal":{"name":"Minimally Invasive Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0031-1297987","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30414675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-10-01Epub Date: 2012-01-25DOI: 10.1055/s-0031-1283126
N McLaughlin, D Bresson, L F S Ditzel Filho, R L Carrau, D F Kelly, D M Prevedello, A B Kassam
Background: Lesions originating in the vidian canal are extremely rare. Most frequently, they are extensions from contiguous carcinomas. We present a rare case of a vidian nerve neurofibroma and discuss its surgical management.
Case report: A 62-year-old woman with a history of a basal cell skin cancer was evaluated for bilateral tinnitus. Imaging revealed a left-sided lesion at the medial aspect of the pterygoid process base, over the vidian canal. Under image-guidance, an endonasal endoscopic transpterygoid approach was performed. The histopathological examination supported the diagnosis of neurofibroma.
Conclusion: Benign nerve sheath tumors of the vidian nerve should be considered in the differential diagnosis of a vidian canal lesion. Given the propensity of more aggressive tumors, a tissue diagnosis should be warranted in order to coordinate appropriate subsequent treatment. The expanded endonasal transpterygoid approach offers a safe, less invasive, and effective route to perform the excisional biopsy of such a lesion.
{"title":"Vidian nerve neurofibroma removed via a transpterygoid approach.","authors":"N McLaughlin, D Bresson, L F S Ditzel Filho, R L Carrau, D F Kelly, D M Prevedello, A B Kassam","doi":"10.1055/s-0031-1283126","DOIUrl":"https://doi.org/10.1055/s-0031-1283126","url":null,"abstract":"<p><strong>Background: </strong>Lesions originating in the vidian canal are extremely rare. Most frequently, they are extensions from contiguous carcinomas. We present a rare case of a vidian nerve neurofibroma and discuss its surgical management.</p><p><strong>Case report: </strong>A 62-year-old woman with a history of a basal cell skin cancer was evaluated for bilateral tinnitus. Imaging revealed a left-sided lesion at the medial aspect of the pterygoid process base, over the vidian canal. Under image-guidance, an endonasal endoscopic transpterygoid approach was performed. The histopathological examination supported the diagnosis of neurofibroma.</p><p><strong>Conclusion: </strong>Benign nerve sheath tumors of the vidian nerve should be considered in the differential diagnosis of a vidian canal lesion. Given the propensity of more aggressive tumors, a tissue diagnosis should be warranted in order to coordinate appropriate subsequent treatment. The expanded endonasal transpterygoid approach offers a safe, less invasive, and effective route to perform the excisional biopsy of such a lesion.</p>","PeriodicalId":49808,"journal":{"name":"Minimally Invasive Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0031-1283126","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30414188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-10-01Epub Date: 2012-01-25DOI: 10.1055/s-0031-1284394
T Menovsky, M Plazier, R Rasschaert, A I R Maas, P M Parizel, S Verbeke
Background: Oxidized regenerated cellulose is commonly used in many surgical fields as a hemostatic agent. Complications related to swelling or compression after application of small portions of Surgicel® Fibrillar™ have not yet been described.
Patients: We report on a 65-year-old woman who was operated for a high-grade spinal stenosis at the L2-L3 level. Small portions of Surgicel® Fibrillar™ were used to control bleeding from the epidural venous plexus. The immediate postoperative course was uneventful. However, one day after surgery, the patient complained about progressive worsening pain at the operated level. A non-contrast lumbar CT scan showed no evidence of a postoperative hematoma or other complication. MR imaging showed a horseshoe-shaped mass compressing the dural sac at the operated level from posterior and both sides. Because we suspected a postoperative hematoma, the patient was re-operated. No hemorrhage was seen but instead we found large, swollen firm pieces of Surgicel® Fibrillar™ compressing the dural sac. These pieces were removed.
Result: Postoperatively no neurological deficit or pain was present. Histological examination of the removed mass of Surgicel® Fibrillar™ revealed only the presence of blood, fibrin and an amorphous eosinophilic content. There was no sign of any inflammation.
Conclusion: On the basis of this experience, we advise caution with the use of hemostatic agents during spinal surgery and - if used - strongly advise the removal of Surgicel® Fibrillar™ after the hemostasis has been achieved to avoid the development of complications due to a mass effect.
