scholarly journals Brainstem navigation with Intraoperative anatomical landmarks registration: Technical note

2019 ◽  
Vol 29 (01) ◽  
pp. 40-46
Author(s):  
Erasmo Barros da Silva Júnior ◽  
Gustavo Simiano Jung ◽  
Jerônimo Buzetti Milano ◽  
Joseph Franklin Chenisz da Silva ◽  
Ricardo Ramina
Keyword(s):  
Fourth Ventricle ◽  
Surgical Planning ◽  
Skin Incision ◽  
Foramen Magnum ◽  
Technical Note ◽  
Anatomical Landmarks ◽  
Registration Method ◽  
Brainstem Surgery ◽  
Spinal Navigation ◽  
Bone Structures

Background. Cranial navigation in brainstem surgery can be especially challenging due to registration method limitation and complex anatomic orientation. Surface anatomical landmarks are not available and fiducial registration usually needs image acquisition at the day of surgery. Intraoperative registration is often used during spinal navigation with safe and reliable accuracy. We present our technique of navigation for brainstem lesions surgeries using intraoperative anatomical landmarks for registration. Methods. From March 2008 to November 2018, 38 patients underwent suboccipital midline approaches for removal of brainstem and/or fourth ventricle lesions with frameless navigation. We performed CT scan and MRI sequence with gadolinium enhancement for each patient a day before the operation. The CT/MRI image fusion and surgical planning was performed in Brainlab® workstation. Navigation registration was performed after skin incision and external skull base anatomical landmarks exposure. Results. The anatomical landmarks used for registration was based on bone structures visible on CT images. The accuracy flaw was insignificant for brainstem navigation, especially for the roof and lateral limits of the fourth ventricle. The image-guided system was very useful for tumor localization and removal in all cases. Conclusions. Intraoperative anatomical landmarks registration is a fast and safe method for brainstem navigation. The brainstem is a fixed encephalic structure and the shifting is insignificant. Anatomical landmarks (inion, foramen magnum, nucal lines, C1 posterior arc) and a careful surgical planning are necessary in order to avoid accuracy lost.

scholarly journals Fully Endoscopic Minimally Invasive Transrectus Capitis Posterior Muscle Triangle Approach to the Posterolateral Condyle and Jugular Tubercle

2017 ◽  
Vol 78 (05) ◽  
pp. 359-370 ◽  
Author(s):  
Wang Mingdong ◽  
Roger Mathias ◽  
Eric Wang ◽  
Paul Gardner ◽  
Hong Wang ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Fourth Ventricle ◽  
Jugular Foramen ◽  
Foramen Magnum ◽  
Endoscopic Approach ◽  
Occipital Condyle ◽  
Anatomical Landmarks ◽  
Bone Removal ◽  
Soft Tissue Dissection ◽  
Greater Occipital Nerve

Background We evaluated a transrectus capitis posterior muscle triangle approach to the posterolateral foramen magnum, occipital condyles, jugular tubercle, and the fourth ventricle. We also assessed factors that affect the amount of bone removal required. Objective To evaluate if the proposed approach is as effective as standard open approaches to expose the lateral portion of the foramen magnum. Methods The proposed minimally invasive fully endoscopic approach was performed in 15 cadaveric specimens using 4-mm (0- and 45-degree) endoscopes. Results Using a 5-cm straight paramedian incision, the rectus capitis posterior minor and major muscles were partially removed unilaterally, providing a corridor through the muscles to reach the foramen magnum region. After meticulous soft tissue dissection, key anatomical landmarks can be identified such as the greater occipital nerve, the vertebral artery that wraps around the atlanto-occipital joint, and the bony protuberance that heralds the occipital condyle. A suboccipital craniotomy associated with the transcondylar, supracondylar or paracondylar approach is performed depending on the amount of bone removal desired to maximize the surgical view. By doing so, the jugular foramen can be exposed laterally as well as the fourth ventricle medially. Conclusion The proposed endoscopic approach can provide access through the transrectus capitis posterior muscle triangle leading directly to the occipital condyle. A stepwise approach is critical to gain a surgical corridor to the inferolateral petroclival region and the fourth ventricle.

