Skull base Webinar
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Approaches
OPEN APPROACHES TO THE SKULL BASE – Online IRCAD University
EANS SKULL BASE SECTION : Craniocervical junction surgeries with vertebral artery management
Endoscopic endonasal approches
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Pathologies
Chordomas
SKULL BASE SATURDAY : SBN Sociedade Brasileira de Neurocirurgia
Vestibular Schwannomas
EANS SKULL BASE SECTION : Managment and surgical treatment of vestibular Schwannoma
Meningiomas
SMNC Webinar : Petroclival Meningioma
Petroclival Meningiomas
Neurosurgery Playlist
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AANS/CNS Neurosurgical Sessions
Infratentorial Supracerebellar Approach
Bilateral Frontotemporal Decompressive Craniectomy (Kjellberg Procedure)
Occipital Transtenorial Approach
Production of a Neurosurgery Online Curriculum (NOC) Video
Pterional Craniotomy
Retrosigmoid Craniectomy
Operating Room Principles
Patient Safety and Clinical Communications
Emergency Spinal Radiological Assessment
Professionalism, Supervision and Pearls for the PGY1 Resident
Trigeminal Neuralgia: Surgical Options
Emergency Evaluation of Hydrocephalus and Shunts
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The Rhoton Collection
Cerebellopontine Angle and Fourth Ventricle - Part 1 of 2
Cerebellopontine Angle and Fourth Ventricle - Part 2 of 2
Cavernous Sinus and Middle Fossa - Part 1 of 2
Cavernous Sinus and Middle Fossa - Part 2 of 2
Far Lateral Approach and Jugular Foramen - Part 1 of 2
Far Lateral Approach and Jugular Foramen - Part 2 of 2
Navigating the Temporal Bone - Part 1 of 3
Navigating the Temporal Bone - Part 2 of 3
Navigating the Temporal Bone - Part 3 of 3
Anterior Skull Base, Part 1
Anterior Skull Base, Part 2
Approaches to the Brainstem
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The Photon Collection 3D
Cerebellopontine Angle and Fourth Ventricle (3D) - Part 1 of 2
Cerebellopontine Angle and Fourth Ventricle (3D) - Part 2 of 2
Cavernous Sinus and Middle Fossa (3D) - Part 1 of 2
Cavernous Sinus and Middle Fossa (3D) - Part 2 of 2
Far Lateral Approach and Jugular Foramen (3D) - Part 1 of 2
Far Lateral Approach and Jugular Foramen (3D) - Part 2 of 2
Navigating the Temporal Bone (3D) - Part 1 of 3
Navigating the Temporal Bone (3D) - Part 2 of 3
Navigating the Temporal Bone (3D) - Part 3 of 3
Anterior Skull Base, Part 1 (3D)
Anterior Skull Base, Part 2 (3D)
Approaches to the Brainstem (3D)
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Journal of Neurosurgery – Neurosurgical Focus
A case of severe basilar invagination and AAD, corrected using the technique of DCER ...
P. Sarat Chandra, MCh, and Mohit Agarwal, MCh
Department of Neurosurgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
The author has described his own technique of DCER (distraction, compression, extension, and reduction) to reduce and realign the deformity and relieve spinal compression (indicated in congenital anomalies with occipitalized C1 arch). In addition, he developed special C1–2 spacers and a universal reducer. Here, a 30-year-old male with severe BI (20 mm, above the clivus) with AAD underwent the technique of spacer placement (distraction) followed by cable reduction (leading to compression and extension at the occiput–C1–C2 region). Another short example is presented where an 8-year-old boy (severe BI, AAD with posterior fossa dermoid) underwent additional correction—C2 forward translation and excision of the dermoid.
