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Marcelo Magaldi Ribeiro de Oliveira, Carlos Eduardo Ferrarez, Taise Mosso Ramos, Jose Augusto Malheiros, Arthur Nicolato, Carla Jorge Machado, Mauro Tostes Ferreira, Fellype Borges de Oliveira, Cecília Félix Penido Mendes de Sousa, Pollyana Helena Vieira Costa, Sebastiao Gusmao, Giuseppe Lanzino, Rolando Del Maestro
OBJECTIVE Surgery for brain aneurysms is technically demanding. In recent years, the process to learn the technical skills necessary for these challenging procedures has been affected by a decrease in the number of surgical cases available and progressive restrictions on resident training hours. To overcome these limitations, surgical simulators such as cadaver heads and human placenta models have been developed. However, the effectiveness of these models in improving technical skills is unknown. This study assessed concurrent and predictive validity of brain aneurysm surgery simulation in a human placenta model compared with a "live" human brain cadaveric model...
March 24, 2017: Journal of Neurosurgery
Amol Raheja, William T Couldwell
Cavernous sinus (CS) involvement by sinonasal and ventral skull base malignancies is infrequently encountered in neurosurgical practice. Despite advancements in skull base microneurosurgery and endoscopic techniques, detailed knowledge and experience of the surgical management of these lesions are limited. This article elaborates on surgical strategies and approaches for CS involvement of malignant ventral skull base tumors. The article discusses the indications, techniques, nuances, advantages, limitations, and complications of minimally invasive CS biopsy, transcranial microscopic, and transfacial endoscopic approaches to the CS using illustrative diagrams and operative videos...
April 2017: Otolaryngologic Clinics of North America
Z H Zhao, X M Zhong, Y Q Wang, J G Yang, Y Cai, Z H Fei, L Zhang
Objective: To discuss the clinical feasibility and practical application of retractorless surgical for patients with hypertensive basal ganglia hemorrhage. Methods: A total of 84 patients underwentretractorless surgery in The First People's Hospital of Huzhou from Jun 2014 to Jun 2016 were retrospectively reviewed.There were 53 male and 31 female of the 84 patients. Their mean age were 58.7 years with range: 29-74 years.Glasgow coma scale score(GCS) at admissionwereas follow: GCS 4-5 points 10 cases(including 3 cases companied dilated pupils), GCS 6-8 points 25 cases, GCS 9-12 points 32 cases, and GCS 13-14 points 17 cases...
March 7, 2017: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Ali Zomorodi, Takanori Fukushima
A new technique for collaborative performance of complex skull base and cerebrovascular procedures is described. The benefits of this approach for patient safety and surgical education are discussed.
February 28, 2017: Neurosurgical Review
V Wierzbicki, A Pesce, R Caruso
Gripping forceps "double action" for microneurosurgery.
September 2017: Il Giornale di Chirurgia
Jian-Peng Wang, Ze-Yu Wu, Jian Xu, Yi-He Dou
Clipping bilateral middle cerebral artery (bMCA) aneurysms via unilateral approach in a single-stage operation is considered as a challenge procedure. To our knowledge, there is no study in surgical management of patients with bMCA aneurysms by fully endoscope-controlled techniques. The author reported a patient with bMCA aneurysms who underwent aneurysms clipping via a unilateral supraorbital keyhole approach by endoscope-controlled microneurosurgery, and the patient had an uneventful postoperative course without neurologic impairment and complication...
November 2016: Journal of Craniofacial Surgery
Tomasz A Dziedzic, Przemysław Kunert, Andrzej Marchel
Vestibular schwannoma treatment with stereotactic radiosurgery (SRS) carries a risk of facial nerve (CNVII) palsy that is lower than that with microneurosurgery. The results of hemihypoglossal-facial nerve anastomosis (HHFA) have not been described yet in CNVII palsy after failed stereotactic radiosurgery (SRS). Here we report a case series of the first four consecutive patients (three women; average age 58.5, age range: 46-74), who underwent HHFA due to failed SRS. All patients were admitted because of progressive peripheral facial nerve palsy...
April 2017: Journal of Neurosurgical Sciences
Carlo Serra, Uğur Türe, Niklaus Krayenbühl, Gülgün Şengül, Dianne C H Yaşargil, M Gazi Yaşargil
OBJECTIVE: To describe the topographic anatomy of surgically accessible surfaces of the human thalamus as a guide to surgical exploration of this sensitive area. METHODS: Using the operating microscope, we applied the fiber microdissection technique to study 10 brain specimens. Step-by-step dissections in superior-inferior, medial-lateral, and posterior-anterior directions were conducted to expose the surfaces and nuclei of the thalamus and to investigate the relevant anatomic relationships and visible connections...
