Operative neurosurgery (Hagerstown, Md.)
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Oper Neurosurg (Hagerstown) · Jun 2020
Surgery for Brainstem Cavernous Malformations: Association between Preoperative Grade and Postoperative Quality of Life.
Brainstem cavernous malformations (BSCMs) are associated with substantial neurologic morbidity, but the literature on quality of life (QoL) after surgical treatment is limited. There is a need for validating the clinical utility of current grading scales for cavernous malformations. ⋯ Outcome of surgery for BSCM was good, as assessed by mRS and QoL. The Lawton grading scale for BSCMs correlated significantly with the postoperative mRS score and QoL, suggesting this grading scale may become a useful clinical tool for treatment prognostication at the individual level.
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Oper Neurosurg (Hagerstown) · May 2020
Case ReportsInterhemispheric Craniotomy for Resection of Thalamic Arteriovenous Malformation: 2-Dimensional Operative Video.
Arteriovenous malformations (AVMs) that occupy the deep brain structures are a formidable challenge during neurosurgical intervention. The heightened hemorrhage risk associated with these lesions necessitates intervention that often requires multimodal management. This patient presented following a large intraventricular hemorrhage and finding of a left thalamic AVM. ⋯ 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.
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Oper Neurosurg (Hagerstown) · May 2020
Effects of Intraoperative Magnetic Resonance Thermal Imaging Signal Artifact During Laser Interstitial Thermal Therapy on Thermal Damage Estimate and Postoperative Magnetic Resonance Imaging Ablative Area Concordance.
Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a minimally invasive procedure that utilizes intraoperative magnetic resonance thermal imaging (MRTI) to generate a thermal damage estimate (TDE) of the ablative area. In select cases, the MRTI contains a signal artifact or defect that distorts the ablative region. No study has considered the impact of this artifact on TDE accuracy. ⋯ MRTI signal artifact is common during LITT. The presence of signal artifact during intraoperative MRTI results in higher variation between intraoperative TDE and postoperative MRI cross-sectional ablative area. In cases in which intraoperative MRTI artifact is observed, there may be a larger degree of variation between observed intraoperative TDE and measured postoperative MRTI ablative area.
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Oper Neurosurg (Hagerstown) · Apr 2020
Advanced Techniques for Endoscopic Intracerebral Hemorrhage Evacuation: A Technical Report With Case Examples.
Multiple surgical techniques to perform minimally invasive intracerebral hemorrhage (ICH) evacuation are currently under investigation. The use of an adjunctive aspiration device permits controlled suction through an endoscope, minimizing collateral damage from the access tract. As with increased experience with any new procedure, performance of endoscopic minimally invasive ICH evacuation requires development of a unique set of operative tenets and techniques. ⋯ As experience builds with endoscopic minimally invasive ICH evacuation, academic discussion of specific surgical techniques will be critical to maximizing its safety and efficacy.
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Oper Neurosurg (Hagerstown) · Apr 2020
Gross Total Resection of a Grade IV Astrocytoma Adjacent to the Precentral Gyrus With Nonawake Motor Mapping and Motor-Evoked Potential Monitoring: 3-Dimensional Operative Video.
Surgical treatment of the gliomas located in or adjacent to the eloquent areas poses significant challenge to neurosurgeons. The main goal of the surgery is to achieve maximal safe resection while preserving the neurological function. This might be possible with utilizing pre- and intraoperative adjuncts such as functional magnetic resonance imaging (MRI), image guidance, mapping of the function of interest, intraoperative MRI, and neurophysiological monitoring. ⋯ Nonawake motor mapping and MEP monitoring enabled us to perform gross total resection. Because it has been shown that supratotal resection may provide improved survival outcome,1,2 we extended the white matter resection beyond the contrast enhancing area in noneloquent parts of the tumor. Surgical steps in dealing with vascular anatomy as well as utilizing intraoperative adjuncts such as motor mapping and MEP monitoring to enhance the extent of resection while preserving the function are demonstrated in this 3-dimensional surgical video. The patient consented to publication of her operative video.