scholarly journals Pediatric functional hemispherectomy: operative techniques and complication avoidance

2020 ◽  
Vol 48 (4) ◽  
pp. E9 ◽  
Author(s):  
Christopher C. Young ◽  
John R. Williams ◽  
Abdullah H. Feroze ◽  
Margaret McGrath ◽  
Ali C. Ravanpay ◽  
...  
Keyword(s):  
Surgical Techniques ◽  
Internal Capsule ◽  
Surgical Approaches ◽  
Seizure Freedom ◽  
Operative Techniques ◽  
Surgical Morbidity ◽  
Anatomical Structures ◽  
Functional Hemispherectomy ◽  
Temporal Structures ◽  
History Of

Functional hemispherectomy/hemispherotomy is a disconnection procedure for severe medically refractory epilepsy where the seizure foci diffusely localize to one hemisphere. It is an improvement on anatomical hemispherectomy and was first performed by Rasmussen in 1974. Less invasive surgical approaches and refinements have been made to improve seizure freedom and minimize surgical morbidity and complications. Key anatomical structures that are disconnected include the 1) internal capsule and corona radiata, 2) mesial temporal structures, 3) insula, 4) corpus callosum, 5) parietooccipital connection, and 6) frontobasal connection. A stepwise approach is indicated to ensure adequate disconnection and prevent seizure persistence or recurrence. In young pediatric patients, careful patient selection and modern surgical techniques have resulted in > 80% seizure freedom and very good functional outcome. In this report, the authors summarize the history of hemispherectomy and its development and present a graphical guide for this anatomically challenging procedure. The use of the osteoplastic flap to improve outcome and the management of hydrocephalus are discussed.

scholarly journals Hemispherectomy: historical review and recent technical advances

2013 ◽  
Vol 34 (6) ◽  
pp. E11 ◽  
Author(s):  
Alexandra D. Beier ◽  
James T. Rutka
Keyword(s):  
Surgical Techniques ◽  
Historical Review ◽  
Seizure Freedom ◽  
The Novel ◽  
Surgical Strategies ◽  
Noninvasive Diagnostics ◽  
Technical Advances ◽  
History Of ◽  
Surgical Options ◽  
Initial Description

The surgical options available for intractable hemispheric epilepsy have evolved since their initial description in the early 20th century. Surgical techniques have advanced, as has the ability to predict good surgical outcomes with noninvasive diagnostics. The authors review the history of hemispherectomy and detail the novel imaging and surgical strategies used to confer seizure freedom.

Surgical approaches to posterior fossa tumours

2019 ◽  
pp. 375-382
Author(s):  
Jacques J. Morcos ◽  
Osaama Khan ◽  
Ashish H. Shah
Keyword(s):  
Posterior Fossa ◽  
Fourth Ventricle ◽  
Cranial Nerves ◽  
Surgical Techniques ◽  
Foramen Magnum ◽  
Surgical Approaches ◽  
Tumour Resection ◽  
Surgical Morbidity ◽  
Preoperative Workup ◽  
Lower Cranial Nerves

Lesions of the fourth ventricle and foramen magnum can be difficult to manage surgically due to their proximity to critical brainstem structures. Understanding the anatomy of the fourth ventricle, lower cranial nerves, and basilar cisterns remains paramount for deciding surgical approaches to this location. Detailed preoperative workup and planning are necessary to minimize surgical morbidity and maximize tumour resection. This chapter provides an overview of the relevant anatomy and surgical techniques for lesions in the posterior fossa, specifically the fourth ventricle the foramen magnum. We will split this chapter into two main sections: microsurgical approaches to the fourth ventricle and skull base approaches to the foramen magnum.

