Pub Date : 2011-08-01Epub Date: 2011-09-15DOI: 10.1055/s-0031-1284399
D Singh, S Sinha, H Singh, A Jagetia, S Gupta, P Gangoo, M Tandon
Background: Anterior cervical discoidectomy with or without fusion is a well established surgical remedy for cervical prolapsed intervertebral disc (PIVD) disease. If fusion is done by an iliac bone graft then internal fixation is commonly used to keep the graft in position. This study was conducted to determine the efficacy and tolerability of shape memory alloys, especially NiTi (nickel titanium) clips in the stabilization of grafts following anterior cervical discoidectomy.
Methods: 133 NiTi clips were applied in 119 patients between January 2002 and December 2008. The patients age ranged from 38-60 years. There were 66 male and 53 females. Various indications for fixation of the spine included degenerated cervical spondylosis with single level PIVD (105) and two level PIVD in 14 patients. The cine mode fluoroscopy confirmed the perioperative correct placement of grafts and clips in all the patients. Follow-up ranged from 2 to 8 years (mean: 4.6 years).
Results: Single level discoidectomy was performed in 105 patients and two level disc removal was done in 14 patients. A single NiTi clip was applied in all the cases except for 14 cases of two level PIVD. No procedural complication or adverse reaction to the clip was noted. There was no movement at the operated level in dynamic lateral view X-ray of cervical spine at the 1st postoperative day as well as on follow-up. Graft extrusion was seen in one patient on the 2nd day after surgery and was reoperated. Bony fusion occurred in all patients after 9 - 12 months of surgery. There was no incidence of breakage or dislodgement of the clip from the site where it was inserted. No artifact was noted in cervical MRI done in 33 patients.
Conclusion: NiTi clips are a simple alternative for cervical spine stabilization after discoidectomy. Their insertion is simple, minimally invasive, does not require any special set of instruments and they are much more economical than other established methods of treatment. These clips are accepted well by human tissue and do not interfere with MRI.
{"title":"Use of nitinol shape memory alloy staples (NiTi clips) after cervical discoidectomy: minimally invasive instrumentation and long-term results.","authors":"D Singh, S Sinha, H Singh, A Jagetia, S Gupta, P Gangoo, M Tandon","doi":"10.1055/s-0031-1284399","DOIUrl":"https://doi.org/10.1055/s-0031-1284399","url":null,"abstract":"<p><strong>Background: </strong>Anterior cervical discoidectomy with or without fusion is a well established surgical remedy for cervical prolapsed intervertebral disc (PIVD) disease. If fusion is done by an iliac bone graft then internal fixation is commonly used to keep the graft in position. This study was conducted to determine the efficacy and tolerability of shape memory alloys, especially NiTi (nickel titanium) clips in the stabilization of grafts following anterior cervical discoidectomy.</p><p><strong>Methods: </strong>133 NiTi clips were applied in 119 patients between January 2002 and December 2008. The patients age ranged from 38-60 years. There were 66 male and 53 females. Various indications for fixation of the spine included degenerated cervical spondylosis with single level PIVD (105) and two level PIVD in 14 patients. The cine mode fluoroscopy confirmed the perioperative correct placement of grafts and clips in all the patients. Follow-up ranged from 2 to 8 years (mean: 4.6 years).</p><p><strong>Results: </strong>Single level discoidectomy was performed in 105 patients and two level disc removal was done in 14 patients. A single NiTi clip was applied in all the cases except for 14 cases of two level PIVD. No procedural complication or adverse reaction to the clip was noted. There was no movement at the operated level in dynamic lateral view X-ray of cervical spine at the 1st postoperative day as well as on follow-up. Graft extrusion was seen in one patient on the 2nd day after surgery and was reoperated. Bony fusion occurred in all patients after 9 - 12 months of surgery. There was no incidence of breakage or dislodgement of the clip from the site where it was inserted. No artifact was noted in cervical MRI done in 33 patients.</p><p><strong>Conclusion: </strong>NiTi clips are a simple alternative for cervical spine stabilization after discoidectomy. Their insertion is simple, minimally invasive, does not require any special set of instruments and they are much more economical than other established methods of treatment. These clips are accepted well by human tissue and do not interfere with MRI.</p>","PeriodicalId":49808,"journal":{"name":"Minimally Invasive Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0031-1284399","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30146667","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 : 2011-08-01Epub Date: 2011-09-15DOI: 10.1055/s-0031-1280832
S Ott, T Struffert, V Hertel, T Engelhorn, P Gölitz, V Arlt, A Dörfler
Background: Epistaxis is one of the most common emergencies of ENT surgery and can be managed conservatively in most cases. However, transarterial embolization is an accepted treatment option for intractable epistaxis, if conservative management fails. But often, direct detection of the bleeding point by obvious contrast extravasation is not possible in conventional subtracted angiographic series (DSA). Then the suspected bleeding point is treated by endovascular embolization based on the clinical suspicion.
