Microsurgical Resection and Stabilization of a Giant Spinal Schwannoma: 2-Dimensional Operative Video

Abstract We illustrate the microsurgical resection of a giant lumbar spinal schwannoma in a 37-yr-old male who presented with worsening low back pain, weakness, and numbness and tingling in the bilateral legs and feet. Lumbar spine imaging demonstrated a large, heterogeneously enhancing intradural mass with notable bony erosion. Given the thinning of the pedicles, large tumor size, and bony remodeling, instrumentation was performed in addition to decompression, with direct stimulation-triggered electromyography and intraoperative neurophysiological monitoring. This video demonstrates the surgical technique for resection and accompanied reconstruction necessary for the management of these giant intradural lesions. Postoperatively, the patient had no complications, with improvement of neurological symptoms at follow-up. Though improved, the patient had some residual numbness at postoperative follow-up visit. The patient consented to the procedure. This video was deemed Institutional Review Board (IRB) exempt by the University of Pennsylvania IRB, as it is considered a case report, which does not require IRB approval or patient consent.

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Endoscopic Paramedian Sitting Craniotomy for Resection of a Dorsal Midbrain Cavernous Malformation: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opz427 ◽

2020 ◽

Vol 19 (3) ◽

pp. E300-E300

Author(s):

Omar A Choudhri ◽

Gregory Glauser ◽

Kalil G Abdullah ◽

John Y K Lee

Keyword(s):

Cavernous Malformation ◽

University Of Pennsylvania ◽

Neurophysiologic Monitoring ◽

Institutional Review ◽

Patient Consent ◽

Stereotactic Navigation ◽

Microsurgical Resection ◽

The Right ◽

The University

Abstract This case video demonstrates the surgical technique for resection of a cavernous malformation in the right dorsal midbrain. This video was deemed exempt by the University of Pennsylvania Institutional Review Board (IRB), as it is considered a case report, which does not require IRB approval or patient consent. The patient was a 57-yr-old male with cerebral cavernous malformation syndrome with multiple intracranial cavernomas. He was noticed to have progressively slowed speech with worsening confusion and drowsiness. On exam, the patient exhibited worsening in swallowing and upward gaze paresis, secondary to Parinaud phenomena. The patient was treated with microsurgical resection, utilizing stereotactic navigation and intraoperative neurophysiologic monitoring. Intraoperative view provided in the video was captured using a Karl Storz Endoscope (Karl Storz SE & Co KG, Tuttlingen, Germany). Postoperatively, the patient had worsening double vision, which improved on follow-up, in addition to improvement in sensorium and swallowing.

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Microsurgical resection of foramen magnum meningioma through a transcondylar approach: three-dimensional operative video

Neurosurgical Focus: Video ◽

10.3171/2019.10.focusvid.19465 ◽

2019 ◽

Vol 1 (2) ◽

pp. V3

Author(s):

Guilherme H. W. Ceccato ◽

Rodolfo F. M. da Rocha ◽

Duarte N. C. Cândido ◽

Wladimir O. Melo ◽

Marcio S. Rassi ◽

...

Keyword(s):

Nerve Palsy ◽

Three Dimensional ◽

Foramen Magnum ◽

Complete Resection ◽

Neurophysiological Monitoring ◽

Cervical Instability ◽

Transcondylar Approach ◽

Postoperative Mri ◽

Microsurgical Resection

Foramen magnum (FM) meningiomas are challenging lesions. We present the case of a 38-year-old female with neck pain, dysphonia, and slight twelfth nerve palsy. Imaging workup was highly suggestive of an FM meningioma, and microsurgical resection with the aid of intraoperative neurophysiological monitoring was indicated. A transcondylar approach was employed, the vertebral artery was mobilized, and the tumor was completely removed. Postoperative MRI demonstrated complete resection. There were no signs of cervical instability. The patient presented with improvement of her symptoms and no new neurological deficit on follow-up. FM meningiomas can be successfully resected using a transcondylar approach, since it increases the exposure of the ventral FM, allowing the surgeon to work parallel to the skull base and flush with the tumor’s attachment. Informed consent was obtained from the patient for publication of this operative video.The video can be found here: https://youtu.be/itfUOB-6zM0.

