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In Chan Baek, Kyungeun Park, Tae Lim Kim, Jehoon O, Hun-Mu Yang, Shin Hyung Kim
Purpose: The spread patterns between different injectate volumes have not yet been investigated in ultrasound-guided greater occipital nerve (GON) block at the C2 level. This cadaveric study was undertaken to compare the spread pattern and nerve involvements of different volumes of dye using this technique. Materials and methods: After randomization, ultrasound-guided GON blocks with 1 or 5 mL dye solution were performed at the C2 level on the right or left side of five fresh cadavers...
2018: Journal of Pain Research
Christopher P Kellner, Frank Moore, Marc S Arginteanu, Alfred A Steinberger, Kevin Yao, Jacopo Scaggiante, J Mocco, Yakov Gologorsky
INTRODUCTION: Spontaneous cerebellar intracerebral hemorrhage (scICH) makes up approximately 10% of all cases of spontaneous ICH and carries a mortality of 20-50%. Suboccipital craniectomy is commonly performed for scICH causing brain stem compression or hydrocephalus but unfortunately has long anesthesia times and a high complication rate. We present a series of minimally invasive scICH evacuation as an alternative to traditional suboccipital craniectomy. METHODS: Operative records were retrospectively reviewed for patients presenting to a single center from 1/1/09 to 3/1/17...
October 3, 2018: World Neurosurgery
Chukwuemeka Samuel Okoye, Nan Zheng, Sheng-Bo Yu, Hong-Jin Sui
The dense connective tissue that connects muscles to the cervical spinal dura mater is known as the myodural bridge in human anatomy and has been a subject of interest to anatomists and clinicians. The myodural bridge was originally discovered in humans, and also has been observed in other mammals and in reptilian sauropsids. We investigated the existence of the myodural bridge in a bird, that is, the Common Rock Pigeon Columba livia, to expand the understanding of the structure and function of the myodural bridge...
October 3, 2018: Journal of Morphology
Joham Choque-Velasquez, Juha Hernesniemi
Background: In this video abstract, we present an unedited microsurgical resection of a fourth ventricular ependymoma performed by a senior author (JH). Currently, the goal of a standard treatment of a fourth ventricular ependymoma is based on microsurgical resection followed by radiochemotherapy. Our aim is to demonstrate the efficiency and safety of our microsurgical technique in deep brain territories under the principle "simple, clean, and preserving the normal anatomy." For this, a midline suboccipital approach and a proper praying sitting position are essential...
2018: Surgical Neurology International
Daniel D Cavalcanti, Eberval G Figueiredo, Mark C Preul, Robert F Spetzler
OBJECTIVE: Apparently similar intra-axial pontine lesions may demand distinct surgical approaches. Selecting the optimal approach reduces unnecessary manipulation of tracts and nuclei. This study aims to reveal a quantitative analysis of main surgical corridors dealing with intrinsic pontine pathology. METHODS: Six approaches were performed repeatedly in ten cadaveric heads: 1) retrosigmoid, 2) retrolabyrinthine, 3) subtemporal transtentorial, 4) anterior petrosectomy, 5) combined petrosal approach, and 6) suboccipital telovelar...
September 24, 2018: World Neurosurgery
Eun-Dong Jeong, Chang-Yong Kim, Seung-Min Kim, Seok-Jun Lee, Hyeong-Dong Kim
BACKGROUND: Cervical spinal instability often leads to neck pain and forward head posture (FHP). To improve neck pain and FHP, both the suboccipital muscle inhibition (SMI) technique and cranio-cervical flexion exercise (CCFE) have been used. However, little is known regarding the validity of hamstring flexibility in neck pain subjects after CCFE as a treatment index, and comparison between the SMI technique and CCFE for neck pain treatment. OBJECTIVE: This study aimed to determine the short-term effects of SMI technique and CCFE, which represent passive and active exercise programs, respectively, and whether these improve the straight leg raise (SLR) test results, popliteal angle (PA), cranio-vertebral angle (CVA), and cervical range of motion (CROM) and are equally effective in immediate enhancement of such measures in neck pain subjects...
September 10, 2018: Journal of Back and Musculoskeletal Rehabilitation
Florian Bernard, Lucas Troude, Laurent Laccourreye, Pierre-Hugues Roche, Henri-Dominique Fournier
The use of 3-dimensional (3D) videos allows students to visualize surgical procedures from the perspective of the surgeon without missing the essential parts.1 This 3D commented video demonstrates the operative technique and surgical nuances of the combined petrosectomy, visualize using virtual reality headsets. Historically, traditional intradural cisternal routes using suboccipital and pterional approaches have been proposed to remove petroclival tumors.2-5 It allows rapid identification of neurovascular structures and a short exposure time...
