Microsurgical resection of a glioblastoma multiforme of the medulla oblongata with intraoperative subcortical stimulation and mapping

2019 ◽  
Vol 1 (2) ◽  
pp. V1
Author(s):  
Sima Sayyahmelli ◽  
Jian Ruan ◽  
Bryan Wheeler ◽  
Mustafa K. Başkaya
Keyword(s):  
Glioblastoma Multiforme ◽  
Surgical Resection ◽  
Medulla Oblongata ◽  
Cranial Nerves ◽  
The Body ◽  
Fine Motor ◽  
Surgical Video ◽  
Inferior Aspect ◽  
Hyperintense Signal ◽  
Microsurgical Resection

Primary glioblastoma multiforme tumors of the medulla oblongata are rare, especially in the adult population. Perhaps due to this rarity, we are not aware of any previous reports addressing the resection of these tumors or their clinical outcomes.In this surgical video, we present a 43-year-old man with a 1-month history of left-sided paresthesia. The paresthesia initiated in the left hand, along with weakness and reduced fine motor control, and then spread to the entire left side of the body. He had recent weight loss, imbalance, difficulty in swallowing, and hoarseness in his voice. He also had a diminished gag reflex, and significant atrophy of the right side of the tongue with an accompanying deviation of the uvula and fasciculations of the tongue. MRI showed an infiltrative expansile mass within the medulla with peripheral enhancement and central necrosis. In T2/FLAIR sequences, a hyperintense signal extended superiorly into the left inferior aspect of the pons and left inferior cerebellar peduncle and inferiorly into the upper cervical cord.The decision was made to proceed with surgical resection. The patient underwent a midline suboccipital craniotomy with C1 laminectomy for surgical resection of this infiltrative expansile intrinsic mass in the medulla oblongata, with concurrent monitoring of motor and somatosensory evoked potentials and monitoring of lower cranial nerves IX, X, XI, and XII. A gross-total resection of the enhancing portion of the tumor was performed, along with a subtotal resection of the nonenhancing portion. The surgery and postoperative course were uneventful. Histopathology revealed a grade IV astrocytoma. The patient received radiation therapy.In this surgical video, we demonstrate important steps for the microsurgical resection of this challenging glioblastoma multiforme of the medulla oblongata.The video can be found here: https://youtu.be/QHbOVxdxbeU.

Surgical Management Of Posterior Fossa Arteriovenous Malformations

2006 ◽  
Vol 58 (suppl_4) ◽  
pp. ONS-189-ONS-201 ◽  
Author(s):  
John Sinclair ◽  
Michael E. Kelly ◽  
Gary K. Steinberg
Keyword(s):  
Stereotactic Radiosurgery ◽  
Surgical Resection ◽  
Posterior Fossa ◽  
Arteriovenous Malformations ◽  
Cranial Nerves ◽  
Venous Drainage ◽  
Cerebellar Nuclei ◽  
Preoperative Embolization ◽  
Frameless Stereotaxy ◽  
Microsurgical Resection

Abstract Objective: Arteriovenous malformations (AVMs) involving the cerebellum and brainstem are relatively rare lesions that most often present clinically as a result of a hemorrhagic episode. Although these AVMs were once thought to have a more aggressive clinical course in comparison with supratentorial AVMs, recent autopsy data suggests that there may be little difference in hemorrhage rates between the two locations. Although current management of these lesions often involves preoperative embolization and stereotactic radiosurgery, surgical resection remains the treatment of choice, conferring immediate protection to the patient from the risk of future hemorrhage. Methods: Most symptomatic AVMs that involve the cerebellum and the pial or ependymal surfaces of the brainstem are candidates for surgical resection. Preoperative angiography and magnetic resonance imaging studies are critical to determine suitability for resection and choice of operative exposure. In addition to considering the location of the nidus, arterial supply, and predominant venous drainage, the surgical approach must also be selected with consideration of the small confines of the posterior fossa and eloquence of the brainstem, cranial nerves, and deep cerebellar nuclei. Results: Since the 1980s, progressive advances in preoperative embolization, frameless stereotaxy, and intraoperative electrophysiologic monitoring have significantly improved the number of posterior fossa AVMs amenable to microsurgical resection with minimal morbidity and mortality. Conclusion: Future improvements in endovascular technology and stereotactic radiosurgery will likely continue to increase the number of posterior fossa AVMs that can safely be removed and further improve the clinical outcomes associated with microsurgical resection.

scholarly journals Microsurgical resection of a large cavernous malformation of the medulla oblongata

