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Cerebrovascular

Creator:   Neurosurgery
Created:   4/10/2012
Contains:  11 items
This collection includes videos from Neurosurgery's most recent cerebrovascular articles.

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Force Characterization of Intracranial Endovascular Embolization Video 1

Neurosurgery

Membrane Displacement. A representative video of membrane displacement during a simulated embolization by Cosmos coil at 30 mm/min and central microcatheter tip placement demonstrates the raw images analyzed in the study.

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Force Characterization of Intracranial Endovascular Embolization Video 2

Neurosurgery

Embolization: Manual Insertion. Simulated embolization was performed manually with the Cosmos coil under surgical microscope to demonstrate the interaction between the endovascular coil and the membrane. Specifically evident in the video is the relationship between insertion and increasing membrane displacement.

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Force Characterization of Intracranial Endovascular Embolization Video 3

Neurosurgery

Embolization: Automated Insertion. Simulated embolization was performed with automated insertion by CSTM at a rate of 30 mm/min with the Cosmos coil and microcatheter tip placement in the center of the aneurysm. The painting motion of the microcatheter is evident and coincident with force build-up and release on the membrane.

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Bypass for Iatrogenic ICA Injury

Neurosurgery

We present a 65-year-old male with recurrent skull base chordoma. The patient had undergone several endoscopic skull base resections and radiation therapy due to multiple recurrence. Most recent MRI showed aggressive recurrence of the tumor invading the skull base, ethmoid sinus, cavernous sinus and right orbit. He underwent a radical transfacial, transmaxillary resection of the tumor and orbital content. During the procedure the ICA was injured. Immediate cerebral angiogram showed stenosis and possible dissection of the cavernous ICA but with adequate distal flow. The next day, the patient experienced progressive left hemiparesis. A repeat cerebral angiogram showed worsening of the stenosis with minimal distal flow. Endovascular therapy failed. The patient did not pass the balloon test occlusion. An urgent cerebral revascularization procedure was recommended. The patient underwent a high-flow ICA-MCA bypass with a radial artery graft. Intraoperative indocyanine green angiogram showed adequate patency of the bypass. The patient remained neurologically intact. A postoperative cerebral angiogram 24-48hrs after the procedure showed adequate cerebral blood flow. The arterial graft had a focal stenosis that required balloon angioplasty.

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Augmented Reality in the Surgery of Cerebral Aneurysms

Neurosurgery

Augmented reality aided clipping of an unruptured, 4 mm, growing left posterior communicating artery aneurysm in a patient with a past medical history significant for the clipping of a ruptured left MCA aneurysm five years earlier and for the placement of a Pipeline stent due to neck re-growth. Before incision (00’06’’-00’34’’): The patient is settled in the supine position and her head is turned to the right. Skull exposition (00’35’’-01’05’’): The superior orbital rim, zygoma and titanium plate from a previous intervention are seen. The segmented skull images are superposed. After craniotomy (01’06’’-02’08’’): Arachnoid dissection, identification of the anterior choroidal artery, choice of clip and clip placement is guided by image injection. Note the presence of an intravascular stent in the M1 segment of the MCA from a previous endovascular intervention.

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Flow-diverter Hemodynamics

Neurosurgery

Video of a digital subtraction angiography series showing the effects of implantation of one or more pipeline stents on aneurysm hemodynamics. First, a sidewall aneurysm with a straight parent vessel prior to implantation of a flow diverter stent is shown. A turbulent, circulating, high velocity intra-aneurysmal flow profile can be seen, indicative of high wall shear stress. After implantation of a single stent a reduction of total contrast inflow and time until maximum contrast density is reached. In addition, the turbulent high-velocity aneurysm inflow is scrambled. After superimposition of a second pipeline embolization device a further decrease of inflow-speed and intra-aneurysmal contrast is observed.
Next, digital subtraction angiography series of a fusiform aneurysm model before and after implantation of FDS are shown. Before treatment, a straddling turbulent flow pattern is visualized at the distal aneurysm wall along the outflow tract. After telescoping implantation of two stents contrast flow into the aneurysm is reduced and a pulsatile pattern of contrast inflow through the stent mesh can be seen. Consequently, a reduction in total contrast inflow and time until maximum contrast density is reached. After superimposition of a third pipeline embolization device the contrast agent more homogeneously oozes out of the stent lumen into the aneurysm.

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Omental-cranial Transposition for Pediatric Moyamoya

Neurosurgery

This video demonstrates laparoscopic harvest of pedicled omentum for cranial transposition in children with moyamoya disease.

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CO2 Laser for Cavernous Malformation Resections Video 1

Neurosurgery

Video 1 shows the resection of a pontomedullary CM by CO2 laser and bipolar coagulation.

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MCA Aneurysm Anatomical Classification Scheme

Neurosurgery

This video demonstrates the aspects of the different aneurysm classifications as well as potential clip solutions for each category.

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Interposition Graft in MCA Aneurysms

Neurosurgery

This video shows surgical treatment of giant and large fusiform MCA aneurysms with excision and interposition radial artery graft in a four year old child.

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Carotid Artery Injury During Endoscopic Endonasal Skull Base Surgery: Incidence and Outcomes

Neurosurgery

This video shows carotid artery injury and management with bipolar coagulation salvage.

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