THE HISTORY OF SPINAL DEFORMITY

Neurosurgery ◽  
2008 ◽  
Vol 63 (suppl_3) ◽  
pp. A5-A15 ◽  
Author(s):  
Robert F. Heary ◽  
Karthik Madhavan
Keyword(s):  
Spinal Deformity ◽  
Thoracolumbar Spine ◽  
Surgical Techniques ◽  
Pedicle Screws ◽  
First Record ◽  
Surgical Approaches ◽  
Spinal Deformities ◽  
X Rays ◽  
Rod System ◽  
History Of

ABSTRACT SPINAL DEFORMITY IS the oldest disease known to humankind. The first record of correction of spinal deformity was documented in an Indian religious mythological book written between 3500 BC and 1800 BC. Initially, all spinal deformities were treated with the use of braces, traction, or casts. Hippocrates was the first physician to treat spinal deformities by using axial traction combined with direct pressure. Galen specifically described the anatomy of the spine and spinal nerves. The treatment of spinal deformity was greatly improved by the development of radiographic imaging by Roentgen. After x-rays became available, spinal fusions began to be used to treat scoliotic curves. Hibbs described the first spinal fusion to stabilize a deformed tuberculous spine. Soon enough, other investigators began to report on a variety of surgical techniques used to treat spinal deformity. Surgical approaches from both the posterior and anterior directions were developed and modified in an attempt to achieve durable curve corrections. Harrington's distraction rod system was a major innovation in providing a method to improve coronal plane deformity. Luque introduced segmental instrumentation, which opened up the era of modern surgical techniques for spinal deformity. This concept allowed surgeons to begin to achieve three-dimensional corrections by respecting both the sagittal and coronal curves simultaneously. The introduction of pedicle screws, throughout the thoracolumbar spine, has increased the ability of surgeons to achieve greater degrees of curve correction than had previously been possible. The history of spinal deformity is still maturing as newer procedures continue to be performed on a daily basis.

scholarly journals History of endoscopic and keyhole spinal surgery

2020 ◽  
Vol 1 ◽  
pp. 141-145
Author(s):  
Hamzah A. Soleiman ◽  
Colin Nnadi ◽  
Bednash R. R. Chaudhary
Keyword(s):  
Light Source ◽  
Spinal Surgery ◽  
Surgical Techniques ◽  
Surgical Approaches ◽  
Minimal Access ◽  
Surgical Morbidity ◽  
Perioperative Morbidity ◽  
Surgical Technology ◽  
Surgical Field ◽  
Tissue Trauma

Development of endoscopic and keyhole surgery is often considered among the greatest scientific advancements in medicine alongside other scientific breakthroughs such as the discovery of antibiotics and the deciphering of DNA structure. The earliest concept of laparoscopy or endoscopy dates back to the use of instruments to visualize various body orifices as recorded in the notes of Hippocrates dating between 460 and 375 B.C. Adequate exposure of the surgical field which is key to safe surgical procedures required large incisions to identify the anatomical structures in the traditional open surgical approaches, and in an attempt to reduce the iatrogenic tissue trauma, smaller corridors were developed to utilize the technological advancements in magnification and illumination, and more recently navigation. As expected, perioperative morbidity is directly proportional to the extent of tissue trauma and surgical dissection, and the shift toward minimizing tissue dissection and prolonged retraction has been generally associated with earlier mobilization, reduced bleeding, and generally reduced morbidity in comparison to traditional open techniques. The advances in surgical technology, particularly in the light source and smaller cameras allowed the use of smaller incisions and adoption of minimal access surgery in the various surgical disciplines, laparoscopic cholecystectomy evolved as a cultural changing procedure and highlighted the focus on minimizing the surgical morbidity experienced by the patient. In spinal surgery, the evolution of surgical loupes, operating microscope, fiber optic light source, and minimal access surgical tools and retractors, allowed for improved surgical field visualization, resulting in smaller incisions and approaches. The initial adoption started with Lumbar discectomy and spinal stenosis decompression and evolved in other aspects of percutaneous fixation and minimal access fusion techniques applicable to trauma, degenerative disease, and tumors. This brief outline of the development of endoscopic and microscopic keyhole techniques in spinal surgery attempts to touch upon the major developments that paved the way for the large plethora of keyhole spinal surgical techniques currently available from the authors’ perspective.

