scholarly journals Lateral Suboccipital Approach in Semisitting Position for Resection of Vagal Schwannoma: 2-Dimensional Operative Video

2020 ◽  
Author(s):  
Stefan Lieber ◽  
Maximiliano Nunez ◽  
Marcos Tatagiba
Keyword(s):  
Jugular Foramen ◽  
Progressive Multiple Sclerosis ◽  
Proliferation Index ◽  
Gag Reflex ◽  
Lateral Suboccipital Approach ◽  
Cranial Fossa ◽  
Set Up ◽  
The Right ◽  
Suboccipital Approach

AbstractWe present a case of a sizeable vagal schwannoma that was resected through a lateral suboccipital approach in semisitting position. An extra-axial lesion, occupying the left cerebellomedullary cistern and extending from the pontomedullary junction to the jugular foramen was incidentally discovered in a 40-year-old woman afflicted with secondary progressive multiple sclerosis during repeated magnetic resonance imaging (Fig. 1). On physical examination, a mild deviation of the uvula to the right and a diminished gag reflex were observed. The patient was referred to our department after considerable growth of the lesion was noted and a broad interdisciplinary consensus was reached to treat the lesion surgically.A gross total resection was achieved, histopathology confirmed a WHO I schwannoma with a low proliferation index. Postoperative dysphonia resolved completely within a few weeks, there was no collateral neurological deficit and especially no functional dysphagia. At 3-year follow-up, there was no indication of residual or recurrence.This 2-dimensional video demonstrates pre- and postoperative imaging, positioning and set-up of operating room, anatomical and surgical nuances of the skull base approach, and the operative technique for microdissection of the schwannoma from the critical neurovascular structures (Fig. 2).In summary, the lateral suboccipital approach in semisitting position is a powerful tool in the armamentarium for the microsurgical management of various pathologies residing in the posterior cranial fossa, especially large and vascularized schwannomas. Provided the necessary anesthesiological precautions and intraoperative procedures the semisitting position is safe and effective.The link to the video can be found at: https://youtu.be/-9o_qJGkQhg.

Three-Dimensional Computed Tomography Angiography Assisted Resection of Ventral Foramen Magnum and Jugular Foramen Tumours via Modified Far Lateral Suboccipital Approach

2019 ◽  
Vol 9 (2) ◽  
pp. 354-359
Author(s):  
Dongxue Li ◽  
Xuefei Deng ◽  
Shiying Ling ◽  
Nan Zhang ◽  
Dejun Bao ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Facial Paralysis ◽  
Computed Tomography Angiography ◽  
Three Dimensional ◽  
Jugular Foramen ◽  
Foramen Magnum ◽  
Lateral Suboccipital Approach ◽  
Far Lateral ◽  
Suboccipital Approach

Objective: The anatomical relationship of ventral foramen magnum and jugular foramen tumour is complex and the operation is very difficult. The aim of this study was to summarize the microsurgical experience of the removal of the ventral foramen magnum and jugular foramen tumours via the modified far lateral suboccipital approach assisted by three-dimensional computed tomography angiography (3D-CTA). Methods: The clinical data and follow-up results of 13 cases of 3D-CTA assisted suboccipital far lateral approach from July 2011 to September 2017 were analyzed retrospectively. There were 5 males and 8 females. Preoperative CT and MRI were used for routine imaging diagnosis, and the 3D-CTA simulated surgical approach was performed. The preoperative operation scheme was established, and the risk of operation was evaluated according simulated operation. After individualized exposure, the modified far lateral suboccipital approach was completed under the neuroelectrophysiological monitoring technique. Results: The preoperative images were completely consistent with the findings in the surgery. There were 9 cases of jugular foramen tumour and 4 cases of ventral foramen magnum tumour. Of the 13 cases, only 1 case of jugular glomus tumour had extra-cranial residual, while the whole intracranial tumour was removed. In other 12 cases, the tumours were completely removed under the microscope. After operation, the headache disappeared, and hearing loss was improved. There was no perioperative deaths, infection and cerebrospinal fluid leakage. The facial paralysis was occurred in 1 patient. After 3–39 months of follow-up, there was no recurrence of tumour, or new nerve function defect. Hoarseness, choking of drinking water and numbness of limbs were all improved at the end of the follow-up period. The symptoms of postoperative facial paralysis were also improved during the follow-up period. Conclusion: After the preoperative simulation and evaluation by 3D-CTA, the ventral foramen magnum and jugular foramen tumours can be rescted safely and effectively via far modified lateral suboccipital approach.

