scholarly journals Large Cervical Ependymoma: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (1) ◽  
pp. E42-E42
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Informed Consent ◽  
Surgical Resection ◽  
Video Recording ◽  
Institutional Review Board ◽  
Venous Plexus ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Upper Cervical ◽  
Posterior Midline ◽  
Spinal Gliomas

Abstract Spinal ependymomas compose approximately 60% of spinal gliomas, the predominance occurring within adults. These tumors are generally benign, and maximal surgical resection with neurological preservation is the surgical goal. This patient had a large upper cervical ependymoma, which was approached through a cervical laminotomy. The surgical resection of this lesion demonstrates the principles of pial venous plexus preservation during posterior midline raphe identification and dissection. Gross total surgical resection was achieved with the preservation of the patient's baseline neurological function. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Cervical 3 to Cervical 6 Laminectomy for Arteriovenous Malformation: 2-Dimensional Operative Video

2019 ◽  
Vol 17 (5) ◽  
pp. E200-E200
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Arteriovenous Malformation ◽  
Surgical Resection ◽  
Video Recording ◽  
Institutional Review Board ◽  
Digital Subtraction ◽  
Pia Mater ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Complete Obliteration ◽  
System 1

Abstract According to the Spetzler spinal cord classification system,1 this patient had an extradural-intradural arteriovenous malformation (AVM), also known as a type III or juvenile AVM. The patient underwent a surgical resection of the lesion via a cervical 3 to cervical 6 laminoplasty. Direct observation confirmed intra- and extramedullary components. During the surgical resection, an attempt was made to avoid transgressing the pia mater. Therefore, the traversing vessels were interrupted during the circumdissection. The nidus was removed, and postprocedural digital subtraction angiography confirmed complete obliteration. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Grade 4 Temporal Arteriovenous Malformation: 2-Dimensional Operative Video

2019 ◽  
Vol 18 (2) ◽  
pp. E36-E37
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Informed Consent ◽  
Arteriovenous Malformations ◽  
Video Recording ◽  
Venous Drainage ◽  
Complete Resection ◽  
Elevated Risk ◽  
Institutional Review Board ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Martin Grade

Abstract The 2% to 4% annual rupture rate for arteriovenous malformations (AVMs) must be weighed against the risk of intervention during surgery within an eloquent brain region. Following a hemorrhage event, AVMs that were initially considered to be nonoperative or unfavorable for surgical resection can be intervened on to avoid the significantly elevated risk of rehemorrhage. This patient had a dominant temporal lobe Spetzler–Martin grade 4 AVM with deep venous drainage, representing a significant surgical challenge. The arachnoid plane microdissection was performed using microscissors but was tenuous, and it was necessary to define the draining vein and adjacent feeding arteries. This video demonstrates the major principles of AVM resection during the circumdissection and disconnection of the nidus. The postoperative angiography demonstrated complete resection. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

Interhemispheric Transfalcine Approach for Resection of Contralateral Arteriovenous Malformation: 2-Dimensional Operative Video

2020 ◽  
Vol 18 (5) ◽  
pp. E155-E156 ◽  
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Informed Consent ◽  
Arteriovenous Malformation ◽  
Frontal Lobe ◽  
Video Recording ◽  
Complete Removal ◽  
Institutional Review Board ◽  
Ipsilateral Hemisphere ◽  
Institutional Review Board Approval ◽  
Interhemispheric Approach ◽  
Institutional Review

Abstract The high versatility and efficacy of the contralateral interhemispheric approach is demonstrated in this resection of an arteriovenous malformation (AVM). This patient had a large AVM along the medial frontal lobe amenable to approach via the contralateral interhemispheric approach. The head was rotated to permit gravity retraction of the ipsilateral hemisphere to the AVM, avoiding the use of rigid retractors. Under the guidance of neuronavigation, the falx was opened to permit visualization of the AVM. Circumdissection with a disconnection of the nidus was performed in a standard fashion. Postoperative angiography confirmed complete removal of the AVM. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Contralateral Interhemispheric Approach for Resection of A Meningioma: 2-Dimensional Operative Video

