Spinal Arteriovenous Fistula: 2-Dimensional Operative Video

2020 ◽  
Vol 18 (6) ◽  
pp. E226-E226
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Venous Pressure ◽  
Video Recording ◽  
Mass Effect ◽  
Type I ◽  
Venous Flow ◽  
Arteriovenous Fistulas ◽  
Root Entry Zone ◽  
Spinal Arteriovenous Fistula ◽  
Institutional Review ◽  
Icg Angiography

Abstract Spinal dural arteriovenous fistulas (AVFs) have been categorized on the basis of the Anson and Spetzler classification into 4 types. Type I is the most common type and describes an abnormal connection between a radicular artery at the nerve root sleeve and an intradural draining vein. This communication results in progressive dilatation and mass effect from the draining vein experiencing arterial pressures without intervening arterioles. In this patient, preoperative angiography showed a type I dural AVF. A laminoplasty was performed to provide dural exposure, and a midline durotomy was performed. Indocyanine green (ICG) angiography was used to visualize flow within the fistula. This dorsal dural AVF demonstrated the characteristic slow venous flow. Pressure recordings were obtained and confirmed the elevated venous pressure observed in these lesions. Bipolar coagulation of the fistulous point was performed, and the vessel was removed at the site of the root entry zone to permit pathologic confirmation of the arteriovenous interface. Intraoperative ICG angiography findings confirmed disconnection. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Lumbar 4-5 Laminoplasty for Ligation of Dural Fistula: 2-Dimensional Operative Video

2019 ◽  
Vol 18 (3) ◽  
pp. E70-E71
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Video Recording ◽  
Mass Effect ◽  
Imaging Evaluation ◽  
Thoracic Spinal Cord ◽  
Arteriovenous Fistulas ◽  
Institutional Review ◽  
Thoracic Spinal ◽  
Surgical Cure ◽  
Spinal Dural Arteriovenous Fistulas ◽  
Arterial Feeder

Abstract The goal of treatment for spinal dural arteriovenous fistulas is disconnection of the fistulous point to eliminate venous congestion-associated hypoperfusion and mass effect. The nidus can be surgically excised or disconnected from the arterial feeder just proximal to the dilated venous plexus. This patient had a filus terminale dural arteriovenous fistula. The patient had multiple findings of myelopathy, which prompted the imaging evaluation that revealed prominent flow voids and significant caudal thoracic spinal cord edema. Preoperative digital subtraction angiography demonstrated a fistulous point at the lumbar 4 level. A lumbar 4 and lumbar 5 laminoplasty was performed for spinal canal access. Following achievement of intradural access, exploration was performed, augmented by indocyanine green fluoroscopy. The filum terminale was then transected, and the fistula was then completely excised to achieve surgical cure. Following the procedure, the patient's myelopathy improved, and she regained ambulatory status. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Frontal Ethmoidal Dural Arteriovenous Fistula: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (1) ◽  
pp. E46-E46
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Video Recording ◽  
Endovascular Embolization ◽  
Intraoperative Angiography ◽  
Arteriovenous Fistulas ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Drainage Vein ◽  
Dural Arteriovenous Fistulas ◽  
Cranial Fossa ◽  
Ethmoidal Arteries

Abstract Anterior cranial fossa dural arteriovenous fistulas (DAVFs) are an infrequent subtype of cranial DAVFs. These lesions are most commonly derived from the ophthalmic artery. These lesions are often best treated utilizing endovascular embolization; however, this modality can be challenging because of the difficulty in catheterizing the ophthalmic or ethmoidal arteries. Surgical intervention is therefore indicated and requires approaching the proximal portion of the drainage vein to appropriately obliterate the fistulous point. For ethmoidal DAVFs, this is frequently along the dura of the cranial base adjacent to the cribriform plate. This patient had a right frontal hematoma with a typical ethmoidal DAVF. The fistula was exposed through a frontal craniotomy, and the ethmoidal branch was identified at the fistulous point. Intraoperative angiography was used to test for obliteration, which revealed a contralateral DAVF. The contralateral fistula was then obliterated in a similar manner, demonstrated on a second intraoperative angiogram. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Modified Orbitozygomatic Craniotomy for a Previously Coiled Anterior Communicating Artery Aneurysm: 2-Dimensional Operative Video

2020 ◽  
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Video Recording ◽  
Artery Aneurysm ◽  
Mass Effect ◽  
Optic Chiasm ◽  
Anterior Communicating Artery ◽  
Aneurysm Neck ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Clip Occlusion

Abstract Clip occlusion of previously coiled aneurysms poses unique technical challenges. The coil mass can complicate aneurysm neck access and clip tine approximation. This patient had a previously ruptured anterior communicating artery (ACOM) aneurysm that had been treated with coil embolization. On follow-up evaluation, the patient was found to have a recurrence of the aneurysm, which prompted an orbitozygomatic craniotomy for clip occlusion. The approach provided a favorable view of the aneurysm neck with the coil mass protruding outside the aneurysm dome. Indocyanine green fluoroscopy was used to assist with ideal permanent clip placement along the aneurysm neck. The segment of coils present outside the aneurysm neck was removed to reduce mass effect on the optic chiasm. Postoperative imaging demonstrated aneurysm obliteration. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Cervical 7-Thoracic 3 Laminoplasty for Resection of Arteriovenous Malformation: 2-Dimensional Operative Video

