scholarly journals Falcotentorial meningiomas: Optimal surgical planning and intraoperative challenges – case report

2021 ◽  
Vol 3 (2) ◽  
pp. 23-28
Author(s):  
Otávio da Cunha Ferreira Neto ◽  
Pedro Lukas Do Rêgo Aquino ◽  
Marcelo Diniz de Menezes ◽  
Nilson Batista Batista Lemos ◽  
Bianca Domiciano Vieira Costa Cabral ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Surgical Planning ◽  
Third Ventricle ◽  
Lower Limbs ◽  
Preoperative Imaging ◽  
Imaging Analysis ◽  
Solid Mass ◽  
Effective Removal ◽  
Neurovascular Structures ◽  
Selection Of

Meningiomas arising from the falcotentorial junction are rare, and the selection of the optimal surgical approach is essential. We report a 41-year-old man presented with progressive left paresis in the lower limbs. An MRI showed a solid mass inside the third ventricle in contact with the falcotentorial dural junction. The tumor was removed by the transtentorial/transfalcine occipital approach, performed with the patient in the three-quarter prone position. The tumor was devascularized from the tentorium, then debulked and finally dissected. The affected falx and tentorium were resected, but all of patent dural venous sinuses were preserved. The tumor was a subtotal resect. Choosing the surgical approach is essential for the safe and effective removal of an FTM and preoperative imaging analysis should identify the tumor’s anatomical relations and guide toward the least disruptive route that preserves the neurovascular structures. This article aims to report a successfully treated FTM.

scholarly journals Contralateral Interhemispheric Transcallosal Transchoroidal Approach for Resection of a Tumor in the Lateral Wall of the Third Ventricle: 2-Dimensional Operative Video

2019 ◽  
Vol 17 (5) ◽  
pp. E197-E197
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Surgical Approach ◽  
Third Ventricle ◽  
Video Recording ◽  
Lateral Wall ◽  
Metastatic Lesion ◽  
Foramen Of Monro ◽  
The Third ◽  
Institutional Review ◽  
Surgical Field ◽  
Selection Of

Abstract Third ventricular tumors pose a surgical challenge, given the intricate surrounding anatomy and depth of the surgical field. A surgical approach to these lesions can involve several different trajectories, the selection of which is dependent on the location of the tumor. Approaches include transforaminal, translamina terminalis, interforniceal, occipital transtentorial, endoscopic transventricular, transchoroidal, and supracerebellar infratentorial. This patient had a metastatic lesion within the lateral wall of the third ventricle. The selection of the surgical approach was dependent on the laterality of the tumor. The foramen of Monro was identified, and landmarks were confirmed. The choroid plexus could then be retracted medially, and the choroidal sulcus was identified. The sulcus was entered laterally to minimize the risk of transgressing the fornix. The tumor was identified along the lateral third ventricular wall, and the plane between the tumor and normal plane was readily created. The tumor was then removed entirely, and postoperative imaging demonstrated a complete resection. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

Revising the Indications of Transtemporal Surgical Approaches in the Modern Endoscopic Era of Skull Base Surgery: A Dying Art

2020 ◽  
Author(s):  
Ravi Sankar Manogaran ◽  
Raj Kumar ◽  
Arulalan Mathialagan ◽  
Anant Mehrotra ◽  
Amit Keshri ◽  
...  
Keyword(s):  
Skull Base ◽  
Surgical Approach ◽  
Nerve Palsy ◽  
Tertiary Care ◽  
Surgical Approaches ◽  
Microsurgical Anatomy ◽  
Complete Excision ◽  
Lateral Skull Base ◽  
The Individual ◽  
Selection Of

Abstract Objectives The aim of the study is to emphasize and explore the possible transtemporal approaches for spectrum of complicated lateral skull base pathologies. Design Retrospective analysis of complicated lateral skull base pathologies was managed in our institute between January 2017 and December 2019. Setting The study was conducted in a tertiary care referral center. Main Outcome Measures The study focused on the selection of approach based on site and extent of the pathology, the surgical nuances for each approach, and the associated complications. Results A total of 10 different pathologies of the lateral skull base were managed by different transtemporal approaches. The most common complication encountered was facial nerve palsy (43%, n = 6). Other complications included cerebrospinal fluid (CSF) collection (15%, n = 2), cosmetic deformity (24%, n = 4), petrous internal carotid artery injury (7%, n = 1), and hypoglossal nerve palsy (7%, n = 1). The cosmetic deformity included flap necrosis (n = 2) and postoperative bony defects leading to contour defects of the scalp (n = 2). Conclusion Surgical approach should be tailored based on the individual basis, to obtain adequate exposure and complete excision. Selection of appropriate surgical approach should also be based on the training and preference of the operating surgeon. Whenever necessary, combined surgical approaches facilitating full tumor exposure are recommended so that complete tumor excision is feasible. This requires a multidisciplinary team comprising neurosurgeons, neuro-otologist, neuroanesthetist, and plastic surgeons. The surgeon must know precise microsurgical anatomy to preserve the adjacent nerves and vessels, which is necessary for better surgical outcomes.

