Creator: Nathan R Selden
Duration: 9:52
Journal: Neurosurgery
This video summarizes a dural splitting craniocervical decompression procedure for Chiari I without syringomyelia. The goal of surgery for Chiari 1 malformation is to restore normal cerebral spinal fluid dynamics at the craniocervical junction. Traditionally, shrinkage or even resection of the cerebellar tonsils has been advocated. More recently, simple duraplasty without manipulation of the intradural contents or even extradural decompression have been undertaken. A dural splitting decompression procedure in a 17-year-old male who presented with medically refractory, unremitting and progressive suboccipital headaches is described.
Creator: Peter Nakaji
Duration: 5:34
Journal: 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.
Creator: Michael T. Lawton
Duration: 5:51
Journal: Neurosurgery
In this 3-D video, we show the case of a 66 year-old ophthalmologist who presented with hemiparkinsonism and slow cognitive decline due to a 3 cm lesion located beneath the head of his left caudate nucleus. A contralateral transcallosal approach allowed the identification and complete removal of a cavernous malformation located immediately below the ependymal surface of his left lateral ventricle.
Creator: Ivan Cabrilo
Duration: 2:12
Journal: 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.
Creator: Thomas Westermaier
Duration: 2:15
Journal: Neurosurgery
Screen video of the reconstruction procedure. After the subtraction of the enhanced and non-enhanced images, the volume rendering mode of the OsiriX® software was used for 3-D reconstruction. Thereafter, the bone was manually removed, the arterial tree was selectively depicted and a 360° rotation video was generated.
Creator: Xin-guang Yu
Duration: 0:28
Journal: Neurosurgery
This video describes the schematic form of the intraoperative manipulation and reduction process of the C1-2 dislocation and basilar invagination. After opening the facet joint, C1 lateral mass and C2 pedicle screws were inserted in both sides. Then, two rods were connected bilaterally. When the rods were gradually fastened with the screws, the screw-rod system distracted the C1 backward and pushed the C2 downward and forward, thus achieving the reduction.
Creator: Richard Mannion
Duration: 5:59
Journal: Neurosurgery
This video demonstrates the minimally invasive approach to intradural tumors using the transmuscular dilating tubes with an oblique angle to the spine and a hemilaminotomy using the high speed drill. This allows preservation of the spinous processes, inter- and supraspinous ligaments and hemilamina on the contralateral side, while not compromising the microsurgical technique required for tumor dissection, mobilization and resection. Thus, we feel that this technique offers distinct advantages to the patient through a reduction in tissue trauma with no disadvantageous implications for tumor removal.
Creator: Nicholas Theodore
Duration: 4:22
Journal: Neurosurgery
Intraoperative video of a left-sided transpedicular approach to the T3-4 disk space. The dura is opened laterally and the spinal cord mobilized to visualize the ventral herniation. Upon identifying the dural defect, the opening is lengthened sharply both superiorly and inferiorly and then packed with dural substitute. The spinal cord demonstrates good reduction at the end of the procedure.
Creator: Timo Krings
Duration: 1:30
Journal: Neurosurgery
SFE video demonstrating deployment of aneurysm coils from a 2.8F microcatheter. Flow is temporarily arrested proximally with a coaxial balloon guide catheter, and after detachment inspection of the coil mass demonstrates a hanging detachment zone end as well as the dense packing of coils at the level of the orificium.
Creator: Aaron A. Cohen-Gadol
Duration: 4:21
Journal: Neurosurgery
In this 3-D video, the authors demonstrate their preferred technical nuances to resect a large middle to medial sphenoid wing meningioma. The patient is a 41-year-old man with a large left sphenoid wing meningioma found during routine imaging after a minor head trauma. MRI evaluation revealed minimal edema associated with this tumor. The resection was performed via a standard pterional craniotomy and drilling of the sphenoid wing.
Creator: Bernard R. Bendok
Duration: 0:47
Journal: 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.
