scholarly journals Endoscope-assisted microsurgical resection of intrinsic brainstem epidermoid: technical note and review of the literature

2020 ◽  
Vol 26 (6) ◽  
pp. 654-660
Author(s):  
Alan R. Cohen ◽  
Scellig S. D. Stone
Keyword(s):  
Management Strategies ◽  
Conservative Surgery ◽  
Early Recurrence ◽  
Technical Note ◽  
Neurophysiological Monitoring ◽  
Dramatic Improvement ◽  
Benign Lesions ◽  
Surgical Morbidity ◽  
Microsurgical Resection ◽  
Pontomedullary Junction

Intrinsic epidermoid tumors of the brainstem are rare, histologically benign lesions associated with high surgical morbidity and mortality due to their eloquent location. The authors report a child with progressive severe neurological deterioration from a large midline intrinsic brainstem epidermoid at the pontomedullary junction. The mass was removed through a posterior fossa craniotomy and midline endoscope-assisted microsurgical corridor through the floor of the fourth ventricle, using neurophysiological monitoring. Postoperatively, there was dramatic improvement in the patient’s symptoms. Early recurrence of the mass necessitated reoperation with more aggressive resection of the cyst capsule, which led to complete radiographic reconstitution of the brainstem. The patient remains well with a durable recovery 7 years after presentation. The authors review the literature on brainstem epidermoids and discuss the differential diagnosis and management strategies for approaching these lesions, advocating for conservative surgery with resection of as much of the tumor capsule as is safely possible.

Laser-assisted microsurgical resection of thoracic intramedullary spinal cord ependymoma

2012 ◽  
Vol 33 (Suppl1) ◽  
pp. 1 ◽  
Author(s):  
James K. Liu
Keyword(s):  
Spinal Cord ◽  
Progression Free Survival ◽  
Neurophysiological Monitoring ◽  
Surgical Morbidity ◽  
Intramedullary Spinal Cord ◽  
Neurological Improvement ◽  
Formidable Challenge ◽  
Microsurgical Techniques ◽  
Microsurgical Resection ◽  
Spinal Cord Ependymoma

The surgical management of intramedullary spinal cord ependymomas remains a formidable challenge amongst neurosurgeons because of the potential risk of surgical morbidity. From on an oncological perspective, complete resection—if technically feasible—should be the goal of surgery, since this can result in excellent local control and progression-free survival. Advances in microsurgical techniques, intraoperative neurophysiological monitoring, and the use of lasers have contributed to our ability to achieve gross-total resection. This is also largely dependent on the presence of an identifiable surgical plane of dissection between the tumor and spinal cord, which appears to have a positive prognosis with overall neurological improvement. In this operative video manuscript, the author demonstrates an illustrative step-by-step technique for microsurgical resection of a thoracic intramedullary spinal cord ependymoma (T-3 to T-5) associated with an extensive cervicothoracic syrinx. The application of a handheld non-contact CO2 laser for performing the midline myelotomy is also highlighted. The operative technique and surgical nuances, including the surgical approach, intradural tumor removal, and closure, are illustrated in this video atlas. The video can be found here: http://youtu.be/itE2tuBFmgw.

Microsurgical resection of foramen magnum meningioma through a transcondylar approach: three-dimensional operative video

2019 ◽  
Vol 1 (2) ◽  
pp. V3
Author(s):  
Guilherme H. W. Ceccato ◽  
Rodolfo F. M. da Rocha ◽  
Duarte N. C. Cândido ◽  
Wladimir O. Melo ◽  
Marcio S. Rassi ◽  
...  
Keyword(s):  
Nerve Palsy ◽  
Three Dimensional ◽  
Foramen Magnum ◽  
Complete Resection ◽  
Neurophysiological Monitoring ◽  
Cervical Instability ◽  
Transcondylar Approach ◽  
Postoperative Mri ◽  
Microsurgical Resection