10.3171/2020.4.FocusVid.20138
**Intro music: "Daybreak" by Graeme Rosner
Giant diffuse cerebellar AVM: managing ultimate intraoperative challenges
Benjamin K. Hendricks, MD,1 and Aaron A. Cohen-Gadol, MD, MSc, MBA1,2
1The Neurosurgical Atlas, Carmel; and 2Department of Neurological Surgery, Indiana University, Indianapolis, Indiana
Surgery within the posterior cranial fossa uniquely requires excellence in microsurgical technique, given the complexity of the neurovascular structures housed within this region. Arteriovenous malformations (AVMs) within this region represent the greatest surgical challenge because of the difficulty in resecting an AVM completely while preserving the highly eloquent surrounding structures. The AVM in this video exemplifies a surgeon’s “most challenging case,” a surgery that spanned two stages, including 14 hours of resection, but concluded with complete resection despite the complexity of deep arterial and dural feeders.
https://thejns.org/doi/abs/10.3171/2020.10.FOCVID2093
**Intro music: "Daybreak" by Graeme Rosner
Endoscopic-assisted parieto-occipital interhemispheric precuneal transtentorial approach for...
Kevin Zhao, DO, Joseph Quillin, MD, and James K. Liu, MD
Department of Neurological Surgery, Center for Skull Base and Pituitary Surgery, Rutgers University, New Jersey Medical School, Newark; Saint Barnabas Medical Center, RWJ Barnabas Health, Livingston, New Jersey
In this illustrative video, the authors demonstrate resection of a superior vermian arteriovenous malformation (AVM) using the endoscopic-assisted parieto-occipital interhemispheric precuneal transtentorial approach. Lateral positioning allows for gravity-assisted access to the interhemispheric fissure without retractors. The parieto-occipital trajectory is useful in patients who have a steep tentorial angle and avoids manipulation of the occipital lobe and visual cortex. In addition, the authors utilize an angled endoscope, which allows full inspection of the resection bed after AVM removal to visualize areas hidden from the microsurgical view to minimize the chance of residual disease in a deep corridor with multiple visual obstructions.
https://thejns.org/doi/abs/10.3171/2020.10.FOCVID2067
**Intro music: "Daybreak" by Graeme Rosner
Sitting supracerebellar infratentorial approach for resection of posterior fossa arteriovenous...
Evan Joyce, MD, MS, Ramesh Grandhi, MD, and William T. Couldwell, MD, PhD
Department of Neurosurgery, Clinical Neuroscience Center, University of Utah, Salt Lake City, Utah
Arteriovenous malformations (AVMs) of the posterior fossa represent just 5%–15% of all intracranial AVMs. Rupture often leads to devastating brainstem compression, with mortality reported as high as 67%. A life-saving decompressive craniectomy with or without hematoma evacuation may be necessary in the acute setting to alleviate mass effect before proceeding with definitive treatment of the vascular pathology. Here, the authors demonstrate the utility of using a generously sized temporizing decompressive suboccipital craniectomy to subsequently allow for a more judicious resection of a Spetzler-Martin grade III AVM fed by the right superior cerebellar artery using a sitting supracerebellar infratentorial approach.
https://thejns.org/doi/abs/10.3171/2020.10.FOCVID2091
**Intro music: "Daybreak" by Graeme Rosner
Lateral supracerebellar infratentorial approach for a ruptured cerebellomesencephalic fissure...
Livio Pereira, MD, and Eduardo Vieira, MD
Department of Neurological Surgery, Hospital Da Restauração, Recife, Brazil
In this surgical video, the authors present a case of a 24-year-old male patient who presented with sudden-onset headache and imbalance. On examination, he had a right-sided dysmetria and was otherwise neurologically intact. MRI showed a right cerebellar hematoma associated with multiple flow voids in the cerebellomesencephalic fissure and an enlarged lateral mesencephalic vein. Preoperative angiogram confirmed an arteriovenous malformation supplied by branches of the superior cerebellar artery. The patient underwent a lateral supracerebellar infratentorial approach for resection of the arteriovenous malformation resection (AVM). He recovered well from surgery and was discharged home on postoperative day 6. Postoperative angiogram confirmed complete AVM resection.
https://thejns.org/doi/abs/10.3171/2020.10.FOCVID2090
**Intro music: "Daybreak" by Graeme Rosner
Intraoperative application of a new-generation 3D IV-DSA technology in resection of a hemorrhagic...
