Intraparenchymal Epidermoid Cyst Close to Broca Area—Awake Craniotomy and Gross Total Resection

2020 ◽  
Vol 141 ◽  
pp. 367-372 ◽  
Author(s):  
Leonardo J.M. de Macêdo Filho ◽  
Gilnard C.M. Aguiar ◽  
Fátima C. Pessoa ◽  
Gabryella S. Diógenes ◽  
Felipe S. Borges ◽  
...  
Keyword(s):  
Epidermoid Cyst ◽  
Awake Craniotomy ◽  
Gross Total Resection ◽  
Total Resection

Surgical Resection of a Recurrent Intramedullary Spinal Epidermoid Cyst: 2-Dimensional Operative Video

2019 ◽  
Vol 17 (5) ◽  
pp. E204-E204 ◽  
Author(s):  
Noah Nichols ◽  
Ketan Yerneni ◽  
Joseph A Osorio ◽  
Michael McDermott ◽  
Lee A Tan
Keyword(s):  
Surgical Resection ◽  
Epidermoid Cyst ◽  
Radiation Treatment ◽  
Tumor Location ◽  
Gross Total Resection ◽  
Spinal Tumors ◽  
Adjuvant Radiation ◽  
Total Resection ◽  
Epidermoid Cysts ◽  
Patient Consent

Abstract Intramedullary spinal epidermoid cysts are rare tumors and only account for 1% of all spinal tumors in adults. Epidermoid cysts can develop from ectodermal tissue that was inappropriately positioned in the primitive neural tube during closure; acquired forms exist for epidermoid cysts as they can emerge in an iatrogenic manner following repeated lumbar punctures. Malignant progression of epidermoid cysts is extremely rare, and symptoms typically depend on tumor location. Surgical resection is the preferred treatment. Gross total resection is ideal; however, partial resections have demonstrated satisfactory long-term outcomes.  We present a 54-yr-old man with symptomatic recurrence of thoracic intramedullary epidermoid cyst after two prior resections (25 yr and 11 yr ago, respectively). The patient noted worsening back pain, leg spasticity and weakness. Magnetic resonance imaging (MRI) of the thoracic spine demonstrated interval expansion of the upper thoracic intramedullary epidermoid cyst compared to surveillance MRI from 3 yr prior.  Given the progressive nature of symptoms, the patient elected to have surgical resection of the tumor. This operative video highlights the technique and surgical nuances of gross-total resection of a recurrent thoracic intramedullary spinal epidermoid cyst. This patient was noted to have a stable neurological exam at the 6-mo follow-up visit with planned adjuvant radiation treatment.  There is no identifying information in this video. Patient consent was obtained for publishing of the material included in the video.

Failed awake craniotomy: a retrospective analysis in 424 patients undergoing craniotomy for brain tumor

2013 ◽  
Vol 118 (2) ◽  
pp. 243-249 ◽  
Author(s):  
Erez Nossek ◽  
Idit Matot ◽  
Tal Shahar ◽  
Ori Barzilai ◽  
Yoni Rapoport ◽  
...  
Keyword(s):  
Medical Center ◽  
Brain Regions ◽  
Awake Craniotomy ◽  
Gross Total Resection ◽  
Total Resection ◽  
Failure Group ◽  
Communication History ◽  
Hospitalization Period ◽  
Successful Group ◽  
History Of

Object Awake craniotomy for removal of intraaxial tumors within or adjacent to eloquent brain regions is a well-established procedure. However, awake craniotomy failures have not been well characterized. In the present study, the authors aimed to analyze and assess the incidence and causes for failed awake craniotomy. Methods The database of awake craniotomies performed at Tel Aviv Medical Center between 2003 and 2010 was reviewed. Awake craniotomy was considered a failure if conversion to general anesthesia was required, or if adequate mapping or monitoring could not have been achieved. Results Of 488 patients undergoing awake craniotomy, 424 were identified as having complete medical, operative, and anesthesiology records. The awake craniotomies performed in 27 (6.4%) of these 424 patients were considered failures. The main causes of failure were lack of intraoperative communication with the patient (n = 18 [4.2%]) and/or intraoperative seizures (n = 9 [2.1%]). Preoperative mixed dysphasia (p < 0.001) and treatment with phenytoin (p = 0.0019) were related to failure due to lack of communication. History of seizures (p = 0.03) and treatment with multiple antiepileptic drugs (p = 0.0012) were found to be related to failure due to intraoperative seizures. Compared with the successful awake craniotomy group, a significantly lower rate of gross-total resection was achieved (83% vs 54%, p = 0.008), there was a higher incidence of short-term speech deterioration postoperatively (6.1% vs 23.5%, p = 0.0017) as well as at 3 months postoperatively (2.3% vs 15.4%, p = 0.0002), and the hospitalization period was longer (4.9 ± 6.2 days vs 8.0 ± 10.1 days, p < 0.001). Significantly more major complications occurred in the failure group (4 [14.8%] of 27) than in the successful group (16 [4%] of 397) (p = 0.037). Conclusions Failures of awake craniotomy were associated with a lower incidence of gross-total resection and increased postoperative morbidity. The majority of awake craniotomy failures were preventable by adequate patient selection and avoiding side effects of drugs administered during surgery.

