Neurosurgical focus: Video最新文献

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Can exoscope improve brain AVMs surgery? 外窥镜能否改善脑动静脉畸形手术？

Neurosurgical focus: Video

Pub Date : 2024-01-01 DOI: 10.3171/2023.10.focvid23114

S. Tola, Federico Capelli, Alessandro Della Puppa

The advantages of the surgical view provided by the exoscope have been described before, although reports of its application to brain arteriovenous malformation (AVM) surgery are lacking. The ampler field of view and magnification up to ×24 allow for enhanced visualization during microsurgical procedures. Furthermore, the live visualization provided by indocyanine green video angiography (ICG-VA) helps emphasize the hemodynamics of AVMs, even allowing the detection of possible residual vein arterialization as an indirect expression of nidal remnants. With this illustrative video showing the resection of a hemorrhagic right frontoinsular Spetzler-Martin grade III AVM, the authors describe the technical implications of exoscope brain AVM surgery using the Olympus ORBEYE 4K-3D, with a final focus on ICG-VA as an asset. The video can be found here: https://stream.cadmore.media/r10.3171/2023.10.FOCVID23114

外窥镜提供的手术视野的优势以前已有描述，但缺乏将其应用于脑动静脉畸形（AVM）手术的报道。扩大的视野和高达 ×24 的放大倍率使显微外科手术过程中的可视化得到增强。此外，吲哚菁绿视频血管造影术（ICG-VA）提供的实时可视化有助于强调 AVM 的血液动力学，甚至可以检测到可能残留的静脉动脉化，这也是静脉残余的间接表现。通过这段展示切除出血性右前庭 Spetzler-Martin III 级 AVM 的视频，作者描述了使用奥林巴斯 ORBEYE 4K-3D 进行外窥镜脑 AVM 手术的技术意义，最后重点介绍了 ICG-VA 的优势。视频请点击： https://stream.cadmore.media/r10.3171/2023.10.FOCVID23114

引用次数: 0

Exoscopic microvascular decompression for hemifacial spasm and trigeminal neuralgia 外窥镜微血管减压术治疗半面痉挛和三叉神经痛

Neurosurgical focus: Video

Pub Date : 2024-01-01 DOI: 10.3171/2023.10.focvid23122

Hiroki Toda, Hirokuni Hashikata, Ryota Ishibashi

The 4K 3D exoscope system is becoming increasingly used in neurosurgery. Its 3D ultra-high-definition image is valuable in identifying and dissecting the delicate neural and vascular structures during microvascular decompression. In this video, the authors describe several nuances and details to perform the exoscopic microvascular decompression, including the exoscope layout and the modified supine position. Several illustrative case presentations highlight the benefits of exoscopic surgery. The authors’ exoscopic microvascular decompression series of 159 patients showed noninferior surgical outcomes compared to the operative microscope with no significant increase in surgical risk. In conclusion, an exoscope can be a practical alternative to performing microvascular decompression. The video can be found here: https://stream.cadmore.media/r10.3171/2023.10.FOCVID23122

4K 3D 外窥镜系统在神经外科的应用越来越广泛。其三维超高清图像对于在微血管减压术中识别和解剖精细的神经和血管结构非常有价值。在这段视频中，作者介绍了进行外镜下微血管减压术的几个细微差别和细节，包括外镜布局和改良仰卧位。几例例证突出了外镜手术的优势。作者在外镜下对 159 名患者进行了微血管减压，结果显示手术效果并不逊于手术显微镜，手术风险也没有显著增加。总之，外窥镜是进行微血管减压术的一种实用替代方法。视频请点击此处： https://stream.cadmore.media/r10.3171/2023.10.FOCVID23122

引用次数: 0

Occipital-interhemispheric transtentorial pineal mass resection 枕部-大脑半球间横隔松果体肿块切除术