Intrathecal treatment trial of rituximab in progressive MS

Neurology ◽  
2018 ◽  
Vol 91 (20) ◽  
pp. e1893-e1901 ◽  
Author(s):  
Joakim Bergman ◽  
Joachim Burman ◽  
Jonathan D. Gilthorpe ◽  
Henrik Zetterberg ◽  
Elena Jiltsova ◽  
...  
Keyword(s):  
Progressive Multiple Sclerosis ◽  
Intrathecal Administration ◽  
Control Group ◽  
Csf Biomarkers ◽  
Ventricular Catheter ◽  
Frontal Horn ◽  
Severe Infections ◽  
Phase 1B ◽  
The Right

ObjectivesTo perform a phase 1b assessment of the safety and feasibility of intrathecally delivered rituximab as a treatment for progressive multiple sclerosis (PMS) and to evaluate the effect of treatment on disability and CSF biomarkers during a 1-year follow-up period.MethodsThree doses of rituximab (25 mg with a 1-week interval) were administered in 23 patients with PMS via a ventricular catheter inserted into the right frontal horn and connected to a subcutaneous Ommaya reservoir. Follow-ups were performed at 1, 3, 6, 9, and 12 months.ResultsMild to moderate vertigo and nausea were common but temporary adverse events associated with intrathecal rituximab infusion, which was otherwise well tolerated. The only severe adverse event was a case of low-virulent bacterial meningitis that was treated effectively. Of 7 clinical assessments, only 1 showed statistically significant improvement 1 year after treatment. No treatment effect was observed during the follow-up period among 6 CSF biomarkers.ConclusionsIntrathecal administration of rituximab was well tolerated. However, it may involve a risk for injection-related infections. The lack of a control group precludes conclusions being drawn regarding treatment efficacy.ClinicalTrials.gov identifierNCT01719159.Classification of evidenceThis study provides Class IV evidence that intrathecal rituximab treatment is well tolerated and feasible in PMS but involves a risk of severe infections.

scholarly journals Retrosigmoid Transmeatal Endoscope-Assisted Approach in Semi-Sitting Position for Resection of Vestibular Schwannoma: 2-D operative Video

2018 ◽  
Vol 79 (S 05) ◽  
pp. S385-S386
Author(s):  
Rocio Evangelista-Zamora ◽  
Stefan Lieber ◽  
Florian Ebner ◽  
Marcos Tatagiba
Keyword(s):  
Vestibular Schwannoma ◽  
Internal Auditory Canal ◽  
Sitting Position ◽  
Speech Discrimination ◽  
Endoscopic Assistance ◽  
Set Up ◽  
One Year ◽  
The Right ◽  
Neurovascular Structures

We present a case of a mid-sized vestibular schwannoma (T3b according to the Hannover classification) that was resected through a retrosigmoid transmeatal approach in semi-sitting position under endoscopic assistance. The patient is a 52-year-old male with acute loss of functional hearing on the right side. Audiometry confirmed a loss of up to 60 dB and lost speech discrimination, there were no associated symptoms such as tinnitus or vertigo. This 2D video demonstrates positioning, OR set-up, anatomical and surgical nuances of the skull base approach and the operative technique for microdissection of the tumor from the critical neurovascular structures, especially the facial and cochlear nerves. A gross total resection was achieved and the patient discharged home after four days with unaltered function of the facial nerve (HB I). At one year follow up there was no indication of residual or recurrence.In summary, the retrosigmoid transmeatal approach is an important and powerful tool in the armamentarium for the microsurgical management of all kinds of vestibular schwannomas. Provided the necessary anesthesiological precautions and intraoperative procedures the semi-sitting position is safe and effective. If needed, the approach can be complemented by the use of an endoscope for visualization of the distal internal auditory canal.The link to the video can be found at: https://youtu.be/pPKT4_5nIn0.

scholarly journals Intrathecal treatment trial of rituximab in progressive MS: results after a 2-year extension

2020 ◽  
Author(s):  
Joakim Bergman ◽  
Joachim Burman ◽  
Tommy Bergenheim ◽  
Anders Svenningsson
Keyword(s):  
Bacterial Meningitis ◽  
Disease Progression ◽  
Walking Speed ◽  
Progressive Multiple Sclerosis ◽  
Ventricular Catheter ◽  
Open Label ◽  
Frontal Horn ◽  
Open Label Phase ◽  
The Right

