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

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.

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

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.

scholarly journals Extreme Lateral Supracerebellar Infratentorial Approach to the Lateral Midbrain

2018 ◽  
Vol 79 (S 05) ◽  
pp. S415-S417
Author(s):  
M. Kalani ◽  
William Couldwell
Keyword(s):  
Cranial Nerves ◽  
Sudden Onset ◽  
Superior Cerebellar Artery ◽  
Entry Zone ◽  
Cerebellar Artery ◽  
Sensory Disturbances ◽  
History Of ◽  
Supracerebellar Infratentorial Approach ◽  
The Right ◽  
Piecemeal Resection

This video illustrates the case of a 52-year-old man with a history of multiple bleeds from a lateral midbrain cerebral cavernous malformation, who presented with sudden-onset headache, gait instability, and left-sided motor and sensory disturbances. This lesion was eccentric to the right side and was located in the dorsolateral brainstem. Therefore, the lesion was approached via a right-sided extreme lateral supracerebellar infratentorial (exSCIT) craniotomy with monitoring of the cranial nerves. This video demonstrates the utility of the exSCIT for resection of dorsolateral brainstem lesions and how this approach gives the surgeon ready access to the supracerebellar space, and cerebellopontine angle cistern. The lateral mesencephalic safe entry zone can be accessed from this approach; it is identified by the intersection of branches of the superior cerebellar artery and the fourth cranial nerve with the vein of the lateral mesencephalic sulcus. The technique of piecemeal resection of the lesion from the brainstem is presented. Careful patient selection and respect for normal anatomy are of paramount importance in obtaining excellent outcomes in operations within or adjacent to the brainstem.The link to the video can be found at: https://youtu.be/aIw-O2Ryleg.

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

2021 ◽  
Author(s):  
Ryan Dimentberg ◽  
Gregory Glauser ◽  
Donald K Detchou ◽  
Kerry A Vaughan ◽  
Omar Choudhri
Keyword(s):  
University Of Pennsylvania ◽  
Neurophysiological Monitoring ◽  
Direct Stimulation ◽  
Large Tumor ◽  
Institutional Review ◽  
Patient Consent ◽  
Microsurgical Resection ◽  
Spinal Schwannoma ◽  
Lumbar Spinal

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.

scholarly journals Morphological Characteristics of the Superior Cerebellar Artery/ Морфолошки Карактеристики На Горната Церебеларна Артерија

PRILOZI ◽  
2015 ◽  
Vol 36 (1) ◽  
pp. 80-84
Author(s):  
Ace Dodevski ◽  
Dobrila Tosovska Lazarova ◽  
Julija Zhivadinovik ◽  
Menka Lazareska ◽  
Elizabeta Stojovska-Jovanovska
Keyword(s):  
Basilar Artery ◽  
Morphological Characteristics ◽  
Clinical Work ◽  
Daily Basis ◽  
Superior Cerebellar Artery ◽  
Adult Type ◽  
New Techniques ◽  
Cerebellar Artery ◽  
The Right ◽  
The University

Abstract With the introduction of new techniques in diagnostic and interventional radiology and progress in micro neurosurgery, accurate knowledge of the brain blood vessels is essential for daily clinical work. The aim of this study was to describe the morphological characteristics of the superior cerebellar artery and to emphasize their clinical significance. In this study we examined radiographs of 109 patients who had CT angiography at the University Clinic for Radiology in Skopje, R. Macedonia. This study included 49 females and 60 males, ranging in age from 27 to 83 years; mean age 57.4 ± 11.8 years. In 105 patients SCA arose from the basilar artery on both sides as a single vessel. In two patients SCA arose as a duplicate trunk from the basilar artery. We found unilateral duplication on the right SCA in one patient, and bilateral duplication in one patient. In two patients was noticed origin of the SCA from PCA as a single trunk from adult type of the PCA. Through knowledge of the anatomy and variations of SCA is important for clinicians as well as basic scientists who deal with problems related to intracranial vasculature in daily basis for save performance of diagnostic and interventional procedures.

Lateral supracerebellar infratentorial approach for a ruptured cerebellomesencephalic fissure arteriovenous malformation resection

2021 ◽  
Vol 4 (1) ◽  
pp. V15
Author(s):  
Livio Pereira ◽  
Eduardo Vieira
Keyword(s):  
Arteriovenous Malformation ◽  
Male Patient ◽  
Sudden Onset ◽  
Superior Cerebellar Artery ◽  
Surgical Video ◽  
Link Type ◽  
Cerebellar Artery ◽  
Lateral Mesencephalic Vein ◽  
Supracerebellar Infratentorial Approach ◽  
Neurologically Intact

In this surgical video, the authors present a case of a 24-year-old male patient who presented with sudden-onset headache and imbalance. On examination, he had a right-sided dysmetria and was otherwise neurologically intact. MRI showed a right cerebellar hematoma associated with multiple flow voids in the cerebellomesencephalic fissure and an enlarged lateral mesencephalic vein. Preoperative angiogram confirmed an arteriovenous malformation supplied by branches of the superior cerebellar artery. The patient underwent a lateral supracerebellar infratentorial approach for resection of the arteriovenous malformation (AVM). He recovered well from surgery and was discharged home on postoperative day 6. Postoperative angiogram confirmed complete AVM resection.The video can be found here: https://youtu.be/tY4Go2n7V80

Production of New and Revised A.A.V.S.O. Charts

1979 ◽  
Vol 46 ◽  
pp. 368
Author(s):  
Clinton B. Ford
Keyword(s):  
Variable Star ◽  
Standard Form ◽  
Original Data ◽  
University Of Pennsylvania ◽  
Standard Format ◽  
Additional Information ◽  
The Gift ◽  
The University

A “new charts program” for the Americal Association of Variable Star Observers was instigated in 1966 via the gift to the Association of the complete variable star observing records, charts, photographs, etc. of the late Prof. Charles P. Olivier of the University of Pennsylvania (USA). Adequate material covering about 60 variables, not previously charted by the AAVSO, was included in this original data, and was suitably charted in reproducible standard format.Since 1966, much additional information has been assembled from other sources, three Catalogs have been issued which list the new or revised charts produced, and which specify how copies of same may be obtained. The latest such Catalog is dated June 1978, and lists 670 different charts covering a total of 611 variables none of which was charted in reproducible standard form previous to 1966.

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