scholarly journals Versatile Use of Intraoperative Ultrasound Guidance for Brain Puncture

2021 ◽  
Author(s):  
Tugrul Cem Unal ◽  
Cafer Ikbal Gulsever ◽  
Duran Sahin ◽  
Huseyin Emre Dagdeviren ◽  
Ilyas Dolas ◽  
...  
Keyword(s):  
Stereotactic Biopsy ◽  
Imaging System ◽  
Perioperative Complications ◽  
Intraoperative Ultrasound ◽  
Case Series ◽  
Technical Note ◽  
Burr Hole ◽  
Guidance System ◽  
Third Ventriculostomy ◽  
Current Case

Abstract BACKGROUND Intraoperative ultrasound (iUS) is an effective guidance and imaging system commonly used in neuro-oncological surgery. Despite the versatility of iUS, its utility for single burr hole puncture guidance remains fairly underappreciated. OBJECTIVE To highlight the simplicity, versatility, and effectiveness of iUS guidance in brain puncture by presenting the current case series and technical note collection. METHODS We present 4 novel uses of iUS guidance for single burr hole brain puncture: cannulation of normal-sized ventricles, endoscopic third ventriculostomy (ETV) guidance, evacuation of interhemispheric empyema, and stereotactic biopsy assistance. RESULTS All techniques were performed successfully in a total of 16 patients. Normal-sized ventricles were cannulated in 7 patients, among whom 5 underwent Ommaya reservoir placement and 2 underwent ventriculoperitoneal shunt placement for idiopathic intracranial hypertension. No more than 1 attempt was needed for cannulation. All ventricular tip positions were optimal as shown by postoperative imaging. iUS guidance was used in 5 ETV procedures. The working cannula was successfully introduced to the lateral ventricle, providing the optimal trajectory to the third ventricular floor in these cases. Interhemispheric subdural empyema was aspirated with iUS guidance in 1 patient. Volume reduction was clearly visible, allowing near-total evacuation of the empyema. iUS guidance was used for assistive purposes during stereotactic biopsy in 3 patients. No major perioperative complications were observed throughout this series. CONCLUSION iUS is an effective and versatile guidance system that allows for real-time imaging and can be easily and safely employed for various brain puncture procedures.

scholarly journals Implication of image guidance in endoscopic third ventriculostomy: Technical note

2020 ◽  
Vol 11 ◽  
pp. 87
Author(s):  
Muhammad Samir Irfan Wasi ◽  
Salman Yousuf Sharif ◽  
Farhan Gulzar
Keyword(s):  
Fourth Ventricle ◽  
Image Guidance ◽  
Endoscopic Third Ventriculostomy ◽  
Aqueductal Stenosis ◽  
Technical Note ◽  
Guidance System ◽  
Moderate Intensity ◽  
Third Ventriculostomy ◽  
Resonance Imaging ◽  
Magnetic Resonance Imaging Mri

Background: Endoscopic third ventriculostomy (ETV) is an advanced surgical procedure and plays a major role in the management of hydrocephalus. The complications associated with this procedure are grave and unforgiving. Image guidance system (IGS) can help reduce these complications. This technical note describes the technique for utilizing image guidance in carrying out ETV with safety and efficacy. Methods: The authors have performed ETV on more than 75 cases. We describe a step-by-step technique for the implication of image guidance while performing ETV including the trajectory planning, coregistration, approach, and third ventricular floor perforation. For illustration, we present the case of a 54-year-old female with moderate-intensity headache and central vertigo for 2 months presented with no significant findings on examination. Magnetic resonance imaging (MRI) showed dilated lateral and third ventricles with normal sized fourth ventricle. A diagnosis of aqueductal stenosis was made and ETV was performed under image guidance. Results: Since 2012, we performed 78 cases of ETV with the help of image guidance. None of the patients had any episode of intraoperative hemorrhage. Two patients (2.56%) had fornix contusions. Conclusion: Image guidance can help reduce complications and is becoming an essential tool in performing ETV. IGS ETV technique may benefit young neurosurgeons the most and can help them overcome the learning curve with safety.

