Resection of a Lumbar Intradural Extramedullary Schwannoma: 3-Dimensional Operative Video

2018 ◽  
Vol 16 (5) ◽  
pp. 640-640 ◽  
Author(s):  
Simone E Dekker ◽  
Chad A Glenn ◽  
Thomas A Ostergard ◽  
Mickey L Smith ◽  
Brian D Rothstein ◽  
...  
Keyword(s):  
Back Pain ◽  
Treatment Options ◽  
Tumor Resection ◽  
Sensory Nerve ◽  
En Bloc ◽  
3 Dimensional ◽  
Postoperative Mri ◽  
Intradural Extramedullary ◽  
Magnetic Resonance Imaging Mri ◽  
Dural Opening

Abstract This 3-dimensional operative video illustrates resection of a lumbar schwannoma in a 57-yr-old female who presented with right lower extremity numbness, paresthesias, as well as a long history of lower back pain with rest. On magnetic resonance imaging (MRI), there was evidence of an intradural extramedullary enhancing lesion at L5, nearly completely encompassing the spinal canal. This video demonstrates the natural history, treatment options, surgical procedure, risks, and complications of treatment of these types of tumors. The patient underwent a posterior lumbar laminectomy with a midline dural opening for tumor resection. The tumor was encountered intradurally and electromyography recording confirmed that the tumor arose from a lumbar sensory nerve root. The sensory root was then divided and the tumor was then removed. The mass was removed en bloc and histopathologic analysis was consistent with a schwannoma. Postoperative MRI demonstrated gross total resection of the patient's neoplasm with excellent decompression of the spinal cord. The patient had an uneventful postoperative course with full recovery and complete resolution of her back pain and leg paresthesias.

Posterior Cervical Laminoplasty for Resection Intradural Extramedullary Spinal Meningioma: 2-Dimensional Operative Video

2018 ◽  
Vol 16 (3) ◽  
pp. 392-392 ◽  
Author(s):  
Simone E Dekker ◽  
Thomas A Ostergard ◽  
Chad A Glenn ◽  
Efrem Cox ◽  
Nicholas C Bambakidis
Keyword(s):  
High Speed ◽  
Treatment Options ◽  
Tumor Resection ◽  
Cervical Laminoplasty ◽  
En Bloc ◽  
Who Grade ◽  
Left Hand ◽  
Postoperative Mri ◽  
Intradural Extramedullary ◽  
Magnetic Resonance Imaging Mri

Abstract This operative video demonstrates a posterior cervical laminoplasty for the resection of a cervical intradural extramedullary meningioma. In addition, the natural history, treatment options, and potential complications are discussed. The patient is a 68-yr-old male who presented with left-hand grip weakness and paresthesias. Magnetic resonance imaging (MRI) demonstrated an enhancing mass that displacing the spinal cord anteriorly and causing severe flattening of the cord at C4 and C5. The patient underwent a posterior cervical laminoplasty for tumor resection. Removal of the dorsal elements with a high-speed drill was performed at C3, C4, and C5. A midline durotomy was performed and a large extra-axial intradural tumor was encountered. The tumor was resected en bloc and specimens were sent for permanent pathological analysis. The dura was closed in a watertight fashion using 6-0 Prolene sutures. The laminoplasty was performed by using titanium miniplates and screws to reconstruct the dorsal bony elements, and the wound was closed in layers using sutures. There were no complications. Final pathology was consistent with a WHO grade I meningioma. Postoperative MRI demonstrated gross total resection. The patient's perioperative course was uncomplicated and his preoperative weakness completely resolved by time of discharge.