scholarly journals 3D-printed models for periacetabular osteotomy surgical planning

2021 ◽  
Author(s):  
B Keegan Markhardt ◽  
Matthew A Beilfuss ◽  
Scott J Hetzel ◽  
David C Goodspeed ◽  
Andrea M Spiker
Keyword(s):  
Radiation Dose ◽  
Blood Loss ◽  
Surgical Planning ◽  
Preoperative Planning ◽  
Periacetabular Osteotomy ◽  
Total Blood Loss ◽  
Preoperative Imaging ◽  
Total Blood ◽  
Patient Age ◽  
3D Printed

Abstract The purpose of this study was to determine the feasibility and clinical benefits of using 3D-printed hemipelvis models for periacetabular osteotomy preoperative planning in the treatment of hip dysplasia. This retrospective study included 28 consecutive cases in 26 patients, with two bilateral cases, who underwent periacetabular osteotomy between January 2017 and February 2020 and had routine radiographs, CT and MR imaging. Of these, 14 cases [mean patient age 30.7 (SD 8.4) years, 11 female] had routine preoperative imaging, and 14 cases [mean patient age 28.0 (SD 8.7) years, 13 female] had routine preoperative imaging and creation of a full-scale 3D-printed hemipelvis model from the CT data. The expected surgical cuts were performed on the 3D-printed models. All patients underwent Bernese periacetabular osteotomy. Operative times, including time to achieve proper acetabular position and total periacetabular osteotomy time, fluoroscopy radiation dose and estimated total blood loss were compiled. ANOVA compared outcome variables between the two patient groups, controlling for possible confounders. On average, patients who had additional preoperative planning using the 3D-printed model had a 5.5-min reduction in time to achieve proper acetabular position and a 14.5-min reduction in total periacetabular osteotomy time; however, these changes were not statistically significant (P = 0.526 and 0.151, respectively). No significant difference was identified in fluoroscopy radiation dose or total blood loss. Detailed surgical planning for periacetabular osteotomy using 3D-printed models is feasible using widely available and affordable technology and shows promise to improve surgical efficiency.

scholarly journals Assessment of reproductive potential in patients after myomectomy

2021 ◽  
Vol 8 (1) ◽  
pp. 35-39
Author(s):  
Yan Van ◽  
Yuliya A. Romadanova ◽  
Alla A. Bakhvalova ◽  
Ekaterina V. Fedina ◽  
Aleksandr A. Zinov’yev ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Ovarian Function ◽  
Reproductive Potential ◽  
Morphological Structure ◽  
Clinical Situation ◽  
Functional Restoration ◽  
Hormonal Profile ◽  
Abdominal Myomectomy ◽  
Time Required ◽  
Selection Of

The aim of the study is to assess the restoration of anatomical and functional integrity of the uterus and identify changes in hormonal profile in women after laparoscopic and abdominal myomectomy. Material and methods. 58 patients aged 36,2 5,9 years old with uterine myoma underwent myomectomy: 31 patients underwent laparoscopic myomectomy and 27 patients underwent abdominal myomectomy. The selection of surgical approach didnt depend on the size, the number and localization of uterine myomas and the patients concomitant pathology. The hormonal profile of the patients including AMH level was assessed befor myomectomy and in the 6 months after the operation. Postoperative assessment was performed on day 5th8th after surgery and in 1 and 6 months after myomectomy. Results. No significant differences were found in the processes of reparation of the uterus and in hormonal profile of the patients after laparoscopic or abdominal myomectomy. The time required for the patients reabilitation and for the restoration of the ovarian function and uterine morphological structure was similar in both groups. Conclusion. The hormonal profile of the patients and the anatomical and functional restoration of myometrium after myomectomy doesnt depend on the surgical approach if myomectomy is performed by an experienced surgeon after the correct assessment of the clinical situation.