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Combined Endovascular and Microsurgical Management of a Tentorial Arteriovenous Malformation in a Hybrid Neurovascular Operating Room: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opab142 ◽

2021 ◽

Author(s):

Gregory Glauser ◽

Donald K E Detchou ◽

John Arena ◽

Omar Choudhri

Keyword(s):

Operating Room ◽

University Of Pennsylvania ◽

Superior Cerebellar Artery ◽

Institutional Review ◽

Cerebellar Artery ◽

Patient Consent ◽

Supracerebellar Infratentorial Approach ◽

Lumbar Cerebrospinal Fluid ◽

The University ◽

Lateral Positioning

Abstract Tentorial margin arteriovenous malformations (AVMs) at the cerebello-mesencephalic fissure are deep lesions, which can be safely resected via a lateral supracerebellar infratentorial approach. This video illustrates the case of a patient who presented with hemorrhage from a tentorial AVM. He was managed in the hybrid neurovascular operating room with Onyx (Medtronic) embolization of a superior cerebellar artery feeder followed by resection of the AVM, which included cerebellar relaxation from lumbar cerebrospinal fluid (CSF) drainage and lateral positioning. Wide cisternal arachnoid dissection at the quadrigeminal cistern allowed for a straight trajectory to the AVM without fixed retraction. Intraoperative transradial angiography confirmed complete AVM exclusion. This video was deemed Institutional Review Board (IRB) exempt by the University of Pennsylvania IRB as it is considered a case report, which does not require IRB approval or patient consent. The patient consented to the procedure.

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MR-Guided High-Power Microwave Ablation in Hepatic Malignancies: Initial Results in Clinical Routine

CardioVascular and Interventional Radiology ◽

10.1007/s00270-020-02584-5 ◽

2020 ◽

Vol 43 (11) ◽

pp. 1631-1638

Author(s):

Moritz T. Winkelmann ◽

Georg Gohla ◽

Jens Kübler ◽

Jakob Weiß ◽

Stephan Clasen ◽

...

Keyword(s):

High Power ◽

Microwave Ablation ◽

Tumour Progression ◽

High Power Microwave ◽

Institutional Review ◽

Mr Conditional ◽

Patient Consent ◽

Power Microwave ◽

Hepatic Malignancies

Abstract Purpose Evaluation of technique effectiveness, patient safety and ablation parameters of MR-guided microwave ablation in hepatic malignancies using an MR-conditional high-power microwave ablation system. Materials and Methods Institutional review board approval and informed patient consent were obtained. Patients who underwent MR-guided microwave ablation of hepatic malignancies in a 1.5T wide-bore scanner using a perfusion-cooled high-power microwave ablation system with a maximum generator power of 150 W were included. Ablation parameters comprising procedure durations, net ablation duration, applicator positions and ablation zone dimensions were recorded. Adverse events were classified according to the CIRSE classification system. Technique effectiveness was assessed after 1 month. Follow-up was conducted with contrast-enhanced MRI and ranged from 1 to 20 months (mean: 6.1 ± 5.4 months). Results Twenty-one consecutive patients (age: 63.4 ± 10.5 years; 5 female) underwent 22 procedures for 28 tumours (9 hepatocellular carcinomas, 19 metastases) with a mean tumour diameter of 14.6 ± 5.4 mm (range: 6–24 mm). Technique effectiveness was achieved in all lesions. Tumours were treated using 1.7 ± 0.7 applicator positions (range: 1–3). Mean energy and ablation duration per tumour were 75.3 ± 35.4 kJ and 13.3 ± 6.2 min, respectively. Coagulation zone short- and long-axis diameters were 29.1 ± 6.4 mm and 39.9 ± 7.4 mm, respectively. Average procedure duration was 146.4 ± 26.2 min (range: 98–187 min). One minor complication was reported. Five patients developed new tumour manifestations in the untreated liver. Local tumour progression was not observed during initial follow-up. Conclusion MR-guided high-power microwave ablation provides safe and effective treatment of hepatic malignancies with short ablation times and within acceptable procedure durations.

