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Neurosurgical Focus

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https://www.readbyqxmd.com/read/28669301/editorial-advancement-in-brain-machine-interfaces-for-patients-with-tetraplegia-neurosurgical-perspective
#1
Kejia Hu, Firas Bounni, Ziv Williams
No abstract text is available yet for this article.
July 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28669300/contralateral-c-7-transfer-is-direct-repair-really-superior-to-grafting
#2
Anil Bhatia, Piyush Doshi, Ashok Koul, Vitrag Shah, Justin M Brown, Mahmoud Salama
It is not uncommon for a severe traumatic brachial plexus injury to involve all 5 roots, resulting in a flail upper limb. In such cases, surgical reconstruction is often palliative, providing only rudimentary function. Nerve transfers are the mainstay of reconstructive strategies due to the predominance of root avulsions. Consistent results are obtained only for restoration of shoulder stability and elbow flexion, whereas restoring useful hand function remains a challenge. The transfer of the contralateral C-7 (cC-7) is commonly used in an attempt to restore basic hand function, but results are notoriously unreliable and inconsistent...
July 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28669299/introduction-neurosurgical-rehabilitation
#3
Justin M Brown, Bob S Carter, Keith E Tansey, Ross Zafonte
No abstract text is available yet for this article.
July 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28669298/letter-to-the-editor-surgical-strategy-for-craniopharyngiomas-and-the-tumor-infundibulum-relationship
#4
André Beer-Furlan, Ali O Jamshidi, Ricardo L Carrau, Daniel M Prevedello
No abstract text is available yet for this article.
July 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28669297/establishing-reconstructive-neurosurgery-as-a-subspecialty
#5
Justin M Brown, Mark A Mahan, Ross Mandeville, Bob S Carter
Neurosurgery is experiencing the emergence of a new subspecialty focused on function restoration. New, evolving, and reappraised surgical procedures have provided an opportunity to restore function to many patients with previously undertreated disorders. Candidates for reconstruction were previously limited to those with peripheral nerve and brachial plexus injuries, but this has been expanded to include stroke, spinal cord injury, and a host of other paralyzing disorders affecting both upper and lower motor neurons...
July 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28669296/a-neurophysiological-approach-to-nerve-transfer-to-restore-upper-limb-function-in-cervical-spinal-cord-injury
#6
Ross M Mandeville, Justin M Brown, Geoffrey L Sheean
A successful nerve transfer surgery can provide a wealth of benefits to a patient with cervical spinal cord injury. The process of surgical decision making ideally uses all pertinent information to produce the best functional outcome. Reliance on clinical examination and imaging studies alone can miss valuable information on the state of spinal cord health. In this regard, neurophysiological evaluation has the potential to effectively gauge the neurological status of even select pools of anterior horn cells and their axons to small nerve branches in question to determine the potential efficacy of their use in a transfer...
July 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28669295/nerve-transfer-versus-muscle-transfer-to-restore-elbow-flexion-after-pan-brachial-plexus-injury-a-cost-effectiveness-analysis
#7
Arvin R Wali, David R Santiago-Dieppa, Justin M Brown, Ross Mandeville
OBJECTIVE Pan-brachial plexus injury (PBPI), involving C5-T1, disproportionately affects young males, causing lifelong disability and decreased quality of life. The restoration of elbow flexion remains a surgical priority for these patients. Within the first 6 months of injury, transfer of spinal accessory nerve (SAN) fascicles via a sural nerve graft or intercostal nerve (ICN) fascicles to the musculocutaneous nerve can restore elbow flexion. Beyond 1 year, free-functioning muscle transplantation (FFMT) of the gracilis muscle can be used to restore elbow flexion...
July 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28669294/unilateral-thalamic-and-pallidal-deep-brain-stimulation-for-idiopathic-hemidystonia-results-of-individual-and-combined-stimulations-case-report
#8
Victor Goulenko, Paulo Luiz da Costa Cruz, Paulo Niemeyer Filho
Pallidal stimulation has been the usual surgical treatment for dystonia in the last decades. The continuous investigation of the physiopathology and the motor pathways involved leads to the search for complementary targets to improve results. The authors present the case of a 37-year-old woman who had suffered from idiopathic hemidystonia with hyperkinetic and hypokinetic movements for 11 years, and who was treated with deep brain stimulation. A brief literature review is also provided. The globus pallidus internus and the ventral intermediate/ventral oral posterior complex of the thalamus were stimulated separately and simultaneously for 3 months and compared using the Burke-Fahn-Marsden Dystonia Rating Scale and the Global Dystonia Severity Rating Scale, with a 3...