Resection of a Thoracic Hemangioblastoma in a Patient With Von Hippel-Lindau: 3-Dimensional Operative Video

2018 ◽  
Vol 16 (3) ◽  
pp. 395-395 ◽  
Author(s):  
Simone E Dekker ◽  
Thomas A Ostergard ◽  
Chad A Glenn ◽  
Berje Shammassian ◽  
Efrem Cox ◽  
...  
Keyword(s):  
Treatment Options ◽  
Spinal Cord Tumor ◽  
Tumor Resection ◽  
En Bloc ◽  
Intramedullary Spinal Cord ◽  
Von Hippel Lindau ◽  
3 Dimensional ◽  
Intramedullary Lesion ◽  
Postoperative Mri ◽  
History Of

Abstract This 3-dimensional operative video illustrates resection of a thoracic hemangioblastoma in a 30-year-old female with a history of Von Hippel-Lindau disease. The patient presented with right lower extremity numbness and flank pain. Magnetic resonance imaging (MRI) demonstrated an enhancing intradural intramedullary lesion at T 7 consistent with a hemangioblastoma. The patient underwent a thoracic laminectomy with a midline dural opening for tumor resection. This case demonstrates the principles of intradural intramedullary spinal cord tumor resection. In this particular case, internal debulking was untenable owing to the vascular nature of hemangioblastomas. The operative video demonstrates en bloc tumor removal. Postoperative MRI demonstrated gross total resection. The postoperative course was uneventful. The natural history of this disease, treatment options, and potential complications are discussed.

Resection of 2 Intradural Extramedullary Cervical Spine Tumors in a Patient With Neurofibromatosis Type 2: 3-Dimensional Operative Video

2018 ◽  
Vol 16 (2) ◽  
pp. 274-274
Author(s):  
Simone E Dekker ◽  
Chad A Glenn ◽  
Thomas A Ostergard ◽  
Osmond C Wu ◽  
Fernando Alonso ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Treatment Options ◽  
Tumor Resection ◽  
Neurofibromatosis Type ◽  
Cord Compression ◽  
Neurofibromatosis Type 2 ◽  
3 Dimensional ◽  
Intradural Extramedullary

Abstract This 3-dimensional operative video illustrates resection of 2 cervical spine schwannomas in a 19-yr-old female with neurofibromatosis type 2. The patient presented with lower extremity hyperreflexity and hypertonicity. Magnetic resonance imaging (MRI) demonstrated 2 contrast-enhancing intradural extramedullary cervical spine lesions causing spinal cord compression at C4 and C5. The patient underwent a posterior cervical laminoplasty with a midline dural opening for tumor resection. Curvilinear spine cord compression is demonstrated in the operative video. After meticulous dissection, the tumors were resected without complication. The dural closure was performed in watertight fashion followed by laminoplasty using osteoplastic titanium miniplates and screws. Postoperative MRI demonstrated gross total resection with excellent decompression of the spinal cord. The postoperative course was uneventful. The natural history of this disease, treatment options, and potential complications are discussed.

scholarly journals Aggressive, Multidisciplinary Staged Microsurgical Resection of a Giant Cervicomedullary Junction Chordoma

2019 ◽  
Vol 80 (S 04) ◽  
pp. S378-S379
Author(s):  
Sima Sayyahmelli ◽  
Ihsan Dogan ◽  
Aaron M. Wieland ◽  
Mark Pyle ◽  
Mustafa K. Başkaya
Keyword(s):  
Tumor Resection ◽  
Cranial Nerves ◽  
Surgical Removal ◽  
Retropharyngeal Space ◽  
Recurrence Rates ◽  
Recent Onset ◽  
Postoperative Mri ◽  
Swallowing Difficulties ◽  
Magnetic Resonance Imaging Mri ◽  
Two Stages