Management of Complex Distal Radius Fractures: Review of Treatment Principles and Select Surgical Techniques

2016 ◽  
Vol 21 (02) ◽  
pp. 140-154 ◽  
Author(s):  
Peter Charles Rhee ◽  
Alexander Y. Shin
Keyword(s):  
Soft Tissue ◽  
Distal Radius ◽  
Surgical Techniques ◽  
High Energy ◽  
Low Energy ◽  
Distal Radius Fractures ◽  
Surgical Approaches ◽  
Vascular Injuries ◽  
Operative Techniques ◽  
Radius Fractures

Most distal radius fractures are the result of low-energy mechanisms that can be successfully treated either non-operatively or with a variety of operative techniques if indicated. Complex distal radius fractures occur most commonly in high-energy injuries with extensive comminution or bone loss and associated soft tissue or vascular injuries. These high-energy fractures can present many challenges in reconstructing the distal radius. Effective restoration of the bony architecture requires a thorough knowledge of distal radius anatomy, understanding of the goals of treatment, versatility in surgical approaches, and familiarity with multiple fixation options.

scholarly journals Insular glioma surgery: an evolution of thought and practice

2019 ◽  
Vol 130 (1) ◽  
pp. 9-16 ◽  
Author(s):  
Shawn L. Hervey-Jumper ◽  
Mitchel S. Berger
Keyword(s):  
Internal Capsule ◽  
World Health ◽  
Surgical Approaches ◽  
High Grade ◽  
Glioma Surgery ◽  
Lenticulostriate Arteries ◽  
History Of ◽  
High Grade Gliomas ◽  
Cortical Regions ◽  
Health Organization

OBJECTIVEThe goal of this article is to review the history of surgery for low- and high-grade gliomas located within the insula with particular focus on microsurgical technique, anatomical considerations, survival, and postoperative morbidity.METHODSThe authors reviewed the literature for published reports focused on insular region anatomy, neurophysiology, surgical approaches, and outcomes for adults with World Health Organization grade II–IV gliomas.RESULTSWhile originally considered to pose too great a risk, insular glioma surgery can be performed safely due to the collective efforts of many individuals. Similar to resection of gliomas located within other cortical regions, maximal resection of gliomas within the insula offers patients greater survival time and superior seizure control for both newly diagnosed and recurrent tumors in this region. The identification and the preservation of M2 perforating and lateral lenticulostriate arteries are critical steps to preventing internal capsule stroke and hemiparesis. The transcortical approach and intraoperative mapping are useful tools to maximize safety.CONCLUSIONSThe insula’s proximity to middle cerebral and lenticulostriate arteries, primary motor areas, and perisylvian language areas makes accessing and resecting gliomas in this region challenging. Maximal safe resection of insular gliomas not only is possible but also is associated with excellent outcomes and should be considered for all patients with low- and high-grade gliomas in this area.

scholarly journals Resection of a large left opercular cavernoma in a child using neuronavigation

2021 ◽  
Vol 3 (2(May-August)) ◽  
pp. e832020
Author(s):  
Ricardo Santos De Oliveira ◽  
Vinícius Marques Carneiro ◽  
Kaliny Batista De Oliveira ◽  
Érica Sany Brito Oliveira Costa ◽  
Matheus Fernando Manzolli Ballestero
Keyword(s):  
Complex Structure ◽  
Internal Capsule ◽  
Cavernous Angioma ◽  
Surgical Morbidity ◽  
Long Time ◽  
Neuronavigation System ◽  
History Of ◽  
Language Pathways ◽  
Functional Interface ◽  
Dominant Side

The insular lobe is a complex structure constituting anatomic, cytoarchitectonic, and functional interface between the allocortex and the neocortex. This area is a part of a larger system that includes the orbitofrontal, temporopolar, and insular regions, constituting the paralimbic system or mesocortex. For a long time, the issue in studying this entity accounted for the poor understanding of its precise functionality. Because of the technical complexity in approaching and dissecting this region, very few neurosurgeons attempted surgery of the insula. Particularly on the dominant side, the natural history of these lesions must be carefully balanced with the surgical morbidity involved in their resection. Surgical treatment of cavernomas arising around the insula (especially in dominant cerebral hemisphere) is challenging in reason of the proximity to the internal capsule and lenticulostriate arteries. The advent of image guidance systems and intraoperative mapping of the subcortical language pathways has broadened the surgical indications for these lesions. In the case reported here we removed a cavernous angioma of the left dominant operculum in a child with the aid of a neuronavigation system guidance.  