Revision of Vagal Nerve Stimulator Electrodes Through a Posterior Cervical Triangle Approach: Technical Note

2010 ◽  
Vol 67 (suppl_2) ◽  
pp. ons457-ons460
Author(s):  
Brent R. O'Neill ◽  
James E. Wilberger
Keyword(s):  
Skin Incision ◽  
Electrode Site ◽  
Technical Note ◽  
Vagal Nerve ◽  
Electrode Placement ◽  
Lead Wire ◽  
Posterior Border ◽  
Nerve Stimulator ◽  
Vagal Nerve Stimulator ◽  
Back Ground

ABSTRACT BACK GROUND: We describe an approach to vagal nerve stimulator (VNS) lead replacement through the posterior cervical triangle. Scar around the structures of the carotid sheath is avoided and new leads are placed on a pristine section of the vagus nerve proximal to the original site. CLINICAL PRESENTATION: Skin incision from the implantation surgery is incorporated and extended to allow access to the posterior border of the sternocleidomastoid muscle (SCM). Dissection proceeds along the posterior border of the SCM. The SCM and jugular vein are retracted anterior to expose a fresh segment of the vagal nerve immediately superficial to the carotid artery and proximal to the original electrode site. Once the nerve is adequately exposed, electrode placement proceeds in the standard fashion. Dysfunctional electrodes are left in place, and the lead wire is cut as near the electrodes as can be easily accessed. Three patients have undergone lead revision with this approach. Lead placement was successful and free from complications in all cases. CONCLUSION: The posterior cervical triangle approach provides a virgin dissection plane for VNS revision.

Anterior transcorporeal tunnel approach for cervical myelopathy guided by CT-based intraoperative spinal navigation: Technical note

2018 ◽  
Vol 48 ◽  
pp. 218-223 ◽  
Author(s):  
Javier Quillo-Olvera ◽  
Guang-Xun Lin ◽  
Tsz-King Suen ◽  
Hyun-Jin Jo ◽  
Jin-Sung Kim
Keyword(s):  
Cervical Myelopathy ◽  
Technical Note ◽  
Spinal Navigation

scholarly journals Working Cannula-Based Endoscopic Foraminoplasty: A Technical Note

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Suxi Gu ◽  
Kedong Hou ◽  
Wei Jian ◽  
Jianwei Du ◽  
Songhua Xiao ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Operation Time ◽  
Skin Incision ◽  
Technical Note ◽  
Lumbar Discectomy ◽  
New Technique ◽  
Foraminal Stenosis ◽  
Transforaminal Approach ◽  
A New Technique ◽  
Endoscopic Lumbar Discectomy

Purpose. Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive disc surgery that can be performed under local anesthesia and requires only an eight-mm skin incision. For the patients with lumbar foraminal stenosis, the migrated disc is difficult to remove with a simple transforaminal approach. In such cases, the foraminoplasty techniques can be used. However, obtaining efficient foramen enlargement while minimizing radiation exposure and protecting the nerves can be challenging. Methods. In this study, we propose a new technique called the Kiss-Hug maneuver. Under endoscopic viewing, we used the bevel tip of a working cannula as a bone reamer to enlarge the foramen. This allowed us to efficiently enlarge the lumbar foramen endoscopically without the redundancy and complications associated with reamers or trephines. Results. Details of the four steps of the Kiss-Hug maneuver are reported along with adverse events. The advantages of this new technique include minimizing radiation exposure to both the surgeon and the patient and decreasing the overall operation time. Conclusion. The endoscopic Kiss-Hug maneuver is a useful and reliable foraminoplasty technique that can enhance the efficiency of foraminoplasty while ensuring patient safety and reducing radiation exposure.

scholarly journals NT scan: can it prevent second trimester MTP complications?

2018 ◽  
Vol 7 (6) ◽  
pp. 2497
Author(s):  
Anne Johncy ◽  
G. Rohini ◽  
Lekha Shri
Keyword(s):  
Folic Acid ◽  
Congenital Anomalies ◽  
Fourth Ventricle ◽  
First Trimester ◽  
Folic Acid Supplementation ◽  
Foramen Magnum ◽  
Type Ii ◽  
Second Trimester ◽  
Arnold Chiari Malformation ◽  
Cerebellar Tonsils

The NT scan (11 to 13 weeks+6 days) is used as dating scan and genetic scan. Now it is emerging as a basic checklist for examination of the whole fetal anatomy and also to identify congenital anomalies in early trimester. Arnold-Chiari malformation type II is the most common which is characterized by displacement of cerebellar tonsils, parts of the cerebellum- fourth ventricle, pons and medulla oblongata through the foramen magnum into the spinal canal. This is usually associated with hydrocephalus and myelomeningocele. This can be prevented by preconceptional folic acid supplementation. Second trimester MTP complications can be prevented if we diagnose congenital anomalies in first trimester itself.

scholarly journals Posterior fossa decompression with duraplasty in Chiari surgery: A technical note