Recurrence of Rathke’s Cleft Cysts Based on Gross Total Resection of Cyst Wall: A Meta-analysis

2020 ◽  
Author(s):  
Victor Lu ◽  
Avital Perry ◽  
Christopher Graffeo ◽  
Krishnan Ravindran ◽  
Jamie Van Gompel
Keyword(s):  
Cyst Wall ◽  
Meta Analysis ◽  
Gross Total Resection ◽  
Total Resection ◽  
Rathke's Cleft Cysts ◽  
Rathke's Cleft

Letter to the Editor Regarding “Association Between Facility Volume and Overall Survival for Patients with Grade II Meningioma after Gross Total Resection”

2020 ◽  
Vol 142 ◽  
pp. 537
Author(s):  
Gustavo Correa Lordelo ◽  
Victor Salviato Nespoli ◽  
Iuri Santana Neville ◽  
Wellingson Silva Paiva
Keyword(s):  
Overall Survival ◽  
Gross Total Resection ◽  
Total Resection ◽  
Letter To The Editor ◽  
Grade Ii

scholarly journals Resection of a Lumbar Intradural Extramedullary Schwannoma: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Michael J Strong ◽  
Timothy J Yee ◽  
Siri Sahib S Khalsa ◽  
Yamaan S Saadeh ◽  
Whitney E Muhlestein ◽  
...  
Keyword(s):  
Spinal Nerve ◽  
Gross Total Resection ◽  
Preoperative Imaging ◽  
Benign Tumors ◽  
Total Resection ◽  
Intradural Tumor ◽  
Key Points ◽  
Intraoperative Fluoroscopy ◽  
Patient Consent ◽  
Intradural Extramedullary

Abstract Schwannomas are typically benign tumors that arise from the sheaths of nerves in the peripheral nervous system. In the spine, schwannomas usually arise from spinal nerve roots and are therefore extramedullary in nature. Surgical resection-achieving a gross total resection, is the main treatment modality and is typically curative for patients with sporadic tumors. In this video, we present the case of a 38-yr-old male with worsening left leg radiculopathy, found to have a lumbar schwannoma. Preoperative imaging demonstrated that the tumor was at the level of L4-L5. A laminectomy at this level was performed with gross total resection of the tumor. The key points of the video include use of intraoperative fluoroscopy to confirm surgical level and help plan surgical exposure, use of ultrasound for intradural tumor localization, and advocating for maximum safe resection using neurostimulation. The patient tolerated the surgery well without any complications. He was discharged home with no additional therapy needed. Appropriate patient consent was obtained.

scholarly journals Transcavernous Resection of a Giant Extensive Chondrosarcoma with Endoscopic Assistance

2021 ◽  
Author(s):  
Walid Elshamy ◽  
Burcak Soylemez ◽  
Sima Sayyahmelli ◽  
Nese Keser ◽  
Mustafa K. Baskaya
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Skull Base ◽  
Internal Carotid ◽  
Gross Total Resection ◽  
Petrous Apex ◽  
Left Internal Carotid Artery ◽  
Total Resection ◽  
Complete Occlusion ◽  
Grade Ii

AbstractChondrosarcomas are one of the major malignant neoplasms which occur at the skull base. These tumors are locally invasive. Gross total resection of chondrosarcomas is associated with longer progression-free survival rates. The patient is a 55-year-old man with a history of dysphagia, left eye dryness, hearing loss, and left-sided facial pain. Magnetic resonance imaging (MRI) showed a giant heterogeneously enhancing left-sided skull base mass within the cavernous sinus and the petrous apex with extension into the sphenoid bone, clivus, and the cerebellopontine angle, with associated displacement of the brainstem (Fig. 1). An endoscopic endonasal biopsy revealed a grade-II chondrosarcoma. The patient was then referred for surgical resection. Computed tomography (CT) scan and CT angiogram of the head and neck showed a left-sided skull base mass, partial destruction of the petrous apex, and complete or near-complete occlusion of the left internal carotid artery. Digital subtraction angiography confirmed complete occlusion of the left internal carotid artery with cortical, vertebrobasilar, and leptomeningeal collateral development. The decision was made to proceed with a left-sided transcavernous approach with possible petrous apex drilling. During surgery, minimal petrous apex drilling was necessary due to autopetrosectomy by the tumor. Endoscopy was used to assist achieving gross total resection (Fig. 2). Surgery and postoperative course were uneventful. MRI confirmed gross total resection of the tumor. The histopathology was a grade-II chondrosarcoma. The patient received proton therapy and continues to do well without recurrence at 4-year follow-up. This video demonstrates steps of the combined microsurgical skull base approaches for resection of these challenging tumors.The link to the video can be found at: https://youtu.be/WlmCP_-i57s.

