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Neurosurgical planning

Maxime Chamberland, Benoit Scherrer, Sanjay P Prabhu, Joseph Madsen, David Fortin, Kevin Whittingstall, Maxime Descoteaux, Simon K Warfield
Streamline tractography algorithms infer connectivity from diffusion MRI (dMRI) by following diffusion directions which are similarly aligned between neighboring voxels. However, not all white matter (WM) fascicles are organized in this manner. For example, Meyer's loop is a highly curved portion of the optic radiation (OR) that exhibits a narrow turn, kissing and crossing pathways, and changes in fascicle dispersion. From a neurosurgical perspective, damage to Meyer's loop carries a potential risk of inducing vision deficits to the patient, especially during temporal lobe resection surgery...
September 20, 2016: Human Brain Mapping
Guo-Chen Sun, Xiao-Lei Chen, Yuan-Zheng Hou, Xin-Guang Yu, Xiao-Dong Ma, Gang Liu, Lei Liu, Jia-Shu Zhang, Hao Tang, Ru-Yuan Zhu, Ding-Biao Zhou, Bai-Nan Xu
OBJECTIVE Endoscopic removal of intracerebral hematomas is becoming increasingly common, but there is no standard technique. The authors explored the use of a simple image-guided endoscopic method for removal of spontaneous supratentorial hematomas. METHODS Virtual reality technology based on a hospital picture archiving and communications systems (PACS) was used in 3D hematoma visualization and surgical planning. Augmented reality based on an Android smartphone app, Sina neurosurgical assist, allowed a projection of the hematoma to be seen on the patient's scalp to facilitate selection of the best trajectory to the center of the hematoma...
September 16, 2016: Journal of Neurosurgery
Merritt Weaver Brown, Tülin Serap Yilmaz, Ekkehard M Kasper
BACKGROUND: Lumbar puncture (LP) rarely results in complications such as spinal hematomas. However, it remains unclear if certain variables increase likelihood of these events, or if surgical intervention improves outcome. METHODS: In addition to two clinical vignettes, we evaluated the post-1974 literature for cases of spinal hematoma and subsequent intervention. Based on our compilation of data, we evaluated outcome relative to numerous distinct variables. RESULTS: Based on 35 LP-related spinal hematoma cases in the post-1974 literature and our encounters, we found 28...
2016: Surgical Neurology International
Michael G Hart, Stephen J Price, John Suckling
OBJECTIVE Resection of focal brain lesions involves maximizing the resection while preserving brain function. Mapping brain function has entered a new era focusing on distributed connectivity networks at "rest," that is, in the absence of a specific task or stimulus, requiring minimal participant engagement. Central to this frame shift has been the development of methods for the rapid assessment of whole-brain connectivity with functional MRI (fMRI) involving blood oxygenation level-dependent imaging. The authors appraised the feasibility of fMRI-based mapping of a repertoire of functional connectivity networks in neurosurgical patients with focal lesions and the potential benefits of resting-state connectivity mapping for surgical planning...
August 26, 2016: Journal of Neurosurgery
Ido Stahl, Daniel Dreyfuss, Dror Ofir, Lior Merom, Michael Raichel, Nir Hous, Doron Norman, Elias Haddad
BACKGROUND CONTEXT: Timely interpretation of computed tomography (CT) scans is of paramount importance in diagnosing and managing spinal column fractures, which can be devastating. Out-of-hospital, on-call spine surgeons are often asked to evaluate CT scans of patients who have sustained trauma to the thoracolumbar spine to make diagnosis and to determine the appropriate course of urgent treatment. Capturing radiographic scans and video clips from computer screens and sending them as instant messages have become common means of communication between physicians, aiding in triaging and transfer decision-making in orthopedic and neurosurgical emergencies...
August 16, 2016: Spine Journal: Official Journal of the North American Spine Society
Ouzi Nissim, Roberto Spiegelmann
The article by Dr. Cohen-Inbar published in this issue of Harefuah is a timely review that brings to the general medical community the recent important developments in the field of radiosurgery--the evolution of multi-session radiosurgery [or "FSR", standing for Fractionated Stereotactic Radiation]. Radiosurgery and FSR continue to have a tremendous impact on modern neurosurgery. Sharing sub-millimetric accuracy in radiation delivery made possible by real-time-imaging positioning, frameless single and multisession radiosurgery have become two faces of a therapeutic technique with wide application in the field of intracranial pathology...
