scholarly journals How I do it: the trans-laminar, facet-joint sparing minimal invasive approach for ventral dural repair in spontaneous intracranial hypotension—a 2-dimensional operative video

2021 ◽  
Author(s):  
Marco V. Corniola ◽  
Torstein R. Meling
Keyword(s):  
Minimally Invasive ◽  
Intracranial Hypotension ◽  
Facet Joint ◽  
Spontaneous Intracranial Hypotension ◽  
Skin Incision ◽  
Lateral Approach ◽  
Dural Defect ◽  
Dural Repair ◽  
Invasive Approach ◽  
Minimal Invasive Approach

Abstract Background We describe the minimally invasive, facet-sparing postero-lateral approach to the thoracic spine for a ventral dural repair in a patient with intracranial hypotension secondary to a spontaneous dural breach. Methods We performed a minimally invasive approach using a short paramedian posterior skin incision followed by a 10 × 10 mm targeted trans-laminar approach, to achieve a microsurgical repair of a symptomatic ventral dural defect causing severe disability. Conclusion The facet-sparing postero-lateral approach is safe and effective in the surgical management of thoracic dural tears, even in the most anterior ones, and avoids the traditional costotransversectomy.

Novel hydrogel application in minimally invasive surgical approaches to spontaneous intracranial hypotension

2014 ◽  
Vol 121 (4) ◽  
pp. 976-982 ◽  
Author(s):  
Casey M. Chai ◽  
Matei A. Banu ◽  
William Cobb ◽  
Neel Mehta ◽  
Linda Heier ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Intracranial Hypotension ◽  
Fluid Collection ◽  
Spontaneous Intracranial Hypotension ◽  
Patch Repair ◽  
Surgical Approaches ◽  
Dural Defect ◽  
Dural Repair ◽  
Blood Patch ◽  
Csf Leaks

The authors report 2 cases of orthostatic headaches associated with spontaneous intracranial hypotension (SIH) secondary to CSF leaks that were successfully treated with an alternative dural repair technique in which a tubular retractor system and a hydrogel dural sealant were used. The 2 patients, a 63-year-old man and a 45-year-old woman, presented with orthostatic headache associated with SIH secondary to suspected lumbar and lower cervical CSF leaks, respectively, as indicated by bony defects or epidural fluid collection. Epidural blood patch repair failed in both cases, but both were successfully treated with the minimally invasive application of a hydrogel dural sealant as a novel adjunct to traditional dural repair techniques. Both patients tolerated the procedure well. Moreover, SIH symptoms and MRI signs were completely resolved at 1-month follow-up in both patients. The minimally invasive dural repair procedure with hydrogel dural sealant described here offers a viable alternative in patients in whom epidural blood patches have failed, with obscure recalcitrant CSF leaks at the cervical as well as lumbar spinal level. The authors demonstrate that the adjuvant use of sealant is a safe and efficient repair method regardless of dural defect location.

Minimally invasive repair of spontaneous intracranial hypotension

2011 ◽  
Vol 114 (2) ◽  
pp. 505-509 ◽  
Author(s):  
Hamad I. Farhat ◽  
Brian Hood ◽  
Steven Vanni ◽  
Allan D. Levi
Keyword(s):  
Minimally Invasive ◽  
Intracranial Hypotension ◽  
Therapeutic Option ◽  
Treatment Options ◽  
Spontaneous Intracranial Hypotension ◽  
Surgical Correction ◽  
Invasive Approach ◽  
Epidural Blood Patching ◽  
Csf Leakage ◽  
Cerebrospinal Fluid Leaks

Spontaneous spinal CSF leakage with the development of intracranial hypotension is a well-described entity. Cerebrospinal fluid leaks, mostly from the thoracic spine, are the major cause of spontaneous intracranial hypotension (SIH). Conservative treatment options include hydration, oral caffeine, and epidural blood patching. Alternatively, open surgical correction of meningeal diverticula is a therapeutic option. The authors describe 4 cases of spontaneous spinal CSF leakage producing symptoms of intracranial hypotension. All patients had multiple spinal diverticula with an identified leaking level. The patients were treated using a minimally invasive approach via surgical correction of the meningeal diverticulum.

