Awake Craniotomy for Resection of Left Temporal Cavernoma: 3-Dimensional Operative Video

2018 ◽  
Vol 17 (3) ◽  
pp. E102-E102
Author(s):  
Krunal Patel ◽  
Leonardo Desessards Olijnyk ◽  
Karol P Budohoski ◽  
Thomas Santarius ◽  
Ramez W Kirollos ◽  
...  
Keyword(s):  
Informed Consent ◽  
Medical Treatment ◽  
Seizure Control ◽  
Surgical Excision ◽  
Neurological Deficits ◽  
Awake Surgery ◽  
Cortical Mapping ◽  
3 Dimensional ◽  
Bipolar Stimulation ◽  
Eloquent Cortex

Abstract Cavernomas presenting with seizures refractory to medical treatment may require surgical excision for seizure control. If superficial, they can be surgically accessible but can pose additional risks when located in or near eloquent cortex. In this 3D operative video we illustrate the technique for the resection of a left temporal cavernoma located near eloquent cortex for speech with awake surgery and cortical mapping to avoid a speech deficit postoperatively. Informed consent was obtained for this procedure. Navigation is used to localize the cavernoma following which a large craniotomy is performed exposing the temporal lobe, frontal lobe, and sylvian vein. Bipolar stimulation is used to localize speech with the patient awake until speech arrest occurs. The cavernoma is situated immediately inferior to the sulcus over which speech arrest occurs. The sulcus immediately above the cavernoma is opened and adjacent arteries are carefully preserved. The glial plane around the cavernoma is used to dissect the cavernoma from the surrounding cortex. Care is taken to remove the haemosiderin as this can act as a precipitant for ongoing seizures. In this case the patient had no neurological deficits following surgery and was seizure free.

scholarly journals Dysmorphic neuron density underlies intrinsic epileptogenicity of the centre of cortical tubers

2019 ◽  
Author(s):  
Sarah EM. Stephenson ◽  
Harley G. Owens ◽  
Kay L. Richards ◽  
Wei Shern Lee ◽  
Colleen D’Arcy ◽  
...  
Keyword(s):  
Seizure Control ◽  
Focal Cortical Dysplasia ◽  
Epileptic Activity ◽  
Neurological Deficits ◽  
Unbiased Stereology ◽  
Neuron Density ◽  
Mri Studies ◽  
Cortical Tubers ◽  
Eloquent Cortex ◽  
Dysmorphic Neurons

AbstractCortical tubers are benign lesions that develop in patients with tuberous sclerosis complex (TSC), often resulting in drug-resistant epilepsy. Surgical resection may be required for seizure control, but the extent of the resection required is unclear. Many centres include resection of perituberal cortex, which may be associated with neurological deficits. Also, patients with tubers in eloquent cortex may be excluded from epilepsy surgery.Our electrophysiological and MRI studies indicate that the tuber centre is the source of seizures, suggesting that smaller resections may be sufficient for seizure control. Here we report five epilepsy surgeries in four children with TSC and focal motor seizures from solitary epileptogenic tubers in the sensorimotor cortex in whom the resection was limited to the tuber centre, leaving the tuber rim and surrounding perituberal cortex intact. Seizures were eliminated in all cases, and no functional deficits were observed. On routine histopathology we observed an apparent increase in density of dysmorphic neurons at the tuber centre, which we confirmed using unbiased stereology which demonstrated a significantly greater density of dysmorphic neurons within the resected tuber centre (1951 ± 215 cells/mm3) compared to the biopsied tuber rim (531 ± 189 cells/mm3, n = 4, p = 0.008).Taken together with our previous electrophysiological and MRI studies implicating the tuber centre as the focus of epileptic activity, and other electrophysiological studies of dysmorphic neurons in focal cortical dysplasia, this study supports the hypothesis that dysmorphic neurons concentrated at the tuber centre are the seizure generators in TSC. Furthermore, our results support limiting resection to the tuber centre, decreasing the risk of neurological deficits when tubers are located within eloquent cortex.