May 2016: Harefuah
Andrey Bokov, Sergey Mlyavykh, Alexander Aleynik, Marina Kutlaeva, Greg Anderson
BACKGROUND: Bone cement leakage during vertebroplasty is a frequently reported complication with the potential for neural injury. OBJECTIVE: To assess risk factors for epidural cement leakage during vertebroplasty. SETTING: Neurosurgical department of a scientific research institute. STUDY DESIGN: This is a prospective cross-sectional randomized trial. METHODS: Seventy-five patients with intractable pain due to low energy vertebral compression fractures between T11 and L5 were treated with vertebroplasty at 150 vertebral levels...
July 2016: Pain Physician
Aurora S Cruz, Marc Moisi, Jeni Page, R Shane Tubbs, David Paulson, Michael Zwillman, Rod Oskouian, Arthur Lam, David W Newell
Venous air embolism (VAE) is a known neurosurgical complication classically and most frequently occurring in patients undergoing posterior cranial fossa or cervical spine surgery in a sitting or semi-sitting position. The authors present a case of VAE that occurred during posterior cervical spine surgery in a patient in the prone position, a rare intraoperative complication. The patient was a 65-year-old man who was undergoing a C1-2 fusion for a nonunion of a Type II dens fracture and developed a VAE. While VAE in the prone position is uncommon, it is a neurosurgical complication that may have significant clinical implications both intraoperatively and postoperatively...
July 22, 2016: Journal of Neurosurgery. Spine
Timothy G Dyster, Charles B Mikell, Sameer A Sheth
The role of neuroimaging in psychiatric neurosurgery has evolved significantly throughout the field's history. Psychiatric neurosurgery initially developed without the benefit of information provided by modern imaging modalities, and thus lesion targets were selected based on contemporary theories of frontal lobe dysfunction in psychiatric disease. However, by the end of the 20th century, the availability of structural and functional magnetic resonance imaging (fMRI) allowed for the development of mechanistic theories attempting to explain the anatamofunctional basis of these disorders, as well as the efficacy of stereotactic neuromodulatory treatments...
2016: Frontiers in Neuroanatomy
Seyed Amirhossein Javadi, Arya Nabavi, Mario Giordano, Elham Faghihzadeh, Amir Samii
BACKGROUND: The accuracy of intraoperative diffusion tensor imaging (DTI)-based tractography of the corticospinal tract (CST) is crucial for its use in neurosurgical planning and its implementation in image-guided surgery. To the best of our knowledge, this is the largest prospective study of the intraoperative direct electrical subcortical stimulation (DESS) of the CST with intraoperative DTI tractography of the CST, with application of intraoperative magnetic resonance imaging (iMRI)...
July 13, 2016: Neurosurgery
Anthony Beardsworth Costa, Joshua B Bederson
INTRODUCTION: The practice of pre- and intraoperative interactive visualization and modeling continues to grow as its value to clinical practice is augmented by new technologies, such as virtual and augmented reality, or 3D printing. Current tools that extract the necessary structural information from medical imaging modalities and allow virtual or other interrogation of the data are either difficult to use in a practical clinical setting, or sufficiently simple as to limit the knowledge available to the operator...
August 2016: Neurosurgery
Mikkel V Petersen, Torben E Lund, Niels Sunde, Jesper Frandsen, Frederikke Rosendal, Niels Juul, Karen Østergaard
OBJECTIVE Diffusion-weighted MRI (DWI) and tractography allows noninvasive mapping of the structural connections of the brain, and may provide important information for neurosurgical planning. The hyperdirect pathway, connecting the subthalamic nucleus (STN) with the motor cortex, is assumed to play a key role in mediating the effects of deep brain stimulation (DBS), which is an effective but poorly understood treatment for Parkinson disease. This study aimed to apply recent methodological advances in DWI acquisition and analysis to the delineation of the hyperdirect pathway in patients with Parkinson disease selected for surgery...
July 8, 2016: Journal of Neurosurgery
Hideaki Shigematsu, Takatoshi Sorimachi, Takahiro Osada, Rie Aoki, Kittipong Srivatanakul, Shinri Oda, Mitsunori Matsumae
OBJECTIVE: Numerous studies have identified different predictors for secondary hydrocephalus after aneurysmal subarachnoid hemorrhage (SAH), although predictors regarding timing of the shunt operation have never been reported. Predictors for an early shunt, which was defined as a shunt operation performed ≤30 days after SAH onset, and for a late shunt, performed at >40 days, were investigated. METHODS: A total of 735 consecutive SAH patients admitted to our hospital between 2003 and 2014 who underwent surgery for ruptured aneurysms within five days of onset were retrospectively assessed...
