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Microsurgical Anatomy

Satoshi Matsuo, Serhat Baydin, Abuzer Güngör, Koichi Miki, Noritaka Komune, Ryota Kurogi, Koji Iihara, Albert L Rhoton
OBJECTIVE A common approach to lesions of the pineal region is along the midline below the torcula. However, reports of how shifting the approach off midline affects the surgical exposure and relationships between the tributaries of the vein of Galen are limited. The purpose of this study is to examine the microsurgical and endoscopic anatomy of the pineal region as seen through the supracerebellar infratentorial approaches, including midline, paramedian, lateral, and far-lateral routes. METHODS The quadrigeminal cisterns of 8 formalin-fixed adult cadaveric heads were dissected and examined with the aid of a surgical microscope and straight endoscope...
October 7, 2016: Journal of Neurosurgery
Chichi Xie, Weiwei Wei, Andrea Schenk, Lars Ole Schwen, Sara Zafarnia, Michael Schwier, Felix Gremse, Isabel Jank, Olaf Dirsch, Uta Dahmen
A modified silicone injection procedure was used for visualization of the hepatic vascular tree. This procedure consisted of in-vivo injection of the silicone compound, via a 26 G catheter, into the portal or hepatic vein. After silicone injection, organs were explanted and prepared for ex-vivo micro-CT (µCT) scanning. The silicone injection procedure is technically challenging. Achieving a successful outcome requires extensive microsurgical experience from the surgeon. One of the challenges of this procedure involves determining the adequate perfusion rate for the silicone compound...
2016: Journal of Visualized Experiments: JoVE
Anthony M T Chau, Filippo Gagliardi, Adam Smith, Nicholas R Pelzer, Fiona Stewart, Pietro Mortini, Samer K Elbabaa, Anthony J Caputy, Cristian Gragnaniello
BACKGROUND: The posterior fusiform gyrus lies in a surgically challenging region. Several approaches have been described to access this anatomical area. The paramedian supracerebellar transtentorial (SCTT) approach benefits from minimal disruption of normal neurovascular tissue. The aim of this study was to demonstrate its application to access the posterior fusiform gyrus. METHODS: Three brains and six cadaveric heads were examined. A stepwise dissection of the SCTT approach to the posterior fusiform gyrus was performed...
November 2016: Acta Neurochirurgica
G Chen, W W Zhai, Z Q Yu
Objective: To explore experience and methods in the microsurgical treatment of midline deep brain lesions. Methods: The clinical data of patients with midline deep brain lesions were retrospectively analyzed. The clinical manifestation, imaging findings, lesion locations, surgical procedures, pathological diagnosis and follow-up results were summarized and analyzed. All the lesions were located deeply in the brain midline: corpus callosum (n=1), thalamus and basal ganglia (n=6), lateral ventricle (n=4), the third ventricle (n=2), pineal region (n=8), brainstem and fourth ventricle region (n=4)...
September 13, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Joseph W Duncumb, Kana Miyagi, Parto Forouhi, Charles M Malata
Abdominal free flaps for microsurgical breast reconstruction are most commonly harvested based on the deep inferior epigastric vessels that supply skin and fat via perforators through the rectus muscle and sheath. Intact perforator anatomy and connections are vital for subsequent optimal flap perfusion and avoidance of necrosis, be it partial or total. The intraflap vessels are delicate and easily damaged and it is generally advised that patients should avoid heparin injection into the abdominal pannus preoperatively as this may compromise the vascular perforators through direct needle laceration, pressure from bruising, haematoma formation, or perforator thrombosis secondary to external compression...
2016: Case Reports in Surgery
Baran Bozkurt, Kaan Yagmurlu, Erik H Middlebrooks, Ali Karadag, Talat Cem Ovalioglu, Bharathi Jagadeesan, Gauravjot Sandhu, Necmettin Tanriover, Andrew W Grande
OBJECTIVE: To evaluate the microsurgical anatomy of the fiber tract connections of the supplementary and pre-supplementary motor areas, and its potential functional role with reference to clinical trials in the literature. METHODS: 10 postmortem formalin-fixed human brains (20 sides) and 1 cadaveric head were prepared with Klingler's method. The fiber dissection was performed in a stepwise fashion, both from lateral to medial and medial to lateral under an operating microscope with 3D images captured at every stage...