Case report: We here present the case of a young woman with intractable epistaxis where hemorrhage with contrast extravasation was only faintly visible. We used the new imaging modality of flat detector computed tomography (FD-CT) to visualize acute hemorrhage and treatment effect accurately.
Conclusion: FD-CT was helpful to visualize both irregular branches of the bleeding mucosa and active hemorrhage and also to monitor an effective embolization within the angio suite. Acquisition of FD-CT imaging in addition to conventional 2-D imaging with the same system enhances the possibility to a better understanding of the individual patient's anatomy and could be beneficial in the accurate depiction of active bleeding, and it might also improve surgical management, if endovascular attempts should fail.
{"title":"Visualization and monitoring of acute epistaxis during endovascular treatment using a flat detector CT.","authors":"S Ott, T Struffert, V Hertel, T Engelhorn, P Gölitz, V Arlt, A Dörfler","doi":"10.1055/s-0031-1280832","DOIUrl":"https://doi.org/10.1055/s-0031-1280832","url":null,"abstract":"<p><strong>Background: </strong>Epistaxis is one of the most common emergencies of ENT surgery and can be managed conservatively in most cases. However, transarterial embolization is an accepted treatment option for intractable epistaxis, if conservative management fails. But often, direct detection of the bleeding point by obvious contrast extravasation is not possible in conventional subtracted angiographic series (DSA). Then the suspected bleeding point is treated by endovascular embolization based on the clinical suspicion.</p><p><strong>Case report: </strong>We here present the case of a young woman with intractable epistaxis where hemorrhage with contrast extravasation was only faintly visible. We used the new imaging modality of flat detector computed tomography (FD-CT) to visualize acute hemorrhage and treatment effect accurately.</p><p><strong>Conclusion: </strong>FD-CT was helpful to visualize both irregular branches of the bleeding mucosa and active hemorrhage and also to monitor an effective embolization within the angio suite. Acquisition of FD-CT imaging in addition to conventional 2-D imaging with the same system enhances the possibility to a better understanding of the individual patient's anatomy and could be beneficial in the accurate depiction of active bleeding, and it might also improve surgical management, if endovascular attempts should fail.</p>","PeriodicalId":49808,"journal":{"name":"Minimally Invasive Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0031-1280832","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30146670","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 : 2011-06-01Epub Date: 2011-08-23DOI: 10.1055/s-0031-1283129
Y R Yadav, V Parihar, M Agarwal, S Sherekar, P Bhatele
Background: Microvascular decompression is an effective method of treatment in trigeminal neuralgia. It may fail if a compressing vessel is overlooked during surgery. The endoscope has an edge over the microscope in visualizing such conflicts.
Materials and methods: This is a prospective study of 51 patients. Preoperative computed tomography and magnetic resonance imaging scans were performed in all the cases. A 4 − 5 cm retroauricular skin incision was made and an about 3 cm craniectomy was performed. A 0° 4 mm telescope supported by the holder was used after the dural opening. A 2 by 6 cm sheet prepared from hand gloves was used to protect the brain. A Karl Storz 30° telescope was used for the visualization of the trigeminal nerve from the pons to Meckel's cave and dissection of the anterior conflict. Small pieces of dura patch were interposed between the nerve and the vessel. The microscope was not used at any stage. Post-operative infection, cerebrospinal fluid leak, cranial nerve deficit, failure of procedure in terms of pain relieves and recurrences of pain were recorded. The follow-up period ranged from 24 to 55 months with an average of 36 months.
