Clip retraction of the tentorium: application of a novel technique for tentorial retraction during supracerebellar transtentorial approaches

Supracerebellar transtentorial (SCTT) approaches have become a popular option for treatment of a variety of pathologies in the medial and basal temporal and occipital lobes and thalamus. Transtentorial approaches provide numerous advantages over transcortical approaches, including obviating the need to traverse eloquent cortex, not requiring parenchymal retraction, and circumventing critical vascular structures. All of these approaches require a tentorial opening, and numerous techniques for retraction of the incised tentorium have been described, including sutures, fixed retractors, and electrocautery. However, all of these techniques have considerable drawbacks and limitations. The authors describe a novel application of clip retraction of the tentorium to the supracerebellar approaches in which an aneurysm clip is used to suspend the tentorial flap, and an illustrative case is provided. Clip retraction of the tentorium is an efficient, straightforward adaptation of an established technique, typically used for subtemporal approaches, that improves visualization and surgical ergonomics with little risk to nearby venous structures. The authors find this technique particularly useful for the contralateral SCTT approaches.

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A novel technique for olfactory bulb measurements

PLoS ONE ◽

10.1371/journal.pone.0243941 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0243941

Author(s):

Akshita Joshi ◽

Divesh Thaploo ◽

Xiaoguang Yan ◽

Theresa Herrmann ◽

Hudaa Alrahman Khabour ◽

...

Keyword(s):

Olfactory Bulb ◽

Manual Segmentation ◽

Cronbach’S Alpha ◽

Volume Calculation ◽

Cronbach's Alpha ◽

Novel Technique ◽

Observer Reliability ◽

Frame Method ◽

Established Technique

Background To introduce new ways to calculate OB volumes, checking their validity and comparing them to already established technique i.e. OB volumetric based on manual segmentation of OB boundaries. Methods Two approaches were used to calculate OB volumes (1) Manual Segmentation using planimetric manual contouring; (2) Box-frame method, calculating the parameters based on a box placed around the OB. Results We calculated OB volumes using both techniques and found comparable outcomes. High inter-observer reliability was found for volumes calculated by both observers. For manual segmentation, Cronbach’s alpha (α) was 0.91 and 0.93 for right and left OB volume, respectively, whereas for the box-frame method α was 0.94 and 0.90 for right and left OB, respectively. Conclusions The simple box-frame method of OB volume calculation appears reliable. Its results are comparable to an established technique.

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Contralateral insular epileptogenic hub causing seizure relapse after opercular focal cortical dysplasia surgery and response to radiofrequency thermocoagulation: illustrative case

Journal of Neurosurgery: Case Lessons ◽

10.3171/case21251 ◽

2021 ◽

Vol 2 (5) ◽

Author(s):

Pushkaran Jayapaul ◽

Shameer Aslam ◽

Bindhu Mangalath Rajamma ◽

Siby Gopinath ◽

Ashok Pillai

Keyword(s):

Focal Cortical Dysplasia ◽

Positron Emission Tomography Imaging ◽

Cortical Dysplasia ◽

Illustrative Case ◽

Epileptogenic Zone ◽

Pharmacoresistant Epilepsy ◽

Novel Technique ◽

Positron Emission ◽

Seizure Relapse ◽

The Right

BACKGROUND The reevaluation and management of seizure relapse following resective surgery in magnetic resonance imaging (MRI)-negative pharmacoresistant epilepsy remains a significant challenge. OBSERVATIONS A 25-year-old right-handed male with medically refractory epilepsy presented with nonlocalizing electroencephalography (EEG) and MRI. Stereo-EEG (SEEG) implantation based on semiology and positron emission tomography imaging revealed a left frontal opercular focus with rapid bilateral insular ictal synchrony. The initial epileptogenic zone was resected and pathologically proven to be type 2A focal cortical dysplasia (FCD). Seizure relapse after 9 months was eventually reinvestigated, and repeat SEEG revealed a secondary epileptogenic focus in the contralateral insula. A novel technique of volumetric stereotactic radiofrequency ablation (vRFA) was utilized for the right insular focus, following which, the patient remains seizure-free for 20 months. He suffered a transient bilateral opercular syndrome following the second intervention that eventually resolved. LESSONS The authors present clinical evidence to suggest epileptogenic nodes distant from the primary focus as a mechanism for seizure relapse following FCD surgery and the importance of bilateral insular SEEG coverage. The authors also describe a novel technique of minimally invasive vRFA that allows ablation of a larger volume of cerebral cortex when compared to conventional bedside SEEG electrode thermocoagulation.

