scholarly journals Insular cavernous malformation resection through a minipterional, transsylvian approach

2019 ◽  
Vol 1 (1) ◽  
pp. V26
Author(s):  
Peyton L. Nisson ◽  
Robert T. Wicks ◽  
Xiaochun Zhao ◽  
Whitney S. James ◽  
David Xu ◽  
...  

Cavernous malformations of the brain are low-flow vascular lesions that have a propensity to hemorrhage. Extensive surgical approaches are often required for operative cure of deep-seated lesions. A 23-year-old female presented with a cavernous malformation of the left posterior insula with surrounding hematoma measuring up to 3 cm. A minimally invasive (mini-)pterional craniotomy with a transsylvian approach was selected. Endoscopic assistance was utilized to confirm complete resection of the lesion. The minipterional craniotomy is a minimally invasive approach that provides optimal exposure for sylvian fissure dissection and resection of many temporal and insular lesions.The video can be found here: https://youtu.be/9z6_EhU6lxs.

2010 ◽  
Vol 29 (3) ◽  
pp. E8 ◽  
Author(s):  
Adib A. Abla ◽  
Jay D. Turner ◽  
Alim P. Mitha ◽  
Gregory Lekovic ◽  
Robert F. Spetzler

Brainstem cavernous malformations (CMs) are low-flow vascular lesions in eloquent locations. Their presentation is often marked with symptomatic hemorrhages that appear to occur more frequently than hemorrhage from supratentorial cavernomas. Brainstem CMs can be removed using 1 of the 5 standard skull-base approaches: retrosigmoid, suboccipital (with or without telovelar approach), supracerebellar infratentorial, orbitozygomatic, and far lateral. Patients being referred to a tertiary institution often have lesions that are aggressive with respect to bleeding rates. Nonetheless, the indications for surgery, in the authors' opinion, are the same for all lesions: those that are symptomatic, those that cause mass effect, or those that abut a pial surface. Patients often have relapsing and remitting courses of symptoms, with each hemorrhage causing a progressive and stepwise decline. Many patients experience new postoperative deficits, most of which are transient and resolve fully. Despite the risks associated with operating in this highly eloquent tissue, most patients have had favorable outcomes in the authors' experience. Surgical treatment of brainstem CMs protects patients from the potentially devastating effects of rehemorrhage, and the authors believe that the benefits of intervention outweigh the risks in patients with the appropriate indications.


2018 ◽  
Vol 16 (2) ◽  
pp. E51-E51
Author(s):  
Giorgio Palandri ◽  
Thomas Sorenson ◽  
Mino Zucchelli ◽  
Nicola Acciarri ◽  
Paolo Mantovani ◽  
...  

Abstract Cavernous malformations of the third ventricle are uncommon vascular lesions. Evidence suggests that cavernous malformations in this location might have a more aggressive natural history due to their risk of intraventricular hemorrhage and hydrocephalus.1 The gold standard of treatment is considered to be microsurgical gross total resection of the lesion. However, with progressive improvement in endoscopic capabilities, several authors have recently advocated for the role of minimally-invasive neuroendoscopy for resecting intraventricular cavernous malformations.2-4 In this timely intraoperative video, we demonstrate the gross total resection of a third ventricle cavernous malformation that presented with hemorrhage via a right-sided trans-frontal neuroendoscopic approach.


2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Norberto Daniel Velasco Hernandez ◽  
Héctor Rául Horiuchi ◽  
Lucas Abal ◽  
Matías Sabatini ◽  
Agustina Redondo ◽  
...  