Results: There was no mortality or any major permanent complications. The duration of stay ranged from 3 to 10 days with an average of 3.6 days. The pain was relieved in 48 patients.
Conclusion: Endoscopic vascular decompression is an effective and safe alternative to endoscopic assisted microvascular decompression in trigeminal neuralgia.
{"title":"Endoscopic vascular decompression of the trigeminal nerve.","authors":"Y R Yadav, V Parihar, M Agarwal, S Sherekar, P Bhatele","doi":"10.1055/s-0031-1283129","DOIUrl":"https://doi.org/10.1055/s-0031-1283129","url":null,"abstract":"<p><strong>Background: </strong>Microvascular decompression is an effective method of treatment in trigeminal neuralgia. It may fail if a compressing vessel is overlooked during surgery. The endoscope has an edge over the microscope in visualizing such conflicts.</p><p><strong>Materials and methods: </strong>This is a prospective study of 51 patients. Preoperative computed tomography and magnetic resonance imaging scans were performed in all the cases. A 4 − 5 cm retroauricular skin incision was made and an about 3 cm craniectomy was performed. A 0° 4 mm telescope supported by the holder was used after the dural opening. A 2 by 6 cm sheet prepared from hand gloves was used to protect the brain. A Karl Storz 30° telescope was used for the visualization of the trigeminal nerve from the pons to Meckel's cave and dissection of the anterior conflict. Small pieces of dura patch were interposed between the nerve and the vessel. The microscope was not used at any stage. Post-operative infection, cerebrospinal fluid leak, cranial nerve deficit, failure of procedure in terms of pain relieves and recurrences of pain were recorded. The follow-up period ranged from 24 to 55 months with an average of 36 months.</p><p><strong>Results: </strong>There was no mortality or any major permanent complications. The duration of stay ranged from 3 to 10 days with an average of 3.6 days. The pain was relieved in 48 patients.</p><p><strong>Conclusion: </strong>Endoscopic vascular decompression is an effective and safe alternative to endoscopic assisted microvascular decompression in trigeminal neuralgia.</p>","PeriodicalId":49808,"journal":{"name":"Minimally Invasive Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0031-1283129","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30095592","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 : 2011-06-01Epub Date: 2011-08-23DOI: 10.1055/s-0031-1283128
G Singh, P Nakaji, F Chen, M Garrett, A Little, J Milligan
Abstract Background: Clival chordomas are difficult tumors to treat, particularly when they have already grown beyond the confines of the clivus. Patient: We report the case of a 52-year-old man with a clival mass consistent with a chordoma with a prominent extension into the right middle fossa. At the patient’s request, he underwent a simple endonasal biopsy to confirm the diagnosis. A second debulking procedure was planned to debulk the remnant tumor. However, follow-up magnetic resonance imaging showed that much of the middle fossa tumor had decompressed itself through the clival defect into the patient’s pharynx. Results: The patient underwent additional clival debulking and proton-beam therapy. After 44 months of follow-up, he had no clinical or radiographic progression of disease. Conclusion: It is intriguing to think that leaving a path for easy egress for a chordoma from the clivus may prevent it from building up in the bone and spreading.
