Neurosurgical focus: Video最新文献

Surgery of lesions around Wernicke's area is challenging for several reasons. The anatomical boundaries are not clearly defined, necessitating functional identification in addition to anatomical landmarks. There are potential complications secondary to injury of the surrounding structures. This challenge is more substantial when dealing with lower-grade gliomas in this region, as surgeons must balance the extent of resection with the risk of potential injury to the patient, especially considering that there may be other treatment options for the management of residual tumors. In this video, the authors present a case illustration, discussing surgical considerations and strategy. The video can be found here: https://stream.cadmore.media/r10.3171/2024.10.FOCVID24101.

Eloquent brain creates a challenge when resecting brain arteriovenous malformations (bAVMs). Here the authors present their technique of using subcortical motor mapping as an adjunct to increase safety during resection of a high-grade bAVM involving somatosensory cortex as well as cortical spinal tracts and visual tracts. After a bilateral craniotomy, they use direct cortical stimulation of the left motor cortex and subcortical stimulation using a suction stimulator to dynamically map motor tracts during the resection. They get within 3 mm of the corticospinal tracts by stimulation. The video can be found here: https://stream.cadmore.media/r10.3171/2024.10.FOCVID24107.

Surgically remediable epilepsy of the eloquent brain poses the added challenge of preserving function while curing disease. Long-standing epileptogenic lesions have tenacious seizure networks and significant functional reorganizations. Large multilobar lesions may involve multiple functional areas, thereby challenging the limits of functional brain mapping. In this video, the authors describe a dominant hemisphere fronto-parieto-temporo-occipital malformation of cortical development, involving the language, sensorimotor, and visual cortices, placing multiple eloquent cortical and subcortical regions at risk. They illustrate the technique of hexamodal mapping/monitoring involving the language sensorimotor areas, optic radiation, auditory pathway, and ictal irritative zone for a multilobar resection, with good seizure outcome and function preservation. The video can be found here: https://stream.cadmore.media/r10.3171/2024.10.FOCVID24111.

Electrophysiological mapping and monitoring techniques permit the objective measurement of eloquent cortical regions and accompanying white matter tracts to reduce the incidence of iatrogenic injury in glioma surgery. Recently, there has been increased interest in mapping and monitoring of the human arcuate fasciculus via cortico-cortical evoked potentials (CCEPs) during awake and asleep craniotomy. The authors present the case of a 27-year-old female who underwent a hypnosis-assisted awake craniotomy with cortico-subcortical language mapping and arcuate fasciculus CCEPs. There were no adverse effects associated with CCEP monitoring. Further investigation is required in order to substantiate the technique and validate clinical significance criteria, which may reliably permit asleep language mapping and monitoring. The video can be found here: https://stream.cadmore.media/r10.3171/2024.10.FOCVID24126.

Brainstem tumors are bounded by a compact topography of eloquent tracts, cranial nerves, and nuclei. Reliable intraoperative neuromonitoring aids microneurosurgical technique to optimize safe resection. The authors present a case of motor mapping-guided resection of a recurrent brainstem pilocytic astrocytoma. They demonstrate reliable and continuous responses from the corticospinal tract at the level of the midbrain to the pons with dynamic subcortical motor mapping using a monopolar stimulating suction. Contralateral limb and ipsilateral face muscles can be simultaneously detected and tumor resected until a threshold of less than 1 mA, corresponding to 1 mm or less from the corticospinal tracts. The video can be found here: https://stream.cadmore.media/r10.3171/2024.10.FOCVID24110.

This video depicts a left-sided MRI-guided focused ultrasound (MRgFUS) thalamotomy for a right-arm tremor in a 76-year-old, right-handed man with bilateral upper-extremity tremors. The patient tolerated the procedure well, with immediate tremor reduction that persisted at the 1-month follow-up, and there were no adverse events noted during intraoperative testing, postoperative testing, or follow-up. This case highlights MRgFUS as an effective, safe, incision-free treatment option for medically refractory essential tremor. Additional research is required to establish the long-term efficacy of MRgFUS compared with other surgical treatment options such as deep brain stimulation (DBS) and radiosurgery. The video can be found here: https://stream.cadmore.media/r10.3171/2024.7.FOCVID2472.

This video showcases stereotactic radiofrequency lesioning of the caudal zona incerta (CZi) for parkinsonian tremor in a 70-year-old patient. The preoperative evaluation, including imaging and frame placement, is detailed. The surgical procedure involves meticulous targeting and trajectory planning. Intraoperative stimulation is utilized for motor response assessment. Two temporary lesioning phases precede the final procedure at 75°C. The postoperative CT scan highlights the lesion site. Immediate tremor relief is observed postoperatively, with the effect persisting at the 1-month follow-up. Supporting readings underscore the efficacy and safety of CZi for tremor management. The video can be found here: https://stream.cadmore.media/r10.3171/2024.7.FOCVID2462.

Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy has emerged as an effective treatment for tremor, particularly in those patients who are excluded from deep brain stimulation. The authors illustrate an example of MRgFUS thalamotomy, targeting the ventralis intermedius nucleus, in a 78-year-old patient with tremor who had features of essential tremor and tremor-predominant Parkinson's disease. Significant tremor improvement was seen during the procedure. The authors review step-by-step the preoperative considerations, Vim targeting, treatment, and outcomes for this evolving treatment modality. The video can be found here: https://stream.cadmore.media/r10.3171/2024.7.FOCVID249.

This video article presents a case study of a 70-year-old male with medically refractory essential tremor treated with magnetic resonance-guided focused ultrasound (MRgFUS). Following an initial successful ablation of the right thalamus, the patient underwent left-sided thalamotomy. After two tractography-guided sonications, the authors observed a significant reduction in his right-hand tremor with no immediate side effects. Postprocedure evaluation revealed sustained tremor reduction with minimal side effects, showcasing bilateral MRgFUS as an effective, noninvasive option for essential tremor management. The video can be found here: https://stream.cadmore.media/r10.3171/2024.7.FOCVID2483.

Hemispheric epilepsy is quite frequent in children, compared with adults, and encompasses pathological substrates as diverse as hemimegalencephaly, Rasmussen encephalitis, Sturge-Weber syndrome, and porencephaly, among others. These patients most often become pharmacoresistant and thus require surgical management. Although anatomical hemispherectomy is a possibility, the technique that is favored by most epilepsy surgery centers worldwide is functional hemispherotomy, which results in equivalent outcomes with fewer postoperative complications. Therefore, it is essential that pediatric epilepsy neurosurgeons become familiar with these techniques. The present video describes in detail all surgical aspects of the perisylvian hemispherotomy.