Foramen magnum (FM) meningiomas are challenging lesions. We present the case of a 38-year-old female with neck pain, dysphonia, and slight twelfth nerve palsy. Imaging workup was highly suggestive of an FM meningioma, and microsurgical resection with the aid of intraoperative neurophysiological monitoring was indicated. A transcondylar approach was employed, the vertebral artery was mobilized, and the tumor was completely removed. Postoperative MRI demonstrated complete resection. There were no signs of cervical instability. The patient presented with improvement of her symptoms and no new neurological deficit on follow-up. FM meningiomas can be successfully resected using a transcondylar approach, since it increases the exposure of the ventral FM, allowing the surgeon to work parallel to the skull base and flush with the tumor’s attachment. Informed consent was obtained from the patient for publication of this operative video.The video can be found here: https://youtu.be/itfUOB-6zM0.

scholarly journals Surgical outcome of primary intradural spinal arachnoid cysts: a series of 10 cases

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Essam Abdelhameed ◽  
Ahmed Ali Morsy
Keyword(s):  
Tertiary Care ◽  
Outer Wall ◽  
Arachnoid Cysts ◽  
Neurophysiological Monitoring ◽  
Japanese Orthopedic Association ◽  
Common Location ◽  
Before And After ◽  
Microsurgical Resection ◽  
Tertiary Care Centers ◽  
Intradural Arachnoid Cysts

Abstract Background Primary intradural spinal arachnoid cysts are rare pathologies of uncertain etiology and variable presentation from no symptoms to myelopathy or radiculopathy according to cord or root compression. MRI with diffusion and contrast differentiates them from many pathologies. There is a lot of debate regarding when to treat and how to treat such rare pathologies. Objective We present a series of 10 primary intradural arachnoid cysts and evaluate outcome after surgery. Methods This retrospective study includes patients having primary intradural spinal arachnoid cysts operated in two tertiary care centers from October 2012 till October 2019. Symptomatic cysts were subjected to microsurgical resection or outer wall excision and inner wall marsupialization under neurophysiological monitoring. The Japanese Orthopedic Association Score was used for clinical evaluation while MRI with contrast and diffusion was used for radiological evaluation before and after surgery. Results This series included 10 patients, 4 males and 6 females, with mean age of 40 years. Pain was the most common presentation. The most common location was dorsal thoracic region. Total excision was achieved in 2 cases and marsupialization in 8 cases. All symptoms improved either completely or partially after surgery. No neurological deterioration or recurrence was reported during the follow-up period in this series. Conclusion Treatment of symptomatic primary intradural spinal arachnoid cysts should be microsurgical resection, when the cyst is adherent to the cord, microscopic fenestration can be safe and effective.

Novel Hemicraniectomy Technique for Malignant Middle Cerebral Artery Infarction: Technical Note

2019 ◽  
Vol 17 (3) ◽  
pp. 273-276 ◽  
Author(s):  
Kristopher A Lyon ◽  
Nitesh P Patel ◽  
Yilu Zhang ◽  
Jason H Huang ◽  
Dongxia Feng
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Technical Note ◽  
Surgical Morbidity ◽  
Middle Cerebral Artery Infarction ◽  
Decompressive Hemicraniectomy ◽  
Bone Window ◽  
Large Bone

Abstract BACKGROUND AND IMPORTANCE Decompressive hemicraniectomy (DH) is the mainstay of treatment for malignant middle cerebral artery infarction (MMI). Although this operation significantly reduces mortality and improves functional outcomes, the conventional technique involves a reverse question mark incision starting anterior to the tragus that can injure the scalp's major blood supply, the superficial temporal artery (STA), which increases the risk of postoperative complications. CLINICAL PRESENTATION We developed a modified DH technique to reduce surgical morbidity associated with injury to the STA, accommodate a large bone window for effective decompression, and improve operative speed. After performing hospital chart review, a total of 34 patients were found who underwent this DH technique for MMI. Of these, 22 patients had this performed for right-sided MMI and 12 patients had this performed for left-sided MMI. CONCLUSION In each case, our approach preserved the STA and thereby minimized the risk for ischemic necrosis of the scalp flap. Since our technique avoids dissection of the preauricular temporalis muscle, we believe operative times can be decreased while still accommodating a large bone window to allow for effective decompression of the infarcted brain parenchyma.

scholarly journals P.106 Functional approach using intraoperative brain mapping and neurophysiological monitoring for surgery of arteriovenous malformations in eloquent areas