{"title":"Spontaneous debulking of middle fossa chordoma extension after transnasal petroclival biopsy--report of a case.","authors":"G Singh, P Nakaji, F Chen, M Garrett, A Little, J Milligan","doi":"10.1055/s-0031-1283128","DOIUrl":"https://doi.org/10.1055/s-0031-1283128","url":null,"abstract":"Abstract Background: Clival chordomas are difficult tumors to treat, particularly when they have already grown beyond the confines of the clivus. Patient: We report the case of a 52-year-old man with a clival mass consistent with a chordoma with a prominent extension into the right middle fossa. At the patient’s request, he underwent a simple endonasal biopsy to confirm the diagnosis. A second debulking procedure was planned to debulk the remnant tumor. However, follow-up magnetic resonance imaging showed that much of the middle fossa tumor had decompressed itself through the clival defect into the patient’s pharynx. Results: The patient underwent additional clival debulking and proton-beam therapy. After 44 months of follow-up, he had no clinical or radiographic progression of disease. Conclusion: It is intriguing to think that leaving a path for easy egress for a chordoma from the clivus may prevent it from building up in the bone and spreading.","PeriodicalId":49808,"journal":{"name":"Minimally Invasive Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0031-1283128","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30096133","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 : 2011-06-01Epub Date: 2011-08-23DOI: 10.1055/s-0031-1283171
K Van Loock, T Menovsky, N Kamerling, D De Ridder
Background: Fixation of bone flaps after craniotomy is a routine part of every neurosurgical procedure and there are various options to fixate the bone flap. In this paper, we report on a new cranial bone flap fixation d(Cranial Loop) implanted in 35 consecutive patients.
Methods: The principle of cranial loop is the same as that of a tie rope. With a simple “pull and tighten” movement, the device is implanted without the need for additional instruments. The cranial loop is made of PEEK [poly(aryl)-ether-ether-ketone] material with the main advantage of being artifact free on postoperative imaging. In 35 consecutive patients operated by a single surgeon, the cranial loops were used for bone flap fixation. All patients had a postoperative CT scanning and a follow-up period of at least 9 months.
Results: In all patients, the bone flap could be easily fixed with 3 or more cranial loops without difficulties or material breakage, this within 3 min. The postoperative infection rate was 0%, postoperative hemorrhage (either epi/sub or intraparenchymatous) requiring reoperation was 0%. None of the patients experienced a bone flap dislocation, either clinically or on the postoperative CT-images. 3D CT-scanning revealed all of the flaps being in a good anatomic position.
Conclusions: Although this is a preliminary report in a relatively small number of patients, we are of opinion that the cranial loop is a very fast, easy, and safe to use bone flap fixation device with the main advantage of the absence of artifacts on postoperative CT or MR imaging and lack of cosmetic disadvantage.
{"title":"Cranial bone flap fixation using a new device (Cranial LoopTM).","authors":"K Van Loock, T Menovsky, N Kamerling, D De Ridder","doi":"10.1055/s-0031-1283171","DOIUrl":"https://doi.org/10.1055/s-0031-1283171","url":null,"abstract":"<p><strong>Background: </strong>Fixation of bone flaps after craniotomy is a routine part of every neurosurgical procedure and there are various options to fixate the bone flap. In this paper, we report on a new cranial bone flap fixation d(Cranial Loop) implanted in 35 consecutive patients.</p><p><strong>Methods: </strong>The principle of cranial loop is the same as that of a tie rope. With a simple “pull and tighten” movement, the device is implanted without the need for additional instruments. The cranial loop is made of PEEK [poly(aryl)-ether-ether-ketone] material with the main advantage of being artifact free on postoperative imaging. In 35 consecutive patients operated by a single surgeon, the cranial loops were used for bone flap fixation. All patients had a postoperative CT scanning and a follow-up period of at least 9 months.</p><p><strong>Results: </strong>In all patients, the bone flap could be easily fixed with 3 or more cranial loops without difficulties or material breakage, this within 3 min. The postoperative infection rate was 0%, postoperative hemorrhage (either epi/sub or intraparenchymatous) requiring reoperation was 0%. None of the patients experienced a bone flap dislocation, either clinically or on the postoperative CT-images. 3D CT-scanning revealed all of the flaps being in a good anatomic position.</p><p><strong>Conclusions: </strong>Although this is a preliminary report in a relatively small number of patients, we are of opinion that the cranial loop is a very fast, easy, and safe to use bone flap fixation device with the main advantage of the absence of artifacts on postoperative CT or MR imaging and lack of cosmetic disadvantage.</p>","PeriodicalId":49808,"journal":{"name":"Minimally Invasive Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0031-1283171","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30095594","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 : 2011-06-01Epub Date: 2011-08-23DOI: 10.1055/s-0031-1277198
Z Idris, A R I Ghani, B Idris, M Muzaimi, S Awang, H K Pal, J M Abdullah
Background: Shunt surgery is frequently chosen to manage periventricular metastasis of pineal region tumours which obscured the floor of the third ventricle. However, this procedure falls short due to distant metastasis. Neuronavigation-guided endoscopic surgery offers a viable alternative.