The walls of the femoral neck as an auxiliary tool for femoral stem positioning

2021 ◽  
pp. 112070002110407
Author(s):  
Samuel Morgan ◽  
Ofer Sadovnic ◽  
Moshe Iluz ◽  
Simon Garceau ◽  
Nisan Amzallag ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Accurate Determination ◽  
Femoral Stem ◽  
Posterior Wall ◽  
Anterior Wall ◽  
Femoral Anteversion ◽  
Lower Limbs ◽  
Imaging Analysis ◽  
Femoral Condyles

Background: Femoral anteversion is a major contributor to functionality of the hip joint and is implicated in many joint pathologies. Accurate determination of component version intraoperatively is a technically challenging process that relies on the visual estimation of the surgeon. The following study aimed to examine whether the walls of the femoral neck can be used as appropriate landmarks to ensure appropriate femoral prosthesis version intraoperatively. Methods: We conducted a retrospective study based on 32 patients (64 hips) admitted to our centre between July and September 2020 who had undergone a CT scan of their lower limbs. Through radiological imaging analysis, the following measurements were performed bilaterally for each patient: anterior wall version, posterior wall version, and mid-neck femoral version. Anterior and posterior wall version were compared and evaluated relative to mid-neck version, which represented the true version value. Results: Mean anterior wall anteversion was 20° (95% CI, 17.6–22.8°) and mean posterior wall anteversion was −12° (95% CI, −15 to −9.7°). The anterior walls of the femoral neck had a constant of −7 and a coefficient of 0.9 (95% CI, −9.8 to −4.2; p  < 0.0001; R2 0.77). The posterior walls of the femoral neck had a constant of 20 and a coefficient of 0.7 (95% CI, 17.8–22.5; p  < 0.0001; R2 0.60). Conclusions: Surgeons can accurately obtain femoral anteversion by subtracting 7° from the angle taken between the anterior wall and the posterior femoral condyles or by adding 20° to the angle taken between the posterior wall and the posterior femoral condyles.

VOLUME VISUALIZATION FOR SURGICAL PLANNING SYSTEM

2007 ◽  
Vol 07 (01) ◽  
pp. 55-63 ◽  
Author(s):  
CHAN CHEE FATT ◽  
IRWAN KASSIM ◽  
CHARLES LO ◽  
IVAN NG ◽  
KWOH CHEE KEONG
Keyword(s):  
Computer Technology ◽  
Surgical Approach ◽  
Surgical Planning ◽  
Volume Visualization ◽  
Planning System ◽  
Neurosurgical Planning ◽  
2D Imaging ◽  
3D Volume ◽  
Volume Models

The 3D volume visualization is to overcome the difficulties of the 2D imaging by using computer technology. A volume visualization approach has been successfully implemented for Surgical Planning System in National Neuroscience Institute (NNI). The system allows surgeons to plan a surgical approach on a set of 2D image slices and process into volume models and visualise them in 3D rapidly and interactively on PC. In our implementation, we have applied it in neurosurgical planning. The surgeon can visualize objects of interest like tumor and surgical path, and verify that the surgical plan avoids the critical features and the planning of the surgical path can thus be optimal.

Preliminary application of 3D-printed individualised guiding templates for total hip arthroplasty in Crowe type IV developmental dysplasia of the hip

2020 ◽  
pp. 112070002094800
Author(s):  
Qiang Tu ◽  
Huan-wen Ding ◽  
Hu Chen ◽  
Jian-jian Shen ◽  
Qiu-ju Miao ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Surgical Planning ◽  
Developmental Dysplasia ◽  
Femoral Osteotomy ◽  
Lower Limbs ◽  
Total Hip ◽  
Type Iv ◽  
3D Printed ◽  
Dysplasia Of The Hip

Objective: To evaluate the feasibility and accuracy of three-dimensional (3D)-printed individualised guiding templates in total hip arthroplasty (THA) for the treatment of developmental dysplasia of the hip (DDH). Methods: 12 hips in 12 patients with Crowe type IV DDH were treated with THA. A 3D digital model of the pelvis and lower limbs was reconstructed using the computed tomography data of the patients. Preoperative surgical simulations were performed to determine the most suitable surgical planning, including femoral osteotomy and prosthesis placement. Based on the ideal surgical planning, individualised guiding templates were designed by software, manufactured using a 3D printer, and used in acetabulum reconstruction and femoral osteotomy during surgery. Results: 12 patients were followed up for an average of 72.42 months (range 38–135 months). During surgery, the guiding template for each case was matched to the bony markers of the acetabulum and proximal femur. Preoperative and follow-up Harris hip scores were 34.2 ± 3.7 and 85.2 ± 4.2; leg length discrepancy, 51.5 ± 6.5 mm and 10.2 ± 1.5 mm; and visual analogue scale scores, 6.2 ± 0.8 and 1.3 ± 0.3, respectively, with statistical difference. Shortened deformity and claudication of the affected limb were obviously improved after surgery. However, 1 patient had artificial hip dislocation 2 weeks after surgery, and another patient had sciatic nerve traction injury, both of whom recovered after physical treatment. Conclusions: Preoperative surgical simulation and 3D-printed individualised guiding templates can fulfil surgeon-specific requirements for the treatment of Crowe type IV DDH. Accurate THA can be achieved using 3D-printed individualised templates, which provide a new personalised surgical plan for the precise positioning and orientation of acetabular reconstruction and femoral osteotomy.