2018 ◽  
Vol 45 (s2) ◽  
pp. S44-S44
Author(s):  
P Lopez-Ojeda ◽  
J Sanmillan ◽  
A Fernandez-Coello ◽  
I Fernandez-Conejero ◽  
Y Ali-Ciurana ◽  
...  
Keyword(s):  
Brain Mapping ◽  
Arteriovenous Malformations ◽  
Complete Recovery ◽  
Functional Approach ◽  
Neurophysiological Monitoring ◽  
Good Clinical Outcome ◽  
Surgical Morbidity ◽  
Language Functions ◽  
Eloquent Areas

Background: Surgical resection of arteriovenous malformations (AVMs) in eloquent areas is significantly associated with greater surgical morbidity. We describe a functional approach for surgical treatment of these lesions Methods: A total of 20 patients with AVMs in eloquent areas were surgically treated and retrospectively analyzed. Individualized functional approach, using brain mapping and/or neurophysiological monitoring was performed in each case according to every case specific features and location. Seventeen patients underwent surgery under assleep conditions and 3 -patients underwent awake intraoperative mapping Results: There was no mortality. Four patients had hemorrhagic complications (20%). Ten (50%) presented neurological immediate postoperative worsening. Eight of them achieved complete recovery in follow up and 2 showed a permanent deficit. At 6 months follow up all the patients (100%) had good clinical outcome (mRS less than 2). There were no intraoperative seizures but 5 patients (26.3%) developed postoperative seizures. Fifteen patients (75%) had total AVM resection. Language and/or motor function were identified in all but one patient (95%). Each case required changes in surgical strategy to preserve the motor and/or language functions during surgery. Conclusions: Intraoperative monitoring and brain mapping are valuable and safe for the treatment of eloquent AVMs by indentifying and protecting motor and language function during resection.

Staged bilateral far-lateral approach for bilateral cervicomedullary junction neurenteric cysts in a 10-year-old girl

2013 ◽  
Vol 12 (3) ◽  
pp. 274-280 ◽  
Author(s):  
Smruti K. Patel ◽  
James K. Liu
Keyword(s):  
Unusual Case ◽  
Pediatric Population ◽  
Craniocervical Junction ◽  
Lateral Approach ◽  
Rare Occurrence ◽  
Benign Lesions ◽  
Far Lateral Approach ◽  
The Central Nervous System ◽  
Far Lateral ◽  
Pontomedullary Junction

Neurenteric cysts are rare and benign lesions that consist of ectopic alimentary tissue residing in the central nervous system. They tend to occur most frequently in an intraspinal rather than intracranial location. Intracranial neurenteric cysts are a rare occurrence in the pediatric population. These lesions typically present as unilateral cystic structures in the lower cerebellopontine angle and craniocervical junction. To the authors' knowledge, there have been no reported cases of bilateral localization of intracranial neurenteric cysts. In this report, they present an unusual case of a 10-year-old girl who was found to have bilateral intracranial neurenteric cysts at the pontomedullary junction. The patient was successfully treated with staged, bilateral far-lateral transcondylar resection of the cysts. The authors also provide a brief overview of the literature describing intracranial neurenteric cysts in children.

scholarly journals An overview of a study on patients’ experiences of bowel symptoms and symptom management strategies following surgery for rectal cancer

2010 ◽  
pp. 89-92
Author(s):  
Margaret Landers
Keyword(s):  
Rectal Cancer ◽  
Anal Sphincter ◽  
Cancer Survival ◽  
Traditional Approach ◽  
Management Strategies ◽  
Dramatic Improvement ◽  
Permanent Colostomy ◽  
Perineal Surgery ◽  
Sphincter Saving ◽  
Surgical Treatments

Colo-rectal cancer is reported as the second most common cancer among both males and females in Ireland with approximately 2,700 patients diagnosed annually. There has been a dramatic improvement in colo-rectal cancer survival over the last 15 years with approximately 50% of patients now expected to survive this cancer in Ireland National Cancer Registry (2009). Earlier diagnosis lends toward more effective and less invasive surgical treatments such as anal sphincter saving surgery. Sphincter saving surgery is now viewed as an advance over the traditional approach involving abdominal perineal surgery which typically leaves patients with a permanent colostomy for life. Sphincter saving surgery preserves the anal sphincter and therefore a permanent colostomy can be avoided. A colostomy is a surgical procedure in which a stoma (or opening) is formed by bringing the end of the large intestine or colon through an incision in the abdominal wall and suturing it into place. ...