Patient: A 17-year-old man became symptomatic from widespread periventricular metastasis of a pineal region tumour which completely obscured the floor of the third ventricle.
Results: Endoscopic tumour biopsy followed by neuronavigation-guided endoscopic third ventriculotomy was performed successfully.
Conclusion: This case report emphasizes the value of neuronavigation-guided endoscopic third ventriculostomy as a feasible surgical alternative for pineal region tumours with widespread periventricular metastasis that obscure the third ventricular floor.
{"title":"Neuronavigation-guided endoscopic management of a pineal region tumour with obscured floor of the third ventricle: case report.","authors":"Z Idris, A R I Ghani, B Idris, M Muzaimi, S Awang, H K Pal, J M Abdullah","doi":"10.1055/s-0031-1277198","DOIUrl":"https://doi.org/10.1055/s-0031-1277198","url":null,"abstract":"<p><strong>Background: </strong>Shunt surgery is frequently chosen to manage periventricular metastasis of pineal region tumours which obscured the floor of the third ventricle. However, this procedure falls short due to distant metastasis. Neuronavigation-guided endoscopic surgery offers a viable alternative.</p><p><strong>Patient: </strong>A 17-year-old man became symptomatic from widespread periventricular metastasis of a pineal region tumour which completely obscured the floor of the third ventricle.</p><p><strong>Results: </strong>Endoscopic tumour biopsy followed by neuronavigation-guided endoscopic third ventriculotomy was performed successfully.</p><p><strong>Conclusion: </strong>This case report emphasizes the value of neuronavigation-guided endoscopic third ventriculostomy as a feasible surgical alternative for pineal region tumours with widespread periventricular metastasis that obscure the third ventricular floor.</p>","PeriodicalId":49808,"journal":{"name":"Minimally Invasive Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0031-1277198","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30095595","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 : 2011-06-01Epub Date: 2011-08-23DOI: 10.1055/s-0031-1277230
M Kirsch, H Henkes
Background: True aneurysms of the ophthalmic artery (OA) are extremely rare and most often arise at the origin of this artery. We present the endovascular management of a ruptured intraorbital OA aneurysm and of an associated dural arteriovenous fistula (dAVF).
Patient: A patient with a ruptured intraorbital ophthalmic artery aneurysm, associated with a dAVF with cortical drainage presented with acute visual loss and intra- and periorbital hematoma. The aneurysm was treated by endovascular coil occlusion. The dAVF was occluded by transvenous obliteration of the draining basal vein of Rosenthal. Both intraorbital ophthalmic artery aneurysms and their rupture are extremely rare.
Conclusion: Transvenous treatment of dAVFs is well feasible even with very far going catheterization, in this case to the origin of the basal vein of Rosenthal.
