Operative neurosurgery (Hagerstown, Md.)
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Oper Neurosurg (Hagerstown) · Jan 2020
Microsurgical Treatment of Ruptured Spetzler-Martin Grade 3 Right Hippocampal Arteriovenous Malformation: 3-Dimensional Operative Video.
We present a 14-yr-old male with a history of traumatic brain injury in March 2016, secondary to clonic tonic generalized seizures. CT scan showed hemorrhage at mesial temporal region in the body of right hippocampus, intraventricular hemorrhage at the level of lateral ventricles (right and left side) and fourth ventricle. After this the patient presented with pulsating right temporal headache of high intensity (VAS 10/10) that improved with common analgesics, dizziness, and clonic tonic generalized seizures despite taking Phenobarbital 100 mg/24 h. ⋯ Postoperatively, the patient was without medical complications. We present a 3-dimensional video of the microsurgical treatment for right hippocampal AVM performed through a trans-T2 approach. The patient signed the Institutional Consent Form, which allows the use of his/her images and videos for any type of medical publications in conferences and/or scientific articles.
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Oper Neurosurg (Hagerstown) · Jan 2020
Multimodal Management of a Ruptured Right Medial Parietal Arteriovenous Malformation: 2-Dimensional Operative Video.
Arteriovenous malformations (AVM) of the medial surface of the cerebral hemispheres are challenging because of the limited access to the interhemispheric fissure, the presence of the bridging veins, and the difficult control of arterial feeders and deep venous drainage. We present a 20-yr-old patient with a grade 3 Spetzler Martin ruptured right medial parietal AVM revealed by headaches, left hemiparesis, and ataxia. We highlight the importance of a detailed and selective study of AVM angioarchitecture with new sequences as XperCT (Philips Medical) viewing which permits a better understanding of the anatomy and pathology and a better therapeutical planning. ⋯ At the last follow-up, the patient had only slight left ataxia. Multimodal management with planned selective embolization may facilitate microsurgical resection of AVMs. Given the retrospective nature of this report, informed consent was not required.
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Oper Neurosurg (Hagerstown) · Dec 2019
Overcoming Daunting Challenges of Clipping of Paraclinoid Carotid-Ophthalmic and Superior Hypophyseal Artery Aneurysms: 2-Dimensional Operative Video.
This surgical video emphasizes the nuances that needed to overcome daunting challenges of clipping of paraclinoid carotidophthalmic and superior hypophyseal artery (SHA) aneurysms. To avoid hazardous manipulations, scarifying the ipsilateral SHA under visual evoked potential (VEP) guidance can be done without risk of postoperative visual decline. This technique is associated with better visual outcome.1 A 66-yr-old woman presented with gradually enlarging right paraclinoid carotidophthalmic and SHA aneurysms. ⋯ The postoperative course was uneventful. There was no evidence of postoperative visual disturbances. The patient has consented to the submission of the case report to the journal.
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Oper Neurosurg (Hagerstown) · Oct 2019
Single Vessel Double Anastomosis for Flow Augmentation - A Novel Technique for Direct Extracranial to Intracranial Bypass Surgery.
A double anastomosis using a single superficial temporal artery (STA) donor branch for both a proximal side-to-side (S2S) and a distal end-to-side anastomosis is a novel direct bypass technique for use in selected patients necessitating flow augmentation. ⋯ SVDA is a novel technique that can be advantageous for selected cases of extracranial-to-intracranial bypass. Expertise in bypass procedures is a necessary prerequisite. Graft patency rates and complications appear comparable to other bypass techniques.
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Oper Neurosurg (Hagerstown) · Sep 2019
Microsurgical Resection of Low-Grade Spinal Cord Astrocytoma: 2-Dimensional Operative Video.
This video demonstrates microsurgical resection of low-grade (Grade I) thoracic spinal cord astrocytoma. Astrocytomas are the most common pediatric intramedullary tumors and occur secondary to ependymomas in adults.1,2 The treatment goal should be radical gross total resection while preserving neurological function with intraoperative neuromonitoring.2-4 To our knowledge, this is the first video report on microsurgical resection of low-grade spinal cord astrocytoma. A 58-yr-old female presented with gait disturbances has been featured in this video. A spinal MRI revealed T1/T2 hyperintense intramedullary tumor at T4, suggesting spinal cord astrocytoma versus ependymoma. ⋯ Follow-up MRI showed no sign of tumor or recurrence. The patient recovered fully and was neurologically intact. Written consent was obtained directly from the patient.