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A Novel Technique for Attaining Maxillomandibular Fixation in the Edentulous Mandible Fracture

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0031-1300962 ◽

2012 ◽

Vol 5 (1) ◽

pp. 7-10 ◽

Cited By ~ 4

Author(s):

Christopher Knotts ◽

Meredith Workman ◽

Kamal Sawan ◽

Christian El Amm

Keyword(s):

Oral Cavity ◽

External Fixation ◽

Oral Hygiene ◽

Illustrative Case ◽

Maxillomandibular Fixation ◽

Novel Technique ◽

Mandible Fracture ◽

Edentulous Mandible ◽

Gunning Splint ◽

Mandible Fractures

Edentulous mandible fractures present a unique and challenging surgical problem, particularly because of lack of occlusive dental surfaces to capitalize upon maxillomandibular fixation (MMF). We present a novel technique to achieve MMF using rigid plates spanning the oral cavity to fixate the maxilla to the mandible. The process is rapid and allows stability using the established principles of rigidity, external fixation, and osteosynthesis. This technique allows for a faster MMF than with a Gunning splint and allows for easier oral hygiene. An illustrative case and pre- and postoperative imaging are provided.

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Redo surgery with longitudinal resection for dilated bowel in Hirschsprung disease: an illustrative case series

International Journal of Colorectal Disease ◽

10.1007/s00384-019-03399-8 ◽

2019 ◽

Vol 34 (11) ◽

pp. 1983-1987 ◽

Cited By ~ 1

Author(s):

Daniëlle Roorda ◽

Tessa J. Surridge ◽

Ruben G. J. Visschers ◽

Joep P. M. Derikx ◽

L. W. Ernest van Heurn

Keyword(s):

Case Series ◽

Hirschsprung Disease ◽

Bowel Function ◽

Uneventful Recovery ◽

Illustrative Case ◽

Redo Surgery ◽

Short Term ◽

Novel Technique ◽

Primary Surgery ◽

Distended Bowel

Abstract Purpose Patients with Hirschsprung disease (HD) can have persistent obstructive symptoms after resection of the aganglionic segment. If obstructive symptoms are treated inadequately, this may lead to recurrent faecal stasis and impaction, and may result in severe distension of the bowel. A permanently distended bowel which not responds to conservative treatment may be an indication for redo surgery. The aim of this study is to describe our experiences and the short-term results of a novel technique: longitudinal antimesenteric resection with a longitudinal anastomosis. Methods We reviewed the medical records of our three patients who underwent longitudinal resection of severe distended bowel. This technique aims to improve defecation by improving faecal passage and is characterized by resection of the antimesenteric side of the distended intestinal segment, followed by plication with a longitudinal anastomosis. In this paper, this novel technique is described in detail, as well as short-term outcomes. Results All patients had an uneventful recovery after longitudinal antimesenteric resection. During follow-up, the functional outcomes were excellent, with a large improvement of bowel function. All patients were continent for faeces, and treated with low-dose laxatives or occasional preventive irrigation in one patient. There were no more complaints of persistent constipation or soiling. Conclusion Longitudinal resection is a surgical redo-procedure offering large benefits for patients with Hirschsprung disease with distended bowel after primary surgery.

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Awake craniotomy for glioblastoma in COVID-19–positive patients and delivering the standard of care: illustrative case

Journal of Neurosurgery: Case Lessons ◽

10.3171/case21246 ◽

2021 ◽

Vol 2 (1) ◽

Author(s):

Reinier Alvarez ◽

Rupesh Kotecha ◽

Michael W. McDermott ◽

Vitaly Siomin

Keyword(s):

Standard Of Care ◽

Awake Craniotomy ◽

Illustrative Case ◽

Speech Mapping ◽

Viral Particles ◽

Positive Treatment ◽

Frontal Operculum ◽

Eloquent Cortex ◽

Poor Outcomes ◽

Novel Coronavirus

BACKGROUND Providing the standard of care to patients with glioblastoma (GBM) during the novel coronavirus of 2019 (COVID-19) pandemic is a challenge, particularly if a patient tests positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Further difficulties occur in eloquent cortex tumors because awake speech mapping can theoretically aerosolize viral particles and expose staff. Moreover, microscopic neurosurgery has become difficult because the use of airborne-level personal protective equipment (PPE) crowds the space between the surgeon and the eyepiece. However, delivering substandard care will inevitably lead to disease progression and poor outcomes. OBSERVATIONS A 60-year-old man with a left insular and frontal operculum GBM was found to be COVID-19 positive. Treatment was postponed pending a negative SARS-CoV-2 result, but in the interim, he developed intratumoral hemorrhage with progressive expressive aphasia. Because the tumor was causing dominant hemisphere language symptomatology, an awake craniotomy was the recommended surgical approach. With the use of airborne-level PPE and a surgical drape to protect the surgeon from the direction of potential aerosolization, near-total gross resection was achieved. LESSONS Delaying the treatment of patients with GBM who test positive for COVID-19 will lead to further neurological deterioration. Optimal and timely treatment such as awake speech mapping for COVID-19–positive patients with GBM can be provided safely.