{"title":"Massive swelling of Surgicel® Fibrillar™ hemostat after spinal surgery. Case report and a review of the literature.","authors":"T Menovsky, M Plazier, R Rasschaert, A I R Maas, P M Parizel, S Verbeke","doi":"10.1055/s-0031-1284394","DOIUrl":"https://doi.org/10.1055/s-0031-1284394","url":null,"abstract":"<p><strong>Background: </strong>Oxidized regenerated cellulose is commonly used in many surgical fields as a hemostatic agent. Complications related to swelling or compression after application of small portions of Surgicel® Fibrillar™ have not yet been described.</p><p><strong>Patients: </strong>We report on a 65-year-old woman who was operated for a high-grade spinal stenosis at the L2-L3 level. Small portions of Surgicel® Fibrillar™ were used to control bleeding from the epidural venous plexus. The immediate postoperative course was uneventful. However, one day after surgery, the patient complained about progressive worsening pain at the operated level. A non-contrast lumbar CT scan showed no evidence of a postoperative hematoma or other complication. MR imaging showed a horseshoe-shaped mass compressing the dural sac at the operated level from posterior and both sides. Because we suspected a postoperative hematoma, the patient was re-operated. No hemorrhage was seen but instead we found large, swollen firm pieces of Surgicel® Fibrillar™ compressing the dural sac. These pieces were removed.</p><p><strong>Result: </strong>Postoperatively no neurological deficit or pain was present. Histological examination of the removed mass of Surgicel® Fibrillar™ revealed only the presence of blood, fibrin and an amorphous eosinophilic content. There was no sign of any inflammation.</p><p><strong>Conclusion: </strong>On the basis of this experience, we advise caution with the use of hemostatic agents during spinal surgery and - if used - strongly advise the removal of Surgicel® Fibrillar™ after the hemostasis has been achieved to avoid the development of complications due to a mass effect.</p>","PeriodicalId":49808,"journal":{"name":"Minimally Invasive Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0031-1284394","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30414190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-10-01Epub Date: 2012-01-25DOI: 10.1055/s-0031-1287833
Y Ma, Q Lan
Background: No anatomic data are available addressing the surgical indication for upper BA aneurysms via the supraorbital keyhole approach (SOKA).
Objective: An anatomic study of the SOKA to the upper BA via the optico-carotid window (OCW) was designed. Our clinical experience is reported.
Methods: After completing the SOKA craniotomy on 8 cadaveric heads, the width and length of OCW and the length of the supraclinoid internal carotid artery (SCICA) were measured. Measurement of the following was carried out through the OCW: (i) linear distance (a) of the BA from the most proximal point of visualization of the BA to the posterior clinoid process level, (ii) perpendicular distance (b) from the most distal point of visualization along the elongation of the BA to the anterior fossa level. After posterior clinoidectomy and orbitectomy, the measurement of (a) and (b) was repeated.
Results: The width and length of OCW and the SCICA length were 7.6±2.1 mm, 11.6±2.3 mm, and 12.7±2.4 mm. The distance (a) was 5.0±1.2 mm, increased by 3.4±1.0 mm after posterior clinoidectomy. The distance (b) was 12.8±2.6 mm, increased by 3.3±1.2 mm after orbitectomy. 9 aneurysms were completely clipped.
Conclusion: When the width and length of the OCW are > 5 mm and > 7 mm, respectively, the SOKA can meet the requirement of exposure and manipulation of the upper BA. The upper BA aneurysms located < 10 mm higher than the anterior fossa and not more than 5 mm lower than the PCP can be treated via the SOKA. Posterior clinoidectomy and orbitectomy can increase the proximal and the distal exposure of the BA, respectively.
