Three-Dimensional Endoscopic Magnification for Treatment of Thoracic Spinal Dural Arteriovenous Fistulas: Technical Note

2017 ◽  
Vol 14 (3) ◽  
pp. 259-266
Author(s):  
Alexander G Weil ◽  
Sami Obaid ◽  
Chiraz Chaalala ◽  
Daniel Shedid ◽  
Elsa Magro ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Technical Note ◽  
Minimally Invasive Approach ◽  
Tubular Retractor ◽  
Invasive Approach ◽  
Arteriovenous Fistulas ◽  
Tunnel Vision ◽  
Thoracic Spinal ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas

Abstract BACKGROUND Treatment of thoracic spinal dural arteriovenous fistulas (DAVFs) by microsurgery has recently been approached using minimally invasive spine surgery (MISS). The advantages of such an approach are offset by difficult maneuverability within the tubular retractor and by the creation of “tunnel vision” with reduced luminosity to a remote surgical target. OBJECTIVE To demonstrate how the pitfalls of MISS can be addressed by applying 3-D endoscopy to the minimally invasive approach of spinal DAVFs. METHODS We present 2 cases of symptomatic thoracic DAVFs that were not amenable to endovascular treatment. The DAVFs were excluded solely via a minimally invasive approach using a 3-D endoscope. RESULTS Two patients underwent exclusion of a DAVF following laminotomy, one through a midline 5-cm incision and the other through a paramedian 3-cm incision using minimally invasive nonexpandable tubular retractors. The dura opening, intradural exploration, fistula exclusion, and closure were performed solely under endoscopic 3-D magnification. No incidents were recorded and the postoperative course was marked by clinical improvement. Postoperative imaging confirmed the exclusion of the DAVFs. Anatomical details are exposed using intraoperative videos. CONCLUSION When approaching DAVFs via MISS, replacing the microscope with the endoscope remedies the limitations related to the “tunnel vision” created by the tubular retractor, but at the expense of losing binocular vision. We show that the 3-D endoscope resolves this latter limitation and provides an interesting option for the exclusion of spinal DAVFs.

Minimally invasive tubular retractor system for adequate exposure during surgical obliteration of spinal dural arteriovenous fistulas with the aid of indocyanine green intraoperative angiography

2012 ◽  
Vol 17 (2) ◽  
pp. 160-163 ◽  
Author(s):  
Atman Desai ◽  
Kimon Bekelis ◽  
Kadir Erkmen
Keyword(s):  
Minimally Invasive ◽  
Indocyanine Green ◽  
Successful Treatment ◽  
Indocyanine Green Angiography ◽  
Intraoperative Angiography ◽  
Tubular Retractor ◽  
Microsurgical Treatment ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas

Effective surgical obliteration of spinal dural arteriovenous fistulas (DAVFs) traditionally requires laminectomy or hemilaminectomy to allow intradural exposure and occlusion of the draining vein. The authors present successful treatment of a spinal DAVF by using a tubular retractor system to provide minimally invasive exposure at the L5–S1 level adequate for both microsurgical treatment and intraoperative indocyanine green angiography.

scholarly journals Transulcal parafascicular minimally invasive approach to deep and subcortical cavernomas: technical note

2016 ◽  
Vol 125 (6) ◽  
pp. 1360-1366 ◽  
Author(s):  
Robert A. Scranton ◽  
Steve H. Fung ◽  
Gavin W. Britz
Keyword(s):  
White Matter ◽  
Minimally Invasive ◽  
Technical Difficulty ◽  
Subcortical White Matter ◽  
Technical Note ◽  
Vascular Lesions ◽  
Invasive Technique ◽  
Minimally Invasive Approach ◽  
Unique Challenge ◽  
Invasive Approach

Cavernomas comprise 8%–15% of intracranial vascular lesions, usually supratentorial in location and superficial. Cavernomas in the thalamus or subcortical white matter represent a unique challenge for surgeons in trying to identify and then use a safe corridor to access and resect the pathology. Previous authors have described specific open microsurgical corridors based on pathology location, often with technical difficulty and morbidity. This series presents 2 cavernomas that were resected using a minimally invasive approach that is less technically demanding and has a good safety profile. The authors report 2 cases of cavernoma: one in the thalamus and brainstem with multiple hemorrhages and the other in eloquent subcortical white matter. These lesions were resected through a transulcal parafascicular approach with a port-based minimally invasive technique. In this series there was complete resection with no neurological complications. The transulcal parafascicular minimally invasive approach relies on image interpretation and trajectory planning, intraoperative navigation, cortical cannulation and subcortical space access, high-quality optics, and resection as key elements to minimize exposure and retraction and maximize tissue preservation. The authors applied this technique to 2 patients with cavernomas in eloquent locations with excellent outcomes.