scholarly journals Efficacy and safety of flexible versus rigid endoscopic third ventriculostomy in pediatric and adult populations: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Alessandro Boaro ◽  
Bhargavi Mahadik ◽  
Anthony Petrillo ◽  
Francesca Siddi ◽  
Sharmila Devi ◽  
...  
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Perioperative Complications ◽  
Meta Analysis ◽  
Case Series ◽  
Optimal Choice ◽  
Third Ventriculostomy ◽  
Efficacy And Safety ◽  
Bleeding Events ◽  
Random Effects Models ◽  
Hydrocephalus Treatment

AbstractEndoscopic third ventriculostomy (ETV) is a well-established surgical procedure for hydrocephalus treatment, but there is sparse evidence on the optimal choice between flexible and rigid approaches. A meta-analysis was conducted to compare efficacy and safety profiles of both techniques in pediatrics and adults. A comprehensive search was conducted on PubMED, EMBASE, and Cochrane until 11/10/2019. Efficacy was evaluated comparing incidence of ETV failure, while safety was defined by the incidence of perioperative complications, intraoperative bleedings, and deaths. Random-effects models were used to pool the incidence. Out of 1365 studies, 46 case series were meta-analyzed, yielding 821 patients who underwent flexible ETV and 2918 who underwent rigid ETV, with an age range of [5 days–87 years]. Although flexible ETV had a higher incidence of failure in adults (flexible: 54%, 95%CI: 22–82% vs rigid: 20%, 95%CI: 22–82%) possibly due to confounding due to etiology in adults treated with flexible, a smaller difference was seen in pediatrics (flexible: 36%, pediatric: 32%). Safety profiles were acceptable for both techniques, with a certain degree of variability for complications (flexible 2%, rigid 18%) and death (flexible 1%, rigid 3%) in pediatrics as well as complications (rigid 9%, flexible 13%), death (flexible 4%, rigid 6%) and intra-operative bleeding events (rigid 6%, flexible 8%) in adults. No clear superiority in efficacy could be depicted between flexible and rigid ETV for hydrocephalus treatment. Safety profiles varied by age but were acceptable for both techniques. Well-designed comparative studies are needed to assess the optimal endoscopic treatment option for hydrocephalus.

Feasibility and Clinical Utility of Ultra-Widefield–Navigated Swept-Source Optical Coherence Tomography Imaging

2021 ◽  
pp. 247412642199733
Author(s):  
Kyle D. Kovacs ◽  
M. Abdallah Mahrous ◽  
Luis Gonzalez ◽  
Benjamin E. Botsford ◽  
Tamara L. Lenis ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Clinical Utility ◽  
Clinical Decision Making ◽  
Imaging System ◽  
Imaging Modality ◽  
Case Series ◽  
Subretinal Fluid ◽  
Optical Coherence ◽  
Swept Source ◽  
Oct Imaging

Purpose: This work aims to evaluate the clinical utility and feasibility of a novel scanning laser ophthalmoscope-based navigated ultra-widefield swept-source optical coherence tomography (UWF SS-OCT) imaging system. Methods: A retrospective, single-center, consecutive case series evaluated patients between September 2019 and October 2020 with UWF SS-OCT (modified Optos P200TxE, Optos PLC) as part of routine retinal care. The logistics of image acquisition, interpretability of images captured, nature of the peripheral abnormality, and clinical utility in management decisions were recorded. Results: Eighty-two eyes from 72 patients were included. Patients were aged 59.4 ± 17.1 years (range, 8-87 years). During imaging, 4.4 series of images were obtained in 4.1 minutes, with 86.4% of the image series deemed to be diagnostic of the peripheral pathology on blinded image review. The most common pathologic findings were chorioretinal scars (18 eyes). In 31 (38%) eyes, these images were meaningful in supporting clinical decision-making with definitive findings. Diagnoses imaged included retinal detachment combined with retinoschisis, retinal hole with overlying vitreous traction and subretinal fluid, vitreous inflammation overlying a peripheral scar, Coats disease, and peripheral retinal traction in sickle cell retinopathy. Conclusions: Navigated UWF SS-OCT imaging was clinically practical and provided high-quality characterization of peripheral retinal lesions for all eyes. Images directly contributed to management plans, including laser, injection or surgical treatment, for a clinically meaningful set of patients (38%). Future studies are needed to further assess the value of this imaging modality and its role in diagnosing, monitoring, and treating peripheral lesions.