{"title":"Supraorbital keyhole approach to upper basilar artery aneurysms via the optico-carotid window: a cadaveric anatomic study and preliminary application.","authors":"Y Ma, Q Lan","doi":"10.1055/s-0031-1287833","DOIUrl":"https://doi.org/10.1055/s-0031-1287833","url":null,"abstract":"<p><strong>Background: </strong>No anatomic data are available addressing the surgical indication for upper BA aneurysms via the supraorbital keyhole approach (SOKA).</p><p><strong>Objective: </strong>An anatomic study of the SOKA to the upper BA via the optico-carotid window (OCW) was designed. Our clinical experience is reported.</p><p><strong>Methods: </strong>After completing the SOKA craniotomy on 8 cadaveric heads, the width and length of OCW and the length of the supraclinoid internal carotid artery (SCICA) were measured. Measurement of the following was carried out through the OCW: (i) linear distance (a) of the BA from the most proximal point of visualization of the BA to the posterior clinoid process level, (ii) perpendicular distance (b) from the most distal point of visualization along the elongation of the BA to the anterior fossa level. After posterior clinoidectomy and orbitectomy, the measurement of (a) and (b) was repeated.</p><p><strong>Results: </strong>The width and length of OCW and the SCICA length were 7.6±2.1 mm, 11.6±2.3 mm, and 12.7±2.4 mm. The distance (a) was 5.0±1.2 mm, increased by 3.4±1.0 mm after posterior clinoidectomy. The distance (b) was 12.8±2.6 mm, increased by 3.3±1.2 mm after orbitectomy. 9 aneurysms were completely clipped.</p><p><strong>Conclusion: </strong>When the width and length of the OCW are > 5 mm and > 7 mm, respectively, the SOKA can meet the requirement of exposure and manipulation of the upper BA. The upper BA aneurysms located < 10 mm higher than the anterior fossa and not more than 5 mm lower than the PCP can be treated via the SOKA. Posterior clinoidectomy and orbitectomy can increase the proximal and the distal exposure of the BA, respectively.</p>","PeriodicalId":49808,"journal":{"name":"Minimally Invasive Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0031-1287833","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30415445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-10-01Epub Date: 2012-01-25DOI: 10.1055/s-0031-1286335
K Mori, T Esaki, T Yamamoto, Y Nakao
Objective: Individualized surgical simulation using three-dimensional (3D) imaging to allow safe performance of clipping surgery for unruptured middle cerebral artery (MCA) aneurysm via pterional keyhole mini-craniotomy was performed in 100 consecutive patients.
Methods: 3D images were reconstructed of the skin, skull, cerebral arteries and veins, and aneurysm. The size, shape, and location of the scheduled keyhole and the patient's head position were individually optimized using this preoperative simulation system. The site of opening of the sylvian fissure was also preoperatively determined according to the spatial relationships between the aneurysm and sylvian veins. 110 pterional keyhole clipping surgeries were consecutively performed in 100 patients.
Results: The mean diameter of the pterional keyhole was 25±2 mm. Magnetic resonance imaging detected lacunar infarction in 4 cases (3.6%) but no other abnormalities. 1 patient suffered a reversible ischemic neurological deficit and 1 patient (79 years old) showed mild dementia. The modified Rankin scale at 3 months after the operation was grade 0 in all cases except 1 patient with mild dementia (grade 1). Mini-mental state examination, Hamilton rating scale for depression, and Beck depression inventory were all significantly improved (p<0.01) after the operations.
Conclusion: Pterional keyhole clipping surgery based on careful surgical simulation with 3D images is a safe and less invasive means to treat relatively small unruptured MCA aneurysms.
目的:对100例连续行翼点锁眼小开颅术治疗未破裂的大脑中动脉动脉瘤的患者进行个体化手术模拟,以保证手术的安全性。方法:重建皮肤、颅骨、脑动静脉和动脉瘤的三维图像。使用该术前模拟系统分别优化预定锁孔的大小、形状和位置以及患者的头部位置。根据动脉瘤与侧静脉的空间关系,术前确定了侧裂的开放位置。对100例患者进行了110例翼侧锁眼夹闭手术。结果:翼侧锁孔平均直径为25±2mm。磁共振成像发现腔隙性梗死4例(3.6%),无其他异常。1例患者出现可逆性缺血性神经功能缺损,1例患者(79岁)出现轻度痴呆。术后3个月改良Rankin量表评分均为0级,除1例患者出现轻度痴呆(1级)外,其余病例均为0级。Mini-mental state examination、Hamilton抑郁量表、Beck抑郁量表评分均有显著改善(p结论:基于仔细的三维图像手术模拟的点侧锁眼夹闭术是治疗相对较小的未破裂MCA动脉瘤的一种安全、微创的方法。
{"title":"Individualized pterional keyhole clipping surgery based on a preoperative three-dimensional virtual osteotomy technique for unruptured middle cerebral artery aneurysm.","authors":"K Mori, T Esaki, T Yamamoto, Y Nakao","doi":"10.1055/s-0031-1286335","DOIUrl":"https://doi.org/10.1055/s-0031-1286335","url":null,"abstract":"<p><strong>Objective: </strong>Individualized surgical simulation using three-dimensional (3D) imaging to allow safe performance of clipping surgery for unruptured middle cerebral artery (MCA) aneurysm via pterional keyhole mini-craniotomy was performed in 100 consecutive patients.</p><p><strong>Methods: </strong>3D images were reconstructed of the skin, skull, cerebral arteries and veins, and aneurysm. The size, shape, and location of the scheduled keyhole and the patient's head position were individually optimized using this preoperative simulation system. The site of opening of the sylvian fissure was also preoperatively determined according to the spatial relationships between the aneurysm and sylvian veins. 