Techniques In Neurosurgery Research Articles

Current surgical management of brain metastases

Metastatic brain tumours are among the most common surgical targets in brain surgery. Up to 40% of cancer patients develop brain metastases during the course of their disease. Lung, breast, kidney, intestine and melanoma are the most common cancers, spreading into the CNS. New techniques in neurosurgery have lead to a significant increase in survival and quality of life of patients suffering from brain metastasis. Image guidance, intraoperative ultrasound, electrophysiological cortical mapping, functional neuronavigation and awake craniotomy expanded the indication of surgery even to patients suffering from multiple metastases. Thus, appropriate selection criteria are necessary to provide benefits of surgery to the widest population of patients possible. Besides traditional criteria like age, Karnofsky performance status (KPS), number, extension, surgical accessibility, histology and status of the systemic disease, recursive partitioning analysis has led to a new preoperative classification system (RPA Classes 1–3), to select patients, having best benefit from surgical treatment.

Multidisciplinary management of spinal lipoma

Spinal lipomas (congenital lipomyelomeningoceles) can cause significant aesthetic deformity of the lower spine in addition to recognised neurological problems. Surgical management consists of untethering the cord in symptomatic cases, and debulking of the lipomatous component to improve the spinal contour. However, management remains controversial. Between May 1998 and November 2002, 23 cases of lumbosacral spinal lipoma were operated on by neurosurgeons at our hospital. Of these, eight (34%) patients were subsequently referred to plastic surgery for aesthetic revision, which was performed by a combined team of plastic surgeons and neurosurgeons. In addition, three new patients had their primary surgery as a planned procedure performed by the same combined team. The purpose of this paper is to present the method and results of combined plastic surgery and neurosurgery technique in these 11 cases of spinal lipoma. Follow up ranged between 12 months and 4 years (mean 20 months). One patient had wound break down and three patients developed seroma. Two patients had cerebrospinal fluid (CSF) leakage which required re-exploration and prolonged hospitalisation. The aesthetic results were very satisfactory in 10 out of the 11 patients. The frequency of secondary referral for aesthetic revision, together with the incidence of CSF leak, underlines the importance of managing spinal lipomas in a multidisciplinary team involving neurosurgeons and plastic surgeons. This series demonstrates that aesthetic results are encouraging but decreasing the CSF leakage rate remains a challenge. Further follow up will determine the role of early combined surgery in the management of spinal lipoma.

Microvascular intraoperative Doppler sonography

The use of Doppler sonographic equipment transmitting pulsed high-frequency (20 MHz) ultrasound in conjunction with miniaturised probes, allowed recordings from small brain vessels having diameters of 1 mm and less. Experience made with this technique in clinical and experimental neurosurgery demonstrated its value in all types of neurovascular operations. Nearly 10% of the immediate results of such operations, though apparently successful or without adverse findings, eventually proved unsatisfactory on Doppler sonography only and could be subsequently corrected. The quality of arterial anastomoses performed in animal experiments as well as the various anastomotic techniques can be investigated in terms of their haemodynamic efficiency. The same holds true for cerebral arterial anastomoses in man. The patency of these anastomoses can be examined intraoperatively and necessary corrections can be made immediately. Similarly the method is most helpful in aneurysm operations by allowing to verify the clipping of the aneurysm neck and the patency of the supplying vessels.