The Rostral Mucosa: The Door to Open and Close for Targeted Endoscopic Endonasal Approaches to the Clivus

2021 ◽  
Author(s):  
Paolo di Russo ◽  
Arianna Fava ◽  
Lorenzo Giammattei ◽  
Thibault Passeri ◽  
Atsushi Okano ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Tumor Resection ◽  
Skin Incision ◽  
Reconstruction Technique ◽  
Endoscopic Endonasal ◽  
Invasive Approach ◽  
Mucosal Incision ◽  
Reconstruction Strategy ◽  
Further Development ◽  
Targeted Approach

Abstract BACKGROUND Extended endoscopic endonasal approaches (EEAs) have progressively widened the armamentarium of skull base surgeons. In order to reduce approach-related morbidity of EEAs and closure techniques, the development of alternative strategies that minimize the resection of normal tissue and alleviate the use of naso-septal flap (NSF) is needed. We report on a novel targeted approach to the clivus, with incision and closure of the mucosa of the rostrum, as the initial and final step of the approach. OBJECTIVE To present an alternative minimally invasive approach and reconstruction technique for selected clival chordomas. METHODS Three cases of clival chordomas illustrating this technique are provided, together with an operative video. RESULTS The mucosa of the rostrum is incised and elevated from the underlying bone, as first step of surgery. Following tumor resection with angled scope and instruments, the mucosa of the sphenoid sinus (SS) is removed and the tumor cavity and SS are filled with abdominal fat. The mucosal incision of the rostrum is then sutured. A hangman knot is prepared outside the nasal cavity and tightened after the first stitch and a running suture is performed. CONCLUSION We propose, in this preliminary report, a new targeted approach and reconstruction strategy, applying to EEAs the classic concept of skin incision and closure for transcranial approaches. With further development in the instrumentations and visualization tools, this technique may become a valuable minimally invasive endonasal approach for selected lesions.

scholarly journals Minimally Invasive Repair of a Delayed Recurrent Traumatic Cerebrospinal Fluid Rhinorrhea: A Case Report of Dislocation of the Bony and Dural Defects

2020 ◽  
Author(s):  
Xiaofei Liu ◽  
Ping Chen ◽  
Bing Wang
Keyword(s):  
Cerebrospinal Fluid ◽  
Minimally Invasive ◽  
Bony Defect ◽  
Dural Defect ◽  
Csf Rhinorrhea ◽  
Invasive Approach ◽  
Fascial Flap ◽  
Anterior Cranial Base ◽  
Csf Leakage ◽  
The Right

Abstract Background：Dural and bony defects mostly occur in the same position in the cerebrospinal fluid（CSF）rhinorrhea of anterior cranial base fractures,and a few cases of delayed CSF leakage after repair are also reported.Case presentation：We report a case in which a pedicled temporoparietal fascial flap was used to repair the comminuted fracture of the anterior skull base with CSF leakage. Delayed CSF leakage occurred 45 days after the operation.A minimally invasive approach through an eyebrow incision was performed for reoperation,it was found that the bony defect was located in the right frontal sinus and the dural defect was located in the right ethmoid plate. Conclusions:This case suggests that delayed traumatic CSF rhinorrhea after reconstructive surgery is more complex than usual,and appropriate approach should be adopted to repair the dural and bony defects , the transeyebrow approach is a good choice.

scholarly journals Splenic Rupture After Minimal Invasive Lateral Retropleural Corpectomy

2020 ◽  
pp. 1-3
Author(s):  
Michele Cappuccio ◽  
Michele Cappuccio ◽  
Gregorio Tugnoli ◽  
Tiziano Fidilio ◽  
Federico De Iure
Keyword(s):  
Lateral Approach ◽  
Minimal Invasive ◽  
Thoracolumbar Junction ◽  
General Surgeon ◽  
Invasive Approach ◽  
Thoracoscopic Approach ◽  
Minimal Invasive Approach ◽  
Tissue Sparing ◽  
Minimal Invasive Techniques ◽  
Invasive Techniques