Neurosurgical focus: Video

Pub Date : 2024-01-01 DOI: 10.3171/2023.10.focvid23161

Grant Arzumanov, Seung W. Jeong, Bhavika Gupta, Rocco Dabecco, Jose Sandoval, Matthew J. Shepard, Jody Leonardo, Alexander Yu

The occipital approach for pineal tumors was first described by James Poppen in 1966. Since then, it has been widely used for accessing deep-seated tumors as it offers a wider surgical view than the supracerebellar transtentorial approach. This video demonstrates the technical nuances of the occipital transtentorial approach and the exoscopic dissection of a pineal gland tumor in a 66-year-old male. Use of the exoscope over the microscope provides certain ergonomic advantages and improves surgical workflow, as demonstrated here. The video can be found here: https://stream.cadmore.media/r10.3171/2023.10.FOCVID23161

1966 年，James Poppen 首次描述了松果体肿瘤的枕骨入路。从那时起，这种方法就被广泛用于切除深部肿瘤，因为它比小脑上横隔入路方法提供了更广阔的手术视野。这段视频演示了枕骨经脑室入路的技术细节，以及在外镜下解剖一名 66 岁男性的松果体肿瘤。与显微镜相比，外窥镜的使用具有一定的人体工程学优势，并能改善手术流程。视频请点击： https://stream.cadmore.media/r10.3171/2023.10.FOCVID23161

引用次数: 0

Exoscopic resection of a parasagittal atypical meningioma 矢状旁非典型脑膜瘤的外镜切除术

Neurosurgical focus: Video

Pub Date : 2024-01-01 DOI: 10.3171/2023.10.focvid23164

Alejandro Carrasquilla, Artur Zgurov, Mira Salih, Chi Le, Stavros Matsoukas, Rui Feng, Alexander J Schupper, Constantinos G. Hadjipanayis

This video demonstrates use of the Synaptive 3D exoscope to enhance complex meningioma resection. The patient was a 58-year-old female who presented with new-onset seizures. Workup revealed a parasagittal meningioma over the bilateral cortices. She was started on 750 mg of Keppra twice daily and tapered dexamethasone and discharged. MR venography demonstrated segmental occlusion of the superior sagittal sinus. She then underwent a diagnostic angiogram and tumor Onyx embolization of the bilateral middle meningeal artery feeders. She then underwent a craniotomy for meningioma resection using 3D exoscope guidance. She awoke with a stable examination in the intensive care unit and worked with physical therapy on postoperative day 1. The video can be found here: https://stream.cadmore.media/r10.3171/2023.10.FOCVID23164

这段视频演示了使用 Synaptive 3D 外窥镜加强复杂脑膜瘤切除术的过程。患者是一名 58 岁的女性，因新发癫痫而就诊。检查发现双侧大脑皮层有一个矢状旁脑膜瘤。患者开始服用750毫克的开普拉（Keppra），每天两次，并逐渐减量地塞米松，随后出院。磁共振静脉造影显示上矢状窦有节段性闭塞。随后，她接受了诊断性血管造影，并对双侧脑膜中动脉供血动脉进行了肿瘤Onyx栓塞治疗。然后，她在三维外窥镜引导下接受了开颅脑膜瘤切除术。她在重症监护室醒来时检查结果稳定，术后第 1 天接受了物理治疗。视频请点击： https://stream.cadmore.media/r10.3171/2023.10.FOCVID23164

引用次数: 0

Exoscope for revision of right lateral femoral cutaneous nerve decompression 用于右侧股外侧皮神经减压术翻修的外窥镜

Neurosurgical focus: Video

Pub Date : 2024-01-01 DOI: 10.3171/2023.10.focvid23162

Matthew C. Findlay, Spencer Twitchell, M. Mahan

The exoscope serves as a valuable addition or alternative to traditional microscope systems in surgery, offering 3D visualization and magnification with enhanced maneuverability. In lateral femoral cutaneous nerve decompression for meralgia paresthetica, the exoscope is effective in identifying strictures of neural compression and minimizing iatrogenic nerve damage that may lead to improved pain management outcomes for patients. In this report, the specific case presented showcases how the exoscope aided in surgical decompression of the lateral femoral cutaneous nerve of a patient with refractory meralgia paresthetica with remote previous decompression and resultant scarring. The video can be found here: https://stream.cadmore.media/r10.3171/2023.10.FOCVID23162

