scholarly journals Left Occipital Craniotomy for Resection of Arteriovenous Malformation: 2-Dimensional Operative Video

2020 ◽  
Vol 18 (4) ◽  
pp. E112-E112
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Cerebral Artery ◽  
Arteriovenous Malformations ◽  
Posterior Cerebral Artery ◽  
Video Recording ◽  
Institutional Review Board ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Standard Manner ◽  
Calcarine Fissure ◽  
Neurologically Intact

Abstract Medial parieto-occipital arteriovenous malformations (AVMs) are fed by distal cortical posterior cerebral artery branches and are generally considered eloquent given the proximity to the calcarine fissure and paracentral lobule. This patient was a neurologically intact 12-yr-old girl with an incidentally discovered left occipital AVM. The patient underwent preoperative angiographic evaluation with embolization of a dominant posterior cerebral artery feeding vessel. The AVM was removed in the standard manner using circumdissection. Indocyanine green angiography was utilized to demonstrate disconnection of the AVM before sacrificing the draining veins. The AVM was removed entirely, as evidenced on postoperative angiography. The patient had a partial right hemianopsia after the operation but was otherwise neurologically intact. 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 Microsurgical Clipping of an Unruptured Basilar Apex Aneurysm: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (4) ◽  
pp. E391-E392
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Video Recording ◽  
Institutional Review Board ◽  
Interpeduncular Cistern ◽  
Microsurgical Clipping ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Increased Risk ◽  
Risk Of Rupture ◽  
Clip Application ◽  
Neurologically Intact

Abstract Aneurysms of the basilar artery apex are generally at an increased risk of rupture compared with aneurysms in other locations, and the risk of rupture increases with increasing aneurysm size. Therefore, these lesions necessitate treatment to decrease the risk of rupture. The location, size, and directionality of dome projection influence the difficulty of microsurgical treatment. The patient presented with an incidental basilar apex aneurysm identified on workup for headaches. The aneurysm projected superoposteriorly into the interpeduncular cistern. The surgical approach involved a wide exposure of the basilar apex complex and meticulous identification and preservation of P1 perforators during clip applications. It was imperative to visualize all perforators on both sides of the clip prior to application, given the severe morbidity associated with a perforator infarct. The patient tolerated the procedure well and remained neurologically intact after the operation. This video is an exemplary demonstration of basilar apex aneurysm clip application for an incidentally discovered aneurysm. 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 Grade 4 Temporal Arteriovenous Malformation: 2-Dimensional Operative Video

2019 ◽  
Vol 18 (2) ◽  
pp. E36-E37
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Informed Consent ◽  
Arteriovenous Malformations ◽  
Video Recording ◽  
Venous Drainage ◽  
Complete Resection ◽  
Elevated Risk ◽  
Institutional Review Board ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Martin Grade

Abstract The 2% to 4% annual rupture rate for arteriovenous malformations (AVMs) must be weighed against the risk of intervention during surgery within an eloquent brain region. Following a hemorrhage event, AVMs that were initially considered to be nonoperative or unfavorable for surgical resection can be intervened on to avoid the significantly elevated risk of rehemorrhage. This patient had a dominant temporal lobe Spetzler–Martin grade 4 AVM with deep venous drainage, representing a significant surgical challenge. The arachnoid plane microdissection was performed using microscissors but was tenuous, and it was necessary to define the draining vein and adjacent feeding arteries. This video demonstrates the major principles of AVM resection during the circumdissection and disconnection of the nidus. The postoperative angiography demonstrated complete resection. 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 3 to Cervical 6 Laminectomy for Arteriovenous Malformation: 2-Dimensional Operative Video

2019 ◽  
Vol 17 (5) ◽  
pp. E200-E200
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Arteriovenous Malformation ◽  
Surgical Resection ◽  
Video Recording ◽  
Institutional Review Board ◽  
Digital Subtraction ◽  
Pia Mater ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Complete Obliteration ◽  
System 1

Abstract According to the Spetzler spinal cord classification system,1 this patient had an extradural-intradural arteriovenous malformation (AVM), also known as a type III or juvenile AVM. The patient underwent a surgical resection of the lesion via a cervical 3 to cervical 6 laminoplasty. Direct observation confirmed intra- and extramedullary components. During the surgical resection, an attempt was made to avoid transgressing the pia mater. Therefore, the traversing vessels were interrupted during the circumdissection. The nidus was removed, and postprocedural digital subtraction angiography confirmed complete 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 Supracerebellar Transtentorial Approach for Mesial Temporal Lobe Cavernous Malformation: 2-Dimensional Operative Video

2019 ◽  
Vol 17 (6) ◽  
pp. E236-E236 ◽  
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Cavernous Malformation ◽  
Video Recording ◽  
Complete Removal ◽  
Institutional Review Board ◽  
Cavernous Malformations ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Stereotactic Navigation ◽  
Mesial Temporal Lobe ◽  
Transtentorial Approach

Abstract Medial temporal cavernous malformations can involve transgression of eloquent parenchyma. For a tentorium-abutting temporal cavernous malformation, the supracerebellar transtentorial corridor is a suitable approach with minimal parenchymal insult. Using dynamic and gravity retraction, lighted bipolar forceps and suction, and stereotactic navigation, this trajectory provides a minimally invasive corridor. The patient in this case has a medial temporal cavernous malformation, with the lesion abutting the tentorial leaflet. The cavernous malformation is accessed and removed in a piecemeal manner. Complete removal of the lesion is achieved. The patient remained neurologically stable after the procedure. 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 Anterior Interhemispheric Transcallosal Approach for Thalamic Cavernous Malformation: 2-Dimensional Operative Video