scholarly journals Transcavernous Approach for Gross Total Resection of a Dumbbell-Shaped Giant Trigeminal Schwannoma

2021 ◽  
Author(s):  
Sima Sayyahmelli ◽  
Emel Avci ◽  
Burak Ozaydin ◽  
Mustafa K. Başkaya
Keyword(s):  
Skull Base ◽  
Cavernous Sinus ◽  
Tumor Resection ◽  
Mass Effect ◽  
World Health ◽  
Gross Total Resection ◽  
Petrous Apex ◽  
Total Resection ◽  
Who Grade ◽  
Trigeminal Schwannoma

AbstractTrigeminal schwannomas are rare nerve sheet tumors that represent the second most common intracranial site of occurrence after vestibular nerve origins. Microsurgical resection of giant dumbbell-shaped trigeminal schwannomas often requires complex skull base approaches. The extradural transcavernous approach is effective for the resection of these giant tumors involving the cavernous sinus.The patient is a 72-year-old man with headache, dizziness, imbalance, and cognitive decline. Neurological examination revealed left-sided sixth nerve palsy, a diminished corneal reflex, and wasting of temporalis muscle. Magnetic resonance imaging (MRI) showed a giant homogeneously enhancing dumbbell-shaped extra-axial mass centered within the left cavernous sinus, Meckel's cave, and the petrous apex, with extension to the cerebellopontine angle. There was a significant mass effect on the brain stem causing hydrocephalus. Computed tomography (CT) scan showed erosion of the petrous apex resulting in partial anterior autopetrosectomy (Figs. 1 and 2).The decision was made to proceed with tumor resection using a transcavernous approach. Gross total resection was achieved. The surgery and postoperative course were uneventful, and the patient woke up the same as in the preoperative period. MRI confirmed gross total resection of the tumor. The histopathology was a trigeminal schwannoma, World Health Organization (WHO) grade I. The patient continues to do well without any recurrence at 15-month follow-up.This video demonstrates important steps of the microsurgical skull base techniques for resection of these challenging tumors.The link to the video can be found at https://youtu.be/TMK5363836M

Sodium Fluorescein-Guided Gross Total Resection of Pediatric Exophytic Brainstem Glioma: 2-Dimensional Operative Video

2020 ◽  
Author(s):  
Christopher Markosian ◽  
Catherine A Mazzola ◽  
Luke D Tomycz
Keyword(s):  
Normal Tissue ◽  
Clinical Case ◽  
Aminolevulinic Acid ◽  
Significant Risk ◽  
Gross Total Resection ◽  
Subtotal Resection ◽  
Sodium Fluorescein ◽  
Total Resection ◽  
Term Survival ◽  
Patient Consent

Abstract Brainstem gliomas comprise 10% to 20% of pediatric intracranial tumors.1 Gross total resection is associated with the greatest long-term survival.1 However, due to the eloquence of surrounding brain tissue, an aggressive resection is not always achievable and can be associated with significant risk.2 Sodium fluorescein can be used to help differentiate between tumor and normal tissue.3,4 In this operative video, we demonstrate the step-by-step technique to utilize fluorescence in surgically resecting an exophytic glioma arising from the midbrain in a 16-yr-old male. Technical nuances are highlighted in this operative video, including the use of the YELLOW 560 (Zeiss) filter to differentiate fluorescent tumor from normal tissue as well as strategic splitting of the tentorium to expose the supratentorial component of the tumor. A decrease in motor potentials of the right leg during the case did not translate into neurological worsening postoperatively; at 3-mo follow-up, the patient attests to better strength and coordination on his affected side. In summary, sodium fluorescein can be used as a critical adjunctive tool for successful surgery in the case of a brainstem tumor. Alternatives to this procedure included gross total resection with 5-aminolevulinic acid, subtotal resection with chemotherapy, and active monitoring, but were not chosen due to their limitations in this clinical case.5-7  Appropriate patient consent was obtained to perform this procedure and present this clinical case and surgical video for academic purposes.

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