Chordomas of the cranial base are locally destructive tumors since they are surrounded by significant complex neurovascular structures. Thus, their surgical removal is challenging, recurrence rates are high, and their therapeutic strategies remain controversial.In this video, we present a 47-year-old man with a recent onset of swallowing difficulties, hoarseness, and weight loss for several weeks. In the neurological examination, he had complete paralysis of the 9th, 10th, 11th, and 12th cranial nerves. Magnetic resonance imaging (MRI) showed a heterogeneously enhancing expansile invasive mass lesion centered within the clivus and involving the C1, the occipitocervical junction, the retropharynx, and the hypoglossal canal. The decision was made to proceed with multiple staged surgeries. In the first surgical stage, we performed a mastoidectomy with the infralabyrinthine approach to perform a test clip ligation of the sigmoid sinus and to resect the tumor component that extended into the infralabyrinthine space. In the second stage, we performed a far-lateral transcondylar approach for tumor resection and occipitocervical fusion. In the third stage, we used a transoral approach with endoscopic assistance to complete the excision of the remaining tumor in the retropharyngeal space and anterior aspect of C1 and C2 bodies that were not accessible in the first two stages.The surgeries and postoperative course were uneventful. Postoperative MRI showed a gross total resection of the tumor. Histopathology indicated a chordoma. The patient subsequently received proton radiotherapy and has continued to do well without recurrence at 14 months' follow-up.The link to the video can be found at: https://youtu.be/uP9OSlKg_rE.

Minimally invasive lumbar intradural extramedullary tumor resection

2012 ◽  
Vol 33 (Suppl1) ◽  
pp. 1 ◽  
Author(s):  
Brian Lee ◽  
Patrick C. Hsieh
Keyword(s):  
Minimally Invasive ◽  
Tumor Resection ◽  
Surgical Techniques ◽  
Csf Leak ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Extramedullary Tumor ◽  
Intradural Extramedullary ◽  
Dural Opening ◽  
Invasive Techniques

Intradural, extramedullary schwannomas have long been treated with open midline incision, laminectomy, and dural opening to expose and resect the lesion. While this technique is well established, today new surgical techniques can be utilized to perform the same procedure while minimizing pain, size of incision, and trauma to adjacent tissues. In cases of intradural surgery, minimally invasive surgery limits the degree of soft tissue disruption. As a result, there is significant decreased dead space within the surgical cavity that may decrease the rate of CSF leak complications. Minimally invasive techniques have continuously improved over the years and have reached a point where they can be used for intradural surgeries. In this case presentation, we demonstrate a minimally invasive approach to the lumbar spine with resection of an intradural schwannoma. Surgical techniques and the nuances of the minimally invasive approach to intradural tumors compared to the standard open procedure will be discussed. The video can be found here: http://youtu.be/XXrvAIq_H48.

Interhemispheric Contralateral Transfalcine Approach for Subparacentral Arteriovenous Malformation: 3-Dimensional Operative Video

2021 ◽  
Author(s):  
Matías Baldoncini ◽  
Alvaro Campero ◽  
Sabino Luzzi ◽  
Juan F Villalonga
Keyword(s):  
Right Hemisphere ◽  
Vascular Lesion ◽  
Neurological Deficits ◽  
3 Dimensional ◽  
Postoperative Mri ◽  
Drainage Vein ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Superior Longitudinal Sinus ◽  
The Right

Abstract Neurovascular procedures along the interhemispheric fissure harbor unique features differentiating them from those arteriovenous malformations (AVMs) located at the lateral surface of the brain.1-4  The aim of this 3-dimensional operative video is to present a microsurgical resection of an AVM in a subparacentral location, operated through an interhemispheric contralateral transfalcine approach.1,3,5  This is a case of a 29-yr-old female, with headaches and history of seizures. The patient presented an interhemispheric bleeding 6 mo before the surgery. The magnetic resonance imaging (MRI) showed a vascular lesion located on the medial surface of the right hemisphere at the confluence between the cingulate sulcus and its ascending sulcus. In the cerebral angiography, a right medial AVM was observed, receiving afference from the right anterior cerebral artery and draining to the superior longitudinal sinus. The patient signed an informed consent for the procedure and agreed with the use of her images and surgical video for research and academic purposes.  The patient was in a supine position, and a left interhemispheric contralateral transfalcine approach was performed,1-3 a circumferential dissection of the nidus, and, finally, the AVM was resected in one piece.  The patient evolved without neurological deficits after the surgery. The postoperative MRI and angiography showed a complete resection of the AVM.  In the case presented, to avoid exposing the drainage vein first and to use the gravity of the exposure, the contralateral transfalcine interhemispheric approach was used,1,2 which finally accomplished the proposed objectives.

