Stimulus techniques and microelectrode recordings of subthalamic-nuclei neurons in Parkinson`s during functional-neurosurgery

This study discusses the various procedures and issues involved in the acquisition of microelectrode recordings (MER) signals of subthalamic nucleus stimulations with induced deep brain stimulation electrodes very rigorously. Bellicose-invasive physiological detections through the methods of sub cortical physio logical detections, electrical induced stimulations and micro electrode recordings, stereo-tactic technique, macro-stimulation, stereo-tactic functional neurosurgical technique, stimulations such as macro and micro, induced stimuli with current and microelectrode recordings, impedance information monitoring, micro injections of test substances, evoked potentials, biomarkers/local field potentials, microelectrode fabrication methods and setups, sub cortical atlas-mapping with micro recording/microelectrode recording (M.E.R.). Thus, the study is very significant to the electrophysiological neurosurgical point of view and is very useful to the field of microelectrode recording and functional neurosurgery. This study is concerned with invasive physiological detection of deep brain structures with micro- or macro-electrodes prior to surgery followed by imaging techniques and their use in cortical and subcortical detection; detection relevant to the superficial cerebral cortex regions.

Unusual intracranial suppuration: illustrative cases

BACKGROUND Intracranial suppuration (ICS) is a rare complication that can arise from various disease processes and is composed of brain abscess, extradural empyema, and subdural empyema. Although significant progress has been achieved with antibiotics, neuroimaging, and neurosurgical technique, ICS remains a serious neurosurgical emergency. An uncommon presentation of ICS is sterile ICS, which has yet to be fully elucidated by clinicians. The authors present 2 cases of unusual sterile ICS: a sterile subdural empyema and a sterile brain abscess. OBSERVATIONS Both patients underwent surgical treatment consisting of craniotomy to evacuate the pus collection. The blood cultures from both the patients, the collected empyema, and the thick capsule from the brain abscess were sterile. However, the necrotic brain tissue surrounding the abscess contained inflammatory cells. The authors’ review of the literature emphasizes the rarity of sterile ICS and substantiates the necessity for additional studies to explore this field. LESSONS Sterile ICS is a disease entity that warrants further investigation to determine appropriate treatment to improve patient outcomes. This study highlights the paucity of data available regarding sterile ICS and supports the need for future studies to uncover the etiology of sterile ICS to better guide management of this condition.

Torkildsen’s Ventriculocisternostomy First Applications: The Anthropological Evidence of a Young Slavic Soldier Who Died in the Torre Tresca Concentration Camp (Bari, Italy) in 1946

Human skeletal remains are considered as real biological archives of each subject’s life. Generally, traumas, wounds, surgical interventions, and many human pathologies suffered in life leave identifiable marks on the skeleton, and their correct interpretation is possible only through a meticulous anthropological investigation of skeletal remains. The study here presented concerns the analysis of a young Slavic soldier’s skeleton who died, after his imprisonment, in the concentration camp of Torre Tresca (Bari, Italy), during the Second World War (1946). In particular, the skull exhibited signs of surgical activity on the posterior cranial fossa and the parieto-occipital bones. They could be attributed to surgical procedures performed at different times, showing various degrees of bone edge remodeling. Overall, it was possible to correlate the surgical outcomes highlighted on the skull to the Torkildsen’s ventriculocisternostomy (VCS), the first clinically successful shunt for cerebrospinal fluid (CSF) diversion in hydrocephalus, which gained widespread use in the 1940s. For this reason, the skeleton we examined represents a rare, precious, and historical testimony of an emerging and revolutionary neurosurgical technique, which differed from other operations for treating hydrocephalus before the Second World War and was internationally recognized as an efficient procedure before the introduction of extracranial shunts.

P51 External Ventricular Drainage Insertion Audit

Introduction External Ventricular Drainage (EVD) is a neurosurgical technique used to lower the intercranial pressure while cerebrospinal fluid (CSF) flow is obstructed. The infection rate associated with the EVD insertion in the UK is 9.3%, with ventriculitis being the most common one. The aim of the audit was to compare our outcomes and infection rates and national standards and to implement an EVD Management protocol to improve patient outcome. Methods The data was collected from 43 patients, 98% of whom were emergency admitted cases. For all EVD procedures, silver coated catheters were used. The surgical factors such as the surgical team performance and the average operative time (1h 11min) were accounted for in the audit. The most common reason for EVD insertion was subarachnoid haemorrhage. Prophylactic antibiotics were administered in all cases before the surgery. 12% of the EVDs were used for Intercranial Pressure Monitoring. Results 12% patients’ samples had catheter associated infections. The average EVD insertion period was 18 days. Leaks occurred in 11 cases (26%). 3 of them subsequently developed ventriculitis. White cell count result was over 10,000 cells per mm3 in 40% of patients. Conclusions Twice longer sampling time then the national average (8 days) increased the number of ITU transfers. The cause would be the use of out-of-date EVD type. However, the silver impregnated lines versus non-impregnated have a lower cerebrospinal fluid infection rate, the bolt connected EVDs would be more precise and decrease the rate of resuturing and hence decrease a chance of CSF infection.