Abstract   Esophageal leiomyoma is the most common benign tumor of the esophagus. Although enucleation via thoracotomy has been considered standard treatment, minimally invasive surgery is increasingly used for the treatment of this disease. The authors report the clinical outcomes of three procedures for enucleation. Methods From November 2011 to December 2020, 3 females (52, 58, and 67 years old) patients were treated for leiomyoma of the middle third of the esophagus. A history of dysphagia and chest pain was present. Upper gastrointestinal endoscopic, computerized tomography, and endoscopic ultrasound were performed, in only one case barium swallow was used. Results The surgical approaches included right thoracoscopy in prone position, enucleation, and small thoracotomy for removing the specimen. There were no major morbidities, including deaths. One patient presented a leak, which was resolved with an endoscopic stent. Conclusion Minimally invasive enucleation of esophageal leiomyoma can be performed effectively and safely. Right thoracoscopic in prone position for the removal of esophageal leiomyomas may be recommended as the treatment of choice in centers experienced with esophageal surgery.


2020 ◽  
Vol 81 (04) ◽  
pp. 357-368
Author(s):  
N. Goncalves ◽  
D.E. Lubbe

AbstractSphenoid wing meningiomas are benign tumors that can result in proptosis, visual impairment, and pain. Traditional open surgical approaches are associated with significant morbidity. Transorbital endoscopic surgery has been developed as a minimally invasive approach to gain access to these tumors and address the main presenting symptoms. Case series reporting transorbital endoscopic resection of sphenoid wing meningiomas using combined endonasal, pre-caruncular, and extended superior eyelid approaches have demonstrated stable and/or improved short- and medium-term visual outcomes. Earlier medial optic nerve decompression appears to result in more favorable long-term visual outcomes. Transorbital endoscopic surgery therefore represents an emerging minimally invasive alternative to deal with these challenging lesions.


2020 ◽  
Vol 33 (03) ◽  
pp. 113-127
Author(s):  
Heather Carmichael ◽  
Patricia Sylla

AbstractMinimally invasive techniques continue to transform the field of colorectal surgery. Because traditional surgical approaches for rectal cancer are associated with significant mortality and morbidity, developing less invasive approaches to this disease is paramount. Natural orifice transluminal endoscopic surgery (NOTES), commonly known as “no incision surgery,” represents the ultimate minimally invasive approach to disease. Although transgastric and transvaginal approaches for NOTES surgery were the initially explored, a transrectal approach for colorectal disease is intuitive given that it makes use of the resected organ for transluminal access. Furthermore, the transanal approach allows for improved, precise visualization of the presacral mesorectal plane compared with an abdominal viewpoint, particularly in the narrow, male pelvis. Finally, experience with existing transanal platforms that have been used for decades for local excision of rectal disease made the development of a transanal approach to total mesorectal excision (TME) feasible. Here, we will review the evolution of minimally invasive and transanal surgical techniques that allowed for the development of transanal TME and its introduction into clinical practice.


Children ◽  
2020 ◽  
Vol 7 (8) ◽  
pp. 94
Author(s):  
Jonathon H. Nelson ◽  
Samantha L. Brackett ◽  
Chima O. Oluigbo ◽  
Srijaya K. Reddy

Robotic assisted neurosurgery has become increasingly utilized for its high degree of precision and minimally invasive approach. Robotic stereotactic assistance (ROSA®) for neurosurgery has been infrequently reported in the pediatric population. The goal of this case series was to describe the clinical experience, anesthetic and operative management, and treatment outcomes for pediatric patients with intractable epilepsy undergoing ROSA® neurosurgery at a single-center institution. Patients who underwent implantation of stereoelectroencephalography (SEEG) leads for intractable epilepsy with ROSA® were retrospectively evaluated between August 2016 and June 2018. Demographics, perioperative management details, complications, and preliminary seizure outcomes after resective or ablative surgery were reviewed. Nineteen children who underwent 23 ROSA® procedures for SEEG implantation were included in the study. Mean operative time was 148 min. Eleven patients had subsequent resective or ablative surgery, and ROSA® was used to assist with laser probe insertion in five patients for seizure foci ablation. In total, 148 SEEG electrodes were placed without any perioperative complications. ROSA® is minimally invasive, provides superior accuracy for electrode placement, and requires less time than traditional surgical approaches for brain mapping. This emerging technology may improve the perioperative outcomes for pediatric patients with intractable epilepsy since large craniotomies are avoided; however, long-term follow-up studies are needed.