2019 ◽  
Vol 17 (6) ◽  
pp. E240-E241
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Cavernous Malformation ◽  
Third Ventricle ◽  
Video Recording ◽  
Complete Resection ◽  
Institutional Review Board ◽  
Transcallosal Approach ◽  
The Third ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Surgical Field

Abstract This patient had a large left ventral thalamic cavernous malformation abutting the third ventricle with evidence of recent hemorrhage. The patient was placed supine with the head in the horizontal position with the dependent hemisphere down to permit use of the anterior interhemispheric transcallosal approach. The lateral ventricle is entered, and the septum pellucidum is opened to prevent it from obstructing the surgical field. The deep cavernous malformation is located with stereotactic neuronavigation and removed piecemeal with the aid of lighted suckers and bipolars. Surgical visualization and postoperative imaging demonstrate a complete resection of the lesion, and the patient remained neurologically stable postoperatively. 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 Modified Orbitozygomatic Craniotomy for Previously Coiled Giant Basilar Apex Aneurysm: 2-Dimensional Operative Video

2019 ◽  
Vol 17 (5) ◽  
pp. E199-E199
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Video Recording ◽  
Institutional Review Board ◽  
Anterior Circulation ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Orbitozygomatic Approach ◽  
Clip Application ◽  
Complicating Factors ◽  
The Right ◽  
Significant Size

Abstract Basilar apex aneurysms are generally preferentially managed with endovascular intervention; however, these lesions can demonstrate refractory persistence despite this treatment and, in such cases, must be managed microsurgically. Successful navigation to and manipulation of the basilar apex through the orbitozygomatic approach requires an intricate understanding of the cerebrovascular microanatomy and arachnoid planes within interpeduncular fossa and comfort with use of the operating microscope for the long surgical trajectory to the basilar apex. This patient had a multiply recurrent basilar apex aneurysm; 3 previous coil embolization attempts had been made without successful aneurysm obliteration. This case presented multiple complicating factors, including the presence of a large coil mass and the significant size of the basilar apex lesion. An Allcock test was performed to determine the collateralization across the posterior communicating arteries, and no posterior communicating arteries were visualized, which suggested isolation of the posterior and anterior circulation. A fenestrated clip was utilized from the right side to occlude the base of the aneurysm. Single-clip application was not impeded by the coil mass. Postoperative angiography demonstrated complete occlusion of the aneurysm. 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 Midline Craniotomy for Resection of Cavernous Malformation: 2-Dimensional Operative Video

2019 ◽  
Vol 17 (6) ◽  
pp. E239-E239
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Choroid Plexus ◽  
Cavernous Malformation ◽  
Third Ventricle ◽  
Video Recording ◽  
Institutional Review Board ◽  
Total Resection ◽  
Operating Room Table ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Intraoperative Visualization

Abstract This patient presented with a cavernous malformation in the inferior posterior third ventricle extending into the aqueduct. The patient was positioned supine on the operating room table with the head rotated into the horizontal plane. The choroidal fissure is opened lateral to the choroid plexus. This technique allows for the choroid plexus to serve as protection against forniceal manipulation. Rigid retraction was applied to the cerebral falx and corpus callosum to permit aqueductal visualization. The lighted instruments are paramount for adequate visualization of the third ventricle and during dissection of the lesion. Intraoperative visualization and postoperative imaging confirm gross total resection of the lesion. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute.

scholarly journals Clipping of Basilar and Middle Cerebral Artery Aneurysms: 2-dimensional operative video

2020 ◽  
Vol 19 (3) ◽  
pp. E290-E290
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Preoperative Planning ◽  
Video Recording ◽  
Surgical Clipping ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Complete Obliteration ◽  
Mca Aneurysm ◽  
Middle Cerebral Artery Aneurysms

Abstract Careful preoperative planning for patients with multiple intracranial aneurysms is paramount given the importance of an appropriate trajectory and exposure for each aneurysm that will be clipped. The general principle is to clip aneurysms in a retrograde manner, such that more distal aneurysms are clipped earlier, and more superficial aneurysms are clipped later. This patient had unruptured middle cerebral artery (MCA) and basilar artery (BA) apex aneurysms and elected for surgical clipping of both lesions. An orbitozygomatic craniotomy ipsilateral to the MCA aneurysm was performed to permit clipping of both lesions. The dissection initially focused on exposure of the MCA aneurysm and then focused on the carotid-oculomotor triangle to permit basilar apex exposure and aneurysm clipping. The MCA aneurysm was clipped second. Postoperative imaging demonstrated complete obliteration of both aneurysms. 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 Large Cervical Ependymoma: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (1) ◽  
pp. E42-E42
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Informed Consent ◽  
Surgical Resection ◽  
Video Recording ◽  
Institutional Review Board ◽  
Venous Plexus ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Upper Cervical ◽  
Posterior Midline ◽  
Spinal Gliomas

Abstract Spinal ependymomas compose approximately 60% of spinal gliomas, the predominance occurring within adults. These tumors are generally benign, and maximal surgical resection with neurological preservation is the surgical goal. This patient had a large upper cervical ependymoma, which was approached through a cervical laminotomy. The surgical resection of this lesion demonstrates the principles of pial venous plexus preservation during posterior midline raphe identification and dissection. Gross total surgical resection was achieved with the preservation of the patient's baseline neurological function. 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.

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