Commentary

Opening the Sylvian fissure is an important technique in neurosurgery. Despite providing excellent anatomic fidelity, cadaveric and synthetic models lack real-time hemodynamics and coagulation physiology. We introduce a live rat aortoiliac model to practice the basic skills of Sylvian fissure splitting based on its arachnoidal microanatomy. Cadaveric dissections were carried out to assess the microanatomical relationships between the Sylvian fissure arachnoid and its contents, namely arteries (A), veins (V), and brain (B). Rat surgeries were performed to assess the similarities between separating aortoiliac arteries from adjacent veins and the various technical aspects of dissecting the Sylvian fissure. The Sylvian fissure could be divided into 3 compartments regarding the progressive steps of its dissection: (1) superficial opercular, (2) deep opercular, and (3) cisternal. The major arachnoidal connections that required division during dissection of each Sylvian compartment were as follows: B-V and V-V types in the superficial opercular; B-B and A-B types in the deep opercular; and A-B and A-A types in the cisternal compartments. Dissection techniques in the rat aortoiliac model correlated with key techniques in Sylvian fissure dissection. Despite lacking brain tissue, the rat aortoiliac arteries offer a model in which the arteries and veins with their investing connective tissues mimic the arachnoid-vessel interconnections in the Sylvian fissure. Therefore, using this model simulates the essential sub-techniques of splitting the Sylvian fissure. The rat model may be used to provide trainees with an opportunity to practice under the duress of the real-time hemodynamics and coagulation physiology.

Use of highend ultrasound in minimally invasive strategy of neurosurgery: Review of 1090 cases

The purpose of this study is to present our routine use of high-end ultrasound technique in neurosurgery. The ALOKA 5000 with four small probes offered a basis to improve minimally invasiveness in our discipline: TCD probe (2.14 to 3.75MHZ) was used in 560 cases mainly at ICU; the small part sector probe (3.8 to 7.5MHZ) was mainly applied intra-operatively in 195 cases and the burr hole probe (3.75 to 7.5MHZ) was also mainly used intra-operatively in 92 cases. The trans-endoscopic mini-probe (360°, 6F + 8F, 10, 15, 20MHZ) was used with strictly indication integrated into high-end machine in 21 cases (out of over100 cases). The complete spectrum of neurosurgical diagnoses presented applicable assistance for therapy in our experience. In 279 intra-operative applications ultrasound proved to be an excellent neuro – navigation system providing the surgeon with real-time imaging and targeting capabilities. Resection control in 55 tumor cases with targeting in 34 small lesions was very satisfying and in four cases craniotomy correction was possible before opening of dura mater. Compensation of computer-navigation failures was possible in 14 cases preventing possible disasters. The 528 cases of application at the ICU showed a bedside use, resulting in decrease of risky out door examination reduce stress for our patients and logistic efforts for the professionals.

Classification of Minimally Invasive Transnasal (Endoneurosurgical) Tumor Surgery

Despite the progress in minimally invasive techniques in endoscopic sinus surgery and neurosurgery, tumors beyond the sphenoid sinus and the sella have generally been considered to be too risky to be approached transnasally. The new endoneurosurgery, in combination with intraoperative MRI, is a minimally invasive surgical concept that allows the removal of tumors of the anterior skull base, the sella, and the clivus by a single transnasal approach. Our presentation aims to illustrate the potential of this concept based on our experience. Forty-eight patients with extensive tumors were operated according to this concept from January 2005 to June 2006. Technical setting comprises a microscope, endoscopes, image guidance, and intraoperative MRI. Patients were categorized according to the applied approach into group A (19 patients; transcribriform approach), B (26 patients; trans-sphenoidal approach) and C (3 patients; transclival approach). The application of these tools for neurosurgeons and otorhinolaryngologists allows resection of even extensive tumors with curative intention, avoiding secondary transcranial approach. According to our experience, tumors with compression of the third ventricle and brainstem can be resected transnasally in a single-stage operation and with relatively low risks. Patient selection for such an endoneurosurgical intervention must be based on perfect imaging. The relatively high effort in technical equipment combined with an experienced team will be justified by the good results of this endoneurosurgery.

Minimally Invasive, Transnasal (Endoneurosurgical) Tumor Resection

Despite the progress in minimally invasive techniques in endoscopic sinus surgery and neurosurgery, tumors beyond the sphenoid sinus and the sella have been considered to be too risky to be approached transnasally.