在外科手术中，外窥镜是传统显微镜系统的重要补充或替代品，可提供三维可视化和放大功能，并具有更强的可操作性。在股外侧皮神经减压治疗麻痹症的手术中，外视镜能有效识别神经压迫狭窄，最大程度地减少对神经的先天性损伤，从而改善患者的疼痛治疗效果。在本报告中，介绍的具体病例展示了外窥镜是如何帮助一名曾接受过远端减压并因此留下疤痕的难治性麻痹患者进行股外侧皮神经手术减压的。请点击此处观看视频： https://stream.cadmore.media/r10.3171/2023.10.FOCVID23162

引用次数: 0

Exoscopic removal of the fourth ventricle choroid plexus papilloma with use of a midline suboccipital osteoplastic craniotomy 利用中线枕骨下开颅骨整形术，在外镜下切除第四脑室脉络丛乳头状瘤

Neurosurgical focus: Video

Pub Date : 2024-01-01 DOI: 10.3171/2023.10.focvid23106

R. Sufianov, I. A. Gaysin, Iurii A. Iakimov, Albert Sufianov

Choroid plexus papillomas are relatively rare vascular tumors. In this video, the authors present a pediatric patient who underwent exoscopic removal of the fourth ventricle choroid plexus papilloma with the use of a midline suboccipital osteoplastic craniotomy. The exoscope in the fourth ventricle lesion helps to improve visualization in all directions, with the surgeon being able to maintain a comfortable position throughout the procedure. In addition, the midline suboccipital osteoplastic craniotomy helps to reduce the potential risks of complications, in particular, CSF leak and craniovertebral junction instability. The video can be found here: https://stream.cadmore.media/r10.3171/2023.10.FOCVID23106

脉络丛乳头状瘤是一种相对罕见的血管肿瘤。在这段视频中，作者介绍了一名小儿患者通过中线枕骨下开颅骨整形术，在外镜下切除了第四脑室脉络丛乳头状瘤。第四脑室病变部位的外窥镜有助于提高各个方向的可视性，外科医生可以在整个手术过程中保持舒适的体位。此外，中线枕骨下开颅骨整形术有助于降低并发症的潜在风险，尤其是脑脊液渗漏和颅椎交界处不稳定。视频请点击： https://stream.cadmore.media/r10.3171/2023.10.FOCVID23106

引用次数: 0

Introduction. Use of the exoscope in neurosurgery 导言。外窥镜在神经外科中的应用

Neurosurgical focus: Video

Pub Date : 2024-01-01 DOI: 10.3171/2023.10.focvid23188

Constantinos G. Hadjipanayis, L. Infinger, M. Lehecka, Gustavo Pradilla, Gabriel Zada

引用次数: 0

Exoscopic resection of giant olfactory groove meningioma 巨大嗅沟脑膜瘤的外镜切除术

Neurosurgical focus: Video

Pub Date : 2024-01-01 DOI: 10.3171/2023.10.focvid23125

Francesco Calvanese, A. M. Auricchio, M. Lehecka

Olfactory groove meningiomas represent 8%–13% of all intracranial meningiomas. Gross-total resection for large (4–6 cm) and giant (> 6 cm) cases remains challenging due to their relationship with critical neurovascular structures and extensive frontal lobe edema. A variety of transcranial and endoscopic approaches have been described. This 2D operative video shows the use of a digital 3D exoscope in the removal of a giant olfactory groove meningioma through a lateral supraorbital approach in a 57-year-old woman with visual impairment and apathy. The exoscope provides a very good angulated view of the subfrontal area on both sides of the anterior cranial fossa even through a small craniotomy. The video can be found here: https://stream.cadmore.media/r10.3171/2023.10.FOCVID23125