2019 ◽  
Vol 18 (1) ◽  
pp. E3-E4
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Spinal Cord ◽  
Video Recording ◽  
Mass Effect ◽  
Feeding Artery ◽  
Pia Mater ◽  
Institutional Review ◽  
Signal Change ◽  
Spinal Arteriovenous Malformations ◽  
Intradural Extramedullary ◽  
Vascular Steal

Abstract Symptomatic spinal arteriovenous malformations (AVMs) are most frequently associated with hypoperfusion of the spinal cord, either from venous congestion or vascular steal, and are less frequently associated with hemorrhage. This patient had a large cervicothoracic spinal AVM and presented with right hemibody sensory deficit with intact motor function. The AVM had significant preoperative mass effect on the dorsal spinal cord with cord signal change. Preoperative digital subtraction angiography demonstrated a left supreme intercostal feeding artery and left thyrocervical feeding artery, which was embolized preoperatively. A laminoplasty was performed from cervical 7 to thoracic 3 to allow for adequate visualization. The lesion demonstrated an intradural extramedullary presence, which made preservation of the pia mater paramount during the resection. The AVM was disconnected and removed in its entirety as determined by operative visualization and postoperative imaging. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Optic Nerve Decompression from Coil Mass Impingement and Adhesion Following Large Internal Cerebral Artery Aneurysm Coil Embolization: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (4) ◽  
pp. E389-E390
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Optic Nerve ◽  
Obstructive Hydrocephalus ◽  
Video Recording ◽  
Artery Aneurysm ◽  
Mass Effect ◽  
Preoperative Imaging ◽  
Cranial Neuropathy ◽  
Microsurgical Decompression ◽  
Institutional Review ◽  
Cerebral Artery Aneurysm

Abstract Aneurysmal mass effect is a consideration for treatment modality selection, particularly in the setting of cranial neuropathy or obstructive hydrocephalus. However, the extent of consequences related to mass effect is not always apparent periprocedurally from the original treatment. This unique video highlights a patient who underwent previous coil occlusion of a supraclinoid internal carotid artery (ICA) aneurysm with subsequent occlusion of the ipsilateral ICA who presented 16 yr later with progressive worsening hemianopsia. The preoperative imaging was suggestive of coil mass impingement prompting operative intervention for decompression. Intraoperative inspection demonstrated that the coil mass was exerting mass effect on the optic nerve and had partially migrated out of the aneurysm dome into the optic nerve. The ICA was also transected and mobilized to further reduce mass effect. Careful microsurgical decompression was achieved and prevented further visual compromise. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Transpetrous Clip Occlusion of a Giant Midbasilar Aneurysm Using Hypothermic Cardiac Arrest: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (2) ◽  
pp. E143-E143
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Cardiac Arrest ◽  
Surgical Intervention ◽  
Video Recording ◽  
Mass Effect ◽  
Institutional Review Board ◽  
High Morbidity ◽  
Vestibulocochlear Nerve ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Clip Occlusion

Abstract Basilar trunk aneurysms are historically associated with extremely high morbidity. The complexity of circumflex perforator arteries responsible for the perfusion of the brainstem makes surgical intervention for these lesions particularly challenging. This patient had a giant midbasilar aneurysm that encompassed multiple perforators but was associated with progressive mass effect and debilitating morbidity. Therefore, a transpetrous approach was used with transposition of the facial nerve and sacrifice of the vestibulocochlear nerve to permit access to the aneurysm. Hypothermic cardiac arrest was used to permit dome manipulation with a tandem fenestrated clipping of the aneurysm. Postoperative imaging demonstrated a reduction in mass effect attributable to the significantly reduced dome size and persistence of flow via a reconstructed basilar trunk. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Recurrent Giant Anterior Cerebral Artery (ACA) Aneurysm With Previous Coiling, Attempted Clipping Then Direct ACA-to-ACA Bypass: 2-Dimensional Operative Video

2020 ◽  
Vol 18 (4) ◽  
pp. E110-E110 ◽  
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Anterior Cerebral Artery ◽  
Surgical Intervention ◽  
Video Recording ◽  
Anterior Communicating Artery ◽  
Aneurysm Neck ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Icg Angiography ◽  
Aneurysmal Neck ◽  
Temporary Clip