Minimally Invasive Resection of a Cervical Anterolateral Meningioma: 2-Dimensional Operative Video

2018 ◽  
Vol 16 (4) ◽  
pp. 520-520
Author(s):  
Federico Landriel ◽  
Santiago Hem ◽  
Eduardo Vecchi ◽  
Claudio Yampolsky
Keyword(s):  
Spinal Cord ◽  
Minimally Invasive ◽  
Neck Pain ◽  
Video Recording ◽  
Tumor Resection ◽  
Spinal Tumors ◽  
Minimally Invasive Approach ◽  
En Bloc ◽  
Invasive Approach ◽  
Intradural Extramedullary

Abstract Intradural extramedullary spinal tumors were historically managed through traditional midline approaches. Although conventional laminectomy or laminoplasty provides a wide tumor and spinal cord exposure, they may cause prolonged postoperative neck pain and late kyphosis deformity. Minimally invasive ipsilateral hemilaminectomy preserves midline structures, reduces the paraspinal muscle disruption, and could avoid postoperative kyphosis deformity. A safe tumor resection through this approach could be complicated in large sized or anteromedullary located lesions. We present a surgical video of C3 antero located meningioma removed en bloc through a minimally invasive approach. The patient signed a written consent to publish video, recording, photograph, image, illustration, and/or information about him.

scholarly journals Extended Endoscopic Endonasal Approach for Craniopharyngioma Removal

2018 ◽  
Vol 79 (S 02) ◽  
pp. S199-S200
Author(s):  
Mahmoud Messerer ◽  
Rodolfo Maduri ◽  
Roy Daniel
Keyword(s):  
Visual Acuity ◽  
Tumor Resection ◽  
Optic Tract ◽  
Nasoseptal Flap ◽  
Endoscopic Endonasal ◽  
Skull Base Reconstruction ◽  
Postoperative Mri ◽  
Planum Sphenoidale ◽  
Dural Opening ◽  
Bitemporal Hemianopia

Objective Endoscopic transsphenoidal extended endoscopic approach (EEA) represents a valid alternative to microsurgery for craniopharyngiomas removal, especially for retrochiasmatic lesions without large parasellar extension. The present video illustrates the salient surgical steps of the EEA for craniopahryngioma removal. Patient A 52-year-old man presented with a bitemporal hemianopia and a bilateral decreased visual acuity. MRI showed a Kassam type III cystic craniopharyngioma with a solid component (Fig. 1, panels A and B). Surgical Procedure The head is rotated 10 degrees toward the surgeons. The nasal step is started through the left nostril with a middle turbinectomy. A nasoseptal flap is harvested and positioned in the left choana. The binostril approach allows a large sphenoidotomy to expose the key anatomic landmarks. The craniotomy boundaries are the planum sphenoidale superiorly, the median opticocarotid recesses, the internal carotid artery laterally and the clival recess inferiorly. After dural opening and superior intercavernous sinus coagulation, the tumor is entirely removed (Fig. 2, panels A and B). Skull base reconstruction is ensured by fascia lata grafting and nasoseptal flap positioning. Results Postoperative MRI showed the complete tumor resection (Fig. 1, panels C and D). At 3 months postoperatively, the bitemporal hemianopia regressed and the visual acuity improved. A novel left homonymous hemianopia developed secondary to optic tract manipulation. Conclusions The extended EEA is a valid surgical approach for craniopharyngioma resection. A comprehensive knowledge of the sellar and parasellar anatomy is mandatory for safe tumor removal with decreased morbidity and satisfactory oncologic results.The link to the video can be found at: https://youtu.be/NrCPPnVK2qA.