July 2016: Neurological Research
Ramsey Ashour, Stephen Reintjes, Michael S Park, Sananthan Sivakanthan, Harry van Loveren, Siviero Agazzi
BACKGROUND: Although intraoperative magnetic resonance imaging (iMRI) increasingly is used during glioma resection, its role in skull base surgery has not been well documented. In this study, we evaluate our experience with iMRI for skull base surgery. METHODS: Medical records were reviewed retrospectively on all neurosurgical cases performed at our institution in the IMRIS iMRI suite between April 2014 and July 2015. RESULTS: During the study period, the iMRI suite was used for 71 skull base tumors...
September 2016: World Neurosurgery
Giulio Anichini, Mazhar Iqbal, Nasir Muhammad Rafiq, James W Ironside, Mahmoud Kamel
BACKGROUND: Venous infarction as a complication of microvascular decompression (MVD) is a recognized but extremely rare occurrence in an otherwise standard neurosurgical procedure. Sacrificing one or more veins is considered safe by majority of experienced surgeons and authors. However, in the recent years, there has been growing debate about the management of venous trigeminal compression and/or superior petrosal complex (separation vs. coagulation and cutting of the vein), with few papers describing mild to severe complications related to venous sacrifice...
2016: Surgical Neurology International
Jean-Pascal Lefaucheur, Thomas Picht
The surgical removal of brain tumours in so-called eloquent regions is frequently associated with a high risk of causing disabling postoperative deficits. Among the preoperative techniques proposed to help neurosurgical planning and procedure, navigated transcranial magnetic stimulation (nTMS) is increasingly performed. A high level of evidence is now available in the literature regarding the anatomical and functional accuracy of this mapping technique. This article presents the principles and facts demonstrating the value of using nTMS in clinical practice to preserve motor or language functions from deleterious lesions secondary to brain tumour resection or epilepsy surgery...
April 2016: Neurophysiologie Clinique, Clinical Neurophysiology
R Rauschenberg, G Tabatabai, E G C Troost, M Garzarolli, S Beissert, F Meier
The majority of patients with metastatic melanoma will develop brain metastases, which are the most common cause of death. Until recently, local therapies (e. g., neurosurgery, radiotherapy) were the only options for brain metastases; however, effective systemic treatment options are now available. Upon suspicion of brain metastases, diagnostic staging with brain MRI and a neurological investigation are indicated. Prognostic factors such as number of cerebral metastases and symptoms, serum lactate dehydrogenase and S‑100 levels, extracerebral metastases, and ECOG status are considered during therapeutic planning...
July 2016: Der Hautarzt; Zeitschrift Für Dermatologie, Venerologie, und Verwandte Gebiete
Yuan-Xing Wu, Han Chen, Qian Li, Jing-Jing Hao, Li-Hong Zhao, Xuan He, Xiu-Mei Sun, Ming Xu, Jian-Xin Zhou
BACKGROUND: Endotracheal extubation is a painful and stressful procedure. The authors hypothesized that the prophylactic use of remifentanil would attenuate the pain intensity and stress responses resulting from extubation in neurosurgical patients. MATERIALS AND METHODS: In this prospective, randomized, double-blinded, controlled trial, 160 patients with planned delay extubation after elective intracranial operation were randomized 1:1 to receive either remifentanil or normal saline (control) before their extubation...
May 5, 2016: Journal of Neurosurgical Anesthesiology
Christian Iorio-Morin, Jocelyn Blanchard, Maxime Richer, David Mathieu
BACKGROUND: Chronic subdural hematoma (CSDH) is one of the most frequent reason for cranial neurosurgical consultation. There is no widely accepted medical treatment for this condition. Herein, we present the protocol for the Tranexamic Acid (TXA) in Chronic Subdural Hematomas (TRACS) trial aiming at determining whether TXA can increase the rate of CSDH resolution following conservative management, lower the number of required surgical procedures and decrease the rate of CSDH recurrence following surgical evacuation...
2016: Trials
Rafael O'Halloran, Brian H Kopell, Emma Sprooten, Wayne K Goodman, Sophia Frangou
Recent advances in neuroimaging data acquisition and analysis hold the promise to enhance the ability to make diagnostic and prognostic predictions and perform treatment planning in neuropsychiatric disorders. Prior research using a variety of types of neuroimaging techniques has confirmed that neuropsychiatric disorders are associated with dysfunction in anatomical and functional brain circuits. We first discuss current challenges associated with the identification of reliable neuroimaging markers for diagnosis and prognosis in mood disorders and for neurosurgical treatment planning for deep brain stimulation (DBS)...
2016: Frontiers in Psychiatry
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