AWAKE CRANIOTOMY FOR BRAIN TUMORS NEAR ELOQUENT CORTEX

Neurosurgery ◽  
2009 ◽  
Vol 64 (5) ◽  
pp. 836-846 ◽  
Author(s):  
Stefan S. Kim ◽  
Ian E. McCutcheon ◽  
Dima Suki ◽  
Jeffrey S. Weinberg ◽  
Raymond Sawaya ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Neurological Status ◽  
Extent Of Resection ◽  
Sensory Function ◽  
Neurological Deficits ◽  
Cortical Mapping ◽  
Eloquent Areas ◽  
Eloquent Cortex ◽  
Low Incidence ◽  
Intraoperative Localization

Abstract OBJECTIVE Intraoperative localization of cortical areas for motor and language function has been advocated to minimize postoperative neurological deficits. We report herein the results of a retrospective study of cortical mapping and subsequent clinical outcomes in a large series of patients. METHODS Patients with intracerebral tumors near and/or within eloquent cortices (n = 309) were clinically evaluated before surgery, immediately after, and 1 month and 3 months after surgery. Craniotomy was tailored to encompass tumor plus adjacent areas presumed to contain eloquent cortex. Intraoperative cortical stimulation for language, motor, and/or sensory function was performed in all patients to safely maximize surgical resection. RESULTS A gross total resection (≥95%) was obtained in 64%, and a resection of 85% or more was obtained in 77% of the procedures. Eloquent areas were identified in 65% of cases, and in that group, worsened neurological deficits were observed in 21% of patients, whereas only 9% with negative mapping sustained such deficits (P < 0.01). Intraoperative neurological deficits occurred in 64 patients (21%); of these, 25 (39%) experienced worsened neurological outcome at 1 month, whereas only 27 of 245 patients (11%) without intraoperative changes had such outcomes (P < 0.001). At 1 month, 83% overall showed improved or stable neurological status, whereas 17% had new or worse deficits; however, at 3 months, 7% of patients had a persistent neurological deficit. Extent of resection less than 95% also predicted worsening of neurological status (P < 0.025). CONCLUSION Negative mapping of eloquent areas provides a safe margin for surgical resection with a low incidence of neurological deficits. However, identification of eloquent areas not only failed to eliminate but rather increased the risk of postoperative deficits, likely indicating close proximity of functional cortex to tumor.

SUPERIOR SAGITTAL SINUS THROMBOSIS CAUSED BY CALVARIAL TUBERCULOSIS

Neurosurgery ◽  
2007 ◽  
Vol 60 (4) ◽  
pp. E776-E776 ◽  
Author(s):  
Ponraj K. Sundaram ◽  
Farook Sayed
Keyword(s):  
Medical Treatment ◽  
Superior Sagittal Sinus ◽  
Sinus Thrombosis ◽  
Bone Destruction ◽  
Rare Condition ◽  
Surgical Excision ◽  
Neurological Deficits ◽  
Sagittal Sinus ◽  
Tuberculous Osteomyelitis ◽  
Sagittal Sinus Thrombosis

Abstract OBJECTIVE Tuberculosis affects the central nervous system in various ways but has not been reported to cause venous sinus thrombosis. In this case report, extensive calvarial tuberculosis caused compression and occlusion of the superior sagittal sinus in an adult man. Early diagnosis combined with surgical and medical treatment resulted in cure of the disease. CLINICAL PRESENTATION A 34-year-old man presented with a nonhealing sinus in the frontal area after a trivial injury without any neurological deficits or features of raised intracranial pressure. Magnetic resonance imaging scans showed evidence of extensive bilateral extradural granulations, bone destruction, and thrombosis of the anterior half of superior sagittal sinus. INTERVENTION The affected bone and extradural granulations were surgically excised. Histopathology showed tuberculous osteomyelitis, and the patient received anti- tuberculous treatment, after which he had a good recovery. CONCLUSION Calvarial tuberculosis as a cause of sagittal sinus thrombosis is a rare condition and is reported here for the first time, to our knowledge. Surgical excision of the compressing granulations followed by medical treatment is curative without sequelae if the intervention is performed before the disease extends intradurally.

scholarly journals MS-1 Surgical strategy for brain tumor based on molecular and functional connectomics profiles

2020 ◽  
Vol 2 (Supplement_3) ◽  
pp. ii2-ii2
Author(s):  
Tatsuya Abe
Keyword(s):  
Overall Survival ◽  
Brain Tumor ◽  
Standard Procedure ◽  
Awake Craniotomy ◽  
Surgical Strategy ◽  
Neurological Deficits ◽  
Cortical Mapping ◽  
Photodynamic Diagnosis ◽  
Tumor Surgery ◽  
Brain Tumor Surgery

