High-Definition Fiber Tractography in the Evaluation and Surgical Planning of Lhermitte-Duclos Disease: A Case Report

Abstract BACKGROUND The endoscopic endonasal approach (EEA) has been proposed as a potential alternative for ventral brainstem lesions. The surgical anatomy, feasibility, and limitations of the EEA for intrinsic brainstem lesions are still poorly understood. OBJECTIVE To describe the surgical planning, anatomy, and technique of an intrinsic pontine glioma operated via EEA. METHODS Six-human brainstems were prepared for white matter microdissection. Ten healthy subjects were studied with high-definition fiber tractography (HDFT). A 56-yr-old female with right-hemiparesis underwent EEA for an exophytic pontine glioma. Pre- and postoperative HDFTs were implemented. RESULTS The corticospinal tracts (CSTs) are the most eloquent fibers in the ventral brainstem. At the pons, CSTs run between the pontine nuclei and the middle cerebellar peduncle (MCP). At the lower medulla, the pyramidal decussation leaves no room for safe ventral access. In our illustrative case, preoperative HDFT showed left-CST displaced posteromedially and partially disrupted, right-CST posteriorly displaced, and MCP severely disrupted. A transclival exposure was performed achieving a complete resection of the exophytic component with residual intra-axial tumor. Immediately postop, patient developed new left-side abducens nerve palsy and worse right-hemiparesis. Ten days postop, her strength returned to baseline. HDFT showed preservation and trajectory restoration of the CSTs. CONCLUSION The EEA provides direct access to the ventral brainstem, overcoming the limitations of lateral approaches. For intrinsic pathology, HDFT helps choosing the most appropriate surgical route/boundaries for safer resection. Further experience is needed to determine the indications and limitations of this approach that should be performed by neurosurgeons with high-level expertise in EEA.

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The epitrigeminal approach to the brainstem

Journal of Neurosurgery ◽

10.3171/2016.12.jns162561 ◽

2018 ◽

Vol 128 (5) ◽

pp. 1512-1521 ◽

Cited By ~ 1

Author(s):

Georgios Andrea Zenonos ◽

David Fernandes-Cabral ◽

Maximiliano Nunez ◽

Stefan Lieber ◽

Juan Carlos Fernandez-Miranda ◽

...

Keyword(s):

Cavernous Malformation ◽

Anatomical Study ◽

Normal Subjects ◽

Surgical Approaches ◽

Illustrative Case ◽

Fiber Tractography ◽

High Definition ◽

Entry Zone ◽

Corticospinal Tracts ◽

Direct Distance

OBJECTIVESurgical approaches to the ventrolateral pons pose a significant challenge. In this report, the authors describe a safe entry zone to the brainstem located just above the trigeminal entry zone which they refer to as the “epitrigeminal entry zone.”METHODSThe approach is presented in the context of an illustrative case of a cavernous malformation and is compared with the other commonly described approaches to the ventrolateral pons. The anatomical nuances were analyzed in detail with the aid of surgical images and video, anatomical dissections, and high-definition fiber tractography (HDFT). In addition, using the HDFT maps obtained in 77 normal subjects (154 sides), the authors performed a detailed anatomical study of the surgically relevant distances between the trigeminal entry zone and the corticospinal tracts.RESULTSThe patient treated with this approach had a complete resection of his cavernous malformation, and improvement of his symptoms. With regard to the HDFT anatomical study, the average direct distance of the corticospinal tracts from the trigeminal entry zone was 12.6 mm (range 8.7–17 mm). The average vertical distance was 3.6 mm (range −2.3 to 8.7 mm). The mean distances did not differ significantly from side to side, or across any of the groups studied (right-handed, left-handed, and ambidextrous).CONCLUSIONSThe epitrigeminal entry zone to the brainstem appears to be safe and effective for treating intrinsic ventrolateral pontine pathological entities. A possible advantage of this approach is increased versatility in the rostrocaudal axis, providing access both above and below the trigeminal nerve. Familiarity with the subtemporal transtentorial approach, and the reliable surgical landmark of the trigeminal entry zone, should make this a straightforward approach.