Abstract Objectives To evaluate the effect of intrathecally (IT) delivered rituximab as a therapeutic intervention for progressive multiple sclerosis (PMS) during a 3-year follow-up period. Methods Participants of a 1-year open-label phase 1b study of IT delivered rituximab to patients with PMS were offered extended treatment with follow-up for an additional 2 years. During the extension phase, treatment with 25 mg rituximab was administered every 6 months via a subcutaneous Ommaya reservoir connected to the right frontal horn with a ventricular catheter. Results Mild to moderate vertigo and nausea occurred in 4 out of 14 participants as temporary adverse events associated with IT rituximab infusion. During the entire 3-year period, two cases of low-virulent bacterial meningitis occurred, which were successfully treated. Walking speed deteriorated significantly during the study. Conclusions IT administration of rituximab via a ventricular catheter was well tolerated. Considering the meningitis cases, the risk of infection was not negligible. The continued loss of walking speed indicates that IT rituximab was not able to stop disease progression. Classification of evidence This study provides class IV evidence that intraventricularly administered rituximab in progressive MS is associated with a risk for bacterial meningitis and does not halt disease progression. EU Clinical Trial Register EudraCT; 2008-002626-11 and 2012-000721-53

scholarly journals Unpredicted Sudden Death due to Recurrent Infratentorial Hemangiopericytoma Presenting as Massive Intratumoral Hemorrhage: A Case Report and Review of the Literature

2014 ◽  
Vol 2014 ◽  
pp. 1-5
Author(s):  
Toshihide Tanaka ◽  
Naoki Kato ◽  
Yuzuru Hasegawa ◽  
Yuichi Murayama
Keyword(s):  
Sudden Death ◽  
Neurological Status ◽  
Massive Hemorrhage ◽  
Long Term Follow Up ◽  
Life Threatening ◽  
Morning Headache ◽  
Cranial Fossa ◽  
The Right

Unpredicted sudden death arising from hemangiopericytoma with massive intracranial hemorrhage is quite rare. We encountered a patient with recurrent infratentorial hemangiopericytoma presenting as life-threatening massive intracerebral hemorrhage. A 43-year-old man who had undergone craniotomy for total resection of an infratentorial hemangiopericytoma 17 months earlier presented with morning headache and generalized convulsions. Computed tomography revealed a massive hematoma in the right infratentorial region causing tonsillar herniation and emergency surgery was performed to evacuate the hematoma. Histological findings revealed hemangiopericytoma with hemorrhage. Neurological status remained unimproved and brain death was confirmed postoperatively. Hemangiopericytoma presenting as massive hemorrhage is quite rare. Since the risk of life-threatening massive hemorrhage should be considered, careful postoperative long-term follow-up is very important to identify tumor recurrences, particularly in the posterior cranial fossa, even if the tumor is completely removed.

scholarly journals Surgical Management of Jugular Foramen Schwannomas

Cancers ◽  
2021 ◽  
Vol 13 (16) ◽  
pp. 4218
Author(s):  
Amir Kaywan Aftahy ◽  
Maximilian Groll ◽  
Melanie Barz ◽  
Denise Bernhardt ◽  
Stephanie E. Combs ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Nerve Palsy ◽  
Hypoglossal Nerve ◽  
Surgical Intervention ◽  
Facial Nerve Palsy ◽  
Jugular Foramen ◽  
Cerebellar Dysfunction ◽  
Total Resection ◽  
Gag Reflex

Background: Resection of jugular foramen schwannomas (JFSs) with minimal cranial nerve (CN) injury remains difficult. Reoperations in this vital region are associated with severe CN deficits. Methods: We performed a retrospective analysis at a tertiary neurosurgical center of patients who underwent surgery for JFSs between June 2007 and May 2020. We included nine patients (median age 60 years, 77.8% female, 22.2% male). Preoperative symptoms included hearing loss (66.6%), headache (44.4%), hoarseness (33.3%), dysphagia (44.4%), hypoglossal nerve palsy (22.2%), facial nerve palsy (33.3%), extinguished gag reflex (22.2%), and cerebellar dysfunction (44.4%). We observed Type A, B, C, and D tumors in 3, 1, 1, and 4 patients, respectively. A total of 77.8% (7/9) underwent a retrosigmoid approach, and 33.3% (3/9) underwent an extreme lateral infrajugular transcondylar (ELITE) approach. Gross total resection (GTR) was achieved in all cases. The rate of shunt-dependent hydrocephalus was 22.2% (2/9). No further complications requiring surgical intervention occurred during follow-up. The median follow-up time was 16.5 months (range 3–84 months). Conclusions: Considering the satisfying outcome, the GTR of JFSs is feasible in performing well-known skull base approaches. Additional invasive and complicated approaches were not needed. Radiosurgery may be an effective alternative for selected patients.

scholarly journals MORPHOMETRIC STUDY OF THE JUGULAR FORAMEN IN DRY NIGERIAN SKULLS. Estudio morfométrico del foramen yugular en cráneos nigerianos secos

2018 ◽  
Vol 10 (3) ◽  
pp. 112-119
Author(s):  
Ukoha U Ukoha ◽  
Chijioke M Okeke ◽  
Chinwe Ukoha ◽  
Izuchukwu F Obazie ◽  
Henry C Nwankwo ◽  
...  
Keyword(s):  
Jugular Vein ◽  
Jugular Foramen ◽  
Posterior Cranial Fossa ◽  
Morphometric Study ◽  
Neurosurgical Procedures ◽  
Cranial Fossa ◽  
Jugular Fossa ◽  
The Difference ◽  
The Right ◽  
Lateral Diameter