MINIMALLY INVASIVE POSTERIOR OSTEOTOMIES

Neurosurgery ◽  
2008 ◽  
Vol 63 (suppl_3) ◽  
pp. A204-A210 ◽  
Author(s):  
Jean-Marc Voyadzis ◽  
Vishal C. Gala ◽  
John E. O'Toole ◽  
Kurt M. Eichholz ◽  
Richard G. Fessler
Keyword(s):  
Computed Tomography ◽  
Minimally Invasive ◽  
Muscle Injury ◽  
Pedicle Subtraction Osteotomy ◽  
Bone Resection ◽  
Minimally Invasive Approach ◽  
Tubular Retractor ◽  
Invasive Approach ◽  
Severe Postoperative Pain ◽  
Human Cadavers

ABSTRACT OBJECTIVE Surgery for thoracolumbar deformity can lead to significant muscle injury, excessive blood loss, and severe postoperative pain. The aim of the following studies was to determine the feasibility of minimally invasive posterior thoracic corpectomy and thoracolumbar osteotomy techniques for deformity in human cadavers and select clinical cases. METHODS Human cadaveric specimens were procured for thoracic corpectomy and Smith-Petersen and pedicle subtraction osteotomy using a minimally invasive approach. Post-procedural computed tomography was used to assess the degree of decompression following corpectomy and the extent of bone resection after osteotomy. Pre and post-osteotomy closure Cobb angles were measured to evaluate the degree of correction achieved. RESULTS The minimally invasive lateral extracavitary approach for thoracic corpectomy provided adequate exposure and allowed excellent spinal canal decompression while minimizing tissue disruption. Nearly complete osteotomies of both types could be achieved through a tubular retractor with a modest change in Cobb angle. CONCLUSION These techniques may play a role in deformity surgery for select cases with further technological advancements.

scholarly journals Minimally invasive approach to extraforaminal disc herniations at the lumbosacral junction using an operating microscope: case series and review of the literature

2008 ◽  
Vol 25 (2) ◽  
pp. E10 ◽  
Author(s):  
Stephen M. Pirris ◽  
Sanjay Dhall ◽  
Praveen V. Mummaneni ◽  
Adam S. Kanter
Keyword(s):  
Minimally Invasive ◽  
Lumbar Disc ◽  
Case Series ◽  
Minimally Invasive Approach ◽  
Tubular Retractor ◽  
Invasive Approach ◽  
Surgical Access ◽  
Small Series ◽  
Disc Herniations ◽  
Anatomical Constraints

Surgical access to extraforaminal lumbar disc herniations is complicated due to the unique anatomical constraints of the region. Minimizing complications during microdiscectomies at the level of L5–S1 in particular remains a challenge. The authors report on a small series of patients and provide a video presentation of a minimally invasive approach to L5–S1 extraforaminal lumbar disc herniations utilizing a tubular retractor with microscopic visualization.

Minimally Invasive Approach for Dorsal Arachnoid Web: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Corentin Dauleac ◽  
Henri-Arthur Leroy ◽  
Richard Assaker
Keyword(s):  
Spinal Cord ◽  
Minimally Invasive ◽  
Skin Incision ◽  
Minimally Invasive Approach ◽  
Tubular Retractor ◽  
Invasive Approach ◽  
Spinal Cord Herniation ◽  
Muscle Sparing ◽  
Magnetic Resonance Imaging Mri ◽  
Spinal Cord Decompression

Abstract A 67-yr-old patient presented with severe paraparesis and lower limb spasticity. The spinal cord magnetic resonance imaging (MRI) revealed the “scalpel sign” 1,2 at the T7 level, suggesting a diagnosis of a dorsal arachnoid web. This video demonstrates a microsurgical technique for the excision of a dorsal arachnoid web with a minimally invasive approach. A paramedian skin incision, understanding the muscular aponeurosis, was performed from T7 to T8. Then, we inserted the tubular dilators until the lamina, to perform a muscle-sparing approach. An expandable tubular retractor of adequate length was passed over the widest dilator and docked into place along the subperiosteal plane. The T7 lamina was drilled, and the resection of the superior and inferior adjacent spine levels was completed with a rongeur. Additional contralateral bone resection was performed after tubular retractor tilt to the midline.3 After dura mater opening, it was carefully suspended and the dorsal arachnoid leaflet was cut to drain the dorsolateral and lateral spinal cisterns.4 The dorsal arachnoid web was, first, disconnected from its lateral anchorages. It was then gently removed with microsurgical forceps, to help its microdissection from the spinal cord surface. At this step, peculiar attention was paid to limit the traction or displacements of the spinal cord and surrounding vessels. Once the dorsal arachnoid web was removed, the quality of the spinal cord decompression was confirmed by its re-expansion. In conclusion, the minimally invasive approach is a safe and appropriate technique for dorsal arachnoid web excision.2,5,6-7  The patient gave her informed and signed consent for the writing and publication of this article.  Image at 1:00 reused with permission from Castelnovo G et al, Spontaneous transdural spinal cord herniation, Neurology, 2014;82(14):1290.