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Surgical management of pediatric rolandic arteriovenous malformations: a single-center case series

Journal of Neurosurgery Pediatrics ◽

10.3171/2020.6.peds18547 ◽

2021 ◽

Vol 27 (1) ◽

pp. 62-68

Author(s):

Newton Cho ◽

Vincent D. W. Nga ◽

Raheel Ahmed ◽

Jerry C. Ku ◽

Pablo M. Munarriz ◽

...

Keyword(s):

Arteriovenous Malformations ◽

Descriptive Analysis ◽

Case Series ◽

Neurological Complications ◽

Neurophysiological Monitoring ◽

Intraoperative Angiography ◽

Study Objective ◽

Microsurgical Resection ◽

Sick Children

OBJECTIVEPediatric rolandic arteriovenous malformations (AVMs) present a treatment challenge given the lifetime risk of hemorrhage, rehemorrhage, and associated long-term morbidity. Microsurgical resection has been recommended as the optimal treatment for AVMs in general, but there is no dedicated literature on the outcomes of resection of pediatric rolandic AVMs. Here, the study objective was to review the outcomes of microsurgical resection of pediatric rolandic AVMs in the modern era, together with the utilization of surgical adjuncts including navigation, intraoperative angiography, and neurophysiological monitoring.METHODSThe authors performed a retrospective review of patients 18 years of age and younger with cerebral AVMs microsurgically treated between January 2000 and May 2016 at The Hospital for Sick Children. Only those patients with an AVM whose nidus was located within the rolandic region were analyzed. A descriptive analysis was performed to identify patient demographics, preoperative AVM characteristics, and postoperative obliteration rates and neurological complications.RESULTSA total of 279 AVMs were evaluated in the study period. Twenty-three of these AVMs were rolandic, and the median age in the 11 microsurgically treated cases was 11 years (range 1–17 years). AVM hemorrhage was the most common presentation, occurring in 8 patients (73%). Lesions were either Spetzler-Martin grade II (n = 8, 73%) or grade III (n = 3, 27%). The postoperative obliteration rate of AVMs was 100%. The mean imaging follow-up duration was 33 months (range 5–164 months). There was no documented recurrence of an AVM during follow-up. One patient developed a transient postoperative hemiparesis, while another patient developed right fingertip hyperesthesia.CONCLUSIONSMicrosurgical resection of rolandic pediatric AVMs yields excellent AVM obliteration with minimal neurological morbidity in selected patients. The incorporation of surgical adjuncts, including neurophysiological monitoring and neuronavigation, allows accurate demarcation of functional cortex and enables effective resection.

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Microsurgical resection of medullary cavernoma via the olivary zone by the retrosigmoid supracondylar approach

Neurosurgical Focus: Video ◽

10.3171/2019.10.focusvid.19293 ◽

2019 ◽

Vol 1 (2) ◽

pp. V7

Author(s):

Ken Matsushima ◽

Michihiro Kohno ◽

Helmut Bertalanffy

Keyword(s):

Cavernous Malformation ◽

Cleavage Plane ◽

Foramen Magnum ◽

Senior Author ◽

Neurological Deficits ◽

Lateral Part ◽

Sitting Position ◽

Brainstem Cavernoma ◽

Microsurgical Resection

Microsurgical resection of the medullary cavernoma is rare, comprising less than 15% of more than 250 surgeries of brainstem cavernoma performed by the senior author (H.B.).1 This video demonstrates a case of a cavernous malformation inside the lateral part of the medulla, which was surgically treated via the olivary zone by the retrosigmoid supracondylar approach in a half-sitting position. Osseous drilling of the lateral foramen magnum provided wide exposure of the cerebellomedullary cistern around the olive.2,3 The lesion was completely dissected at the appropriate cleavage plane from the normal parenchyma. The patient developed no new neurological deficits and had no recurrence during 3 years of follow-up after the operation.The video can be found here: https://youtu.be/7i7SccS5HmU.