Jugular foramen is a hiatus in the posterior cranial fossa that transmits the internal jugular vein among other structures. The knowledge of the jugular foramen is important in neurosurgical procedures. The objective of the study was to characterize the morphology and the dimensions of jugular foramen in dry Nigerian skulls. One hundred and seventy jugular foramens from 85 dry adult skulls of unknown sex were studied. Morphology was studied by observation and measurements were taken with Venier caliper. The parameters that were studied included the shape, septation, medio-lateral diameter, antero-posterior diameter of jugular foramen, and the dome, width and depth of jugular fossa. Oval shaped foramen (77%) was more prevalent than round shaped foramen (23%). Complete septation was found in 19.4% of skulls, while incomplete septation was found in 41.2% of skulls. Absence of septation was found in 39,4% of skulls. Dome over the jugular fossa was present in 67,6% and absent in 32,4% of the skulls. The antero-posterior diameter (right - 13,20mm±2.8, left - 11,72±2.8) and medio-lateral diameter (right – 18.73mm±3.5, left – 17,33mm±3.1) were significantly higher on the right side than on the left side. The depth of jugular fossa was significantly higher on the right side (12.38mm±2.4) than on the left side (10.95mm±2.8). The width of jugular fossa was higher on the right (12.06mm±3.6) than on the left (11.80mm±3.3) but the difference was not significant. The present study demonstrated right sided dominance in the metric parameters of the jugular foramen in our environment. El foramen yugular es un hiato en la fosa craneal posterior que transmite la vena yugular interna entre otras estructuras. El conocimiento del foramen yugular es importante en procedimientos neuro-quirúrgicos. El objetivo del estudio era caracterizar la morfología y las dimensiones del foramen yugular en cráneos nige-rianos secos. Cientos y setenta forámenes yugulares a partir de 85 cráneos secos del adulto de sexo desconocido fueron estudiados. La morfología fue estudiada por la observación y las medidas fueron tomadas con el calibrador de Vernier. Los parámetros que fueron estudiados incluyeron la forma, la tabicación, el diámetro medio-lateral, el diámetro anteroposterior del foramen yugular, y la bóveda, la anchura y la profundidad de la fosa yugular. El agujero de forma oval (el 77%) era más frecuente que el agujero de forma redonda (23%). La tabicación completa fue encontrada en 19,4% de cráneos, mientras que la tabicación incompleta fue encontrada en 41,2% de cráneos. La ausencia de tabicación fue encontrada en 39,4% de cráneos. La bóveda sobre la fosa yugular estaba presente en 67,6% y ausente en 32,4% de los cráneos. El diámetro anteroposterior (derecho: 13,20 mm±2,8, izquierdo: 11,72±2,8) y el diámetro medio-lateral (derecho: 18,73mm ±3,5, izquierdo: 17,33mm±3,1) eran perceptiblemente más altos en el derecho que en el lado izquierdo. La profundidad de la fosa yugular era perceptiblemente más alta en el derecho (12,38mm±2,4) que en el lado izquierdo (10,95mm±2,8). La anchura de la fosa yugular era más alta en la derecha (12,06mm±3,6) que a la izquierda (11,80mm±3,3) pero la diferencia no era significativa. El actual estudio demostró la dominación del lado derecho en los parámetros métricos del foramen yugular en nuestro medio.

CASE REPORT: SURGICAL MANAGEMENT OF LUMBAR COMPRESSION FRACTURE

2019 ◽  
Vol 1 (4) ◽  
Author(s):  
Yustinus Robby Budiman Gondowardojo ◽  
Tjokorda Gde Bagus Mahadewa
Keyword(s):  
Spinal Cord ◽  
Left Lung ◽  
Lumbar Vertebrae ◽  
Compression Fracture ◽  
High Mobility ◽  
Early Mobilization ◽  
Cord Injury ◽  
Cardiothoracic Surgeon ◽  
The Right

The lumbar vertebrae are the most common site for fracture incident because of its high mobility. The spinal cord injury usually happened as a result of a direct traumatic blow to the spine causing fractured and compressed spinal cord. A 38-year-old man presented with lumbar spine’s compression fracture at L2 level. In this patient, decompression laminectomy, stabilization, and fusion were done by posterior approach. The operation was successful, according to the X-Ray and patient’s early mobilization. Pneumothorax of the right lung and pleural effusion of the left lung occurred in this patient, so consultation was made to a cardiothoracic surgeon. Chest tube and WSD insertion were performed to treat the comorbidities. Although the patient had multiple trauma that threat a patient’s life, the management was done quickly, so the problems could be solved thus saving the patient’s life. After two months follow up, the patient could already walk and do daily activities independently.

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