September 22, 2018: Operative Neurosurgery (Hagerstown, Md.)
Shinya Ichimura, Helmut Bertalanffy, Masato Nakaya, Yoichi Mochizuki, Goroku Moriwaki, Ryuichi Sakamoto, Masahito Fukuchi, Koji Fujii
BACKGROUND: It remains controversial whether primary brainstem hemorrhage (PBH) should be managed conservatively or treated promptly via surgical evacuation of the hematoma. In the present study, we discuss five cases with PBH which were treated surgically, as well as the ability of surgical management to improve postoperative functional outcomes. METHODS: The four patients with pontine and medullary hemorrhage underwent surgery via the lateral or midline suboccipital and transrhomboid fossa approaches in the half-sitting position, One patients with medullary hemorrhage underwent surgery via midline suboccipital approach in the half-sitting position...
September 19, 2018: World Neurosurgery
Jaskaran Singh Gosal, Sanjay Behari, Jeena Joseph, Awadhesh K Jaiswal, Jayesh C Sardhara, Mohammad Iqbal, Anant Mehrotra, Arun K Srivastava
Introduction: Petroclival meningiomas are based on or arising from the petro-clival junction in upper two-thirds of clivus, medial to the fifth cranial nerve. This study focuses on the surgical experience in resecting large-giant tumors >3.5 in size predominantly utilizing middle fossa approaches. Material and Methods: 33 patients with a large or a giant petroclival meningioma (size >3.5 cm) were included. Clinical features, preoperative radiological details, operative findings, and postoperative clinical course at the follow-up visit were reviewed...
September 2018: Neurology India
Akihito Sato, Sakyo Hirai, Yoshiki Obata, Taketoshi Maehara, Masaru Aoyagi
Background  The far lateral approach includes exposure of the C1 transverse process, vertebral artery, posterior arch of the atlas, and occipital condyle. We designed a method for systematic muscular-stage dissection and present our experience with this approach. Operative Methods  We used a horseshoe scalp flap that was reflected downward and medially. The lateral muscle layers were separated layer to layer to expose the suboccipital triangle. The medial muscle layers were separated in the midline and reflected in a single layer...
October 2018: Journal of Neurological Surgery. Part B, Skull Base
Amir Goodarzi, Arjang Ahmadpour, Atrin Toussi, Kiarash Shahlaie
Objective  Our primary objective was to retrospectively review our single institution experience using an anatomic multilayered repair of the retrosigmoid suboccipital craniotomy. Our secondary objective was to review the existing body of literature on the repair of this craniotomy and compare our outcomes to previous results. Design  Retrospective review of 25 consecutive patients undergoing repair for the retrosigmoid craniotomy. Setting  University of California Davis Medical Center (2010-2016). Participants  A total of 25 consecutive patients who underwent retrosigmoid craniotomy and repair...
October 2018: Journal of Neurological Surgery. Part B, Skull Base
Joham Choque-Velasquez, Juha Hernesniemi
Background: In this video-abstract, we present one burr-hole craniotomy for the standard suboccipital midline approach developed in Helsinki neurosurgery for the microsurgical management of forth ventricle lesions, distal posterior inferior cerebellar artery aneurysms, and tumoral and vascular lesions of the vermis, cisterna magna region, and posterior brainstem as well. Case Description: We prefer to position the patient in sitting praying position. A midline straight single-layer incision starts on the inion and extends caudally toward the level of C2...
2018: Surgical Neurology International
Álvaro Campero, Jorge Rasmussen, Julio Diloné, Pablo Ajler, Ramiro López Elizalde
Introduction: A retrosigmoid suboccipital approach is the route most commonly utilized to resect vestibular schwannomas (VS). However, the anterior inferior cerebellar artery (AICA) usually runs adjacent to internal auditory canal nerves, and its course may severely impede total tumor resection. Case Report: A 38-year-old male patient presented with presumed grade T3B VS, diagnosed by magnetic resonance imaging (MRI). Surgery was performed using a retrosigmoid approach, during which the AICA was identified to be completely covered by dural and bone tissue...