scholarly journals Intraoperative O-arm Navigation Guided Anterior Cervical Surgery; A technical note and case series

2021 ◽  
pp. 101288
Author(s):  
Masato Tanaka ◽  
Hardik Suthar ◽  
Yoshihiro Fujiwara ◽  
Yoshiaki Oda ◽  
Koji Uotani ◽  
...  
Keyword(s):  
Case Series ◽  
Technical Note ◽  
Cervical Surgery ◽  
Anterior Cervical Surgery

Preoperative Angiography for Free Fibula Flap Harvest: A Case Series: L’angiographie préopératoire pour prélever un lambeau libre de la fibula : une série de cas

2021 ◽  
pp. 229255032199696
Author(s):  
Noor Alolabi ◽  
Haley Augustine ◽  
Forough Farrokhyar ◽  
Carolyn Levis
Keyword(s):  
Lower Extremity ◽  
Physical Examination ◽  
Perioperative Complications ◽  
Case Series ◽  
Vascular Anatomy ◽  
Limb Ischemia ◽  
Free Fibula Flap ◽  
Retrospective Case ◽  
Fibula Flap ◽  
Free Fibula

Purpose: To assess if preoperative angiography of the lower extremity is necessary to detect abnormalities that alter operative planning of a free fibula flap (FFF). The secondary objective is to determine whether abnormalities are identified on physical examination. Methods: A retrospective case series of patients receiving preoperative lower extremity angiography for FFF was performed. Between November 2004 and July 2016, patients assessed for FFF reconstruction by a single surgeon were reviewed. Outcomes analyzed were preoperative physical examination, angiography findings, changes in operative plan, and perioperative complications including flap failure and limb ischemia. Level of agreement between physical examination and angiography findings was analyzed. Results: A total of 132 consecutive patients were assessed for FFF, of which 70 met the inclusion criteria. Mean age was 60.9 (range: 22-88) years old. All patients underwent aortic angiogram runoff, except for 2 who received computed tomography angiography. The surgical plan was altered based on angiography findings in 9 (12.9%) patients, and 7 (77.8%) of these cases had a normal physical examination. A further 6 (8.6%) patients had physical examination findings precluding the use of FFF, whereas imaging demonstrated the contrary. Physical examination demonstrated low predictability of aberrant vascular anatomy, with a sensitivity of 22.2%. There were no limb ischemia complications. Conclusions: Routine preoperative angiography of the lower extremity for all patients being evaluated for FFF is important to ensure safety and success of the procedure. Physical examination alone is insufficient to detect vascular abnormalities that may result in limb or flap compromise.

scholarly journals Minimally invasive spinopelvic “crab-shaped fixation” for unstable pelvic ring fractures: technical note and 16 case series

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Akinori Okuda ◽  
Naoki Maegawa ◽  
Hiroaki Matsumori ◽  
Tomohiko Kura ◽  
Yasushi Mizutani ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Pelvic Ring ◽  
Case Series ◽  
Technical Note ◽  
Pelvic Ring Fractures

Cervical laminoplasty with unilateral C4-5 foraminotomy: Technical note and case series

2021 ◽  
Author(s):  
Francisco Marcó del Pont ◽  
Sebastián Juan María Giovannini ◽  
Tomás Ries Centeno ◽  
Guido Caffaratti ◽  
Emiliano Lorefice ◽  
...  
Keyword(s):  
Case Series ◽  
Technical Note ◽  
Cervical Laminoplasty
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