Cranioplasty Flap Lifting Caused by Intracranial Hypertension Literature Review

Cranioplasty is a neurosurgical technique that replaces a bone defect in the skull with hard replacement tissue. It is indicated in particular after a decompressive craniectomy performed in severe head trauma in order to control intracranial hypertension refractory to medical treatment. Cranioplasty is sometimes associated with a significant number of complications, including hydrocephalus. In this article, we report the case of a cranioplasty flap lifting on intracranial hypertension following postoperative hydrocephalus and discuss the clinical relevance with a review of the literature.

Awake craniotomy for clipping of unruptured aneurysm: anesthesia concerns, management and challenges

Awake craniotomy is a neurosurgical technique performed either as an asleep-awake-asleep technique or a monitored anesthesia care technique, in combination with a scalp block. The surgery indication has been well documented for brain tumor excision at the eloquent cortex, epilepsy and deep brain stimulation surgery. However, this technique’s use during unruptured cerebral aneurysm clipping has only been recently reported. The main goal of awake craniotomy for unruptured cerebral aneurysm clipping is to prevent the risk of ischemia during temporary and permanent clipping by immediate awake neurological assessment during surgery. There have been limited reports on this surgery’s anesthesia issues. The aim of our case report is to discuss the anesthesia concerns, management and challenges during our first successful experience of this surgery. Key words: Awake craniotomy; Clipping; Cerebral aneurysm; Scalp block Citation: Hassan WMNW, Omar SC, Fui WT, Idris Z, Kandasamy R. Awake craniotomy for clipping of unruptured aneurysm: anesthesia concerns, management and challenges. Anaesth. pain intensive care 2021;25(1):96-101; DOI: 10.35975/apic.v25i1.1436 Received: 2 July 2020, Reviewed: 10 August 2020, Accepted: 3 September 2020

Primary empty sella syndrome associated with visual deterioration salvaged by chiasmapexy: Report of a case and discussion of the literature

Background: Empty sella syndrome (ESS) is a condition in which there is loss of volume of the pituitary gland, which is the normal constituent of the sella turcica. There may be visual and endocrine deficits associated with this condition, and radiologically, there may be downward prolapse of the optic chiasm. It occurs in a primary ESS, poorly understood form, as well as a secondary ESS form that follows medical or surgical treatment of a pituitary macroadenoma, or else spontaneous hemorrhage into such a tumor. Case Description: A 56-year-old man presenting with deficits of both visual acuity and visual fields in the setting of radiological ESS without associated optic chiasm prolapse is discussed. He underwent endoscopic endonasal chiasmapexy with gradual improvement of his visual function over the following 6 months. Conclusion: ESS is a potentially potent cause of visual deterioration that lends itself to reversal through a relatively simple neurosurgical technique. This case illustrates that actual prolapse of the chiasm is neither a prerequisite for visual deterioration nor its reversal the mechanism of visual improvement after chiasmapexy, raising the question of the mechanisms at play in cases such as this. It confirms the role of chiasmapexy in the management of selected cases of ESS.

Compartmentalization: An Open Technique for Frontal Sinus Repair and Preservation—Description of Technique and Early Case Series

Background Cranialization or obliteration is widely accepted intervention for traumatic or intentional breach of the frontal sinus. These techniques, however, result in the loss of frontal sinus function and have a persistent risk of cerebrospinal fluid (CSF) leak and mucocele. Compartmentalization is an open technique for repair of the frontal sinus using allograft onlay and a vascularized periosteal flap that allows for preservation of frontal sinus function. Objective The main objective of this article is to describe the technique for compartmentalization of the frontal sinus and demonstrate its efficacy and complication rate with an early patient series. Methods Our technique includes the following key components: harvesting of a pedicled periosteal flap, frontal sinus repair through a bifrontal craniotomy with minimal mucosa removal, ensuring the patency of the nasal frontal outflow tract, and separation of the brain from the frontal sinus with a dual layer of periosteum and allograft.All cases of frontal sinus repair using the compartmentalization technique at our institution were reviewed. Charts were reviewed for CSF leak, mucocele, and other complications. Results Twenty-three patients underwent the described frontal sinus repair technique 17 for tumor and 6 for trauma. There were no CSF leaks and no mucoceles. One patient experienced postoperative anemia and a “parameningeal reaction” that were managed with a short course of antibiotics. Conclusions Compartmentalization, due to its sinus preservation and low complication rate, represents a meaningful step forward in neurosurgical technique for open frontal sinus repair. However, long-term outcomes are necessary to fully evaluate risk of mucocele.

Endoscopic Endonasal Odontoidectomy: Nuances of Neurosurgical Technique

Odontoidectomy is the treatment of choice for some diseases that cause irreducible ventral compression of the brainstem. In this study, we present our series emphasizing the technical nuances of endoscopic endonasal odontoidectomy.