Posts Tagged ‘microsurgery’
Advances and Innovations in Vascular Neurosurgery: Advances and Innovations in Brain Arteriovenous Malformation Surgery
Arteriovenous malformations (AVMs) of the brain are very complex and intriguing pathologies. Since their initial description by Luschka and Virchow in the middle of the 19th century, multiple advances and innovations have revolutionized their management and surgical treatment. Here, we review the historical landmarks in the surgical treatment of AVMs and then illustrate the most recent and futuristic technologies aiming to improve outcomes in AVM surgeries. In particular, we examine potential advances in patient selection, imaging, surgical technique, neuroanesthesia, and postoperative neuro-rehabilitation and quantitative assessments. Read the rest of this entry »
Background: Lasers have a long history in neurosurgery, yet bulky designs and difficult ergonomics limit their use. With its ease of manipulation and multiple applications, the OmniGuide CO2 laser has reintroduced laser technology to the microsurgical resection of brain and spine lesions. This laser, delivered through a hollow core fiber lined with a unidirectional mirror, minimizes energy loss and allows precise targeting.
Objective: To analyze resections performed by the senior author from April 2009 to March 2013 of 58 cavernous malformations (CMs) in the brain and spine using the OmniGuide CO2 laser, to reflect on lessons learned from laser use in eloquent areas, and to share data on comparisons of laser power calibration and histopathology.
Methods: Data were collected from electronic medical records, radiology reports, operative room records, OmniGuide CO2 laser case logs, and pathology records.
Background: Arteriovenous malformations (AVMs) in the basal ganglia, thalamus, and insula are considered inoperable given their depth, eloquence, and limited surgical exposure. While many neurosurgeons opt for radiosurgery or observation, others have challenged the belief that deep AVMs are inoperable. Further discussion of patient selection, technique, and multimodality management is needed.
Objective: To describe and discuss the technical considerations of microsurgical resection for deep-seated AVMs.
Methods: Patients with deep AVMs who underwent surgery during a 14-year period were reviewed using a prospective AVM registry.
Objective: Our study evaluated recurrence rates in patients with total endoscopic resection of colloid cysts versus those with coagulated cyst remnants.
Methods: Sixty-five consecutive patients and 67 procedures for endoscopic resection of colloid cysts from 1995 to 2011 were reviewed. Degree of resection was based upon intra-operative assessment and post-operative MRI. Recurrence rates were compared between patients with complete resection versus coagulated cyst remnants.
Background: Surgery of lesions of the petrous apex involving the inframeatal/infralabyrinthine area is challenging and related to high risk of complications. Various extensive skull base approaches have been utilized.
Objective: To present and evaluate our experience with a new hearing preserving extension of the retrosigmoid approach to the inframeatal/infralabyrinthine area.
Methods: The approach was used in three patients harboring lesions in the petrous apex with variable extension in the inframeatal/infralabyrinthine region. The surgical accessibility of the lesions offered by the approach, the completeness of tumor removal, and the outcome, in particular the functional outcome and complication rate, were assessed.
Objective: To study the clinical features and outcomes following surgery for deep CMs and the complication of hypertrophic olivary degeneration (HOD).
Methods: Clinical records, radiological findings, operative details, and complications of 176 patients with deep CMs were reviewed retrospectively.
Intraoperative imaging disrupts the rhythm of surgery despite providing an excellent opportunity for surgical monitoring and assessment. To allow surgery within real-time images, neuroArm, a teleoperated surgical robotic system, was conceptualized. The objective was to design and manufacture a magnetic resonance-compatible robot with a human-machine interface that could reproduce some of the sight, sound, and touch of surgery at a remote workstation. University of Calgary researchers worked with MacDonald, Dettwiler and Associates engineers to produce a requirements document, preliminary design review, and critical design review, followed by the manufacture, preclinical testing, and clinical integration of neuroArm. During the preliminary design review, the scope of the neuroArm project changed to performing microsurgery outside the magnet and stereotaxy inside the bore. neuroArm was successfully manufactured and installed in an intraoperative magnetic resonance imaging operating room. neuroArm was clinically integrated into 35 cases in a graded fashion. Read the rest of this entry »