Microsurgical Resection and Stabilization of a Giant Spinal Schwannoma: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Ryan Dimentberg ◽  
Gregory Glauser ◽  
Donald K Detchou ◽  
Kerry A Vaughan ◽  
Omar Choudhri
Keyword(s):  
University Of Pennsylvania ◽  
Neurophysiological Monitoring ◽  
Direct Stimulation ◽  
Large Tumor ◽  
Institutional Review ◽  
Patient Consent ◽  
Microsurgical Resection ◽  
Spinal Schwannoma ◽  
Lumbar Spinal

Abstract We illustrate the microsurgical resection of a giant lumbar spinal schwannoma in a 37-yr-old male who presented with worsening low back pain, weakness, and numbness and tingling in the bilateral legs and feet. Lumbar spine imaging demonstrated a large, heterogeneously enhancing intradural mass with notable bony erosion. Given the thinning of the pedicles, large tumor size, and bony remodeling, instrumentation was performed in addition to decompression, with direct stimulation-triggered electromyography and intraoperative neurophysiological monitoring. This video demonstrates the surgical technique for resection and accompanied reconstruction necessary for the management of these giant intradural lesions. Postoperatively, the patient had no complications, with improvement of neurological symptoms at follow-up. Though improved, the patient had some residual numbness at postoperative follow-up visit. The patient consented to the procedure.  This video was deemed Institutional Review Board (IRB) exempt by the University of Pennsylvania IRB, as it is considered a case report, which does not require IRB approval or patient consent.

Effect of Presenting Hemorrhage on Outcome after Microsurgical Resection of Brain Arteriovenous Malformations

Neurosurgery ◽  
2005 ◽  
Vol 56 (3) ◽  
pp. 485-493 ◽  
Author(s):  
Michael T. Lawton ◽  
Rose Du ◽  
Mary Nelson Tran ◽  
Achal S. Achrol ◽  
Charles E. McCulloch ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Predictor Variable ◽  
Consecutive Series ◽  
Surgical Morbidity ◽  
Elective Resection ◽  
Neurological Outcomes ◽  
Improved Outcomes ◽  
Increased Risk ◽  
Microsurgical Resection

Abstract OBJECTIVE: We hypothesized that patients with unruptured arteriovenous malformations (AVMs) at presentation have an increased risk of deterioration compared with patients with ruptured AVMs. METHODS: A consecutive series of 224 patients treated microsurgically by a single neurosurgeon during a period of 6.4 years was analyzed. Initial hemorrhagic presentation was the primary predictor variable. Neurological outcomes were assessed by use of the Modified Rankin Scale (MRS) and Glasgow Outcome Scale (GOS), and logistic regression identified predictors of deterioration at follow-up (mean duration, 1.3 yr) relative to baseline before any intervention. RESULTS: Overall, 120 patients (54%) presented with hemorrhage, and all 224 patients underwent microsurgical resection. Complete resection was achieved in 220 patients (98%). According to GOS score, 13 patients (5.8%) deteriorated; according to MRS score, 45 patients (20.1%) deteriorated. Fifteen patients (6.7%) died. Hemorrhagic presentation was associated with improved outcomes, with a mean change in MRS score of +0.89 in patients with ruptured AVMs and −0.38 in patients with unruptured AVMs (P < 0.001). The final mean MRS scores in patients with unruptured AVMs were better than those in patients with ruptured AVMs (1.44 versus 1.90; P = 0.048). Presentation with an unruptured AVM was a predictor of worsening MRS score (odds ratio, 2.33; 95% confidence interval, 1.3–4.3; P = 0.006) but not of worsening GOS score. CONCLUSION: Presentation with AVM hemorrhage is an underappreciated predictor of outcome after therapy that includes microsurgical resection. Patients with ruptured AVMs tended to have deficits at presentation and generally improved after surgery, whereas patients with unruptured AVMs tended to have normal or nearly normal neurological function at presentation and were susceptible to worsening, albeit slight, as measured by MRS scores. Sensitive outcome measures such as MRS detect subtle symptoms and impairments missed by coarser measures such as GOS. Patients should be counseled that the risks associated with elective resection of unruptured AVMs may be higher than recognized previously. Hemorrhagic brain injury and its secondary effects may mask this surgical morbidity.

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