嗅沟脑膜瘤占所有颅内脑膜瘤的8%-13%。大型（4-6 厘米）和巨型（大于 6 厘米）病例的大体全切除术仍具有挑战性，因为它们与重要的神经血管结构和广泛的额叶水肿有关系。目前已有多种经颅和内窥镜方法。这段二维手术视频展示了使用数字 3D 外窥镜通过眶上外侧入路切除巨大嗅沟脑膜瘤的过程，患者是一名 57 岁的女性，患有视力障碍和冷漠症。即使是通过一个小的开颅手术，外窥镜也能对前颅窝两侧的额下区提供非常好的角度视野。视频请点击此处： https://stream.cadmore.media/r10.3171/2023.10.FOCVID23125

引用次数: 0

Minimally-invasive tubular resection of thoracolumbar intradural schwannoma. 胸腰椎硬膜内神经鞘瘤的微创管状切除术。

Neurosurgical focus: Video

Pub Date : 2023-10-01 DOI: 10.3171/2023.6.FOCVID2335

Maya Harary, Diana Chang, Irene Say, Daniel C Lu

Minimally invasive surgical (MIS) approaches to the spine are increasingly adopted for intradural pathology. In this setting, they may especially be useful to minimize risk of CSF leakage due to the decreased disruption to paraspinal musculature and minimal dead space. Herein, the authors demonstrate their technique for the resection of an intradural thoracolumbar schwannoma in a 30-year-old woman via an MIS approach using a nonexpandable tubular retractor. Salient points include the use of bayonetted instruments and the technique for dural closure in a small corridor. Indications for this technique are discussed in the context of a series of patients with intradural extramedullary lesions.

脊柱微创手术（MIS）方法越来越多地被用于硬膜内病理。在这种情况下，由于减少了对椎旁肌肉组织的破坏和最小的死区，它们可能特别有助于将CSF泄漏的风险降至最低。在此，作者展示了他们的技术，通过MIS方法，使用不可扩展的管状牵开器切除一名30岁女性的胸腰椎神经鞘瘤。突出的要点包括使用刺刀网器械和在小走廊中闭合硬膜的技术。这项技术的适应症是在一系列髓外硬膜内病变患者的背景下讨论的。

引用次数: 0

Robot-assisted T12 pediculectomy and resection of a ventral thoracic meningioma. 机器人辅助T12椎弓根切除术和腹侧胸脊膜瘤切除术。

Neurosurgical focus: Video

Pub Date : 2023-10-01 DOI: 10.3171/2023.7.FOCVID2372

Mahmudur Rahman, Huy Truong, Aditya Vedantam

Spinal meningiomas represent 25%-45% of intradural spinal tumors and are commonly seen in the thoracic spine. Ventral midline spinal meningiomas in the thoracic spine are challenging lesions to resect given their location in relation to the spinal cord. Resection for symptomatic or growing lesions requires adequate bone removal to limit retraction of the spinal cord. Surgical adjuncts such as intraoperative navigation, robotics, and ultrasound can improve the efficiency of and safety for resection of these lesions. The authors present a case of a complete resection of a ventral thoracic meningioma using a T12 transpedicular approach with robot-assisted navigated pediculectomy and intraoperative ultrasonography.

脊膜脑膜瘤占椎管内肿瘤的25%-45%，常见于胸椎。胸椎腹侧中线脊膜脑膜瘤是一种很难切除的病变，因为它们的位置与脊髓有关。有症状或生长性病变的切除需要充分的骨切除，以限制脊髓的回缩。手术辅助手段，如术中导航、机器人和超声波，可以提高这些病变切除的效率和安全性。作者介绍了一例使用T12经椎弓根入路、机器人辅助导航椎弓根切除术和术中超声检查完全切除腹侧胸脊膜瘤的病例。

引用次数: 0

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