2016 ◽  
Vol 125 (6) ◽  
pp. 1360-1366 ◽  
Author(s):  
Robert A. Scranton ◽  
Steve H. Fung ◽  
Gavin W. Britz

Cavernomas comprise 8%–15% of intracranial vascular lesions, usually supratentorial in location and superficial. Cavernomas in the thalamus or subcortical white matter represent a unique challenge for surgeons in trying to identify and then use a safe corridor to access and resect the pathology. Previous authors have described specific open microsurgical corridors based on pathology location, often with technical difficulty and morbidity. This series presents 2 cavernomas that were resected using a minimally invasive approach that is less technically demanding and has a good safety profile. The authors report 2 cases of cavernoma: one in the thalamus and brainstem with multiple hemorrhages and the other in eloquent subcortical white matter. These lesions were resected through a transulcal parafascicular approach with a port-based minimally invasive technique. In this series there was complete resection with no neurological complications. The transulcal parafascicular minimally invasive approach relies on image interpretation and trajectory planning, intraoperative navigation, cortical cannulation and subcortical space access, high-quality optics, and resection as key elements to minimize exposure and retraction and maximize tissue preservation. The authors applied this technique to 2 patients with cavernomas in eloquent locations with excellent outcomes.


2020 ◽  
Author(s):  
Benjamin Hartley ◽  
Corinne Birnbaum ◽  
Caitlin E Hoffman

Abstract Background: Cavernous malformations are rare cerebral pseudo-vascular lesions with annualized bleeding rates of 0.5 – 3% in most studies. Of the various explored risk factors for bleeding to date, only prior hemorrhage has shown significant correlation. Case Presentation: In this case, we describe a 65-year old man with a peri-ventricular atrial cavernous malformation that hemorrhaged after CSF diversion via ventriculoperitoneal shunting. Serial imaging showed that bleeding continued until the shunt was revised with a programmable valve set at maximum resistance with the addition of a gravitational unit, thereby lowering the trans-mural pressure differential across the cavernous malformation. Conclusions: Given that other vascular lesions are subject to hemorrhage from alterations in trans-mural pressure dynamics, we hypothesize that cavernous malformations are similarly affected by trans-mural pressure gradients as they are composed of primitive vascular elements. This hypothesis is corroborated by the temporal correlation of interventions, imaging, and exam findings in the present case, and suggests a potentially important risk factor for hemorrhage in CM patients that affects prognostication and management.


2017 ◽  
Vol 45 ◽  
pp. 4
Author(s):  
Pedro Paulo Maia Teixeira ◽  
Felipe Pereira Farias da Câmara Barros ◽  
Luisa Pucci Bueno Borges ◽  
Aline Eyko Kawanami ◽  
Marco Augusto Machado Silva ◽  
...  

