Journal of neurosurgery
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Journal of neurosurgery · Jan 2024
Use of MR signal intensity variations to highlight structures at risk along brain biopsy trajectories.
Postoperative intracerebral hemorrhages are significant complications following brain stereotactic biopsy. They can derive from anatomical structure (sulci, vessels) damage that is missed during stereotactic trajectory planning. In this study, the authors investigated the ability to detect contact between structures at risk and stereotactic trajectories using signal analysis from MRI obtained during clinical practice, with the aim to propose a visual tool to highlight areas with anatomical structures at risk of damage along the biopsy trajectory. ⋯ Variations of the mean derivative of the MR signal intensity can be converted into a green/red color code along the planned biopsy trajectory to highlight anatomical structures at risk, which can help neurosurgeons during the surgical planning of stereotactic procedures.
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Journal of neurosurgery · Jan 2024
The learning curve for cavernous sinus surgery illustrated by symptomatic intracavernous aneurysm clipping through a pretemporal transcavernous approach.
The anatomy of the cavernous sinus (CS) has been well studied in the laboratory for decades; however, performing surgery in and around the CS is still a challenge. To reveal the learning curve for CS surgery via the pretemporal transcavernous approach (PTTC), surgical procedures were examined. The authors proposed 4 levels of surgical difficulty in opening the walls of the CS through this approach. Details of the approach were illustrated by surgical videos of symptomatic intracavernous aneurysm clipping. ⋯ The learning curve for CS surgery is long. The authors use 4 levels of surgical difficulty to describe applications of the PTTC in CS surgery. This approach serves as an effective workhorse in treating CS pathologies with low morbidity and high success rates when performed by experienced neurosurgeons.
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Journal of neurosurgery · Jan 2024
Preserving the cerebellar hemispheric tentorial bridging veins through a novel tentorial cut technique for supracerebellar approaches.
The objective of this study was to describe the distribution pattern of cerebellar hemispheric tentorial bridging (CHTB) veins on the tentorial surface in a case series of perimedian or paramedian supracerebellar approaches and to describe a novel technique to preserve these veins. ⋯ Because there is no way to determine whether a CHTB vein can be sacrificed without complications, it is important to protect these veins in supracerebellar approaches. This new tentorial cut technique in perimedian or paramedian supracerebellar approaches makes it possible to preserve CHTB veins encountered during supracerebellar surgeries.
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Deep brain stimulation (DBS) is a rapidly growing surgical option for patients with drug-resistant epilepsy who are not candidates for resective/ablative surgery. Recent randomized controlled trials have demonstrated efficacy of DBS of the anterior nucleus of the thalamus (ANT), particularly in frontal or temporal epilepsy, whereas DBS of the centromedian (CM) nucleus appears to be most suitable in well-defined generalized epilepsy syndromes. At the authors' institution, DBS candidates who did not fit the populations represented in these trials were managed with DBS of multiple distinct targets, which included ANT, CM, and less-studied nuclei-i.e., mediodorsal nucleus, pulvinar, and subthalamic nucleus. The goal of this study was to present the authors' experience with these types of cases, and to motivate future investigations that can determine the long-term efficacy of multitarget DBS. ⋯ Multitarget DBS is a procedurally feasible and safe treatment strategy to maximize outcomes in patients with complex epilepsy. The authors highlight their approach to inform future studies that are sufficiently powered to assess its efficacy.
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Hemifacial spasm (HFS) causes both physical and psychological disabilities that significantly impact quality of life. Medical management with serial botulinum toxin injections provides transient spasm relief and is widely reported as highly effective, as compared to no treatment. ⋯ Although the majority of MVD neurosurgeons maintain a low annual case volume, excellent safety and success rates can be achieved with attention to technical nuances and anatomical appreciation of the target facial root exit zone. Attention to better informing patients and optimizing surgical outcomes should lead to a greater role for neurosurgery in the treatment and cure of HFS.