Classification of Minimally Invasive Transnasal (Endoneurosurgical) Tumor Surgery

Despite the progress in minimally invasive techniques in endoscopic sinus surgery and neurosurgery, tumors beyond the sphenoid sinus and the sella have generally been considered to be too risky to be approached transnasally. The new endoneurosurgery, in combination with intraoperative MRI, is a minimally invasive surgical concept that allows the removal of tumors of the anterior skull base, the sella, and the clivus by a single transnasal approach. Our presentation aims to illustrate the potential of this concept based on our experience. Forty-eight patients with extensive tumors were operated according to this concept from January 2005 to June 2006. Technical setting comprises a microscope, endoscopes, image guidance, and intraoperative MRI. Patients were categorized according to the applied approach into group A (19 patients; transcribriform approach), B (26 patients; trans-sphenoidal approach) and C (3 patients; transclival approach). The application of these tools for neurosurgeons and otorhinolaryngologists allows resection of even extensive tumors with curative intention, avoiding secondary transcranial approach. According to our experience, tumors with compression of the third ventricle and brainstem can be resected transnasally in a single-stage operation and with relatively low risks. Patient selection for such an endoneurosurgical intervention must be based on perfect imaging. The relatively high effort in technical equipment combined with an experienced team will be justified by the good results of this endoneurosurgery.

1260: Ultrasound in neurosurgery—analysis of 800 examinations

The purpose of this study is to present our routine use of high-end ultrasound technique in neurosurgery. Moreover, we present a new technique we introduced into neurosurgery: trans-endoscopic ultrasound for simple navigation and intraoperatively imaging in neuroendoscopy. Neurosurgery has the privilege to benefit from long time experience and evolution of techniques of many neighbour disciplines using ultrasound since several decades. The ALOKA 5000 with four small probes offered a basis to improve minimal invasiveness in our discipline: TCD probe (2.14 to 3.75 MHZ) was used in 508 cases, mainly at ICU; the small part sector probe (3.8 to 7.5 MHZ) was mainly applied intraoperatively in 183 cases and the burr hole probe (3.75 to 7.5 MHZ) was also mainly used intraoperatively in 88 cases. The transendoscopic miniprobe (360°, 6 F + 8 F, 10, 15, 20 MHZ) was used with strictly indication integrated into high-end machine in 21 cases (out of over 100 cases). The complete spectrum of neurosurgical diagnoses presented applicable assistance for therapy in our experience. In 265 intraoperative applications, ultrasound proved to be an excellent neuronavigation system providing the surgeon with real-time imaging and targeting capabilities. Resection control in 43 tumor cases with targeting in 25 small lesions was very satisfying, and in four cases craniotomy correction was possible before opening of dura mater. Compensation of computer-navigation failures was possible in 13 cases, preventing possible disasters. The 482 cases of application at the ICU showed a bedside use, resulting in decrease of risky outdoor examination to reduce stress for our patients and logistic efforts for the professionals. Investigations are running in innovative applications such as brain death diagnosis, bedside-sono-CT, aneurysm-monitoring, bridging-vein monitoring and sono-pupillometry. Intraoperatively, we examine sono-angiography in tumors and for clipping control of aneurysms, compensate computer-navigation pitfalls and navigate endoscopes with our “brain-radar”. The purpose of this study is to present our routine use of high-end ultrasound technique in neurosurgery. Moreover, we present a new technique we introduced into neurosurgery: trans-endoscopic ultrasound for simple navigation and intraoperatively imaging in neuroendoscopy. Neurosurgery has the privilege to benefit from long time experience and evolution of techniques of many neighbour disciplines using ultrasound since several decades. The ALOKA 5000 with four small probes offered a basis to improve minimal invasiveness in our discipline: TCD probe (2.14 to 3.75 MHZ) was used in 508 cases, mainly at ICU; the small part sector probe (3.8 to 7.5 MHZ) was mainly applied intraoperatively in 183 cases and the burr hole probe (3.75 to 7.5 MHZ) was also mainly used intraoperatively in 88 cases. The transendoscopic miniprobe (360°, 6 F + 8 F, 10, 15, 20 MHZ) was used with strictly indication integrated into high-end machine in 21 cases (out of over 100 cases). The complete spectrum of neurosurgical diagnoses presented applicable assistance for therapy in our experience. In 265 intraoperative applications, ultrasound proved to be an excellent neuronavigation system providing the surgeon with real-time imaging and targeting capabilities. Resection control in 43 tumor cases with targeting in 25 small lesions was very satisfying, and in four cases craniotomy correction was possible before opening of dura mater. Compensation of computer-navigation failures was possible in 13 cases, preventing possible disasters. The 482 cases of application at the ICU showed a bedside use, resulting in decrease of risky outdoor examination to reduce stress for our patients and logistic efforts for the professionals. Investigations are running in innovative applications such as brain death diagnosis, bedside-sono-CT, aneurysm-monitoring, bridging-vein monitoring and sono-pupillometry. Intraoperatively, we examine sono-angiography in tumors and for clipping control of aneurysms, compensate computer-navigation pitfalls and navigate endoscopes with our “brain-radar”.