January 2017: World Neurosurgery
Hongzhi Xu, Zhiyong Qin, Ming Xu, Chunjui Chen, Junjie Zhang, Xiancheng Chen
BACKGROUND: Intraoperative ultrasonography is widely used in neurosurgery for the management of intracerebral hematoma and brain tumor. However, the clinical value of this method in the surgery of cerebral arteriovenous malformations (AVMs) has not been reported. In this study, the application of intraoperative ultrasonography for AVM surgery was evaluated prospectively. METHODS: This prospective clinical study comprised 41 patients who underwent microsurgical resection of cerebral AVMs at our institute...
January 2017: World Neurosurgery
Vijay Parihar, Y R Yadav, Yatin Kher, Shailendra Ratre, Ashish Sethi, Dhananjaya Sharma
CONTEXT: Steep learning curve is found initially in pure endoscopic procedures. Video telescopic operating monitor (VITOM) is an advance in rigid-lens telescope systems provides an alternative method for learning basics of neuroendoscopy with the help of the familiar principle of microneurosurgery. AIMS: The aim was to evaluate the clinical utility of VITOM as a learning tool for neuroendoscopy. MATERIALS AND METHODS: Video telescopic operating monitor was used 39 cranial and spinal procedures and its utility as a tool for minimally invasive neurosurgery and neuroendoscopy for initial learning curve was studied...
October 2016: Asian Journal of Neurosurgery
S F Chen, Y Kato, A Kumar, G W Tan, D Oguri, J Oda, T Watabe, S Imizu, H Sano, Z X Wang
Intraoperative rerupture (IOR) during clipping of cerebral aneurysms is a difficult complication of microneurosurgery. The aim of this study was to evaluate the incidence of IOR and analyze the strategies for controlling profound hemorrhage. A total of 165 patients with unruptured intracranial aneurysms and 46 patients with subarachnoid hemorrhage (SAH) treated surgically between April 2010 and March 2011, were reviewed. The data were collected with regard to age, sex, presence of symptoms, confounding factors and strategy for controlling intraoperative hemorrhage was analyzed in terms of location of aneurysms, timing of rupture and severity of IOR...
December 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Mario Teo, Jeremiah N Johnson, Teresa E Bell-Stephens, Michael P Marks, Huy M Do, Robert L Dodd, Michael B Bober, Gary K Steinberg
OBJECTIVE Majewski osteodysplastic primordial dwarfism Type II (MOPD II) is a rare genetic disorder. Features of it include extremely small stature, severe microcephaly, and normal or near-normal intelligence. Previous studies have found that more than 50% of patients with MOPD II have intracranial vascular anomalies, but few successful surgical revascularization or aneurysm-clipping cases have been reported because of the diminutive arteries and narrow surgical corridors in these patients. Here, the authors report on a large series of patients with MOPD II who underwent surgery for an intracranial vascular anomaly...
December 2016: Journal of Neurosurgery. Pediatrics
Jian-Peng Wang, Ze-Yu Wu, Jian Xu, Yi-He Dou
Clipping bilateral middle cerebral artery (bMCA) aneurysms via unilateral approach in a single-stage operation is considered as a challenge procedure. To our knowledge, there is no study in surgical management of patients with bMCA aneurysms by fully endoscope-controlled techniques. The author reported a patient with bMCA aneurysms who underwent aneurysms clipping via a unilateral supraorbital keyhole approach by endoscope-controlled microneurosurgery, and the patient had an uneventful postoperative course without neurologic impairment and complication...
August 31, 2016: Journal of Craniofacial Surgery
Michael A Bohl, Mark E Oppenlander, Robert Spetzler
The unique challenges inherent to microneurosurgery demand that we stay on the forefront of new surgical technologies. Many believe the next major technological advance in neurosurgery will be the widespread application of image-guided robotics in the operating room. We evaluated a novel technology for image-guided robotic auto-navigation of the operating microscope in a prospectively enrolled cohort of patients. Twenty patients were prospectively enrolled for analysis. Data were collected on the extent of resection, operative time, estimated blood loss, time taken to set up the new software, and complications encountered...