{"title":"A ruptured intraorbital ophthalmic artery aneurysm, associated with a dural arteriovenous fistula: combined transarterial and transvenous endovascular treatment.","authors":"M Kirsch, H Henkes","doi":"10.1055/s-0031-1277230","DOIUrl":"https://doi.org/10.1055/s-0031-1277230","url":null,"abstract":"<p><strong>Background: </strong>True aneurysms of the ophthalmic artery (OA) are extremely rare and most often arise at the origin of this artery. We present the endovascular management of a ruptured intraorbital OA aneurysm and of an associated dural arteriovenous fistula (dAVF).</p><p><strong>Patient: </strong>A patient with a ruptured intraorbital ophthalmic artery aneurysm, associated with a dAVF with cortical drainage presented with acute visual loss and intra- and periorbital hematoma. The aneurysm was treated by endovascular coil occlusion. The dAVF was occluded by transvenous obliteration of the draining basal vein of Rosenthal. Both intraorbital ophthalmic artery aneurysms and their rupture are extremely rare.</p><p><strong>Conclusion: </strong>Transvenous treatment of dAVFs is well feasible even with very far going catheterization, in this case to the origin of the basal vein of Rosenthal.</p>","PeriodicalId":49808,"journal":{"name":"Minimally Invasive Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0031-1277230","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30096131","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 : 2011-06-01Epub Date: 2011-08-23DOI: 10.1055/s-0031-1279715
R Saito, T Kumabe, M Kanamori, Y Yamashita, Y Sonoda, S Higano, S Takahashi, T Tominaga
Background: Surgical treatment of deep-seated tumors such as supratentorial intraventricular and thalamic-pineal-tectal region tumors carries a risk of postoperative deficits due to possible damage to deep cerebral veins including the internal cerebral vein. It is often difficult to identify whether the vessel encountered during surgery needs to be preserved or not through the small operative field. Therefore, preoperative evaluation of deep venous structures is important. We evaluated the usefulness of 3-Tesla magnetic resonance imaging (3 T MRI) for this purpose.
Methods: First, the ability to detect deep venous structures was compared with both 3-dimensional computed tomographical angiography (3D-CTA) and 3 T MRI in patients without any damage to deep venous structures. Images of 7 consecutive patients suffering from insulo-opercular gliomas who underwent both imaging modes for the identification of lateral striate arteries were reconstructed for evaluation of the deep cerebral veins. Subsequently, surgery for tumors at the supratentorial intraventricular and thalamic-pineal-tectal regions was prospectively performed with preoperative evaluation of deep venous system only using 3 T MRI.
Results: Information on the deep venous systems acquired by 3 T MRI was as useful as that acquired by 3D-CTA. Until today, we have treated 8 cases of supratentorial intraventricular and thalamic-pineal-tectal region tumors with preoperative evaluation of the deep venous system using 3 T MRI without any morbidity.
Conclusion: Information on the deep venous system obtained with 3 T MRI aids the surgery of supratentorial intraventricular and thalamic-pineal-tectal region tumors. As the required sequences of 3 T MRI are same as those necessary for the neuronavigation system, and 3 T MRI can be achieved without the use of iodine-based contrast agents, 3 T MRI can be an alternative for preoperative evaluation of the deep venous systems.
{"title":"Preoperative evaluation of the deep cerebral veins using 3-tesla magnetic resonance imaging.","authors":"R Saito, T Kumabe, M Kanamori, Y Yamashita, Y Sonoda, S Higano, S Takahashi, T Tominaga","doi":"10.1055/s-0031-1279715","DOIUrl":"https://doi.org/10.1055/s-0031-1279715","url":null,"abstract":"<p><strong>Background: </strong>Surgical treatment of deep-seated tumors such as supratentorial intraventricular and thalamic-pineal-tectal region tumors carries a risk of postoperative deficits due to possible damage to deep cerebral veins including the internal cerebral vein. It is often difficult to identify whether the vessel encountered during surgery needs to be preserved or not through the small operative field. Therefore, preoperative evaluation of deep venous structures is important. We evaluated the usefulness of 3-Tesla magnetic resonance imaging (3 T MRI) for this purpose.</p><p><strong>Methods: </strong>First, the ability to detect deep venous structures was compared with both 3-dimensional computed tomographical angiography (3D-CTA) and 3 T MRI in patients without any damage to deep venous structures. Images of 7 consecutive patients suffering from insulo-opercular gliomas who underwent both imaging modes for the identification of lateral striate arteries were reconstructed for evaluation of the deep cerebral veins. Subsequently, surgery for tumors at the supratentorial intraventricular and thalamic-pineal-tectal regions was prospectively performed with preoperative evaluation of deep venous system only using 3 T MRI.