Abstract It is reported that the development of new perioperative motor deficits was associated with decreased overall survival despite similar extent of resection and adjuvant therapy. The maximum safe resection without any neurological deficits is required to improve overall survival in patients with brain tumor. Surgery is performed with various modalities, such as neuro-monitoring, photodynamic diagnosis, neuro-navigation, awake craniotomy, intraoperative MRI, and so on. Above all, awake craniotomy technique is now the standard procedure to achieve the maximum safe resection in patients with brain tumor. It is well known that before any treatment, gliomas generate globally (and not only focally) altered functional connectomics profiles, with various patterns of neural reorganization allowing different levels of cognitive compensation. Therefore, perioperative cortical mapping and elucidation of functional network, neuroplasticity and reorganization are important for brain tumor surgery. On the other hand, recent studies have proposed several gene signatures as biomarkers for different grades of gliomas from various perspectives. Then, we aimed to identify these biomarkers in pre-operative and/or intra-operative periods, using liquid biopsy, immunostaining and various PCR methods including rapid genotyping assay. In this presentation, we would like to demonstrate our surgical strategy based on molecular and functional connectomics profiles.

Crisis and Informed Consent: Analysis of a Law-Medicine Malocclusion

1987 ◽  
Vol 12 (1) ◽  
pp. 55-97 ◽  
Author(s):  
Fran Carnerie
Keyword(s):  
Informed Consent ◽  
Medical Treatment ◽  
Clinical Setting ◽  
Patient Relationship ◽  
Physician Patient Relationship ◽  
Catastrophic Illness ◽  
Physician Patient ◽  
Emotional Impairment

AbstractMany individuals develop a temporary state of cognitive and emotional impairment after being diagnosed with catastrophic illness. Thus, when crucial decisions about medical treatment are required, they are unable to assimilate information; or worse, the legal need to be informed can rival a psychological desire to not be informed. The Canadian informed consent doctrine is unresponsive to crisis and clinically impracticable, and so paradoxically compromises the integrity and autonomy it was designed to protect. Many aspects of the physician-patient relationship and clinical setting also undermine the philosophical values enshrined in this doctrine. This further jeopardizes the individual's integrity. The Article explores proposals for change such as delaying the informing and consenting, improving the concept of consent, and improving the role of the physician.

Certified Patient Decision Aids: Solving Persistent Problems with Informed Consent Law

2017 ◽  
Vol 45 (1) ◽  
pp. 12-40 ◽  
Author(s):  
Thaddeus Mason Pope
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Medical Treatment ◽  
Shared Decision Making ◽  
Decision Aids ◽  
Shared Decision ◽  
Legal Doctrine ◽  
Patient Decision Aids ◽  
Patient Decision ◽  
Decision Making Processes

The legal doctrine of informed consent has overwhelmingly failed to assure that the medical treatment patients get is the treatment patients want. This Article describes and defends an ongoing shift toward shared decision making processes incorporating the use of certified patient decision aids.

Combined Transpetrosal Approach With Preservation of Superior Petrosal Vein Drainage for a Cerebellopontine Angle Epidermoid Cyst Extending Into Meckel's Cave: 3-Dimensional Operative Video

2018 ◽  
Vol 16 (6) ◽  
pp. E172-E173
Author(s):  
Ken Matsushima ◽  
Michihiro Kohno ◽  
Nobuyuki Nakajima ◽  
Norio Ichimasu
Keyword(s):  
Epidermoid Cyst ◽  
Cerebellopontine Angle ◽  
Young Patients ◽  
Neurological Deficits ◽  
Meckel’S Cave ◽  
3 Dimensional ◽  
Petrosal Vein ◽  
Meckel's Cave ◽  
Superior Petrosal Sinus ◽  
Superior Petrosal Vein

Abstract The combined transpetrosal approach enables wide exposure around the petroclival region by cutting the tentorium and superior petrosal sinus. We often choose this approach for removal of tumors ventral to the facial and vestibulocochlear nerves, such as petroclival meningioma and epidermoid cyst, because complete removal of the tumor under direct visualization is required to prevent its later recurrence, especially in young patients. Recent reports revealed anatomical variations of the drainage of the superior petrosal sinus, and dural incision considering preservation of the superior petrosal vein was proposed.1-3 This 3-dimensional video shows a patient with an epidermoid cyst, which was surgically treated using the combined transpetrosal approach, with consideration of the variation of the superior petrosal sinus and preservation of the drainage route of the superior petrosal vein. The video was reproduced after informed consent of the patient. The patient is a 31-yr-old woman who presented with a left cerebellopontine angle epidermoid cyst extending into Meckel's cave. The superior petrosal sinus was of the lateral type, draining only laterally into the transverse–sigmoid junction without medial connection with the cavernous sinus.1 The combined transpetrosal approach was performed with cutting of the superior petrosal sinus medial to the entry point of the superior petrosal vein, in order to preserve its drainage into the transverse–sigmoid junction. Meckel’ cave was opened along its lateral margin, and tumor removal was accomplished, leaving only a minute part of the capsule strongly adhering to the neurovascular structures. The patient had no new permanent neurological deficits during follow-up. The figures in the video were modified from Matsushima et al1 by permission of the Congress of Neurological Surgeons.

