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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: 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: 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: 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: 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: 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: 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: 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: 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: 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: Francesco Prada
Duration: 0:54
Journal: Neurosurgery
Intraoperative video obtained prior to resection of a right parietal glioblastoma. The screen displays dual ultrasound imaging of the same field of view with low MI US B-mode imaging on the left hand side and iCEUS imaging on the right hand side of the screen. Standard B-mode US allows identification of the region of interest while iCEUS is performed. On the left inferior corner is also visible a timer, which is manually started after UCA injection and permits the evaluation of the different vascular phases. Note how iCEUS is able to show the dynamic perfusion of the lesion, highlighting major feeding vessels, intralesion arteries, tumor mass, cystic/necrotic areas and draining veins. iCEUS degree of enhancement of the lesion is compared to normal brain parenchyma CE.
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: 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: 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: 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: 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: 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: 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: 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: Tarik F. Massoud
Duration: 0:12
Journal: Neurosurgery
The realistic, dynamic, high flow transition of opacified blood is appreciated on this cine angiogram at 30 frames per second demonstrating components of the pig AVM model. Upon injection of the left common carotid artery there is fast shunting from the AF (left ascending pharyngeal artery), across the nidus (bilateral retia mirabilia, magnified view), and emptying into the DV (right ascending pharyngeal artery) owing to the sump effect of the right carotid-jugular fistula (not shown). Subtracted views are shown in real time.
Creator: Muneyoshi Yasuda
Duration: 2:54
Journal: Neurosurgery
The anterolateral procedure is one of ideal approaches to the anterior part of the cervical spinal canal because it allows minimally invasive surgery without any fixation. However, it is not frequently used due to various technical difficulties. This patient had an intradural schwannoma ventrolateral to the spinal cord that was removed using this method.
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