Creator: Boulis, Nicholas
Duration: 1:28
Journal: Neurosurgery
This narrated video demonstrates the process of intraspinal microinjection with use of a floating cannula. The cannula is introduced into the cord in rigid confirmation. After the microinjection needle is firmly seated into the spinal cord, the rigid outer cannula is withdrawn. The flexible silastic inner cannula is then able to move with cardioballistic and respiratory-associated cord movement. At microinjection completion, the outer cannula is returned to its original position and the injection cannula is withdrawn.
Creator: Bernard R. Bendok
Duration: 6:02
Journal: Neurosurgery
In this 3-dimensional commented video, we report the case of a 21-year-old nursing student who presented with one episode of seizure. A right frontal lobe AVM one gyrus anterior to the hand motor area was discovered. After careful consideration of all options by the patient and treating team, the AVM was embolized pre-operatively and then completely resected microsurgically.
Creator: Bernard R. Bendok
Duration: 6:39
Journal: Neurosurgery
In this 3-dimensional video, we present the case of a healthy 74-year-old college English professor in whom an incidental high-grade ethmoidal dural arteriovenous fistula was discovered. The fistula was treated by microsurgical clipping of the draining vein where it emanated from the dura of the anterior cranial base without complications. The patient returned to teaching 1 month after surgery.
Creator: Marc A. Brockmann
Duration: 1:09
Journal: 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.
Creator: Bernard R. Bendok
Duration: 3:05
Journal: 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.
Creator: Robert J. Spinner
Duration: 0:53
Journal: Neurosurgery
The formation and propagation of a peroneal intraneural ganglion (the most common type of intraneural cyst) is illustrated. This video highlights the articular branch connection and the phasic nature of ascent (up the articular branch to the common peroneal nerve); cross-over within the shared epineurial sheath of the sciatic nerve; and descent (down the tibial nerve).
Creator: Juan C. Fernández-Miranda
Duration: 1:22
Journal: Neurosurgery
This video illustrates the surgical removal or identification of the middle clinoid in various situations: transellar approach with normal sella, transellar approach with expanded sella, and suprasellar approach with normal sella.
Creator: Jayme A. Bertelli
Duration: 0:51
Journal: Neurosurgery
Nerve Transfer for Thumb Flexion This video demonstrates Pre and postoperative motion of the left hand in a tetraplagegic patient following reconstruction of thumb and finger flexion. Finger flexion was reconstructed by transferring the brachialis muscle to the flexor digitorum profundus with the help of a tendon graft. The distal branch of the extensor carpi radialis brevis was transferred to the motor branch of the flexor pollicis longus.
Creator: Rangel-Castilla, Leonardo
Duration: 2:20
Journal: Neurosurgery
Intraoperative endoscopic video of the lamina terminalis fenestration procedure. The video starts with a standard endoscopic third ventriculostomy and exploration of the basal cisterns. Very limited space for adequate CSF flow within the cisterns was noted. Proceeding with the LT fenestration, the tip of the flexible neuroendoscope is bent ventraly. The optic chiasm is identified. Utilizing a closed grasping forceps for the initial fenestration, the lamina terminalis is perforated. The ostomy is slowly enlarged with the neuroendoscope itself. The anterior communicating artery complex is identified. The ostomy is further enlarged if necessary.