2019 ◽  
Vol 1 (1) ◽  
pp. V25
Author(s):  
Sima Sayyahmelli ◽  
Mustafa K. Başkaya
Keyword(s):  
Surgical Resection ◽  
Medulla Oblongata ◽  
Cavernous Malformation ◽  
Foramen Magnum ◽  
Total Resection ◽  
Postoperative Course ◽  
Suboccipital Craniotomy ◽  
Postoperative Mri ◽  
Microsurgical Resection

In this surgical video, we present a 57-year-old man with neck pain, dizziness, and imbalance. MRI showed a heterogeneously enhancing mass lesion within the posterior medulla at the level of the foramen magnum. Because the patient was symptomatic from this cavernous malformation, the decision was made to proceed with surgical resection. The patient underwent a midline suboccipital craniotomy with C1 laminectomy for surgical resection of the cavernous malformation in the medulla oblongata, with concurrent monitoring of motor and somatosensory evoked potentials.The surgery and postoperative course were uneventful. The postoperative MRI showed gross-total resection of the mass with histopathology indicating a cavernous malformation. The patient continues to do well without recurrence at 7 years of follow-up. In this video, we demonstrate important microsurgical steps for the resection of this challenging and rare vascular malformation.The video can be found here: https://youtu.be/gbGleLowzxo.

scholarly journals Cranio-Orbital Pretemporal Approach for Resection of Right Superior Orbital Fissure/Orbital Renal Cell Metastasis: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Vincent N Nguyen ◽  
Nickalus R Khan ◽  
Kenan I Arnautović
Keyword(s):  
Renal Cell Carcinoma ◽  
Visual Field ◽  
Cell Carcinoma ◽  
Surgical Resection ◽  
Visual Function ◽  
Renal Cell ◽  
High Speed ◽  
Cranial Nerves ◽  
Superior Orbital Fissure ◽  
Microsurgical Resection

Abstract Orbital metastatic lesions are rare entities1-3 best treated with radical surgical resection with preservation/improvement of neurological and visual function.1-9 Renal cell metastases, in particular, respond less favorably to radiation.9 To our knowledge, an operative video of microsurgical resection of a renal cell carcinoma metastasis to the superior orbital fissure and orbit has not been reported.  A patient presented with worsening right eye vision as demonstrated on preoperative visual field testing and found to have a 3 × 1 × 1 cm lesion in the orbit and superior orbital fissure. The patient was placed supine and stealth neuronavigation was used to aid in tumor localization and extension. A cranio-orbital craniotomy and pretemporal exposure2,10,11 were performed to allow extradural dissection of the dura propria off the lateral wall of the cavernous sinus. Right-sided extradural cranial nerves II, III, IV, V1, and V2 were identified, and a high-speed diamond drill was used to perform extradural anterior clinoidectomy and optic nerve decompression. Microsurgical resection of the intraorbital tumor components was performed by the senior author (KIA) to delineate the plane between tumor and periorbita. An oval-shaped dural opening was made to resect the dura involved by tumor, confirmed on histological analysis, followed by closure via dural allograft. The patient's right-sided visual field improved markedly after surgery.  Metastatic renal cell carcinoma of the orbit should be resected while preserving and improving preoperative neurological and visual function. The orbitocranial pretemporal approach offers wide visualization to achieve surgical resection.  The patient provided written consent and permission to publish her image.

scholarly journals Resection of a Lower Clival Meningioma via Posterolateral Approach: Two-Dimensional Operative Video

2020 ◽  
Author(s):  
Pinar E. Ocak ◽  
Selcuk Yilmazlar
Keyword(s):  
Cranial Nerve ◽  
Cranial Nerves ◽  
Posterolateral Approach ◽  
Left Vertebral Artery ◽  
Posterior Arch ◽  
Upper Cervical Spine ◽  
Two Dimensional ◽  
Lower Cranial Nerve ◽  
Complex Anatomy ◽  
Microsurgical Resection