Ocular Cysticercosis — A Profile

2003 ◽  
Vol 33 (3) ◽  
pp. 185-188 ◽  
Author(s):  
Anuradha Chowdhary ◽  
Rajlakshmi Bansal ◽  
Kirti Singh ◽  
Varinder Singh
Keyword(s):  
Retrospective Study ◽  
Medical Treatment ◽  
Surgical Excision ◽  
North India ◽  
Age Group ◽  
Common Site ◽  
Referral Centre ◽  
Tertiary Referral ◽  
Tertiary Referral Centre ◽  
Ocular Cysticercosis

A retrospective study was conducted on all histopathologically proven cases of ocular cysticercosis spanning a decade in a tertiary referral centre of North India. The symptomatology, presentation, complications and treatment therapies of 18 of these patients are discussed. The most common age group to be affected was 11–20 years (50%), while the most common site involved was subconjunctival (78%), followed by lid (11%). Spontaneous extrusion was documented in three cases. Medical treatment with albendazole under the cover of corticosteroids was found to be a useful adjunct to surgical excision.

Microsurgical Resection of a Solitary Spinal Epidural Cavernous Angioma: 3-Dimensional Operative Video

2018 ◽  
Vol 16 (2) ◽  
pp. E47-E47
Author(s):  
Guilherme H W Ceccato ◽  
Lucélio Henning ◽  
Julyana L Prado ◽  
Marcio S Rassi ◽  
Luis A B Borba
Keyword(s):  
Vascular Malformations ◽  
Surgical Excision ◽  
Cavernous Angioma ◽  
Neurophysiological Monitoring ◽  
Ethical Standards ◽  
Patient Identification ◽  
Research Committee ◽  
En Bloc ◽  
3 Dimensional ◽  
Spinal Epidural

Abstract Solitary spinal epidural cavernous angiomas are rare vascular malformations. Surgical excision is the treatment of choice, as these lesions tend to grow or bleed at some point. In this 3-dimensional, narrated video, we present the case of a 61-year-old male who presented with progressive pain in the right paravertebral region secondary to an epidural cavernous angioma located at the T6/T7 level. Under intraoperative neurophysiological monitoring, a laminectomy between T5 and T7 was performed. A reddish, well delimited, and highly vascularized epidural mass was identified and dissected from the adjacent dura and nerve root, and an en bloc total resection was achieved. The patient was discharged neurologically intact on postoperative day 4, presenting a remarkable improvement of his pain at 2-month follow-up. Total excision of these lesions is possible in most of cases, remaining the standard treatment, with minimum complications.  All procedures were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. All data related to patient identification were removed from this surgical video and manuscript, with no need of a written informed consent.

scholarly journals An unusual case of genital filariasis of the testicular tunics in an Italian patient

2021 ◽  
Vol 41 (3) ◽  
pp. 186-189
Author(s):  
Alessia Fassari ◽  
Andrea Polistena ◽  
Giorgio De Toma ◽  
Enrico Fiori
Keyword(s):  
Medical Treatment ◽  
Adult Worm ◽  
Clinical Examination ◽  
Unusual Case ◽  
Surgical Excision ◽  
Singular Case ◽  
Short Term ◽  
Italian Patient ◽  
Immigrant Patient ◽  
Endemic Areas

At least 27 million men present with urogenital manifestations of genital filariasis (GF). Although there is a large burden of GF in residents in endemic regions, infection in short-term travellers and in non-endemic areas is rare. We report the case of a 75-year-old Italian man referred to our institution for a testicular discomfort. Clinical examination and ultrasound detected a mass of 40×18 mm in the scrotum without signs of varicocele, hydrocele and testicular or epididymal abnormalities. After ineffective medical treatment, the patient underwent surgical excision. Histology demonstrated filarial granuloma with thick cuticles pathognomonic of an adult worm in the testicular tunics. Surgery has a fundamental role in localized cases of GF to remove nematodes from the fibrotic nodules. The present manuscript describes a singular case of GF observed in Italy in a non-immigrant patient with evidence of remnants of an adult worm in the testicular tunics. SIMILAR CASES PUBLISHED: 11

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