Operative neurosurgery (Hagerstown, Md.)
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Oper Neurosurg (Hagerstown) · Jul 2020
Surgical Resection of a Complex Spetzler-Martin Grade IV Medial Sylvian Arteriovenous Malformation: 3-Dimensional Operative Video.
Sylvian arteriovenous malformations (AVMs) are challenging lesions for surgical management. They are classified according to the Sugita classification based on the location of the nidus in the sylvian fissure: pure, lateral, medial, and deep. Resection of these lesions are fraught with risks, as it requires extensive arachnoid dissection in the sylvian fissure in close proximity to surrounding eloquent tissue, and the presence of en passage arteries can resemble feeding arteries. ⋯ The detail of the AVM resection is described in the video clip. Postoperative digital subtraction angiography showed complete excision of the lesion, and the patient was discharged to home on postoperative day 6 without any neurological deficit. In 1-yr follow-up angiogram, beside complete obliteration of the AVM, the flow-related MCA bifurcation aneurysm as well as the M1 and M2 vessels have decreased in size and are much less prominent in comparison to the pretreatment angiography.
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Oper Neurosurg (Hagerstown) · Jul 2020
Robotic Orthogonal Implantation of Responsive Neurostimulation (RNS) Depth Electrodes in the Mesial Temporal Lobe: Case Series.
Responsive neurostimulation (RNS) is a closed-loop neurostimulation modality for treating intractable epilepsy in patients who are not candidates for resection. In the past, implantation of depth electrodes was done through a transoccipital approach that transverses the hippocampus. There have been no descriptions of orthogonal approaches to RNS electrode placement. ⋯ The initial experience using an orthogonal approach for depth electrode placement for RNS implantation was described. The potential advantages may include better safety, accuracy, and positioning in comparison to a transoccipital approach.
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Oper Neurosurg (Hagerstown) · Jun 2020
Case ReportsEndoscopic Evacuation of Intracerebral Hematoma Utilizing a Side-Cutting Aspiration Device.
Intracerebral hemorrhage (ICH) is associated with a significant mortality of up to 50%, with almost all survivors suffering from debilitating functional compromise. In most cases, open craniotomy has failed to yield significant survival benefit. However, emerging evidence suggests that minimally invasive surgery (MIS) may yield clinically significant improvements in patient survival and quality of life in cases where open craniotomy has not shown benefit. ⋯ This is the first ICH evacuation with a side-cutting-aspiration device via an endoscopic approach. In our patient, this technique proved to be safe and efficacious, suggesting that this technique may be a promising addition to the armamentarium of MIS for ICH evacuation.
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Oper Neurosurg (Hagerstown) · Jun 2020
Case ReportsIs Transcranial Magnetic Resonance Imaging-Guided Focused Ultrasound a Repeatable Treatment Option? Case Report of a Retreated Patient With Tremor Combined With Parkinsonism.
In recent years, transcranial Magnetic Resonance Imaging-guided Focused Ultrasound (tcMRgFUS) treatments for functional neurological disorders are giving a new thrust to the field of therapeutic brain lesioning. ⋯ Since tcMRgFUS doesn't use ionizing radiations and it is incision-less, repeated and staged treatment procedures have always been hypothesized. Our report suggests that tcMRgFUS retreatment might actually be a feasible, safe, and effective option in selected patients in whom an optimal clinical outcome is not achieved after the first treatment session. However, future well-designed studies in large samples are needed to assess the possible risks of retreatment and the optimal timing of reintervention as well as eligibility and exclusion criteria.
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Oper Neurosurg (Hagerstown) · Jun 2020
Effectiveness of Gamma Knife Radiosurgery in the Treatment of Refractory Trigeminal Neuralgia: A Case Series.
Medical management is the first line of treatment for trigeminal neuralgia (TN). Patients with medically refractory TN may undergo a variety of invasive surgical interventions with varying success rates. Management of TN refractory to both medical and surgical intervention remains somewhat controversial. ⋯ GKRS is a safe and effective treatment modality for both medically and surgically refractory TN. Complete symptom relief was possible in patients with prior surgical or GKRS treatments. Recurrent symptoms following surgery or GKRS should not exclude a patient from future GKRS consideration.