110 pterional keyhole clipping surgeries were consecutively performed in 100 patients.</p><p><strong>Results: </strong>The mean diameter of the pterional keyhole was 25±2 mm. Magnetic resonance imaging detected lacunar infarction in 4 cases (3.6%) but no other abnormalities. 1 patient suffered a reversible ischemic neurological deficit and 1 patient (79 years old) showed mild dementia. The modified Rankin scale at 3 months after the operation was grade 0 in all cases except 1 patient with mild dementia (grade 1). Mini-mental state examination, Hamilton rating scale for depression, and Beck depression inventory were all significantly improved (p<0.01) after the operations.</p><p><strong>Conclusion: </strong>Pterional keyhole clipping surgery based on careful surgical simulation with 3D images is a safe and less invasive means to treat relatively small unruptured MCA aneurysms.</p>","PeriodicalId":49808,"journal":{"name":"Minimally Invasive Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0031-1286335","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30415442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-10-01Epub Date: 2012-01-25DOI: 10.1055/s-0031-1297249
D A Chesler, C Pendleton, G I Jallo, A Quiñones-Hinojosa
Background: In 1908, Anton and von Bramann proposed the Balkenstich method, a corpus callosum puncture which created a communication between the ventricle and subarachnoid space. This method offered the benefit of providing continuous CSF diversion without the implantation of cannula or other shunting devices, yet it received only slight reference in the literature of the time. It remained a novel and perhaps underutilized approach at the time Cushing began expanding his neurosurgical practice at the Johns Hopkins Hospital.
Materials and methods: Following IRB approval, and through the courtesy of the Alan Mason Chesney Archives, the surgical records of the Johns Hopkins Hospital for the period 1896-1912 were reviewed. Patients operated upon by Harvey Cushing were selected.
Results: 7 patients underwent puncture of the corpus callosum for treatment of hydrocephalus. 6 patients were treated for obstructive hydrocephalus secondary to presumed intracranial lesions. 1 patient was treated for congenital hydrocephalus.
Conclusion: The series reported here documents Cushing's early use of the corpus callosum puncture to divert CSF in patients with obstructive hydrocephalus secondary to intracranial tumors, as well as an attempt to use the procedure in a pediatric patient with congenital hydrocephalus. Notably, 3 patients developed new onset left-sided weakness post-operatively, possibly due to retraction injury upon the supplementary motor intra-operative manipulations.
{"title":"\"Colossal\" breakthrough: the callosal puncture as a precursor to third ventriculostomy.","authors":"D A Chesler, C Pendleton, G I Jallo, A Quiñones-Hinojosa","doi":"10.1055/s-0031-1297249","DOIUrl":"https://doi.org/10.1055/s-0031-1297249","url":null,"abstract":"<p><strong>Background: </strong>In 1908, Anton and von Bramann proposed the Balkenstich method, a corpus callosum puncture which created a communication between the ventricle and subarachnoid space. This method offered the benefit of providing continuous CSF diversion without the implantation of cannula or other shunting devices, yet it received only slight reference in the literature of the time. It remained a novel and perhaps underutilized approach at the time Cushing began expanding his neurosurgical practice at the Johns Hopkins Hospital.</p><p><strong>Materials and methods: </strong>Following IRB approval, and through the courtesy of the Alan Mason Chesney Archives, the surgical records of the Johns Hopkins Hospital for the period 1896-1912 were reviewed. Patients operated upon by Harvey Cushing were selected.</p><p><strong>Results: </strong>7 patients underwent puncture of the corpus callosum for treatment of hydrocephalus. 6 patients were treated for obstructive hydrocephalus secondary to presumed intracranial lesions. 1 patient was treated for congenital hydrocephalus.</p><p><strong>Conclusion: </strong>The series reported here documents Cushing's early use of the corpus callosum puncture to divert CSF in patients with obstructive hydrocephalus secondary to intracranial tumors, as well as an attempt to use the procedure in a pediatric patient with congenital hydrocephalus. Notably, 3 patients developed new onset left-sided weakness post-operatively, possibly due to retraction injury upon the supplementary motor intra-operative manipulations.</p>","PeriodicalId":49808,"journal":{"name":"Minimally Invasive Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0031-1297249","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30415447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-10-01Epub Date: 2012-01-25DOI: 10.1055/s-0031-1297986
K Ikuta, K Tarukado, H Senba, T Kitamura, N Komiya, Y Fukutoku, S Shidahara
Background: Microendoscopic discectomy (MED) is one of the minimally invasive endoscopic procedures for treating lumbar disc herniation. The aim of this case report is to describe a patient with thoracic ossification of the ligamentum flavum (OLF) that was completely removed using the microendoscopic technique.