June 30, 2016: Curēus
Akio Morita, Shigeo Sora, Hirofumi Nakatomi, Kanako Harada, Naohiko Sugita, Nobuhito Saito, Mamoru Mitsuishi
Robotics and medical engineering can convert traditional surgery into digital and scientific procedures. Here, we describe our work to develop microsurgical robotic systems and apply engineering technology to assess microsurgical skills. With the collaboration of neurosurgeons and an engineering team, we have developed two types of microsurgical robotic systems. The first, the deep surgical systems, enable delicate surgical procedures such as vessel suturing in a deep and narrow space. The second type allows for super-fine surgical procedures such as anastomosing artificial vessels of 0...
October 15, 2016: Neurologia Medico-chirurgica
Joham Choque-Velasquez, Roberto Colasanti, Behnam Rezai Jahromi, Ahmadreza Rafei, Fransua Sharafeddin, Juha Hernesniemi
OBJECTIVE: Preservation of the integrity of perilesional and intralesional arteries, as well as of perforating vessels, is of utmost importance in microneurosurgery. The purpose of our study was to describe our adaptation of the short-burst bipolar coagulation technique, which was initially introduced by Professor Yasargil, for repairing partially damaged brain arteries. METHODS: When a brain artery is partially and inadvertently damaged during microneurosurgical procedures, microscope magnification is further increased from the high magnification that is routinely used (10-15×) up to 14-17× in order to recognize clearly the injured zone of the vessel...
September 2016: World Neurosurgery
Peng Fu, Yun-Song He, Yong-Cun Cen, Qin Huang, Ke-Tai Guo, Hong-Yang Zhao, Wei Xiang
OBJECTIVE: Functioning pituitary macroadenoma and giant adenoma have large growth volumes and endocrinological abnormalities, requiring proper medical intervention. In this retrospective study, microneurosurgery and subsequent gamma knife radiosurgery (GKRS) is assessed for efficacy and safety for the treatment of functioning pituitary macroadenoma and giant adenoma. METHODS: Between January 2007 and December 2011, 59 patients with functioning pituitary macroadenoma (n=38) or giant adenoma (n=21) received microneurosurgical resection, and after three months, GKRS with average maximum radiation dose ∼42Gy (range 30-66...
June 2016: Clinical Neurology and Neurosurgery
John R Zuniga, David M Yates
PURPOSE: Most patients who seek relief from trigeminal neuropathic pain by trigeminal microneurosurgery techniques do not show permanent pain relief after surgery. However, a small number of patients have permanent relief after surgery. The objective of this study was to determine factors that might be associated with the resolution, decrease, or recurrence of neuropathic pain after trigeminal nerve surgery in those patients who present with neuropathic pain before surgery. PATIENTS AND METHODS: An ambispective study design was used to assess patients who underwent trigeminal nerve repair of the inferior alveolar and lingual nerve who had documented neuropathic pain before surgery from 2006 through 2014...
July 2016: Journal of Oral and Maxillofacial Surgery
Joham C Velasquez, Jane Lau, Danil Kozyrev, Fransua Sharafeddin, Roberto Colasanti, Teemu Luostarinen, Juha Hernesniemi
After the senior author took chairmanship in Helsinki University Hospital in, he led the department into making neurosurgical operations much faster, safer and workflow more efficient, and at the same time maintaining high surgical quality and results. The aim was to describe the philosophies and style of Helsinki Microneurosurgery. The philosophies of Helsinki Neurosurgery are categorized into two concepts: The operation room TEAM concept and the main principle "Simple, clean, fast and respecting the normal anatomy"...
March 2016: Journal of Neurosurgical Sciences
Neriman Özkan, Ilonka Kreitschmann-Andermahr, Sophia Luise Goerike, Karsten Henning Wrede, Bernadette Kleist, Klaus-Peter Stein, Oliver Gembruch, Ibrahim Erol Sandalcioglu, Isabel Wanke, Ulrich Sure
Spinal dural arteriovenous fistulas (SDAVFs) are rare pathologies with a yearly incidence of 5-10 new cases/million, constituting 60-80 % of spinal arteriovenous malformations. Clinical symptoms include progressive paraparesis, paresthesias, bladder, and bowel disturbances. The pathophysiology of SDAVFs is not well elucidated. Microneurosurgery and endovascular techniques are established treatment modalities for permanent fistula occlusion, which are oftentimes accompanied by an amelioration of neurological deficits in the long run...
October 2015: Neurosurgical Review
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