Abstract Giant aneurysms are defined as lesions with a widest diameter of 2.5 cm or greater and account for 2% to 5% of all intracranial aneurysms. These lesions are challenging entities for microsurgical management with techniques such as direct aneurysmal neck clipping, aneurysm neck reconstructions, aneurysmotomy, and aneurysmectomy. This patient had a previously coiled, unruptured, superiorly projecting giant anterior communicating artery (ACom) aneurysm, eccentric toward the left, for which surgical intervention was undertaken. A left orbitozygomatic craniotomy was performed, and a temporary clip was applied to the bilateral proximal A1 segments. Aneurysmotomy was then performed with internal debulking of the aneurysmal thrombus. Aneurysmectomy and removal of the coil mass were performed. Next, the aneurysm neck was reconstructed using multiple surgical clips. After anticipated aneurysm neck reconstruction, indocyanine green (ICG) angiography demonstrated a lack of flow in the ipsilateral A2. The ACom was then transected along the aneurysm neck, and an end-to-end anastomosis of the distal A1 and proximal A2 was performed. Repeat ICG angiography demonstrated patency of the A1-A2 anastomosis. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Left Interhemispheric Craniotomy for Resection of Cavernous Malformation: 2-Dimensional Operative Video

2019 ◽  
Vol 17 (4) ◽  
pp. E154-E154
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Lateral Ventricle ◽  
Cavernous Malformation ◽  
Third Ventricle ◽  
Video Recording ◽  
Mass Effect ◽  
Cavernous Malformations ◽  
Transcallosal Approach ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Surgical Field

Abstract Thalamic cavernous malformations pose variable surgical challenges given that the location and size of the lesion often determine the approach surgical trajectory. The patient in this case has a large thalamic cavernous malformation that results in a mass effect on the third ventricle and directly abuts the lateral ventricle. A small interhemispheric craniotomy is performed to allow for an anterior interhemispheric transcallosal approach to the lesion. The lateral ventricle is accessed, and the septum is removed to enhance visualization of the surgical field. A small rim of normal parenchyma on the lateral margin of the thalamus is transgressed, and the cavernous malformation is entered. The lesion is removed in a piecemeal manner. Use of counter traction assists with the piecemeal removal. The lighted suction is critical during inspection and manipulation of the lesion within the resection cavity given the limited lighting deep within the cavity. The lesion was removed completely, and postoperative imaging confirms gross total resection. The patient gave informed consent for surgery and video recording. The institutional review board approval was deemed unnecessary. Used with permission from the Barrow Neurological Institute.

scholarly journals Microsurgical Resection of Brainstem Arteriovenous Malformation: 2-Dimensional Operative Video

2019 ◽  
Vol 18 (2) ◽  
pp. E38-E38
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Radiation Treatment ◽  
Video Recording ◽  
Cranial Nerves ◽  
Venous Drainage ◽  
Mass Effect ◽  
Fiber Tracts ◽  
Institutional Review ◽  
Ventriculoperitoneal Shunting ◽  
Microsurgical Resection ◽  
Martin Grade

Abstract Brainstem arteriovenous malformations (AVMs) are rare lesions (2%-6% of all intracranial AVMs) that are surgically challenging because of the high eloquence of the brainstem, including dense fiber tracts, cranial nerves, and multiple vital cerebrovascular structures. All these lesions possess eloquence and deep venous drainage, making them innately Spetlzer–Martin grade III or above. This patient had a large midbrain AVM with a complex clinical course beginning with ventriculoperitoneal shunting due to mass effect; the patient experienced 4 hemorrhages, underwent radiation treatment, and finally underwent surgical resection. The surgical approach involved a large torcular craniotomy exposing all posterior sinuses at the confluence. The vein of Galen was exposed and carried deeply to permit ambient cistern opening and relaxation of the cerebellum. Because of earlier radiation therapy, the vessels had undergone hyalinosis, which resulted in difficult manipulation of the nidus but did permit excellent coagulation of the vessels. The complete nidus was removed, as confirmed on postoperative angiography. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Cardiac Arrest due to Tamponade during Endovascular Stent Implantation: a Case Report

2021 ◽  
Author(s):  
Rou Yu ◽  
Jun Zeng
Keyword(s):  
Cardiac Arrest ◽  
Cardiac Tamponade ◽  
Stent Implantation ◽  
Venous Pressure ◽  
Type I ◽  
Endovascular Stent ◽  
Hemodynamic Changes ◽  
Case Presentation ◽  
Heart Injury ◽  
Multidisciplinary Teamwork

Hemorrhagic cardiac tamponade is one of potentially fatal complications of endovascular intervention. Usually it is because of perforation of heart or rupture of aorta. Cases of pericardial effusion without any arterial or heart injury are rare. Case presentation we reported is a clinical case of cardiac arrest due to tamponade in a patient with DeBakey type I aortic dissection (AD) undergoing thoracic aortic stent implantation. In the early phase of the procedure, hemodynamic changes of increased central venous pressure and decreased blood pressure - by tamponade were noticed but unrecognized and lead to cardiac arrest ultimately. During resuscitation, cardiac tamponade was suspected and confirmed by transesophageal echocardiography (TEE). The patient was successfully resuscitated after pericardiocentesis. Conclusion This case of cardiac tamponade emphasizes the importance of vigilant clinical and echo assessments, efficient multidisciplinary teamwork in deal with the rare but severe complication.

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