Endoscopic approach to colloid cyst: what is the optimal entry point and trajectory?

2014 ◽  
Vol 121 (4) ◽  
pp. 790-796 ◽  
Author(s):  
Leonardo Rangel-Castilla ◽  
Fangxiang Chen ◽  
Lawrence Choi ◽  
Justin C. Clark ◽  
Peter Nakaji
Keyword(s):  
Colloid Cyst ◽  
Mean Value ◽  
Entry Point ◽  
Preoperative Imaging ◽  
Target Point ◽  
Coronal Suture ◽  
Anatomical Structures ◽  
Entry Points ◽  
Stereotactic Navigation ◽  
Neurovascular Structures

Object An optimal entry point and trajectory for endoscopic colloid cyst (ECC) resection helps to protect important neurovascular structures. There is a large discrepancy in the entry point and trajectory in the neuroendoscopic literature. Methods Trajectory views from MRI or CT scans used for cranial image guidance in 39 patients who had undergone ECC resection between July 2004 and July 2010 were retrospectively evaluated. A target point of the colloid cyst was extended out to the scalp through a trajectory carefully observed in a 3D model to ensure that important anatomical structures were not violated. The relation of the entry point to the midline and coronal sutures was established. Entry point and trajectory were correlated with the ventricular size. Results The optimal entry point was situated 42.3 ± 11.7 mm away from the sagittal suture, ranging from 19.1 to 66.9 mm (median 41.4 mm) and 46.9 ± 5.7 mm anterior to the coronal suture, ranging from 36.4 to 60.5 mm (median 45.9 mm). The distance from the entry point to the target on the colloid cyst varied from 56.5 to 78.0 mm, with a mean value of 67.9 ± 4.8 mm (median 68.5 mm). Approximately 90% of the optimal entry points are located 40–60 mm in front of the coronal suture, whereas their perpendicular distance from the midline ranges from 19.1 to 66.9 mm. The location of the “ideal” entry points changes laterally from the midline as the ventricles change in size. Conclusions The results suggest that the optimal entry for ECC excision be located at 42.3 ± 11.7 mm perpendicular to the midline, and 46.9 ± 5.7 mm anterior to the coronal suture, but also that this point differs with the size of the ventricles. Intraoperative stereotactic navigation should be considered for all ECC procedures whenever it is available. The entry point should be estimated from the patient's own preoperative imaging studies if intraoperative neuronavigation is not available. An estimated entry point of 4 cm perpendicular to the midline and 4.5 cm anterior to the coronal suture is an acceptable alternative that can be used in patients with ventriculomegaly.

Diagnosis of Neuropathy of Cervical Posterior Longitudinal Ligament by Medical Imaging Technology

2020 ◽  
Vol 10 (9) ◽  
pp. 2084-2089
Author(s):  
Cheng Yang ◽  
Liguo Wang ◽  
Guijiang Wang ◽  
Bortolotti Paolo
Keyword(s):  
Cervical Spine ◽  
Medical Imaging ◽  
Evaluation Method ◽  
Clinical Manifestations ◽  
Posterior Longitudinal Ligament ◽  
Lower Limbs ◽  
Sensory Loss ◽  
Imaging Technology ◽  
International Orthopaedic ◽  
Selection Of

The patients were evaluated by the International Orthopaedic Association evaluation method and graded and correlated by medical imaging technology. The results showed that 41% of the patients had unstable gait and sensory loss of lower limbs or muscle weakness in the analysis of clinical manifestations. In the analysis of therapeutic effect by using medical imaging technology, it was found that the patients’ scores increased significantly after operation, which was significantly different from those before operation (P < 0.01). There was a significant correlation between preoperative scores and imaging changes, but no significant correlation between other indicators after surgery. Therefore, through the study, it is found that the application of medical imaging technology in the observation and treatment of ossification of the posterior longitudinal ligament of cervical spine can play a very positive and accurate role in the analysis of the patient’s condition, and provide an experimental basis for the selection of treatment methods for ossification of the posterior longitudinal ligament of cervical spine and the application direction of medical imaging technology.

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