2017 ◽  
Vol 63 (11) ◽  
pp. 946-949 ◽  
Author(s):  
Marcelo Ferreira Sabba ◽  
Beatriz Souza Renor ◽  
Enrico Ghizoni ◽  
Helder Tedeschi ◽  
Andrei Fernandes Joaquim
Keyword(s):  
Surgical Treatment ◽  
Posterior Fossa ◽  
Foramen Magnum ◽  
Technical Note ◽  
Posterior Fossa Decompression ◽  
State University ◽  
Resonance Imaging ◽  
Tonsillar Herniation ◽  
Craniocervical Instability ◽  
Magnetic Resonance Imaging Mri

Summary Chiari malformation (CM) is the most common and prevalent symptomatic congenital craniocervical malformation. Radiological diagnosis is established when the cerebellar tonsils are located 5 mm or more below the level of the foramen magnum on magnetic resonance imaging (MRI). Surgical treatment is indicated whenever there is symptomatic tonsillar herniation or syringomyelia/hydrocephalus. The main surgical treatment for CM without craniocervical instability (such as atlantoaxial luxation) is posterior fossa decompression, with or without duraplasty. The authors describe in details and in a stepwise fashion the surgical approach of patients with CM as performed at the State University of Campinas, emphasizing technical nuances for minimizing the risks of the procedure and potentially improving patient outcome.

scholarly journals Epidural motor cortex stimulation with functional imaging guidance

2001 ◽  
Vol 11 (3) ◽  
pp. 1-4 ◽  
Author(s):  
Alon Y. Mogilner ◽  
Ali R. Rezai
Keyword(s):  
Motor Cortex ◽  
Mr Imaging ◽  
Functional Imaging ◽  
Surgical Planning ◽  
Functional Brain Imaging ◽  
Anatomical Landmarks ◽  
Motor Cortex Stimulation ◽  
Imaging Data ◽  
Direct Stimulation ◽  
Imaging Guidance

Chronic epidural motor cortex stimulation (MCS) has been shown to have promise in the treatment of patients with refractory deafferentation pain. Precise placement of the electrode over the motor cortex region corresponding to the area of pain is essential for the success of this procedure. Whereas standard anatomical landmarks have been used in the past in conjunction with image guidance, the use of functional brain imaging can be beneficial in the precise surgical planning. The authors report the use of functional imaging–guided frameless stereotactic surgery for epidural MCS. Five patients underwent MCS in which functional imaging guidance was used. Prior to surgery, patients underwent magnetic resonance (MR) imaging with skin fiducial markers placed on standard anatomical reference prints, followed by magnetoencephalography (MEG) mapping of the sensory and motor cortices. In two patients, functional MR imaging was also performed using a motor task paradigm. The functional imaging data were integrated into a frameless stereotactic database by using a three-dimensional coregistration algorithm. Subsequently, a frameless stereotactic craniotomy was performed using the integrated anatomical and functional imaging data for surgical planning. Intraoperative somatosensory evoked potentials (SSEPs) and direct stimulation were used to confirm the target and final placement of the electrode. Direct stimulation and SSEPs performed intraoperatively confirmed the accuracy of the functional imaging data. Trial periods of stimulation successfully reduced pain in three of the five patients who then underwent permanent internal placement of the system. At a mean 6-month follow up, these patients reported an average reduction in pain of 55% on a visual analog scale. The integration of functional and anatomical imaging data allows for precise and efficient surgical planning and may reduce the time necessary for intraoperative physiological verification.

Modified Prone Position for Cranial Remodeling Procedures in Children with Craniofacial Dysmorphism: A Technical Note

Neurosurgery ◽  
1985 ◽  
Vol 16 (2) ◽  
pp. 212-214 ◽  
Author(s):  
T.S. Park ◽  
Charles S. Haworth ◽  
John A. Jane ◽  
Robert B. Bedford ◽  
John A. Persing
Keyword(s):  
Young Children ◽  
Prone Position ◽  
Foramen Magnum ◽  
Head Position ◽  
Technical Note ◽  
One Stage ◽  
Craniofacial Dysmorphism ◽  
Two Stages ◽  
Supraorbital Ridges

Abstract A new head position for use during operation on young children with cranial deformities is described. The position allows exposure of the entire calvarium from the supraorbital ridges to the posterior rim of the foramen magnum. It is a modification of the conventional prone position involving hyperextension of the neck. The authors have safely used this position to perform one-stage radical cranial remodeling procedures that previously required two stages. The advantages of this position and the methods for achieving it are discussed.

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