Background: Foreign bodies are most commonly diagnosed in stomach (proventriculus and gizzard) of galliformes birds and waterfowl. Endoscopyis routinely used to assess birds’ respiratory, gastrointestinal and urogenital tracts. Endosurgeryis also used for sex determination and intra-coelomaticorgan biopsy. Benefits of endoscopic approaches are widely reported in birds. Conventional surgical approaches are far more invasive and risky for those patients. Thus, the purpose of this study was to describe a successful case of gizzard foreign body removal in a greylag goose (Anseranser), using a rigid endoscopic approach through a minimally invasive percutaneous access. Case: A 2-year-old female greylag goose, weighting 3,116 g, was referred to a Veterinary Teaching Hospital presenting apathy and anorexia for at least 24 h. The results on hematologic assessment were within normal range for the species. Radiographic examination indicated presence of radiopaque content, resembling gizzard sediment. Thus, the patient undergone to endoscopy for examination and aspiration of the content. The goose was fasted for 6 h. Anesthesia was induced by face mask and maintained by endotracheal tube, using isoflurane vaporized in 100% oxygen. The patient was positionedin the lateral recumbence. The patient’s neck was longer than the working length of the rigid endoscope. Thus, the telescope was inserted into the esophagus following a small distal esophagotomy, carried out on the caudal third of the neck. A 0º 10-mm operative rigid telescope, with a 6-mm working channel, and a 5-mm diameter and 42-cm in length laparoscopic Babcock forceps were used. The endoscope was inserted through the esophagotomy up to the ventricle level. Sand sediments and stones were viewed. The stones were grasped and retrieved, and the sediments were rinsed with normal saline solution and aspirated with a suction cannula through the working channel of the telescope. Inspection following sediment and foreign body retrieval revealed moderate inflammation of the gizzard mucosa. Total procedure time was 24 min. The patient recovered uneventfully and was discharged following 72 h. Discussion: Rigid endoscopy provided accurate visualization of the thoracic esophagus, proventriculus and gizzard. In general, endosurgery is usually employed for sex determination in birds. It is also useful to access digestive tract using rigid endoscopy, in order to remove foreign body. Such minimally approach reduces postoperative morbidity, which is usually seen following conventional surgical approaches. This technique has been used for removal of foreign body in the digestive tract of several species. Foreign bodies found within crop should require ingluviotomy. However, could be easily removed by endoscopy. If the foreign body is within the proventriculus or gizzard, rigid endoscopy may be useful, as celiotomy could cause morbidity. The small esophagotomy access at the base of the neck was essential for the procedure. In short-necked birds, a 30º Trendelenburg positioning provides more caudal access to the digestive tract. In this case, such positioning was unnecessary. In conclusion, the use of an operative telescope provided accurate retrieval of foreign bodies and drainage of sediments within the digestive tract. Moreover, it can be used as a minimally invasive approach to foreign bodies in the esophagus, crop or stomach (esophagus and gizzard) of geese.


Author(s):  
V. Ya. Lishchishin ◽  
A. G. Barishev ◽  
A. N. Petrovsky ◽  
A. N. Lishchenko ◽  
A. Y. Popov ◽  
...  

Aim. To evaluate the reproducibility and safety of the developed pancreatogastric anastomosis with various surgical approaches during pancreatoduodenectomy.Materials and methods. The experience of surgical treatment of 47 patients with malignant tumours of the periampullary zone, who underwent pancreatoduodenectomy, was considered. The proposed variant of anastomose was performed to 14 (29.8%) patients: in 7 cases with a minimally invasive approach to perform pancreatoduodenectomy; and in 7 cases with an open approach. To compare retrospectively 33 (70.2%) patients who underwent pancreatogastric anastomosis according to the Bassi technique: 9 – with minimally invasive surgery, 24 – with open surgery. The frequency of pancreatic fistulas, the number of repeated interferences, and hospital mortality were taken into account.Results. A significant advantage of the new method of forming an anastomosis in the duration of the operation was noted in comparison with the Bassi technique. There were no statistically significant differences in blood loss while various types of anastomoses (p > 0.05). When using the proposed technique, the formation of pancreatic fistulas was not revealed. The development of pancreatic fistula was observed in 4 (16.7%) patients after open surgery and in 7 (77.8%) patients after minimally invasive Bassi anastomose formation. Reoperations were performed after open surgery in 3 (12.5%) cases and in 4 (44.4%) cases of minimally invasive surgery according to the Bassi technique. There were 2 (22.2%) deaths in the minimally invasive group.Conclusion. The proposed pancreatogastric anastomosis is applicable in clinical practice. This method allows to create relatively fast and less challenging anastomosis, including with a minimally invasive approach. The use of this technique makes it possible to reduce mortality and postoperative complications in patients with a “complex” pancreas.


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