July 28, 2016: World Neurosurgery
H Y Li, H Chen, Y M Li, Y Li, X W Shi
OBJECTIVE: To investigate the causes and strategies for intraoperative rupture during clipping the anterior circulation aneurysms. METHODS: Nineteen patients with anterior circulation aneurysms ruptured during clipping, who admitted to the Department of Neurosurgery, Henan Provincial People's Hospital from November 2012 to February 2014, were enrolled. Their clinical data were analyzed retrospectively to summarize the causes and strategies for intraoperative rupture...
July 5, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Christopher G Finkemeier, Rafael Neiman
OBJECTIVE: To demonstrate the technical aspects of a reverse sural artery (RSA) flap. DESIGN: Video case presentation. SETTING: Community Level 2 Trauma Center. PATIENTS: Single patient with a full thickness soft tissue loss over the posterior calcaneal tuberosity requiring soft tissue coverage. METHOD: Video demonstration of the stepwise planning and technical aspects of performing an RSA flap...
August 2016: Journal of Orthopaedic Trauma
Amol Raheja, William T Couldwell
A better understanding of surgical anatomy, marked improvement in illumination devices, provision of improved hemostatic agents, greater availability of more precise surgical instruments, and better modalities for skull base reconstruction have led to an inevitable evolution of skull base neurosurgery. For the past few decades, many skull base neurosurgeons have worked relentlessly to improve the surgical approach and trajectory for the expansion of operative corridor. With the advent of newer techniques and their rapid adaptation, it is foundational, especially for young neurosurgeons, to understand the basics and nuances of modifications of traditional neurosurgical approaches...
July 20, 2016: Journal of Neuro-oncology
Debraj Mukherjee, Veysel Antar, Bora Gurer, Ulas Cikla, Gabriel Neves, Mehmet Ekici, Tomer Hananya, Aaron S Field, Shahriar M Salamat, Mustafa Kemal Baskaya
INTRODUCTION: Operative management of intrinsic brainstem lesions remains challenging despite advances in electrophysiological monitoring and neuroimaging. Surgical intervention in this region requires detailed knowledge of adjacent, critical white matter tracts and cranial nerve nuclei. Our aim was to systematically verify internal anatomy associated with each brainstem safety zone entry zone (BSEZ) using a cadaveric model supplemented with neuroimaging modalities commonly used in preoperatively planning, namely high-resolution magnetic resonance imaging (MRI) and fiber tracking...
August 2016: Neurosurgery
X Huang, K Y Ji, J Xu, C H Shao, W Wang, M Xu, D Q Chen, M Y Chen, P Zhong
OBJECTIVE: To discuss the surgical technique and common complications from the microsurgical treatment of giant intracranial vestibular schwannoma via suboccipital retrosigmoid approach and to propose strategies for minimizing such complications. METHODS: Surgical outcomes and complications were evaluated in a consecutive series of 657 unilateral giant vestibular schwannomas treated in Shanghai Huashan Hospital via suboccipital retrosigmoid approach from 1999 to 2014...
June 7, 2016: Zhonghua Er Bi Yan Hou Tou Jing Wai Ke za Zhi, Chinese Journal of Otorhinolaryngology Head and Neck Surgery
Yasser Jeelani, Abdulkerim Gokoglu, Tomer Anor, Ossama Al-Mefty, Alan R Cohen
OBJECTIVE Conventional approaches to the atrium of the lateral ventricle may be associated with complications related to direct cortical injury or brain retraction. The authors describe a novel approach to the atrium through a retrosigmoid transtentorial transcollateral sulcus corridor. METHODS Bilateral retrosigmoid craniotomies were performed on 4 formalin-fixed, colored latex-injected human cadaver heads (a total of 8 approaches). Microsurgical dissections were performed under 3× to 24× magnification, and endoscopic visualization was provided by 0° and 30° rigid endoscope lens systems...
June 24, 2016: Journal of Neurosurgery
Shao-Wei Zhu, Yang Yang, Yu-Guang Liu, Jing-Wei Cao, Feng Li
OBJECTIVE: To discuss the significance of the radiculomuscular artery in typical variations of the distal vertebral artery (VA) from the viewpoint of microsurgical anatomy. METHODS: Some variations involving the radiculomuscular artery revealed by digital subtraction angiography (DSA) were recruited and studied together with our findings from cadaver dissections. RESULTS: A total of 29 variants were found in 26 patients, including 10 C‑2 vertebral origins of the posteroinferior cerebellar artery (PICA), 13 duplicated (12 patients) and 6 aberrant V3s...