Abstract Objectives This study aimed to demonstrate resection of a craniovertebral junction (CVJ) meningioma via the posterolateral approach. Design The study is designed with a two-dimensional operative video. Setting This study is conducted at department of neurosurgery in a university hospital. Participants A 50-year-old woman who presented with lower cranial nerve findings due to a left-sided lower clival meningioma (Fig. 1). Main Outcome Measures Microsurgical resection of the meningioma and preservation of the neurovascular structures. Results The patient was placed in park-bench position and a left-sided retrosigmoid suboccipital craniotomy, followed by C1 hemilaminectomy and unroofing the lip of the foramen magnum, was performed. The dural incision extended from the suboccipital region down to the posterior arch of C2 (Fig. 2). The arachnoid overlying the tumor was incised, revealing the course of the cranial nerve (CN) XI on the dorsolateral aspect of the tumor. The left vertebral artery (VA) was encased by the tumor which was originating from the dura below the jugular foramen. The mass was resected in a piecemeal fashion eventually. At the end of the procedure, all relevant cranial nerves and adjacent vascular structures were intact. Postoperative magnetic resonance imaging (MRI) confirmed total resection and the patient was discharged home on postoperative day 3 safely. Conclusions Microsurgical resection of the lesions of the CVJ are challenging as this transition zone between the cranium and upper cervical spine has a complex anatomy. Since adequate exposure of the extradural and intradural segments of the VA can be obtained by the posterolateral approach, this approach can be preferred in cases with tumors anterior to the VA or when the artery is encased by the tumor.The link to the video can be found at: https://youtu.be/d3u5Qrc-zlM.

Symptomatic pancreatic body endometrial cyst requiring en bloc distal pancreatectomy

2021 ◽  
Vol 14 (9) ◽  
pp. e244911
Author(s):  
Cameron Ludwig ◽  
Avery Kopacz ◽  
M Logan Warren ◽  
Edwin Onkendi
Keyword(s):  
Distal Pancreatectomy ◽  
Surgical Resection ◽  
Epigastric Pain ◽  
Rare Condition ◽  
The Body ◽  
Uneventful Recovery ◽  
En Bloc ◽  
Spleen Preserving ◽  
Robotic Resection ◽  
Endometrial Cyst

Pancreatic endometriosis is an extremely rare condition, with only a few cases described in the literature. Definitive diagnosis is often difficult to elucidate and will almost always require biopsy or surgical resection. We present a case of a female in her early thirties with a well-known history of widespread endometriosis presenting with vague epigastric pain. CT imaging showed an 11 cm well-circumscribed simple-appearing cyst in the lessor sac. Its origin could not be determined preoperatively but it appeared to involve the parenchyma of the body of the pancreas. Due to the associated pain and indeterminate nature, subtotal surgical resection of the extrapancreatic cyst was performed with the intrapancreatic cyst being managed by a cystogastrostomy to the adjacent stomach in a planned pancreas-sparing procedure following intraoperative confirmation it was arising within the pancreas. Pathological evaluation of the resected cyst confirmed it to be an endometrial cyst. The cystogastrostomy anastomosis subsequently obstructed a few weeks postoperatively and symptoms recurred from cyst enlargement. Redo robotic resection with resection of the remnant cyst, cystogastrostomy and en bloc spleen-preserving distal pancreatectomy was performed. The patient had an uneventful recovery. She has had no recurrence of cyst or symptoms since. A procedure video is included in the report.

Twisting and Bending: The Functional Role of Salamander Lateral Hypaxial Musculature During Locomotion

2001 ◽  
Vol 204 (11) ◽  
pp. 1979-1989 ◽  
Author(s):  
Wallace O. Bennett ◽  
Rachel S. Simons ◽  
Elizabeth L. Brainerd
Keyword(s):  
High Intensity ◽  
High Speed ◽  
The Body ◽  
Transversus Abdominis ◽  
Fine Motor ◽  
Emg Activity ◽  
Ground Reaction Forces ◽  
Terrestrial Locomotion ◽  
Reaction Forces ◽  
Hypaxial Muscle

SUMMARY The function of the lateral hypaxial muscles during locomotion in tetrapods is controversial. Currently, there are two hypotheses of lateral hypaxial muscle function. The first, supported by electromyographic (EMG) data from a lizard (Iguana iguana) and a salamander (Dicamptodon ensatus), suggests that hypaxial muscles function to bend the body during swimming and to resist long-axis torsion during walking. The second, supported by EMG data from lizards during relatively high-speed locomotion, suggests that these muscles function primarily to bend the body during locomotion, not to resist torsional forces. To determine whether the results from D. ensatus hold for another salamander, we recorded lateral hypaxial muscle EMGs synchronized with body and limb kinematics in the tiger salamander Ambystoma tigrinum. In agreement with results from aquatic locomotion in D. ensatus, all four layers of lateral hypaxial musculature were found to show synchronous EMG activity during swimming in A. tigrinum. Our findings for terrestrial locomotion also agree with previous results from D. ensatus and support the torsion resistance hypothesis for terrestrial locomotion. We observed asynchronous EMG bursts of relatively high intensity in the lateral and medial pairs of hypaxial muscles during walking in tiger salamanders (we call these ‘α-bursts’). We infer from this pattern that the more lateral two layers of oblique hypaxial musculature, Mm. obliquus externus superficialis (OES) and obliquus externus profundus (OEP), are active on the side towards which the trunk is bending, while the more medial two layers, Mm. obliquus internus (OI) and transversus abdominis (TA), are active on the opposite side. This result is consistent with the hypothesis proposed for D. ensatus that the OES and OEP generate torsional moments to counteract ground reaction forces generated by forelimb support, while the OI and TA generate torsional moments to counteract ground reaction forces from hindlimb support. However, unlike the EMG pattern reported for D. ensatus, a second, lower-intensity burst of EMG activity (‘β-burst’) was sometimes recorded from the lateral hypaxial muscles in A. tigrinum. As seen in other muscle systems, these β-bursts of hypaxial muscle coactivation may function to provide fine motor control during locomotion. The presence of asynchronous, relatively high-intensity α-bursts indicates that the lateral hypaxial muscles generate torsional moments during terrestrial locomotion, but it is possible that the balance of forces from both α- and β-bursts may allow the lateral hypaxial muscles to contribute to lateral bending of the body as well.