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Left Pan-Hippocampal Low Grade Glioma—2-Stage Transsylvian Transventricular and Paramedian Supracerebellar Transtentorial Approaches: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opy214 ◽

2018 ◽

Vol 16 (3) ◽

pp. E82-E82

Author(s):

Juan C Fernandez-Miranda

Keyword(s):

Tumor Resection ◽

Spatial Relationship ◽

Low Grade Glioma ◽

Parahippocampal Gyrus ◽

Surgical Approaches ◽

Low Grade ◽

Fiber Tractography ◽

High Definition ◽

Posterior Portion ◽

Fiber Tracts

Abstract The surgical goal for low-grade gliomas (LGGs) is to maximize resection while minimizing morbidity. Pan-hippocampal LGGs extend from the hippocampal head to the hippocampal tail, and involve the parahippocampal gyrus and uncus. Given their anteroposterior extension, they cannot be completely removed with 1 single approach, requiring a 2-stage front-to-back operation. In this video, we present the case of a 52-yr-old man with new onset of generalized seizures and a dominant-side, nonenhancing, pan-hippocampal infiltrative lesion compatible with a low-grade glioma. Preoperative high-definition fiber tractography (HDFT) showed the spatial relationship of the tumor with surrounding fiber tracts, such as the arcuate, inferior fronto-occipital, and middle longitudinal fascicles, and optic radiations. Surgical resection was planned in 2 separate stages. The first stage consisted of a transsylvian transinferior insular sulcus approach to the extra- and intraventricular aspects of the uncohippocampal region. The entire anterior and middle portions of the tumor were successfully removed with minimal morbidity, including transient naming difficulties and permanent superior quadrantanopia. Postoperative HDFT showed preservation of all fiber tracts, except for a portion of Meyer's loop and the inferior-most aspect of the inferior fronto-occipital fascicle. The second stage was completed 8 wk later and consisted of a paramedian supracerebellar-transtentorial approach on sitting position. The posterior portion of the tumor was entirely removed to achieve a complete macroscopic tumor resection. The final diagnosis was IDH1-positive LGG. Pan-hippocampal tumors remain a surgical challenge but accurate knowledge of surgical neuroanatomy and surgical approaches facilitates their safe and effective treatment. The patient signed an informed consent including the use of photographic and video material for educational or academic purposes.

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Schwannoma of the medial plantar nerve: a case report

Journal of the Foot & Ankle ◽

10.30795/jfootankle.2021.v15.1548 ◽

2021 ◽

Vol 15 (2) ◽

pp. 171-174

Author(s):

Adriano Machado Filho ◽

Jefferson Soares Martins ◽

Paulo Victor de Souza Pereira ◽

Ademir Freire de Moura Júnior

Keyword(s):

Case Report ◽

Surgical Planning ◽

Level Of Evidence ◽

Medial Plantar Nerve ◽

Plantar Surface ◽

Patient Level ◽

Red Flag ◽

Plantar Region ◽

Second Toe ◽

Multiple Schwannomas

We report the case of a 60-year-old woman with a schwannoma of the medial plantar nerve. She presented with the complaint of pain for about 2 years and a painful lesion in the medial plantar region of the left forefoot and on the second toe. Physical examination showed well-defined, firm tumor masses painful to palpation on the medial and plantar surface of the left forefoot and second toe. We surgically explored the area and excised 3 lesions, resulting in complete pain relief and no aesthetic complaints. Schwannomas of the medial plantar nerve are rare tumors, with only a few reports of cases extending to the forefoot. The finding of multiple schwannomas may be a red flag for the possible existence of local, painful, nerve lesions despite a negative Tinel sign. Appropriate surgical planning contributed to our successful intervention, without aesthetic, painful, or functional sequelae for the patient. Level of Evidence V; Therapeutic Studies; Expert Opinion.

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Karakteristik radiograf kista dentigerous dengan menggunakan CBCT-scan

Jurnal Radiologi Dentomaksilofasial Indonesia ◽

10.32793/jrdi.v4i2.519 ◽

2020 ◽

Vol 4 (2) ◽

pp. 15

Author(s):

Berty Pramatika ◽

Aga Satria Nurrachman ◽

Eha Renwi Astuti

Keyword(s):

Case Report ◽

Surgical Planning ◽

Dentigerous Cyst ◽

Three Dimensional ◽

Case Series ◽

Impacted Tooth ◽

Adjacent Structures

Objectives: The aim of this report which contains three case series is to describe the radiographic characteristic of dentigerous cyst using CBCT. Case Report: In the case presented here, all of the three patients had dentigerous cyst developing in impacted tooth, but did not have the same symptoms. CBCT radiography examination was carried out to find out the margin of the cortical extension, the diameter of the lesion, and the relations between the lesion and adjacent structures. The result of CBCT examination shows there is a variation of radiograph characteristics of dentigerous cyst among the three patients. Conclusion: CBCT is a very useful complementary tool for diagnosis and surgical planning in cases of dentigerous cyst, because three-dimensional viewing of the structures offers greater accuracy in lesion identification.