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Anterior interhemispheric transsplenial approach to pineal region tumors: anatomical study and illustrative case

Journal of Neurosurgery ◽

10.3171/2016.9.jns16279 ◽

2018 ◽

Vol 128 (1) ◽

pp. 182-192 ◽

Cited By ~ 6

Author(s):

Kaan Yağmurlu ◽

Hasan A. Zaidi ◽

M. Yashar S. Kalani ◽

Albert L. Rhoton ◽

Mark C. Preul ◽

...

Keyword(s):

Corpus Callosum ◽

Anatomical Study ◽

Pineal Region ◽

Venous System ◽

Illustrative Case ◽

Cerebral Veins ◽

Pineal Region Tumors ◽

Deep Venous System ◽

Surgical Corridor ◽

Occipital Lobes

Pineal region tumors are challenging to access because they are centrally located within the calvaria and surrounded by critical neurovascular structures. The goal of this work is to describe a new surgical trajectory, the anterior interhemispheric transsplenial approach, to the pineal region and falcotentorial junction area. To demonstrate this approach, the authors examined 7 adult formalin-fixed silicone-injected cadaveric heads and 2 fresh human brain specimens. One representative case of falcotentorial meningioma treated through an anterior interhemispheric transsplenial approach is also described. Among the interhemispheric approaches to the pineal region, the anterior interhemispheric transsplenial approach has several advantages. 1) There are few or no bridging veins at the level of the pericoronal suture. 2) The parietal and occipital lobes are not retracted, which reduces the chances of approach-related morbidity, especially in the dominant hemisphere. 3) The risk of damage to the deep venous structures is low because the tumor surface reached first is relatively vein free. 4) The internal cerebral veins can be manipulated and dissected away laterally through the anterior interhemispheric route but not via the posterior interhemispheric route. 5) Early control of medial posterior choroidal arteries is obtained. The anterior interhemispheric transsplenial approach provides a safe and effective surgical corridor for patients with supratentorial pineal region tumors that 1) extend superiorly, involve the splenium of the corpus callosum, and push the deep venous system in a posterosuperior or an anteroinferior direction; 2) are tentorial and displace the deep venous system inferiorly; or 3) originate from the splenium of the corpus callosum.

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Management of intractable chronic cough during awake craniotomy: illustrative case

Journal of Neurosurgery: Case Lessons ◽

10.3171/case21480 ◽

2021 ◽

Vol 2 (25) ◽

Keyword(s):

Clinical Condition ◽

Chronic Cough ◽

Treatment Approach ◽

Positive Outcome ◽

Awake Craniotomy ◽

Illustrative Case ◽

Anaplastic Ependymoma ◽

Speech Language Pathologist ◽

Appropriate Treatment ◽

Eloquent Cortex

BACKGROUND Chronic cough is a common but challenging clinical condition that can adversely affect the safety of awake surgical endeavors such as awake craniotomy (AC). This case lesson highlighted a patient with severe refractory chronic cough undergoing AC for resection of a recurrent left frontal, insula, anterior temporal anaplastic ependymoma of the eloquent cortex. OBSERVATIONS The patient was successfully managed using a multifaceted medical treatment regimen combined with preoperative and intraoperative cough suppression therapy with a speech-language pathologist. The patient coughed only once intraoperatively and had a positive outcome. LESSONS Chronic cough is often multifactorial and requires a multifaceted treatment approach. Despite this challenge, select patients can successfully be navigated through AC with appropriate treatment for their condition. A review of neurogenic cough and modern treatments, which were used in this patient and would be helpful to neurologists or neurosurgeons, are also discussed.

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Correlation averaging of two-dimensional crystals: basic strategy and refinements

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100142323 ◽

1986 ◽

Vol 44 ◽

pp. 136-139

Author(s):

W. Baumeister ◽

R. Rachel ◽

R. Guckenberger ◽

R. Hegerl

Keyword(s):

Low Dose ◽

Signal To Noise Ratio ◽

Real Space ◽

Fourier Domain ◽

Two Dimensional ◽

Signal To Noise ◽

Unit Cells ◽

Lateral Displacements ◽

Established Technique ◽

Crystalline Array

IntroductionCorrelation averaging (CAV) is meanwhile an established technique in image processing of two-dimensional crystals /1,2/. The basic idea is to detect the real positions of unit cells in a crystalline array by means of correlation functions and to average them by real space superposition of the aligned motifs. The signal-to-noise ratio improves in proportion to the number of motifs included in the average. Unlike filtering in the Fourier domain, CAV corrects for lateral displacements of the unit cells; thus it avoids the loss of resolution entailed by these distortions in the conventional approach. Here we report on some variants of the method, aimed at retrieving a maximum of information from images with very low signal-to-noise ratios (low dose microscopy of unstained or lightly stained specimens) while keeping the procedure economical.

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