Creator: Joachim Oertel
Duration: 5:29
Journal: Neurosurgery
This is a supplemental video for the manuscript Dual-portal Endoscopic Release of the Transverse Ligament in Carpal Tunnel Syndrome: Results of 411 Procedures with Special Reference to Technique, Efficacy, and Complications
Creator: Leonardo Rangel-Castilla
Duration: 2:44
Journal: Neurosurgery
The endoscope is advanced in a standard approach to the lateral horn and through the foramen of Monro into the third ventricle. The mammillary bodies are visualized; under the massa intermedia the endoscope is oriented posteriorly until the cerebral aqueduct is found. Once at the cerebral aqueduct entrance, the flexible endoscope is rotated clockwise until the fourth ventricle is entered. The choroid plexus is observed at the roof of the fourth ventricle and followed laterally to reach for the foramen of Luschka. The endoscope is passed underneath the inferior cerebellar peduncle. A thin membranous veil covers the Lushcka foramina, in this case the membrane is abnormally thickened. A blunt instrument is used to perforate the membrane and create an opening that is widened by moving the endoscope laterally. Caution should be used to avoid injury to the cranial nerves. The endoscope is drawn back to the midline of the fourth ventricle until the Magendie foramina is identified. Similarly, a blunt instrument is used to open the Magendie foramina. Caution should also be used to avoid injury to the posteroinferior cerebellar arteries. The endoscope is advanced through the foramen magnum into the cisterna magna. Lastly, the endoscopes is carefully withdrawn out of the ventricles.
Creator: Michael T. Lawton
Duration: 5:32
Journal: Neurosurgery
In this 3-D video, the authors present a case of a 53 year-old female who presented with subarachnoid hemorrhage from a P1 segment posterior cerebral artery (PCA) aneurysm, which was coiled at an outside institution, and made an excellent recovery.
Creator: Sang-Ho Lee
Duration: 1:50
Journal: Neurosurgery
A 29-year-old male patient presented with back and radiating pain in both legs. MRI shows large disc herniation at the L4-5 level.
For successful percutaneous endoscopic lumbar discectomy, a working cannula should first be located with herniation. The left side is caudal side, right side is cranial side, 6 o’clock direction is toward the nucleus pulposus, and 12 o’clock is toward the epidural space. Second, we make a working space with the removal of disc tissue using a side-firing laser and forceps. We then release the annular anchorage with the laser. Third, we catch a disc fragment and pull the disc fragment by twisting the forceps.
After removal of the disc fragment, we find the torn annulus and check the epidural space. The torn annulus is shrunk by laser and bipolar coagulator.
After the PELD, the symptoms improved and postoperative MR shows good decompression.
Creator: Nikolay L. Martirosyan
Duration: 0:10
Journal: Neurosurgery
The in vivo video loop obtained from the femoral artery of the rat after ICG injection into the jugular vein. The femoral artery and vein are visible within the field of view. Once ICG enters the blood stream it appears as a bright green fluorescence signal confined within the anatomical boundaries of the femoral artery. The direction of the blood flow can be identified. The segment of the femoral artery covered by fat and connective tissue is clearly delineated.
Creator: Daniel C. Lu
Duration: 3:03
Journal: Neurosurgery
This is an intraoperative video demonstrating the techniques of C1 lateral mass fixation based on a review of 42 consecutive patients who underwent this procedure. The patient population consisted of 24 men and 18 women with a mean age of 64 years. Twenty-two patients had C1-2 constructs. Twelve patients had constructs that started at C1 and extended to the mid/low cervical spine (one extended to T1). Eight patients underwent occipitocervical fusions incorporating C1 screws (two of which were occipito-cervical-thoracic constructs).
Creator: Paolo Ferroli
Duration: 0:09
Journal: Neurosurgery
This patient underwent a microvascular decompression that allowed for the intraoperative diagnosis of a pontine micro-AVM. The petrosal vein was found to be arterialized and the trigeminal root to be embedded in a tangle of abnormal arterialized vessels. ICG videoangiography confirmed the arterialization of the vein and identified the flow direction to be from the brainstem to the superior petrosal sinus.
Creator: Robert F. Spetzler
Duration: 2:37
Journal: Neurosurgery
This video displays right-sided modified orbitozygomatic approach for clipping of a giant previously stent-coiled PCoM artery aneurysm. An emergent extracranial to intracranial bypass was performed using a radial artery graft following rupture of the aneurysm neck.