July 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28669274/resection-of-complex-occipital-arteriovenous-malformation-with-giant-varix-demonstration-of-microsurgical-technique
#9
Pinar Eser Ocak, Cem Dinc, Ulaş Cikla, Mustafa K Başkaya
The complexity of arteriovenous malformations (AVMs) does not necessarily preclude surgical resection. In this video the authors present a 72-year-old male who was known to have an occipital AVM with a large draining varix for the previous 10 years. The patient had progressively worsening visual and cognitive deficits over several years. Total surgical resection was achieved following single stage preoperative embolization. Although resection of the AVMs is challenging, even in experienced hands, it offers a cure and may improve patient clinical outcome...
July 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28669273/motor-cortex-arteriovenous-malformation
#10
Alfred P See, Bruno C Flores, Karam Moon, Andrew F Ducruet, Robert F Spetzler, Felipe C Albuquerque
Supratentorial arteriovenous malformations in eloquent territories can be difficult to resect. This video presents the treatment of a patient with a symptomatic 3-cm arteriovenous malformation in the left motor strip. At the authors' institution, per the surgeon's discretion, preoperative angiography is performed to evaluate the need for preoperative embolization. Multimodality treatment reduced the microsurgical risk by allowing early occlusion of a draining vein, by decreasing overall intraoperative hemorrhage, and by allowing minimal pial dissection in the deep aspect of the arteriovenous malformation that abutted the corticospinal tract...
July 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28669272/utility-of-indocyanine-green-videoangiography-in-subcortical-arteriovenous-malformation-resection
#11
Oriela Rustemi, Renato Scienza, Alessandro Della Puppa
Subcortical arteriovenous malformations (AVMs) are surgically challenging. Localization is crucial for eloquent areas, and complete resection evaluation is uncertain. Indocyanine green videoangiography (ICG-VA) can assist this surgery. An illustrative video of a subcortical frontoparietal bleeding AVM resection assisted by ICG-VA is presented. A bleeding arterial feeder aneurysm was embolized in the acute phase to protect against rebleeding. ICG-VA helped to detect the AVM's superficial arterialized draining vein, distinguishing it from normal cortical veins...
July 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28669271/lateral-parietal-arteriovenous-malformation-with-feeding-artery-aneurysm
#12
Ashish H Shah, Anthony C Wang, Jacques J Morcos
Superficial arteriovenous malformations (AVMs) with favorable Spetzler-Martin grading are amenable to primary surgical resection. Careful preoperative workup including preoperative angiograms is essential to identify feeding artery aneurysms and deep venous drainage. The authors present a 37-year-old female who presented with a Spetzler-Martin Grade II right parietal superficial AVM with a 5-mm feeding artery aneurysm from the posterior cerebral artery. Given the risk of hemorrhage, the AVM was resected completely without any complications...
July 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28669270/selective-embolization-of-ruptured-feeding-artery-aneurysm-followed-by-resection-of-arteriovenous-malformation
#13
Brian P Walcott, Jonathan J Russin, Robin Babadjouni, William J Mack
This is the case of a man in his 40s who suffered sudden collapse into a deep coma as a result of a ruptured arteriovenous malformation (AVM) feeding artery aneurysm within the lateral ventricle. The ruptured aneurysm was successfully treated with Onyx embolization of the feeding pedicle. The AVM and the feeding artery aneurysm were then removed via a transcallosal approach. This case highlights the utility of interrogating the AVM with microcatheterization of the feeding pedicles in order to define the exact anatomical features necessary for treatment planning...
July 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28669269/microsurgical-management-of-a-high-grade-brain-arteriovenous-malformation-in-the-central-lobe-after-unsuccessful-radiosurgery
#14
Jean G de Oliveira, Carlos R Massella, Carlos Vanderlei M de Holanda, Miguel Giudicissi-Filho, Luis A B Borba
The recommendation for the great majority of high-grade brain arteriovenous malformations (bAVMs) is observation, except for those patients with recurrent hemorrhages, progressive neurological deficits, steal-related symptoms, or AVM-related aneurysms, for whom intervention should be considered. These are general recommendations, and the decision should be made on an individual basis. Surgical resection of an AVM in the central lobe may cause postoperative sensorimotor deficits since this anatomical region includes the pre- and postcentral gyri on the lateral surface and the paracentral lobule on the medial surface...