Case report: We report on a 62-year-old male patient who presented with thoracic myelopathy caused by OLF at the Th11-12. A posterior decompression via spinous process splitting approach using the microendoscopic technique at the Th11-12 was performed. The bilateral ossified ligamentum flavum could be en bloc removed separately. A sufficient decompression of the spinal cord and the spinal canal with no evidence of damage on the paraspinal muscles was demonstrated on magnetic resonance images after surgery. The patient's neurological symptoms were alleviated at 24 months after surgery. There was no evidence of postoperative instability at the final follow-up.
Conclusion: The authors found that the microendoscopic technique could be applied to decompression surgery for thoracic OLF. The procedure could provide a sufficient decompression with minimum damage to the paraspinal muscles. However, the microendoscopic procedure should be indicated only for select thoracic OLF, such as OLF without fusion at the middle of the spinal canal and OLF without dural ossification, because of its technical difficulties.
{"title":"Decompression procedure using a microendoscopic technique for thoracic myelopathy caused by ossification of the ligamentum flavum.","authors":"K Ikuta, K Tarukado, H Senba, T Kitamura, N Komiya, Y Fukutoku, S Shidahara","doi":"10.1055/s-0031-1297986","DOIUrl":"https://doi.org/10.1055/s-0031-1297986","url":null,"abstract":"<p><strong>Background: </strong>Microendoscopic discectomy (MED) is one of the minimally invasive endoscopic procedures for treating lumbar disc herniation. The aim of this case report is to describe a patient with thoracic ossification of the ligamentum flavum (OLF) that was completely removed using the microendoscopic technique.</p><p><strong>Case report: </strong>We report on a 62-year-old male patient who presented with thoracic myelopathy caused by OLF at the Th11-12. A posterior decompression via spinous process splitting approach using the microendoscopic technique at the Th11-12 was performed. The bilateral ossified ligamentum flavum could be en bloc removed separately. A sufficient decompression of the spinal cord and the spinal canal with no evidence of damage on the paraspinal muscles was demonstrated on magnetic resonance images after surgery. The patient's neurological symptoms were alleviated at 24 months after surgery. There was no evidence of postoperative instability at the final follow-up.</p><p><strong>Conclusion: </strong>The authors found that the microendoscopic technique could be applied to decompression surgery for thoracic OLF. The procedure could provide a sufficient decompression with minimum damage to the paraspinal muscles. However, the microendoscopic procedure should be indicated only for select thoracic OLF, such as OLF without fusion at the middle of the spinal canal and OLF without dural ossification, because of its technical difficulties.</p>","PeriodicalId":49808,"journal":{"name":"Minimally Invasive Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0031-1297986","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30414194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-10-01Epub Date: 2012-01-25DOI: 10.1055/s-0031-1297988
A E P Cameron, C Connery, J R M De Campos, M Hashmonai, P B Licht, C H Schick, G Bischof
Minim Invas Neurosurg 2011; 54: 290 A. E. P. Cameron 1 , C. Connery 2 , J. R. M. De Campos 3 , M. Hashmonai 4 , P. B. Licht 5 , C. H. Schick 6 , G. Bischof 7 , on behalf of the International Society of Symapathetic Surgery 1 Department of Surgery , The Ipswich Hospital , Ipswich , UK 2 Department of Surgery , St Luke’sRoosevelt Hospital Center , New York , NY , USA 3 Department of Thoracic Surgery , University of Sao Paolo , Sao Paolo , Brazil 4 Faculty of Medicine , Technion-Israel Institue of Technology , Haifa , Israel 5 Department of Cardiothoracic Surgery , Odense University Hospital , Odense , Denmark 6 German Hyperhidrosiscenter , Surgery Isar Clinic , Munich , Germany 7 Department of Surgery , St Josef Hospital , Surgery , Vienna , Austria