June 20, 2016: Clinical Neuroradiology
Serge Makarenko, Erick M Carreras, Ryojo Akagami
OBJECTIVE Microsurgical resection of perisellar meningiomas has remained the gold standard for treatment, with extended endoscopic endonasal surgery emerging as a viable alternative. Historical microsurgical series do not distinguish based on tumor anatomy, but are being used as a comparison against endonasal surgery. In this study, the authors retrospectively reviewed and compared the anatomy of perisellar meningiomas seen at their institution. The tumors were separated into 2 groups based on whether they would be appropriate for endoscopic resection, and the authors compared the surgical outcomes...
June 10, 2016: Journal of Neurosurgery
Daryousch Parvizi, Anna Vasilyeva, Paul Wurzer, Alexandru Tuca, Patricia Lebo, Raimund Winter, Robert P Clayton, Thomas Rappl, Michael V Schintler, Lars-P Kamolz, Heinz K Buerger
BACKGROUND: The perforators of the free lateral femoral condyle flap have yet to be adequately described in humans. Therefore, the authors investigated the perforator vessels of the lateral femoral condyle flap in an anatomical study and discussed potential clinical applications with a particular interest in its indication with vascularized bone and/or iliotibial band for tendon repair surgery. METHODS: The authors dissected thighs of 28 cadavers to evaluate the anatomical properties of perforator vessels that branch from the superior lateral genicular artery and supply bone, cartilage, subcutaneous tissue, and the iliotibial band of the lateral femoral condyle...
June 2016: Plastic and Reconstructive Surgery
Martin Hitier, Go Sato, Yan-Feng Zhang, Yiwen Zheng, Stephane Besnard, Paul F Smith, Ian S Curthoys
BACKGROUND: The rat is one of the most used species in the neurosciences, but how to selectively reach each of its 5 vestibular sensors has never been described. Besides, new functions of the vestibular system have been recently discovered in the rat involving vegetative, circadian and cognitive functions. But the central pathways sustaining these functions and the role of each of the vestibular sensors are not clear. NEW METHODS: Here we want to describe the anatomy and look for a direct surgical approach to the 5 vestibular sensors in rats, as an indispensable technique to further study the central vestibular pathways...
September 1, 2016: Journal of Neuroscience Methods
Ching-Jen Chen, James Caruso, Robert M Starke, Dale Ding, Thomas Buell, R Webster Crowley, Kenneth C Liu
Background and Importance. Ruptured periventricular aneurysms in patients with moyamoya disease represent challenging pathologies. The most common methods of treatment include endovascular embolization and microsurgical clipping. However, rare cases arise in which the location and anatomy of the aneurysm make these treatment modalities particularly challenging. Clinical Presentation. We report a case of a 34-year-old female with moyamoya disease who presented with intraventricular hemorrhage. CT angiography and digital subtraction angiography revealed an aneurysm located in the wall of the atrium of the right lateral ventricle...
2016: Case Reports in Neurological Medicine
Roberto Altieri, Tetsuro Sameshima, Paolo Pacca, Emanuela Crobeddu, Diego Garbossa, Alessandro Ducati, Francesco Zenga
Petroclival meningiomas are a challenge for neurosurgeons due to the complex anatomy of the region that is rich of vessels and nerves. A perfect and detailed knowledge of the anatomy is very demanding in neurosurgery, especially in skull base surgery. The authors describe the microsurgical anatomy to perform an anterior petrosectomy based on their anatomical and surgical experience and perform a literature review. The temporal bone is the most complex and fascinating bone of skull base. The apex is located in the angle between the greater wing of the sphenoid and the occipital bone...
May 19, 2016: Neurosurgical Review
Christina R Vargas, Pieter G L Koolen, Olivia A Ho, Adam M Tobias, Samuel J Lin, Bernard T Lee
BACKGROUND: CT-angiography (CTA) has been introduced as a means of evaluating arterial anatomy and vascular integrity prior to free autologous breast reconstruction. There is limited published data, however, regarding the incidence, indications, and impact of preoperative CTA (pCTA) on procedural and flap outcomes. METHODS: Retrospective review was performed of all autologous microsurgical breast reconstruction procedures at a single academic center between January 2004 and July 2014...
May 9, 2016: Microsurgery
Yinghao Gu, Wei Song, Hu Sun
OBJECTIVE: To investigate the distribution and clinical significance about venous anastomosis of superficial cerebral vein in normal adult. METHODS: The digital subtraction angiography (DSA) images of the venous phase from 50 normal adults were retrospectively analyzed, and the morphology of venous anastomosis of superficial cerebral veins was observed and measured. While venous anastomosis of superficial cerebral veins of 15 (30 sides) cadaveric heads was observed through blood vessel perfusion...
December 19, 2015: Zhonghua Yi Xue za Zhi [Chinese medical journal]
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