Two cases of brainstem neurocysticercosis removal: operative video

Neurocysticercosis is primarily managed with anthelminthic, antiepileptic, and corticosteroid therapies. Surgical removal of the larval cyst is indicated when associated mass effect causes neurological symptoms, as demonstrated in two cases. Cyst resection was achieved via the far lateral approach for a cervicomedullary cyst in one patient and via the subtemporal approach for a mesencephalic cyst in another. The cyst wall should be kept intact, when possible, to avoid dissemination of the inflammation-evoking contents. As the contents are usually semisolid and can be removed via suction, it is not necessary to remove the gliotic capsule or adherent portions of the cyst wall in highly eloquent locations.The video can be found here: https://youtu.be/GqbaJu5sy1o.

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Far Lateral Approach for Resection of Transverse Ligament Cyst

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0040-1701689 ◽

2020 ◽

Author(s):

Lattimore Madison Michael ◽

Vincent Nguyen ◽

Jaafar Basma ◽

William Mangham ◽

Nickalus Khan ◽

...

Keyword(s):

Spinal Cord ◽

Mass Effect ◽

Lateral Approach ◽

Microsurgical Anatomy ◽

Transverse Ligament ◽

Far Lateral Approach ◽

Adequate Understanding ◽

Far Lateral ◽

Microsurgical Resection ◽

Dentate Ligament

Abstract Objectives This study was aimed to describe a far lateral approach for microsurgical resection of a transverse ligament cyst, with emphasis on the microsurgical anatomy and technique. Design A far lateral craniotomy is performed in the lateral decubitus position. After opening the dura laterally, dural sutures are placed for retraction. A stitch placed through the dentate ligament is advantageous to rotate the spinal cord to allow access to the ventral cyst. The cyst is marsupirlized and mass effect on the spinal cord is relieved. Photographs of the region are borrowed from Dr Rhoton's laboratory to illustrate the microsurgical anatomy. Participants The first author performed the surgery and edited the video. Chart review and literature review were performed by the other authors. Outcome Measures Outcome was assessed with postoperative neurological function. Results The patient was discharged home after an uneventful hospital course. At short-term follow-up, the patient had a significant improvement in postoperative strength. Conclusion The far lateral approach provides an adequate corridor to the ventrolateral brainstem in combination with utilization of the dentate ligament to reach ventral cysts compressing the spinal cord. An adequate understanding of the relevant microsurgical anatomy is a key to safe surgery in this region.The link to the video can be found at: https://youtu.be/5MGVPO2Q2pI.

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Far lateral approach for resection of lower pontine cavernous malformation

Neurosurgical Focus: Video ◽

10.3171/2019.7.focusvid.19172 ◽

2019 ◽

Vol 1 (1) ◽

pp. V27

Author(s):

Georgios A. Zenonos ◽

Samir Sur ◽

Maximiliano Nuñez ◽

David T. Fernandes-Cabral ◽

Jacques J. Morcos

Keyword(s):

Cavernous Malformation ◽

Lateral Approach ◽

3D Video ◽

Fiber Tractography ◽

Abducens Palsy ◽

High Definition ◽

Entry Zone ◽

Link Type ◽

Far Lateral Approach ◽

Far Lateral

In this 3D video we review the case of a lower pontine cavernous malformation in a 31-year-old man who presented with hemiparesis and an abducens palsy. The cavernous malformation was completely resected through a far lateral approach and a peritrigeminal brainstem entry zone, with a significant improvement in the patient’s hemiparesis. The relevant anatomy is reviewed in detail through multiple anatomical brainstem dissection specimens, as well as high-definition fiber tractography images. The rationale for the approach is analyzed relative to other possible options, and a number of technical pearls are provided.The video can be found here: https://youtu.be/fH2Q7RjlBKQ.

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A far-lateral approach for removal of a C1–2 extradural neurofibroma

Neurosurgical FOCUS ◽

10.3171/2012.v2.focus12157 ◽

2012 ◽

Vol 33 (Suppl1) ◽

pp. 1

Author(s):

Jon H. Robertson ◽

Jeffrey M. Sorenson

Keyword(s):

Spinal Cord ◽

Spinal Canal ◽

Lateral Approach ◽

Stereoscopic Video ◽

Progressive Myelopathy ◽

Link Type ◽

Far Lateral Approach ◽

Type 1 Neurofibromatosis ◽

Far Lateral

A young man with type 1 neurofibromatosis presented with progressive myelopathy. Imaging revealed an anterolateral mass within the spinal canal at C1–2, with severe compression of the spinal cord. A far-lateral approach was used to remove the mass, which proved to be an extradural neurofibroma. This narrated stereoscopic video details the important steps of the operation. The video can be found here: http://youtu.be/td4MjLtiMbk.

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Foramen Magnum Meningioma: Far Lateral Approach

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0039-1695701 ◽

2019 ◽

Vol 80 (S 04) ◽

pp. S363-S364

Author(s):

Ciro Vasquez ◽

Alexander Yang ◽

A. Samy Youssef

Keyword(s):

Vertebral Artery ◽

Cranial Nerves ◽

Mass Effect ◽

Craniocervical Junction ◽

Foramen Magnum ◽

Lateral Approach ◽

Neurological Deficits ◽

Occipital Condyle ◽

Far Lateral Approach ◽

Far Lateral

We present a case of a foramen magnum meningioma in a 42-year-old female who presented with headaches for 2 years, associated with decreased sensation and overall feeling of “heaviness” of the right arm. The tumor posed significant mass effect on the brainstem, and given the location of the tumor in the anterolateral region of the foramen magnum, a right far lateral approach was chosen. The approach incorporates the interfascial dissection technique to safely expose and preserve the vertebral artery in the suboccipital triangle. After drilling the posteromedial portion of the occipital condyle and opening the dura, the tumor can be entirely exposed with minimal retraction on the cerebellum. The working space offered by the far lateral approach allows careful dissection at the lateral craniocervical junction, and preservation of the V4 segment of the vertebral artery and the lower cranial nerves. Simpson's grade-2 resection was achieved with coagulation of the dural base around the vertebral artery. The postoperative course was unremarkable for any neurological deficits. At the 2-year follow-up, imaging identified no recurrence of tumor and the patient remains asymptomatic.The link to the video can be found at: https://youtu.be/IMN1O7vO5B0.

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