Current Strategies in the Management of Spinal Metastatic Disease

Swiss Surgery ◽  
2003 ◽  
Vol 9 (2) ◽  
pp. 55-62 ◽  
Author(s):  
Bartanusz ◽  
Porchet
Keyword(s):  
Spinal Cord ◽  
Surgical Techniques ◽  
Cord Compression ◽  
Treatment Modalities ◽  
Surgical Approaches ◽  
Spinal Stabilization ◽  
Management Algorithm ◽  
Specific Manner ◽  
Extensive Surgery ◽  
Selection Of

The treatment of metastatic spinal cord compression is complex. The three treatment modalities that are currently applied (in a histologically non-specific manner) are surgery, radiotherapy and the administration of steroids. The development of new spinal instrumentations and surgical approaches considerably changed the extent of therapeutic options in this field. These new surgical techniques have made it possible to resect these tumours totally, with subsequent vertebral reconstruction and spinal stabilization. In this respect, it is important to clearly identify those patients who can benefit from such an extensive surgery. We present our management algorithm to help select patients for surgery and at the same time identifying those for whom primary non-surgical therapy would be indicated. The retrospective review of surgically treated patients in our department in the last four years reveals a meagre application of conventional guidelines for the selection of the appropriate operative approach in the surgical management of these patients. The reasons for this discrepancy are discussed.

Seizure freedom after functional hemispherectomy and a possible role for the insular cortex: the Dutch experience

2007 ◽  
Vol 107 (4) ◽  
pp. 275-280 ◽  
Author(s):  
Elisabeth A. Cats ◽  
Kuan H. Kho ◽  
Onno van Nieuwenhuizen ◽  
Cornelis W. M. van Veelen ◽  
Peter H. Gosselaar ◽  
...  
Keyword(s):  
Insular Cortex ◽  
Seizure Freedom ◽  
Functional Hemispherectomy ◽  
Dutch Experience

scholarly journals The concept of “Four Walls, Two Poles” in the lesions of the thalamus and ganglion regions: case report and literature review

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Haiyang Yang ◽  
Gang Bai ◽  
Yongli Zhang ◽  
Guolong Chen ◽  
Lei Duan ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Literature Review ◽  
Surgical Resection ◽  
Three Dimensional ◽  
Surgical Techniques ◽  
Surgical Approaches ◽  
Surgical Results ◽  
Case Presentation ◽  
Operation Process ◽  
Thalamic Glioma

Abstract Background There are few articles about the surgical techniques of thalamic glioma and the lesions in the basal ganglia area. According to three existing cases and the literature review (Twelve articles were summarized which mainly described the surgical techniques), we discuss the surgical characteristics of lesions of the thalamus and basal ganglia area and summarize the relevant surgical skills. Case presentation Of the three cases, two were thalamic gliomas and one was brain abscess in basal ganglia. According to the three-dimensional concept of the “Four Walls, Two Poles”, lesions of the thalamus and basal ganglia were surgically removed, and the operative effect was analysed by relevant surgical techniques. Surgical resection of the lesions of the thalamus and basal ganglia area according to the three-dimensional concept of the “Four Walls, Two Poles” has achieved good surgical results. Relevant surgical techniques, such as the use of retractors, the use of aspirators, the choice of surgical approaches, and the haemostasis strategy, also played an important role in the operation process. Conclusions In the presented three cases the three-dimensional concept of the “Four Walls, Two Poles” allowed for safe surgical resection of lesions of the thalamus and basal ganglia.

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