</p><p><strong>Results: </strong>Information on the deep venous systems acquired by 3 T MRI was as useful as that acquired by 3D-CTA. Until today, we have treated 8 cases of supratentorial intraventricular and thalamic-pineal-tectal region tumors with preoperative evaluation of the deep venous system using 3 T MRI without any morbidity.</p><p><strong>Conclusion: </strong>Information on the deep venous system obtained with 3 T MRI aids the surgery of supratentorial intraventricular and thalamic-pineal-tectal region tumors. As the required sequences of 3 T MRI are same as those necessary for the neuronavigation system, and 3 T MRI can be achieved without the use of iodine-based contrast agents, 3 T MRI can be an alternative for preoperative evaluation of the deep venous systems.</p>","PeriodicalId":49808,"journal":{"name":"Minimally Invasive Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0031-1279715","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30095591","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 : 2011-06-01Epub Date: 2011-08-23DOI: 10.1055/s-0031-1283170
G Coelho, C Kondageski, F Vaz-Guimarães Filho, R Ramina, S C Hunhevicz, F Daga, M R Lyra, S Cavalheiro, S T Zymberg
Background: Over the last decade, neuroendoscopy has re-emerged as an interesting option in the management of intraventricular lesions in both children and adults. Nonetheless, as it has become more difficult to use cadaveric specimens in training, the development of alternative methods was vital. The aim of this study was to analyze the performance of a real simulator, in association with image-guided navigation, as a teaching tool for the training of intraventricular endoscopic procedures.
Methods: 3 real simulators were built using a special type of resin. 1 was designed to represent the abnormally enlarged ventricles, making it possible for a third ventriculostomy to be performed. The remaining 2 were designed to simulate a person's skull and brain bearing intraventricular lesions, which were placed as follows: in the foramen of Monro region, in the frontal and occipital horns of the lateral ventricles and within the third ventricle. In all models, MRI images were obtained for navigation guidance. Within the ventricles, the relevant anatomic structures and the lesions were identified through the endoscope and compared with the position given by the navigation device. The next step consisted of manipulating the lesions, using standard endoscopic techniques.
Results: We observed that the models were MRI compatible, easy and safe to handle. They nicely reproduced the intraventricular anatomy and brain consistence, as well as simulated intraventricular lesions. The image-based navigation was efficient in guiding the surgeon through the endoscopic procedure, allowing the selection of the best approach as well as defining the relevant surgical landmarks for each ventricular compartment. Nonetheless, as expected, navigation inaccuracies occurred. After the training sessions the surgeons felt they had gained valued experience by dealing with intraventricular lesions employing endoscopic techniques.
Conclusion: The use of real simulators in association with image-guided navigation proved to be an effective tool in training for neuroendoscopy.
{"title":"Frameless image-guided neuroendoscopy training in real simulators.","authors":"G Coelho, C Kondageski, F Vaz-Guimarães Filho, R Ramina, S C Hunhevicz, F Daga, M R Lyra, S Cavalheiro, S T Zymberg","doi":"10.1055/s-0031-1283170","DOIUrl":"https://doi.org/10.1055/s-0031-1283170","url":null,"abstract":"<p><strong>Background: </strong>Over the last decade, neuroendoscopy has re-emerged as an interesting option in the management of intraventricular lesions in both children and adults. Nonetheless, as it has become more difficult to use cadaveric specimens in training, the development of alternative methods was vital. The aim of this study was to analyze the performance of a real simulator, in association with image-guided navigation, as a teaching tool for the training of intraventricular endoscopic procedures.</p><p><strong>Methods: </strong>3 real simulators were built using a special type of resin. 1 was designed to represent the abnormally enlarged ventricles, making it possible for a third ventriculostomy to be performed. The remaining 2 were designed to simulate a person's skull and brain bearing intraventricular lesions, which were placed as follows: in the foramen of Monro region, in the frontal and occipital horns of the lateral ventricles and within the third ventricle. In all models, MRI images were obtained for navigation guidance. Within the ventricles, the relevant anatomic structures and the lesions were identified through the endoscope and compared with the position given by the navigation device. The next step consisted of manipulating the lesions, using standard endoscopic techniques.