Neurosurgery
-
Ventriculoperitoneal shunting is one of the most commonly performed neurosurgical procedures. Typically, for insertion of the peritoneal catheter, a mini-laparotomy technique is used. Although generally safe, it can be cosmetically undesirable and time consuming. Complications include malpositioning, bowel injury, and delayed hernias. Laparoscopic techniques have been advocated to address these issues, but have been slow to gain traction with neurosurgeons. ⋯ Single port optical access laparoscopy is a fast and minimally invasive technique that allows direct visualization of the layers of the abdominal wall as they are traversed and visualization of the peritoneal catheter during placement. It uses a small cosmetic incision and obviates the need for postoperative abdominal radiographic studies. The procedure has a modest learning curve, but can be safely used without the assistance of an assist surgeon after the skills are acquired.
-
The usefulness of 5-aminolevulinic acid (5-ALA) for resection of malignant astrocytomas has been established in recent years. In addition to these tumors, it has been reported that 5-ALA fluorescence could be elicited in other tumors such as intracranial and spinal meningiomas or posterior fossa and spinal cord ependymomas, resulting in improved resections. Here, we present 2 cases of subependymomas of the fourth ventricle that showed intense fluorescence after 5-ALA administration. To the best of our knowledge, these are the first reported cases of subependymomas in this location in which 5-ALA elicited useful fluorescence. ⋯ Fluorescence-guided resection with 5-ALA may be useful for resection of subependymomas of the fourth ventricle. However, further studies are needed.
-
Clinical outcome of children with suspected shunt malfunction evaluated in the emergency department.
Patients with cerebrospinal fluid shunts frequently present to the emergency department (ED) with suspected shunt malfunction. The outcome of those patients who were discharged from ED when shunt malfunction was deemed unlikely has not been previously documented. ⋯ Children with cerebrospinal fluid shunts are often evaluated in the ED. Discharge from the ED, when suspicion for shunt malfunction is low, is an appropriate practice.
-
As with most minimally invasive spine procedures, lateral lumbar interbody fusion (LLIF) requires the use of biplanar fluoroscopy for localization and safe interbody cage placement. Computed tomography (CT)-based intraoperative spinal navigation has been shown to be more effective than fluoroscopic guidance for posterior-based approaches such as pedicle screw instrumentation. However, the use of spinal navigation in LLIF has not been well studied. ⋯ Use of an intraoperative cone-beam CT with an image-guided navigation system is feasible and safe and appears to be accurate, although a larger study is required to confirm these results.
-
Stereotactic laser amygdalohippocampectomy (SLAH) is a promising minimally invasive alternative for mesial temporal lobe epilepsy. As seizure outcome has been associated with the extent of amygdalar and hippocampal ablation, it is important to select a safe trajectory optimizing involvement of both structures; however, variations in temporal anatomy significantly affect the overall complexity of planning. ⋯ The medial AHC angle dictates the medial trajectory angle and a path from the posteroinferior corridor through the hippocampus and the center of the amygdala dictates the caudal angle. These observations led to a protocol for long-axis AHC cannulation that maintains an extraventricular trajectory to minimize hemorrhage risk and targets the center of the amygdala to optimize ablation volumes.