World Neurosurg
-
The engineered herpes simplex virus-1 G207, is a promising therapeutic option for central nervous system tumors. The first-ever pediatric phase 1 trial of continuous-infusion delivery of G207 via intratumoral catheters for recurrent or progressive malignant brain tumors is ongoing. In this article, we describe surgical techniques for the accurate placement of catheters in multiple supratentorial locations and perioperative complications associated with such procedures. ⋯ The placement of multiple intratumoral catheters in pediatric patients with supratentorial tumors via frameless stereotactic techniques is feasible and safe. Intratumoral catheters provide a potentially effective route for the delivery of G207 and may be employed in other trials utilizing oncolytic virotherapy for brain tumors.
-
Case Reports
Retrosigmoid Intradural Temporal Bone Drilling for Intrapetrous Chondrosarcoma Extending to Cerebellopontine Angle.
Recently the intradural temporal bone drilling has been used in conjunction with the retrosigmoid approach to allow expanded to access to a variety of types of intraosseous invasions.1,2Video 1 demonstrates the intradural temporal bone drilling via the retrosigmoid approach in the microsurgical removal of an intrapetrous chondrosarcoma extending to the cerebellopontine angle. The patient was a 23-year-old woman presented with progressive hearing disturbance, hemifacial spasm, and tinnitus. Neuroimaging revealed a left intrapetrous tumor extending as far as the cerebellopontine angle, destroying the temporal bone around the internal acoustic meatus and petrous carotid artery. ⋯ Although slight facial palsy developed postoperatively, the hemifacial spasm and tinnitus disappeared. Her facial palsy almost disappeared within the 6 months of follow-up, and careful observation over a 2-year period revealed no tumor recurrence, without any additional treatment. Informed consent was obtained from the patient.
-
Contralateral acute subdural hematoma (ASDH) is an uncommon but devastating complication during craniotomy and hematoma evacuation. It can lead to extremely poor outcomes if not treated properly and promptly. ⋯ We highlight that super-early intervention of contralateral hematoma is important to improve the prognosis of these patients.
-
Minimally invasive surgery using a mini-open lateral retropleural or retroperitoneal approach for corpectomy is a well-described procedure for treating unstable thoracolumbar burst fractures. Most surgeons have incorporated fluoroscopy for localization and determination of hardware placement accuracy; however, the utility of computer-assisted image-guided spinal navigation has not been well described. We report a series of mini-open lateral approach thoracolumbar corpectomy cases using either fluoroscopy or intraoperative computed tomography (iCT) with computer-assisted navigation and discuss the technical nuances and advantages of using iCT with navigation versus fluoroscopy. ⋯ The use of iCT with spinal navigation for mini-open lateral corpectomy for thoracolumbar burst fractures yields perioperative and clinical outcomes comparable to those using traditional fluoroscopy, with decreased radiation exposure to surgeons.