Type I Spinal Dural Fistula Treated Using a Minimally Invasive Approach With a 20-mm Nonexpandable Tubular Retractor: 3-Dimensional Operative Video

2018 ◽  
Vol 15 (5) ◽  
pp. E52-E52
Author(s):  
Krunal Patel ◽  
Jason McMillen ◽  
Ramez W Kirollos ◽  
Karol P Budohoski ◽  
Thomas Santarius ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Type I ◽  
Minimally Invasive Approach ◽  
Tubular Retractor ◽  
Invasive Approach ◽  
3 Dimensional ◽  
Dural Fistula

MINIMALLY INVASIVE POSTEROLATERAL THORACIC CORPECTOMY

Neurosurgery ◽  
2009 ◽  
Vol 64 (4) ◽  
pp. 746-753 ◽  
Author(s):  
Dae-Hyun Kim ◽  
John E. O'Toole ◽  
Alfred T. Ogden ◽  
Kurt M. Eichholz ◽  
John Song ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Cancer Metastasis ◽  
Burst Fracture ◽  
Invasive Technique ◽  
Complication Rates ◽  
Minimally Invasive Approach ◽  
Tubular Retractor ◽  
Invasive Approach ◽  
Vertebral Bodies ◽  
Clinical Cases

Abstract OBJECTIVE To demonstrate the feasibility of and initial clinical experience with a novel minimally invasive posterolateral thoracic corpectomy technique. METHODS Seven procedures were performed on 6 cadavers to determine the feasibility of thoracic corpectomy using a minimally invasive approach. The posterolateral thoracic corpectomies were performed with expandable 22 mm diameter tubular retractor paramedian incisions. The posterolateral aspects of the vertebral bodies were accessed extrapleurally, and complete corpectomies were performed. Intraprocedural fluoroscopy and postoperative computed tomography were used to assess the degree of decompression. In addition, 2 clinical cases of T6 burst fracture, 1 T4–T5 plasmacytoma, and 1 T12 colon cancer metastasis were treated using this minimally invasive approach. RESULTS In the cadaveric study, an average of 93% of the ventral canal and 80% of the corresponding vertebral body were removed. The pleura and intrathoracic contents were not violated. Adequate exposure was obtained to allow interbody grafting between the adjacent vertebral bodies. The procedures were successfully performed in the 4 clinical cases using a minimally invasive technique, and the patients demonstrated good outcomes. CONCLUSION Based on this study, minimally invasive posterolateral thoracic corpectomy safely and successfully allows complete spinal canal decompression without the tissue disruption associated with open thoracotomy. This approach may improve the complication rates that accompany open or even thoracoscopic approaches for thoracic corpectomy and may even allow surgical intervention in patients with significant comorbidities.

scholarly journals Microscope-assisted endoscopic interlaminar ligation of spinal arteriovenous fistulas: technical note

2016 ◽  
Vol 25 (3) ◽  
pp. 394-397 ◽  
Author(s):  
Chen Wang ◽  
Chien-Min Chen ◽  
Fang Shen ◽  
Xiao-Dong Fang ◽  
Guang-Yu Ying ◽  
...  
Keyword(s):  
Technical Note ◽  
Endoscopic Management ◽  
Short Term ◽  
Endoscopic Techniques ◽  
Arteriovenous Fistulas ◽  
Interlaminar Approach ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Arteriovenous Malformations ◽  
Spinal Dural Arteriovenous Fistulas

Spinal dural arteriovenous fistulas (SDAVFs) are the most common type of spinal arteriovenous malformations, and microsurgical ligation is the treatment modality most frequently used for these lesions. Developments in endoscopic techniques have made endoscopy an even less invasive alternative to routine microsurgical approaches in spine surgery, but endoscopic management of SDAVF or other intradural spinal lesions has not been reported to date. The authors describe the use of a microscope-assisted endoscopic interlaminar approach for the ligation of the proximal draining vein of an L-1 SDAVF in a 58-year-old man. A complete cure was confirmed by postoperative angiography. The postoperative course was uneventful, and short-term follow-up showed improvements in the patient's neurological function. The authors conclude that the endoscopic interlaminar approach with microscope assistance is a safe, minimally invasive, innovative technique for the surgical management of SDAVFs in selected patients.

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