</p><p><strong>Results: </strong>We observed that the models were MRI compatible, easy and safe to handle. They nicely reproduced the intraventricular anatomy and brain consistence, as well as simulated intraventricular lesions. The image-based navigation was efficient in guiding the surgeon through the endoscopic procedure, allowing the selection of the best approach as well as defining the relevant surgical landmarks for each ventricular compartment. Nonetheless, as expected, navigation inaccuracies occurred. After the training sessions the surgeons felt they had gained valued experience by dealing with intraventricular lesions employing endoscopic techniques.</p><p><strong>Conclusion: </strong>The use of real simulators in association with image-guided navigation proved to be an effective tool in training for neuroendoscopy.</p>","PeriodicalId":49808,"journal":{"name":"Minimally Invasive Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0031-1283170","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30095593","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 : 2011-06-01Epub Date: 2011-08-23DOI: 10.1055/s-0031-1283169
P Tabakow, M Czyz, W Jarmundowicz, W Zub
Abstract Background: Treatment of multiloculated hydrocephalus in children remains a difficult neurosurgical problem because of the high recurrence rate. Endoscopic septostomy with subsequent ventriculoperitoneal shunting is one of the most widely accepted therapeutic methods. Intraventricular endoscopic surgery combined with intraoperative magnetic resonance (MR) has been used very seldom in infants. Case Report: A 7-month-old infant presented with a history of postnatal hydrocephalus from the germinal matrix and intraventricular hemorrhage, treated with a ventriculoperitoneal shunt. Treatment was complicated by bacterial meningitis. On admission the child presented with symptoms of elevated intracranial pressure, an MR investigation gave evidence of multiloculated hydrocephalus. The patient underwent endoscopic pellucidotomy, followed by fenestration of the septa inside the third ventricle, third ventriculostomy and aqueductoplasty. Endoscopic navigation was supported by serial intraoperative non-contrast T1-weighted MR (0.15 T, Polestar N20, Medtronic) images. They also served for confirmation of the patency of performed fenestrations and for the planning of further steps of the operation. Conclusion: Intraoperative low-field MR imaging provided an excellent tool for correct navigation of the endoscope inside the pathological ventricular compartments and for intraoperative assessment of surgical goals.
{"title":"Neuroendoscopy combined with intraoperative low-field magnetic imaging for treatment of multiloculated hydrocephalus in a 7-month-old infant: technical case report.","authors":"P Tabakow, M Czyz, W Jarmundowicz, W Zub","doi":"10.1055/s-0031-1283169","DOIUrl":"https://doi.org/10.1055/s-0031-1283169","url":null,"abstract":"Abstract Background: Treatment of multiloculated hydrocephalus in children remains a difficult neurosurgical problem because of the high recurrence rate. Endoscopic septostomy with subsequent ventriculoperitoneal shunting is one of the most widely accepted therapeutic methods. Intraventricular endoscopic surgery combined with intraoperative magnetic resonance (MR) has been used very seldom in infants. Case Report: A 7-month-old infant presented with a history of postnatal hydrocephalus from the germinal matrix and intraventricular hemorrhage, treated with a ventriculoperitoneal shunt. Treatment was complicated by bacterial meningitis. On admission the child presented with symptoms of elevated intracranial pressure, an MR investigation gave evidence of multiloculated hydrocephalus. The patient underwent endoscopic pellucidotomy, followed by fenestration of the septa inside the third ventricle, third ventriculostomy and aqueductoplasty. Endoscopic navigation was supported by serial intraoperative non-contrast T1-weighted MR (0.15 T, Polestar N20, Medtronic) images. They also served for confirmation of the patency of performed fenestrations and for the planning of further steps of the operation. Conclusion: Intraoperative low-field MR imaging provided an excellent tool for correct navigation of the endoscope inside the pathological ventricular compartments and for intraoperative assessment of surgical goals.","PeriodicalId":49808,"journal":{"name":"Minimally Invasive Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0031-1283169","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30096134","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}