2018: Surgical Neurology International
Joham Choque-Velasquez, Juha Hernesniemi
Background: In this video-abstract, we present a one burr-hole craniotomy for the enough lateral approach (ELA) to the foramen magnum developed in Helsinki Neurosurgery, a less invasive variant of the classical far lateral approach. ELA does not require the resection of the occipital condyle nor the exposure of the extracranial/intraosseal course of the lower cranial nerves. The vertebral artery is not transposed and the sigmoid sinus is not skeletonized. ELA allow us to access lesions that are close to the level of the foramen magnum (less than 10 mm)...
2018: Surgical Neurology International
Maurus Marques de Almeida Holanda, José Jailson Costa do Nascimento, Laécio Leitão Batista, Matheus Augusto Pinto Kitamura, Bartolomeu Fragoso Cavalcanti Neto, Marcelo Moraes Valença
BACKGROUND: Authors analyzed surgical patients with Chiari malformation (CM) associated with cerebellar tonsillar cyst. This association is quite rarely encountered in the literature. CASE DESCRIPTION: We retrospectively reviewed 60 surgical adult patients with MRI evaluation who underwent posterior fossa decompression for treatment of CM type I. All surgeries were performed between January 1995 and July 2015. From 60 patients with CM, four cases presented cerebellar tonsillar cysts (male=2)...
August 31, 2018: World Neurosurgery
Arnoley S Abcejo, Jeffrey J Pasternak, William J Perkins
BACKGROUND: Venous air embolism (VAE) is a well-described complication of neurosurgical procedures performed in the seated position. Although most often clinically insignificant, VAE may result in hemodynamic or neurological compromise resulting in urgent change to a level position. The incidence, intraoperative course, and outcome in such patients are provided in this large retrospective study. METHODS: Patients undergoing a neurosurgical procedure in the seated position at a single institution between January 2000 and October 2013 were identified...
August 24, 2018: Journal of Neurosurgical Anesthesiology
Todd D Rozen
OBJECTIVE: To determine the efficacy of high-volume anesthetic suboccipital nerve blocks (HVSON) for chronic cluster headache (CCH) and to define consistency of response over long-term use. BACKGROUND: There are studies showing efficacy of greater occipital and suboccipital nerve block injections for CCH and also their possible use as a preventive treatment modality. There are scant data about the long-term efficacy of repetitive greater occipital and suboccipital nerve injections in CCH...
August 24, 2018: Headache
Yuta Mitobe, Ryo Yaoita, Hiroshi Itagaki, Kenichiro Matsuda, Yukihiko Sonoda
INTRODUCTION: The draining veins of the brain stem and cerebellum commonly drain into the petrosal vein and sigmoid sinus, and often drain into the marginal sinus in the caudal part of the posterior fossa. Here, we report a rare case of anaplastic ependymoma involving a bridging vein that drained directly into the occipital sinus. CASE DESCRIPTION: A 6-year-old boy was admitted to our hospital with a 1-month history of nausea, headache, and dizziness. Magnetic resonance imaging(MRI)revealed a markedly enhanced fourth ventricular tumor and obstructive hydrocephalus...
August 2018: No Shinkei Geka. Neurological Surgery
Min Zeng, Jia Dong, Nan Lin, Wei Zhang, Kaiying Zhang, Kun Peng, Dexiang Wang, Yan Zhao, Yuming Peng, Ruquan Han
BACKGROUND: Gabapentin is an adjuvant antiepileptic agent and helps to reduce acute postoperative pain in several surgery settings. However, the effect of gabapentin on postoperative pain from suboccipital or subtemporal craniotomy is not clear. METHODS: The study was a single-center, randomized, placebo-controlled, and double-blinded trial. A total of 122 patients undergoing elective craniotomy by a suboccipital or subtemporal approach were randomly allocated to a placebo group and gabapentin group...
August 21, 2018: Journal of Neurosurgical Anesthesiology
Jacques Lara-Reyna, Johnny Carlton, Whitney E Parker, Jeffrey P Greenfield
BACKGROUND: The association between mid-facial clefts and Chiari malformation in the medical literature has been restricted to patients with syndromic craniofacial abnormalities. A common shared developmental pathway including causative factors for facial clefts and "complex" Chiari malformations, both midline skull base pathologies, seems logical but has not been reported. The coincident presentation of these findings in a single patient, and our subsequent discovery of other patients harboring these mutual findings prompted further investigation...
August 21, 2018: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
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