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Surgical outcome of primary intradural spinal arachnoid cysts: a series of 10 cases

The Egyptian Journal of Neurology Psychiatry and Neurosurgery ◽

10.1186/s41983-021-00290-8 ◽

2021 ◽

Vol 57 (1) ◽

Author(s):

Essam Abdelhameed ◽

Ahmed Ali Morsy

Keyword(s):

Tertiary Care ◽

Outer Wall ◽

Arachnoid Cysts ◽

Neurophysiological Monitoring ◽

Japanese Orthopedic Association ◽

Common Location ◽

Before And After ◽

Microsurgical Resection ◽

Tertiary Care Centers ◽

Intradural Arachnoid Cysts

Abstract Background Primary intradural spinal arachnoid cysts are rare pathologies of uncertain etiology and variable presentation from no symptoms to myelopathy or radiculopathy according to cord or root compression. MRI with diffusion and contrast differentiates them from many pathologies. There is a lot of debate regarding when to treat and how to treat such rare pathologies. Objective We present a series of 10 primary intradural arachnoid cysts and evaluate outcome after surgery. Methods This retrospective study includes patients having primary intradural spinal arachnoid cysts operated in two tertiary care centers from October 2012 till October 2019. Symptomatic cysts were subjected to microsurgical resection or outer wall excision and inner wall marsupialization under neurophysiological monitoring. The Japanese Orthopedic Association Score was used for clinical evaluation while MRI with contrast and diffusion was used for radiological evaluation before and after surgery. Results This series included 10 patients, 4 males and 6 females, with mean age of 40 years. Pain was the most common presentation. The most common location was dorsal thoracic region. Total excision was achieved in 2 cases and marsupialization in 8 cases. All symptoms improved either completely or partially after surgery. No neurological deterioration or recurrence was reported during the follow-up period in this series. Conclusion Treatment of symptomatic primary intradural spinal arachnoid cysts should be microsurgical resection, when the cyst is adherent to the cord, microscopic fenestration can be safe and effective.

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Mean five years follow up results of a facet replacement device in the treatment of lumbar spinal stenosis and degenerative spondylolisthesis

World Neurosurgery ◽

10.1016/j.wneu.2021.06.045 ◽

2021 ◽

Author(s):

Shahnawaz Haleem ◽

Awaiz Ahmed ◽

Satish Ganesan ◽

Stephen F. McGillion ◽

John L. Fowler

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Degenerative Spondylolisthesis ◽

Lumbar Spinal ◽

Replacement Device

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Amlodipine induced Gingival Overgrowth in Patients at a Tertiary Level Hospital of Nepal

Journal of Nepalese Society of Periodontology and Oral Implantology ◽

10.3126/jnspoi.v2i1.23571 ◽

2018 ◽

Vol 2 (1) ◽

pp. 2-5

Author(s):

Arun Sharma ◽

Rinku Joshi ◽

Sweta Rajya Laxmi Rana ◽

Dhan Bahadur Shrestha ◽

Pramod Raj Joshi ◽

...

Keyword(s):

Large Scale ◽

Tertiary Level ◽

Gingival Overgrowth ◽

Record Keeping ◽

Institutional Review ◽

Short Term Study ◽

Rare Side Effect ◽

Low Prevalence ◽

Ethical Clearance

Background: Amlodipine is a commonly prescribed anti-hypertensive in clinical practice. Gingival overgrowth is a rare side effect of this drug; with a reported prevalence of 1.7-3.3% in literature. Gingival overgrowth can cause aesthetic and functional problems as well as cause hindrance to maintain proper oral hygiene, thereby deteriorating the periodontal condition of the patient. The prevalence of Amlodipine induced gingival overgrowth is poorly defined in our country. Aim: This study aims to assess Amlodipine induced gingival overgrowth in a tertiary level referral hospital of Nepal Army. Materials and Methods: This study was conducted on hypertensive patients with amlodipine therapy under regular follow up in the Department of Internal Medicine of Shree Birendra Hospital from September to December 2017. The data from record keeping was used for the study. Ethical clearance from Institutional Review committee of Nepal Army Institute of Health Sciences was obtained before conducting the study. Results: Out of 507 patients taking amlodipine, 240 were eligible for study and six (2.5%) were found to have amlodipine induced gingival overgrowth. These patients were on a dose of 5-10 mg over six months to 25 years. The gingival overgrowth was correlated with dose and duration which was statistically significant (p<0.05). Conclusion: Low prevalence of amlodipine induced gingival overgrowth and correlation with dose and duration was seen in this short-term study. However further large-scale follow-up studies may be required to assess the severity of the problem.

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