Operative Adjuncts and Technique for En Bloc Removal of Lumbar Intradural-Extramedullary Tumor: 2-Dimensional Operative Video

2019 ◽  
Vol 18 (6) ◽  
pp. E235-E235
Author(s):  
William Clifton ◽  
Alfredo Quinones-Hinojosa ◽  
Selby Chen
Keyword(s):  
Cauda Equina ◽  
Intraoperative Ultrasound ◽  
Leg Pain ◽  
Nerve Roots ◽  
En Bloc ◽  
Tumor Capsule ◽  
Extramedullary Tumor ◽  
Patient Consent ◽  
Intradural Extramedullary ◽  
Dural Opening

Abstract We present a surgical video illustrating the technique for en bloc resection of an intradural-extramedullary lumbar tumor. The patient is a 63-yr-old woman presenting with worsening bilateral leg pain. Imaging of her lumbar spine showed an enhancing, circumscribed intradural-extramedullary tumor compressing her cauda equina at the L2 level. With informed patient consent, an L1-L3 laminectomy was performed, and intraoperative ultrasound provided the tumor location in order to plan the dural opening as well as define the tumor boundaries with respect to the surrounding nerve roots. The nerve roots were found to be dorsal to the tumor on the ultrasound and appeared to be separate from the tumor capsule. After the dura was opened, the nerve roots were dissected from the tumor capsule and the filum was identified at its proximal and distal portions relative to the mass. The tumor appeared to be arising from the filum itself. Intraoperative electromyography monitoring and stimulation identified the motor roots around the filum and were dissected away. The filum was isolated and cut proximally in order to prevent upward displacement of the mass above the dural opening. The distal portion was then cut and the tumor was removed en bloc. The patient had good postoperative relief of her leg pain and no new neurologic or genitourinary complications. This case highlights the preoperative and intraoperative surgical planning as well as detailed technical aspects of en bloc intradural-extramedullary lumbar tumor resection with preservation of the tumor capsule in order to achieve gross total resection.

Transsylvian, Carotid-Oculomotor Triangle Approach for Resection of a Rapidly Enlarging Midbrain-Pontine Cavernous Malformation: 3-Dimensional Operative Video

2019 ◽  
Vol 17 (3) ◽  
pp. E112-E112
Author(s):  
Thomas J Sorenson ◽  
Joshua D Hughes ◽  
Giuseppe Lanzino ◽  
Leonardo Rangel Castilla
Keyword(s):  
Surgical Planning ◽  
Cavernous Malformation ◽  
Mass Effect ◽  
Sylvian Fissure ◽  
Cavernous Malformations ◽  
3 Dimensional ◽  
Postoperative Mri ◽  
Leg Weakness ◽  
Magnetic Resonance Imaging Mri ◽  
Orbital Rim

Abstract Cavernous malformations (CM) of the anterior midbrain are best reached through an orbitozygomatic (OZ) approach with removal of the orbital rim and wide Sylvian fissure dissection. Our surgical video demonstrates this approach to resect a ruptured CM in a 36-yr-old woman who presented with headaches, left face and left arm paresthesias/weakness, and right-sided partial oculomotor nerve (CN III) palsy. Initial magnetic resonance imaging (MRI) showed a midbrain CM, and the patient was managed conservatively. However, 1 wk later, she presented again with worsened left arm and leg weakness and complete CN III palsy. Seven Tesla MRI demonstrated a larger hematoma, and the CM with new mass effect and upper pons extension. The patient underwent a right modified OZ craniotomy and Sylvian fissure split under guidance of intraoperative neuronavigation and with neuromonitoring. The carotid-oculomotor triangle and the Liliequist membrane were dissected to access the midbrain, and CN III was identified and followed posteriorly to the midbrain. Confirmed with neuronavigation, a longitudinal incision of the midbrain was performed, and the CM was encountered. The hematoma and CM were debulked and removed in a piece-meal fashion, leaving hemosiderin-stained brain intact to prevent unnecessary additional damage to the midbrain. Postoperative MRI confirmed gross-total resection, and the patient's weakness recovered substantially. In this video, we demonstrate that the brainstem is no longer forbidden surgical territory, and show how the use of neuronavigation for surgical planning, positioning, and approach, in addition to the understanding of safe entry zones and meticulous microsurgical technique have made safe and effective surgery on the brainstem possible.

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