2020 ◽  
Vol 18 (5) ◽  
pp. E159-E159
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Informed Consent ◽  
Video Recording ◽  
Institutional Review Board ◽  
Total Resection ◽  
En Bloc ◽  
Institutional Review Board Approval ◽  
Interhemispheric Approach ◽  
Institutional Review ◽  
Eloquent Cortex ◽  
Falcine Meningioma

Abstract The contralateral interhemispheric approach is utilized to provide the surgeon with a favorable trajectory for approaching lesions projecting contralaterally from the midline falcine dura. The contralateral approach also requires a less rigid retraction than other approaches, which is paramount when manipulating the eloquent cortex of the paracentral lobule. This patient had a large laterally projecting falcine meningioma. This case demonstrates well the effect that gravity has on the tumor, pulling the tumor medially into the surgeon's view and making the surgical approach ideal for this lesion. The lesion was removed en bloc with the falcine dura, and postoperative imaging demonstrated a gross total resection. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Supracerebellar Transtentorial Approach for Mesial Temporal Lobe Cavernous Malformation: 2-Dimensional Operative Video

2019 ◽  
Vol 17 (6) ◽  
pp. E236-E236 ◽  
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Cavernous Malformation ◽  
Video Recording ◽  
Complete Removal ◽  
Institutional Review Board ◽  
Cavernous Malformations ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Stereotactic Navigation ◽  
Mesial Temporal Lobe ◽  
Transtentorial Approach

Abstract Medial temporal cavernous malformations can involve transgression of eloquent parenchyma. For a tentorium-abutting temporal cavernous malformation, the supracerebellar transtentorial corridor is a suitable approach with minimal parenchymal insult. Using dynamic and gravity retraction, lighted bipolar forceps and suction, and stereotactic navigation, this trajectory provides a minimally invasive corridor. The patient in this case has a medial temporal cavernous malformation, with the lesion abutting the tentorial leaflet. The cavernous malformation is accessed and removed in a piecemeal manner. Complete removal of the lesion is achieved. The patient remained neurologically stable after the procedure. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Anterior Interhemispheric Transcallosal Approach for Thalamic Cavernous Malformation: 2-Dimensional Operative Video

2019 ◽  
Vol 17 (6) ◽  
pp. E240-E241
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Cavernous Malformation ◽  
Third Ventricle ◽  
Video Recording ◽  
Complete Resection ◽  
Institutional Review Board ◽  
Transcallosal Approach ◽  
The Third ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Surgical Field

Abstract This patient had a large left ventral thalamic cavernous malformation abutting the third ventricle with evidence of recent hemorrhage. The patient was placed supine with the head in the horizontal position with the dependent hemisphere down to permit use of the anterior interhemispheric transcallosal approach. The lateral ventricle is entered, and the septum pellucidum is opened to prevent it from obstructing the surgical field. The deep cavernous malformation is located with stereotactic neuronavigation and removed piecemeal with the aid of lighted suckers and bipolars. Surgical visualization and postoperative imaging demonstrate a complete resection of the lesion, and the patient remained neurologically stable postoperatively. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Microsurgical Clipping of an Unruptured Basilar Apex Aneurysm: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (4) ◽  
pp. E391-E392
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Video Recording ◽  
Institutional Review Board ◽  
Interpeduncular Cistern ◽  
Microsurgical Clipping ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Increased Risk ◽  
Risk Of Rupture ◽  
Clip Application ◽  
Neurologically Intact

Abstract Aneurysms of the basilar artery apex are generally at an increased risk of rupture compared with aneurysms in other locations, and the risk of rupture increases with increasing aneurysm size. Therefore, these lesions necessitate treatment to decrease the risk of rupture. The location, size, and directionality of dome projection influence the difficulty of microsurgical treatment. The patient presented with an incidental basilar apex aneurysm identified on workup for headaches. The aneurysm projected superoposteriorly into the interpeduncular cistern. The surgical approach involved a wide exposure of the basilar apex complex and meticulous identification and preservation of P1 perforators during clip applications. It was imperative to visualize all perforators on both sides of the clip prior to application, given the severe morbidity associated with a perforator infarct. The patient tolerated the procedure well and remained neurologically intact after the operation. This video is an exemplary demonstration of basilar apex aneurysm clip application for an incidentally discovered aneurysm. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

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