Plastic Techniques in Neurosurgery

Archives of Facial Plastic SurgeryVol. 8, No. 2 Book and Multimedia ReviewsPlastic Techniques in NeurosurgeryMatthew Rontal and Shan R. BakerMatthew RontalSearch for more papers by this author and Shan R. BakerSearch for more papers by this authorPublished Online:1 Mar 2006https://doi.org/10.1001/archfaci.8.2.143AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Plastic Techniques in Neurosurgery." Archives of Facial Plastic Surgery, 8(2), p. 143FiguresReferencesRelatedDetails Volume 8Issue 2Mar 2006 InformationCopyright 2006 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.To cite this article:Matthew Rontal and Shan R. Baker.Plastic Techniques in Neurosurgery.Archives of Facial Plastic Surgery.Mar 2006.143-143.http://doi.org/10.1001/archfaci.8.2.143Published in Volume: 8 Issue 2: March 1, 2006PDF download

Irrigation-Suction Straw Sheath System for a Rigid Endoscope during Endonasal Endoscopic Pituitary Surgery

One of the most problematic conditions during endonasal endoscopic pituitary surgery is blurred endoscopic vision caused by blood or bone dust. To address this problem we used a new device, the irrigation-suction straw sheath system originally developed for endoscopic sinus surgery in rhinology, for the endoscopic pituitary surgery. The irrigation-suction straw system (K-endosheath; Koken Co., Tokyo, Japan) consists of a flattened disposable straw catheter which can be attached on a rigid endoscope. When the endoscope is inserted into the oblong catheter, two gaps remain on either side of the endoscope. Through each of these gaps irrigation and continuous suction are performed respectively. Clear vision could be immediately obtained by pressing the button to release the irrigation water onto the endoscope's front lens. Even targeted irrigation during drilling was possible. Above all, continuous suction was useful to clear the operative field of blood, smoke, or bone dust, ensuring the safety and uninterrupted progress of the procedure. This irrigation-suction system has proved to be very useful and easy to use for endonasal endoscopic pituitary surgery. Further development of such new devices and instruments specialized for endonasal endoscopic pituitary surgery will promote the increased use of this minimally invasive technique in neurosurgery.

Plastic Techniques in Neurosurgery???Second Edition

Annals of Plastic Surgery: August 2005 - Volume 55 - Issue 2 - p 223 doi: 10.1097/01.sap.0000172327.93618.a4