The Activity of Lateral-Line Efferent Neurones in Stationary and Swimming Dogfish

1972 ◽  
Vol 57 (2) ◽  
pp. 435-448 ◽  
Author(s):  
B. L. ROBERTS ◽  
I. J. RUSSELL
Keyword(s):  
Lateral Line ◽  
Body Movement ◽  
Cranial Nerves ◽  
Regulatory System ◽  
The Body ◽  
Muscle Fibres ◽  
Sense Organs ◽  
Efferent System ◽  
Natural Stimulation ◽  
Stimulation Of

1. The activity of efferent neurones innervating lateral-line organs on the body of dogfish was followed by recording from filaments of cranial nerve X in 41 decerebrate preparations. 2. The efferent nerves were not spontaneously active. 3. Tactile stimulation to the head and body, vestibular stimulation and noxious chemical stimulation were followed by activity of the efferent nerves. 4. In contrast, natural stimulation of lateral-line organs (water jets) did not reflexly evoke discharges from the efferent fibres. 5. Reflex efferent responses were still obtained to mechanical stimulation even after the lateral-line organs had been denervated. 6. Electrical stimulation of cranial nerves innervating lateral-lines organs was followed by reflex activity of the efferent fibres. But similar stimuli applied to other cranial nerves were equally effective in exciting the efferent system. 7. Vigorous movements of the fish, involving the white musculature, were preceded and accompanied by activity of the efferent fibres which persisted as long as the white muscle fibres were contracting. 8. Rhythmical swimming movements were accompanied by a few impulses in the efferent fibres grouped in bursts at the same frequency as the swimming movements. 9. It is concluded that the efferent neurones cannot contribute to a feedback regulatory system because they are not excited by natural stimulation of the lateral-line sense organs. The close correlation found between efferent activity and body movement suggests that the efferent system might operate in a protective manner to prevent the sense organs from being over-stimulated when the fish makes vigorous movements.

Medulla Oblongata and Cranial Nerves.

2006 ◽  
pp. 175-185
Author(s):  
G. L. Freeman
Keyword(s):  
Medulla Oblongata ◽  
Cranial Nerves

scholarly journals Microsurgical resection of ambient cistern arteriovenous malformation

2016 ◽  
Vol 40 (videosuppl1) ◽  
pp. 1
Author(s):  
Omar Choudhri ◽  
Michael T. Lawton
Keyword(s):  
Arteriovenous Malformations ◽  
Posterior Cerebral Artery ◽  
Cranial Nerves ◽  
Superior Cerebellar Artery ◽  
Technical Aspects ◽  
The Third ◽  
Cerebellar Artery ◽  
Basal Vein Of Rosenthal ◽  
Microsurgical Resection ◽  
Ambient Cistern

The middle tentorial incisural space, located lateral to the midbrain and medial to the temporal lobe, contains the ambient cistern through which courses the third, fourth, and fifth cranial nerves, posterior cerebral artery (PCA), superior cerebellar artery, and the choroidal arteries. Arteriovenous malformations (AVMs) in this compartment are supplied by the thalamogeniculate and posterior temporal branches of the PCA, and drain into tributaries of the basal vein of Rosenthal. We present a case of an AVM in this middle tentorial incisural space that persisted after embolization and radiosurgery, and was microsurgically resected through a subtemporal approach. This case demonstrates the anatomy of the middle incisural space and technical aspects in microsurgical resection of these rare AVMs.The video can be found here: https://youtu.be/V-dIWh8ys3E.

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