{"title":"Percutaneous chemical dorsal -sympathectomy for hyperhidrosis.","authors":"A E P Cameron, C Connery, J R M De Campos, M Hashmonai, P B Licht, C H Schick, G Bischof","doi":"10.1055/s-0031-1297988","DOIUrl":"https://doi.org/10.1055/s-0031-1297988","url":null,"abstract":"Minim Invas Neurosurg 2011; 54: 290 A. E. P. Cameron 1 , C. Connery 2 , J. R. M. De Campos 3 , M. Hashmonai 4 , P. B. Licht 5 , C. H. Schick 6 , G. Bischof 7 , on behalf of the International Society of Symapathetic Surgery 1 Department of Surgery , The Ipswich Hospital , Ipswich , UK 2 Department of Surgery , St Luke’sRoosevelt Hospital Center , New York , NY , USA 3 Department of Thoracic Surgery , University of Sao Paolo , Sao Paolo , Brazil 4 Faculty of Medicine , Technion-Israel Institue of Technology , Haifa , Israel 5 Department of Cardiothoracic Surgery , Odense University Hospital , Odense , Denmark 6 German Hyperhidrosiscenter , Surgery Isar Clinic , Munich , Germany 7 Department of Surgery , St Josef Hospital , Surgery , Vienna , Austria","PeriodicalId":49808,"journal":{"name":"Minimally Invasive Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0031-1297988","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30414676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-10-01Epub Date: 2012-01-25DOI: 10.1055/s-0031-1287830
D Logé, O De Coster, W Pollet, T Vancamp
Background: In spinal cord stimulation (SCS) mainly 2 distinctive implantation techniques can be recognized: the percutaneous and surgical technique.
Material and methods: A puncture is made with a blunt 14 gauge Tuohy needle. Once inside the epidural space the guide wire needs to be advanced in the epidural space, then the Tuohy needle is removed. The Epiducer is advanced under the guidance of lateral fluoroscopy, to confirm epidural entry. The S-series electrode is introduced through the sheet in the epidural space.
Conclusion: We present a novel technique to introduce small profile paddle leads (S-Series™: St. Jude Medical - Neuromodulation Division, Plano, TX) in the epidural space via a percutaneous approach using the Epiducer™ (St. Jude Medical - Neuromodulation Division, Plano, TX) lead delivery system.
背景:在脊髓刺激(SCS)中,主要有两种不同的植入技术:经皮植入技术和手术植入技术。材料和方法:用钝的14号陶氏针穿刺。一旦进入硬膜外腔,导丝需要在硬膜外腔中推进,然后取出Tuohy针。在侧位透视引导下推进外硬膜囊,以确认硬膜外进入。s系列电极通过硬膜外间隙的薄片引入。结论:我们提出了一种新技术,通过使用Epiducer™(St. Jude Medical - Neuromodulation Division, Plano, TX)导联系统,经皮入路将小轮廓桨形导联(s系列™:St. Jude Medical - Neuromodulation Division, Plano, TX)引入硬膜外空间。
{"title":"A novel percutaneous technique to implant plate-type electrodes.","authors":"D Logé, O De Coster, W Pollet, T Vancamp","doi":"10.1055/s-0031-1287830","DOIUrl":"https://doi.org/10.1055/s-0031-1287830","url":null,"abstract":"<p><strong>Background: </strong>In spinal cord stimulation (SCS) mainly 2 distinctive implantation techniques can be recognized: the percutaneous and surgical technique.</p><p><strong>Material and methods: </strong>A puncture is made with a blunt 14 gauge Tuohy needle. Once inside the epidural space the guide wire needs to be advanced in the epidural space, then the Tuohy needle is removed. The Epiducer is advanced under the guidance of lateral fluoroscopy, to confirm epidural entry. The S-series electrode is introduced through the sheet in the epidural space.</p><p><strong>Conclusion: </strong>We present a novel technique to introduce small profile paddle leads (S-Series™: St. Jude Medical - Neuromodulation Division, Plano, TX) in the epidural space via a percutaneous approach using the Epiducer™ (St. Jude Medical - Neuromodulation Division, Plano, TX) lead delivery system.</p>","PeriodicalId":49808,"journal":{"name":"Minimally Invasive Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0031-1287830","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30415443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}