July 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28669268/introduction-to-the-supratentorial-cerebral-arteriovenous-malformation-video-supplement
#15
Robert M Starke, Felipe C Albuquerque, Michael T Lawton
It is with great pleasure that we present this Neurosurgical Focus video supplement on supratentorial cerebral arteriovenous malformations (AVMs). We were privileged to view a remarkable number of outstanding videos demonstrating current state-of-the-art management of brain AVMs using endovascular and microsurgical modalities. Careful and critical review was required to narrow down the submitted videos to a workable volume for this supplement, which reflects the excellent work being done at multiple centers with these lesions...
July 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28669267/microsurgical-resection-of-a-high-grade-occipital-arteriovenous-malformation-after-staged-embolization
#16
Liyong Sun, Hongqi Zhang, Jian Ren
The authors demonstrate the case of a 16-year-old girl with a large symptomatic occipital arteriovenous malformation (AVM). The staged embolization was performed to downgrade the AVM from Spetzler-Martin (S-M) Grade IV (Supplementary S-M Grade 7) to Grade III (Supplementary S-M Grade 5). The patient developed a subacute progressive visual field defect after the final time of embolization. MRI revealed an enlarged draining venous ectasia of the AVM compressing the visual cortex. Postoperatively, good radiological results were achieved, and the patient reported an improvement in her symptoms...
July 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28669266/navigation-guided-transsylvian-approach-and-microsurgical-resection-of-a-deep-left-temporal-low-grade-arteriovenous-malformation
#17
William T Couldwell
This video demonstrates stereotactic-guided resection of a ruptured diffuse left temporal arteriovenous malformation (AVM) in an adolescent male who presented with headache and speech difficulties. The diffuse nidus of the AVM, 25 mm in size, was located in the posterior superior temporal gyrus, with drainage into the sylvian veins (Spetzler-Martin Grade II). The AVM was located stereotactically, and resection was performed through a small corticectomy. The clot cavity was evacuated. Feeding branches to the AVM were identified during careful dissection, and parent M1 and M2 branches were preserved...
July 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28669265/contralateral-transcallosal-resection-of-a-ventricular-body-arteriovenous-malformation-3d-operative-video
#18
Brian P Walcott, Jae Seung Bang, Omar Choudhri, Sirin Gandhi, Halima Tabani, Arnau Benet, Michael T Lawton
A 46-year-old male presented with an incidentally discovered left ventricular body arteriovenous malformation (AVM). It measured 2 cm in diameter and had drainage via an atrial vein into the internal cerebral vein (Spetzler-Martin Grade III, Supplementary Grade 4). Preoperative embolization of the posterior medial choroidal artery reduced nidus size by 50%. Subsequently, he underwent a right-sided craniotomy for a contralateral transcallosal approach to resect the AVM. This case demonstrates strategic circumferential disconnection of feeding arteries (FAs) to the nidus, the use of aneurysm clips to control large FAs, and the use of dynamic retraction and importance of a generous callosotomy...
July 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28669264/surgical-treatment-of-a-complex-grade-iii-spetzler-martin-posterior-temporal-arteriovenous-malformation
#19
Amrit Chiluwal, Amir R Dehdashti
Grade III Spetzler-Martin arteriovenous malformations (AVMs) are a distinct subgroup of brain AVMs. Their variety in terms of location, type of venous drainage, and size makes them the most heterogenous group in the AVM classification. The surgical risk of treatment is also variable depending on the specifics of a given Grade III AVM. In this video illustration, the authors describe the technical nuances of surgical resection of a very complex Grade III left posterior temporal AVM. According to supplementary grading, the unruptured aspect and patient age give this lesion a Grade III; therefore, the combined grading gives the patient a score of 6, which puts him at moderate risk of morbidity for surgery...
July 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28669263/microsurgical-treatment-for-arteriovenous-malformation-of-the-corpus-callosum-and-choroidal-fissure
#20
Marcos Devanir Silva da Costa, Bruno Fernandes de O Santos, Felipe Bouchabki de Almeida Guardini, Feres Chaddad-Neto
The management of arteriovenous malformations (AVMs) of the corpus callosum and choroidal fissure is challenging because they commonly receive arterial feeders from the anterior and posterior circulation, and drain to deep veins. In this video the authors present the case of a 20-year-old man who presented with acute onset of headache, loss of consciousness, and nuchal rigidity. Computed tomography, MRI, and cerebral angiography performed in tandem revealed a ruptured, large, Grade IV AVM of the corpus callosum and choroidal fissure with two groups of arterial feeders: one from the pericallosal artery and the other from the medial and lateral posterior choroidal arteries...
July 2017: Neurosurgical Focus
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