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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: 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: 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: 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: 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: 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: 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: Mojgan Hodaie
Duration: 0:32
Journal: Neurosurgery
This movie shows sequential tractography images for all three patients in this study. Images consist in axial and perspective view T1 anatomical images with superimposed 3D volume representation of the tumor and surrounding cranial nerves. Note the anatomical fidelity of the position of the tumor with respect to the underlying 2D MR image.
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: 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: 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: 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: 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: 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: 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: Rossana Romani
Duration: 2:58
Journal: Neurosurgery
Microneurosurgical removal of medium (max diameter: 28 mm) Anterior Clinoidal Meningioma (hard consistency) via a classic right lateral supraorbital approach. The patient was a woman 67 year old with left superior limb paresis completely recovered at the outpatient clinic control, three months after the operation.
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: 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: 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: Tao Wang
Duration: 0:39
Journal: Neurosurgery
Video of a 25-year-old man who suffered complete brachial plexus avulsion, three years after reinnervation of the medial portion of the antebrachial part of the radial nerve at the level of the latissimus dorsi insertion with a full-length phrenic nerve, demonstrating wrist and digit extension function.
Creator: Rangel-Castilla, Leonardo
Duration: 1:09
Journal: Neurosurgery
Intraoperative endoscopic video of the lamina terminalis fenestration procedure. The video starts with the neuroendoscope in the third ventricle looking at the tuber cinerum and optic chiasm. After identifying the optic chiasm, the tip of the flexible neuroendoscope is bent anteriorly, the suprachiasmatic recess and the lamina terminalis are identified next. Once in position, with a closed grasping forceps, the lamina terminalis is perforated. The ostomy is slowly enlarged with the grasping forceps or with the neuroendoscope itself. The anterior communicating artery complex and its branches are identified. The ostomy is further enlarged if necessary. The free edges of the ostomy move with the pulsation of the brain indicating CSF flow. The purpose of this second video is to show that the position of the anterior communicating artery may vary, in this case the ostomy was made closer to the artery but still below it.
Creator: Laligam N. Sekhar
Duration: 3:38
Journal: Neurosurgery
This is a case illustration of a broad based aneurysm with both PCA's arising from neck of the aneurysm treated by microsurgical clipping via right frontotemporal craniotomy and orbitozygomatic osteotomy.
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