Retropleural minimal invasive approach to the thoracolumbar junction has become more popular in the last decade both for degenerative and traumatic spine surgery as it marries the advantages of direct vision typical of open surgery and the philosophy of tissue sparing which characterizes the thoracoscopic approach. Nevertheless, as with the just mentioned techniques, this approach also requires the caudal displacement of the diaphragm with the organs below including the spleen. The authors report one case of postoperative spleen disruption following a retropleural minimal invasive approach in a patient with an underlying grade II spleen lesion occurred 8 days before and considered safe by the general surgeon. We conclude that even negligible spleen injuries must be considered an absolute contraindication to thoracolumbar junction lateral approach even with minimal invasive techniques.

Minimally Invasive Approach for Dorsal Arachnoid Web: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Corentin Dauleac ◽  
Henri-Arthur Leroy ◽  
Richard Assaker
Keyword(s):  
Spinal Cord ◽  
Minimally Invasive ◽  
Skin Incision ◽  
Minimally Invasive Approach ◽  
Tubular Retractor ◽  
Invasive Approach ◽  
Spinal Cord Herniation ◽  
Muscle Sparing ◽  
Magnetic Resonance Imaging Mri ◽  
Spinal Cord Decompression

Abstract A 67-yr-old patient presented with severe paraparesis and lower limb spasticity. The spinal cord magnetic resonance imaging (MRI) revealed the “scalpel sign” 1,2 at the T7 level, suggesting a diagnosis of a dorsal arachnoid web. This video demonstrates a microsurgical technique for the excision of a dorsal arachnoid web with a minimally invasive approach. A paramedian skin incision, understanding the muscular aponeurosis, was performed from T7 to T8. Then, we inserted the tubular dilators until the lamina, to perform a muscle-sparing approach. An expandable tubular retractor of adequate length was passed over the widest dilator and docked into place along the subperiosteal plane. The T7 lamina was drilled, and the resection of the superior and inferior adjacent spine levels was completed with a rongeur. Additional contralateral bone resection was performed after tubular retractor tilt to the midline.3 After dura mater opening, it was carefully suspended and the dorsal arachnoid leaflet was cut to drain the dorsolateral and lateral spinal cisterns.4 The dorsal arachnoid web was, first, disconnected from its lateral anchorages. It was then gently removed with microsurgical forceps, to help its microdissection from the spinal cord surface. At this step, peculiar attention was paid to limit the traction or displacements of the spinal cord and surrounding vessels. Once the dorsal arachnoid web was removed, the quality of the spinal cord decompression was confirmed by its re-expansion. In conclusion, the minimally invasive approach is a safe and appropriate technique for dorsal arachnoid web excision.2,5,6-7  The patient gave her informed and signed consent for the writing and publication of this article.  Image at 1:00 reused with permission from Castelnovo G et al, Spontaneous transdural spinal cord herniation, Neurology, 2014;82(14):1290.

Mini Fronto-Orbital Approach: “Window Opening” Towards the Superomedial Orbit – A Virtual Reality-Planned Anatomic Study

2020 ◽  
Vol 19 (3) ◽  
pp. 330-340 ◽  
Author(s):  
Carmine Antonio Donofrio ◽  
Jody Filippo Capitanio ◽  
Lucia Riccio ◽  
Aalap Herur-Raman ◽  
Anthony J Caputy ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Minimally Invasive ◽  
Three Dimensional ◽  
Skin Incision ◽  
Surgical Approaches ◽  
Target Area ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Window Opening ◽  
Dissection Technique