Plastic Techniques in Neurosurgery, 2nd Edn

Plastic Techniques in Neurosurgery, 2nd Edn

Plastic Techniques in Neurosurgery

Plastic Techniques in Neurosurgery

Battling blood loss in neurosurgery: Harvey Cushing's embrace of electrosurgery

For his pioneering spirit, definitive work, and unparalleled devotion to conquering neurosurgery's toughest obstacles, Harvey Williams Cushing inarguably has earned the title, "The Father of Neurosurgery." His revolutionary incorporation of electrosurgical techniques in neurosurgery was not exceptional, but part of a pattern of recognizing, embracing, and establishing the use of medical technologies with great potential. Until 1910, Cushing had systematically reduced neurosurgery's primary complications--infection and the effects of intracranial pressure--to decrease mortality rates. Hemostasis had always been a concern of William Halsted's surgical protégé, but only after 1910 could Cushing primarily focus on it. In fact, Cushing's crucial collaboration with William T. Bovie and his electrosurgical apparatus conquered this major obstacle in 1926. The nature of their collaboration--two experts in their respective fields who were passionate about their work, working side by side in the operating room--resulted in progress that surpassed all predecessors in the field. Cushing never did learn the physics behind one of the most important advances of his career. Nonetheless, he did know that by greatly reducing blood loss, electrosurgery allowed him to operate in patients whose tumors had been previously deemed inoperable and on the entire spectrum of neurosurgical patients more safely.

J.T. Goodrich and D.A. Staffenberg: Plastic techniques in neurosurgery

J.T. Goodrich and D.A. Staffenberg: Plastic techniques in neurosurgery

Plastic techniques in neurosurgery

Plastic techniques in neurosurgery

Extracorporeal circulation in non-cardiac surgery

Tradition and experience of cardiopulmonary bypass in the hand of cardiac surgeons Led to several spin-offs of this extracorporeal technique. Acute organ support is realized for situations of failing cardiac output, circulatory arrest respectively, of pulmonary failure and of drowning. Extracorporeal circulation is a promising adjunct to aim in better surgical technique and treatment in neurosurgery, thoracic aortic surgery, complex Lung resection, tumor surgery and procedures where safe organ perfusion must be ascertained. Chemotherapy and hyperthermia in limb carcinoma is highly successful if performed with the help of extracorporeal circulation. Progression in transcutaneous cannulation technique makes application of machinery easy and from operation facilities independent. Replacement of Long lasting periods of chest compression for heart massage is a future perspective if circulation is maintained by transcutaneously adapted miniaturized heart-lung-machine. Long lasting traumatizing mechanical ventilation of a severely diseased lung maybe replaced by extracorporeal lung assistance to give better chances for the lung to recover. Thoughts for these new interdisciplinary duties of cardio surgical units were discussed in the committee for the Symposium for the Future of Cardiac Surgery.

Anesthetic Techniques for Neurosurgery

Abstract:The aim of this study was to compare the hemodynamic and recovery profiles of desflurane-remifentanil and desflurane-fentanyl in patients undergoing intracranial surgery. Adult patients with American Society of Anesthesiologist (ASA) II to III physical status who were undergoing intracrania

Endo-Neuro-Sonography: First clinical Series

Purpose: The step from micro-neurosurgery toward Endo-Neuro-Surgery meant a step to a minimally invasive technique, but at the same time decreased its safety, which limits its applicability. The goal to further development had therefore been, to make neuro-endoscopy safer. After laboratory work, in a first series of 65 patients with a broad variety of lesions, a sono – catheter for trans-endoscopic imaging was applied for the first time in neurosurgery. Methods and Materials: A trans-endoscopic sono-catheter (Aloka Deutschland GmbH, Dusseldorf/Germany) with a diameter of 1.9mm (6F) and 2.5mm (8F) was used and introduced into the working canal of an endoscope. The image produced by the probe is a 360° scan (-brain radar“) displayed on a monitor, on which some parameters can be varied to get best view of different anatomical structures. Results: In 51 cases intraoperative imaging was the main reason for investigation and in 15 cases neuronavigation was in the focus of interest. In 20 cases of tumor resection control, targeting a visualized remnant was necessary. ENS proved in this small series to make neuroendoscopy safer and easier by online and real-time imaging with high resolution. There are limitations and artifacts which should reveal themselves in laboratory and clinical experience. Conclusions: Endo-Neuro-Sonography now as it stands, is a technique, which can contribute to the concept of minimally invasive techniques in neurosurgery, as this presentation does describe. Literature: Resch, K.D.M. Endo-Neuro-Sonography: trans-endoscopic sonography for neurosurgery. Springer 6/2005