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A case report detailing the use of 3D printing technology in surgical planning and decision making in ENT surgery-an axial 3D first in Northern Ireland

International Journal of Surgery Case Reports ◽

10.1016/j.ijscr.2021.106407 ◽

2021 ◽

Vol 87 ◽

pp. 106407

Author(s):

Aoife Mallon ◽

Turlough Farnan

Keyword(s):

Decision Making ◽

Case Report ◽

Northern Ireland ◽

3D Printing ◽

Surgical Planning ◽

Printing Technology ◽

3D Printing Technology ◽

Ent Surgery

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High-definition fiber tractography for the evaluation of perilesional white matter tracts in high-grade glioma surgery

Neuro-Oncology ◽

10.1093/neuonc/nov113 ◽

2015 ◽

pp. nov113 ◽

Cited By ~ 12

Author(s):

Kumar Abhinav ◽

Fang-Cheng Yeh ◽

Alireza Mansouri ◽

Gelareh Zadeh ◽

Juan C. Fernandez-Miranda

Keyword(s):

White Matter ◽

High Grade Glioma ◽

High Grade ◽

Fiber Tractography ◽

High Definition ◽

Glioma Surgery ◽

White Matter Tracts

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Virtual surgical planning and 3D-printed guided biopsy of bilateral lesions in the mandible: a case report

Journal of 3D Printing in Medicine ◽

10.2217/3dp-2020-0016 ◽

2020 ◽

Vol 4 (4) ◽

pp. 185-192

Author(s):

Douglas Rangel Goulart ◽

Lucas Raineri Capeletti ◽

Gabriel Henrique Campos Pinheiro ◽

Mateus Veppo dos Santos ◽

Alessandro Lourenço Januario

Keyword(s):

Case Report ◽

Surgical Procedure ◽

Surgical Planning ◽

Inferior Alveolar Nerve ◽

Postoperative Recovery ◽

Virtual Surgical Planning ◽

Drill Guide ◽

Bone Biopsies ◽

3D Printed ◽

Bilateral Lesions

Purpose: To report the use of virtual surgical planning and a 3D printed drill guide for the biopsy of mandibular lesions. Case report: A 38-year-old woman presented with two bilateral lesions in the mandibular body, in close proximity to the inferior alveolar nerve and the molar roots. An incisional biopsy was planned with coDiagnostiX software using the cone beam computed tomography DICOM files and a cast model that had been digitalized using a bench scanner (7series, Dental Wings, Quebec, Canada). A tooth-supported drill guide was produced by 3D printing with digital light processing technology (Moonray S, Sprintray, CA, USA). The surgical procedure was performed under local anesthesia. No complications were observed intraoperatively or during postoperative recovery. Conclusion: The use of an intraoperative surgical 3D-printed drill guide enables a smaller surgical procedure and more precise bone biopsies.

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Survival of multiple nail gun injuries to the head, lung, and heart: A case report

10.21203/rs.3.rs-35448/v1 ◽

2020 ◽

Author(s):

Suo-Hsien Wang ◽

Mao-Yu Chen ◽

Tzu-Yen Huang ◽

Che-Chia Chang ◽

Chih-Ying Chien

Keyword(s):

Emergency Department ◽

Case Report ◽

Suicide Attempt ◽

Surgical Planning ◽

Surgical Intervention ◽

Treatment Strategies ◽

Emergency Physicians ◽

Significant Morbidity ◽

Case Presentation ◽

The Brain

Abstract Background: Most nail gun injuries occur at the extremities due to working accidents. Injuries to the brain or thorax are relatively rare, and cases with both injuries are even rarer. Initial evaluation, resuscitation and surgical planning can be challenging. Case presentation: Here, we present a case with nail gun injuries to the brain, lung, and heart by suicide attempt. The patient presented to the emergency department under shock. After resuscitation and surgical intervention, he was discharged without significant morbidity. Conclusions: Multiple nail gun injuries, especially those to vital organs such as the brain, lung, and heart, can be challenging to emergency physicians and surgeons. Imaging tools, treatment strategies, and possible complications are discussed in this article to provide optimized outcomes in such situations.

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