Abstract BACKGROUND Surgical approaches to the orbit are challenging and require combined multispecialist skills. Considering its increasing relevance in neurosurgical practice, keyhole surgery could be also applied to this field. However, mastering a minimally invasive approach necessitates an extended learning curve. For this reason, virtual reality (VR) can be effectively used for planning and training in this demanding surgical technique. OBJECTIVE To validate the mini fronto-orbital (mFO) approach to the superomedial orbit, using VR planning and specimen dissections, conjugating the principles of skull base and keyhole neurosurgery. METHODS Three-dimensional measurements were performed thanks to Surgical Theater (Surgical Theater© LLC), and then, simulated craniotomies were implemented on cadaver specimens. RESULTS The mFO approach affords optimal exposure and operability in the target area and reduced risks of surrounding normal tissue injuries. The eyebrow skin incision, the minimal soft-tissue retraction, the limited temporalis muscle dissection and the single-piece craniotomy, as planned with VR, are the key elements of this minimally invasive approach. Furthermore, the “window-opening” cotton-tip intraorbital dissection technique, based on widening surgical corridors between neuromuscular bundles, provides a safe orientation and a deep access inside the orbit, thereby significantly limiting the risk of jeopardizing neurovascular structures. CONCLUSION The mFO approach associated to the window-opening dissection technique can be considered safe, effective, suitable, and convenient for treating lesions located in the superomedial orbital aspect, up to the orbital apex.

Spontaneous intracranial hypotension associated with transdural thoracic osteophyte reversed by primary dural repair

2005 ◽  
Vol 2 (5) ◽  
pp. 614-618 ◽  
Author(s):  
Devin K. Binder ◽  
Vahé Sarkissian ◽  
William P. Dillon ◽  
Philip R. Weinstein
Keyword(s):  
Intracranial Hypotension ◽  
Surgical Intervention ◽  
Median Sternotomy ◽  
Spontaneous Intracranial Hypotension ◽  
Imaging Features ◽  
Dural Repair ◽  
Content Type ◽  
Csf Leakage ◽  
Upper Thoracic ◽  
Csf Leaks

✓ Spontaneous intracranial hypotension (SIH) is an increasingly recognized syndrome associated with a specific set of clinical and imaging findings; however, determining the site of spinal cerebrospinal fluid (CSF) leakage in these patients is often difficult, and indications for surgical intervention need to be better defined. The authors report on a 55-year-old woman who presented with posture-related headache, disorientation, and memory impairment. Imaging features were consistent with SIH. Computerized tomography myelography demonstrated a large T2–3 anterior transdural osteophyte associated with a CSF fistula. After an unsuccessful trial of conservative therapy, the patient underwent median sternotomy, T2–3 discectomy and removal of osteophyte, which allowed adequate exposure for primary dural repair. Postoperatively, there was immediate and prolonged resolution of all of her symptoms. This case of SIH was caused by transdural penetration by an anterior osteophyte and CSF leakage in the upper thoracic spine, which was treated effectively by anterior exposure and primary dural repair. Aggressive surgical intervention may be required to treat upper thoracic CSF leaks refractory to other measures.

scholarly journals Factors for a Successful Laparoscopic Hysterectomy in Very Large Uteri

2017 ◽  
Vol 2017 ◽  
pp. 1-5
Author(s):  
Harald Krentel ◽  
Rudy Leon De Wilde
Keyword(s):  
Minimally Invasive ◽  
Vaginal Hysterectomy ◽  
Standard Procedure ◽  
Laparoscopic Hysterectomy ◽  
Cost Effective ◽  
Abdominal Hysterectomy ◽  
Minimal Invasive ◽  
Invasive Approach ◽  
Minimal Invasive Approach ◽  
Laparoscopic Subtotal Hysterectomy

Minimally invasive hysterectomy is a standard procedure. Different approaches, as laparoscopically assisted vaginal hysterectomy, vaginal hysterectomy, and subtotal and total laparoscopic hysterectomy, have been described and evaluated by various investigations as safe and cost-effective methods. In particular, in comparison to abdominal hysterectomy, the minimally invasive methods have undoubted advantages for the patients. The main reason for a primary abdominal hysterectomy or conversion to abdominal hysterectomy during a minimal invasive approach is the uterine size. We describe our course of action in the retrospective analysis of five cases of total minimal-access hysterectomy, combining the laparoscopic subtotal hysterectomy and the vaginal extirpation of the cervix in uterine myomatosis with a uterine weight of more than 1000 grams, and discuss the factors that limit the use of laparoscopy in the treatment of big uteri. Trail Registration. The case report is registered in Research Registry under the UIN researchregistry743.

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