Burak Ozaydin, MD,1 Demi W. Dawkins, MD,1 Stephanie A. Armstrong, MS,1 Beverly Aagaard-Kienitz, MD,1,2 and Mustafa K. Baskaya, MD1
Departments of 1Neurological Surgery and 2Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
Although intravenous digital subtraction angiography (IV-DSA), cone-beam CT, and rotational angiography are well-established technologies, using them in a single system in the hybrid operating room to acquire high-quality noninvasive 3D images is a recent development. This video demonstrates microsurgical excision of a ruptured cerebellar arteriovenous malformation (AVM) in a 66-year-old male followed by intraoperative IV-DSA acquisition using a new-generation system (Artis Icono). IV-DSA confirmed in real time that no residual remained following excision without the need to reposition the patient. To the best of the authors’ knowledge, this is the first surgical video to demonstrate the simplified workflow and application of this technology in neurovascular surgery.
https://thejns.org/doi/abs/10.3171/2020.10.FOCVID2086
**Intro music: "Daybreak" by Graeme Rosner
Combined treatment for a hemispheric cerebellar AVM
Bruno Loof de Amorim, MD,1 Ricardo Chmelnitsky Wainberg, MD, MSc,1 Juan Alberto Paz-Archila, MD,1 Silvio Sarmento Lessa, MD,1 Gabriela Miroslava Bustamante Vargas, MD,1 Leonardo Favi Bocca, MD,1 José Maria de Campos Filho, MD,1,2 Christiane Monteiro de Siqueira Campos, MD, MSc,3 Marcos Devanir Silva da Costa, MD, PhD,1 and Feres Chaddad-Neto, MD, PhD1,2
1Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP/EPM); and Divisions of 2Neurosurgery and 3Neuroradiology, Hospital Beneficência Portuguesa de São Paulo, Brazil
Posterior fossa arteriovenous malformations (AVMs) can be a challenging disease, especially those large in size. AVMs can be treated with a combination of endovascular treatment and microsurgery. Here, the authors present the case of a 16-year-old female patient with progressive dizziness and episodic syncope. The workup of the patient showed a hemispheric cerebellar AVM, Spetzler-Martin grade IV. She underwent combined treatment (endovascular and microsurgery) with no complications and cure of the malformation.
https://thejns.org/doi/abs/10.3171/2020.10.FOCVID2069
**Intro music: "Daybreak" by Graeme Rosner
Microsurgical resection of unruptured cerebellar arteriovenous malformation presenting with...
Walter Marani, MD,1,2 Nicola Montemurro, MD,2,3 Shoichiro Tsuji, MD,1 Paolo Perrini, MD,2,3
Kosumo Noda, MD,1 Nakao Ota, MD, PhD,1 Yu Kinoshita, MD,1 Hiroyasu Kamiyama, MD,1 and Rokuya Tanikawa, MD1
1Far East Neurosurgical Institute, Sapporo Teishinkai Hospital, Sapporo, Japan; 2Department of Neurosurgery, Azienda Ospedaliera Universitaria Pisana (AOUP), Pisa; and 3Department of Translational Research on New Surgical and Medical Technologies, University of Pisa, Italy
Cerebellar arteriovenous malformations (AVMs) represent 10%–15% of all intracranial AVMs and are associated with a greater risk for hemorrhagic presentation compared with supratentorial AVMs. When they reach the cerebellopontine angle cistern, neurovascular compression syndromes, including trigeminal neuralgia and hemifacial spasm, can occur. Due to the aggressive natural history of cerebellar AVM, an effective treatment strategy is required. In this video, the authors demonstrate the technical nuances of microsurgical resection of an unruptured cerebellar AVM in a 24-year-old female presenting with trigeminal neuralgia. The patient underwent right retrosigmoid craniotomy and complete resection of the AVM with resolution of trigeminal neuralgia.
https://thejns.org/doi/abs/10.3171/2020.10.FOCVID2071
**Intro music: "Daybreak" by Graeme Rosner
Multimodal treatment of a pediatric posterior fossa arteriovenous malformation employing endovasc...
Zeferino Demartini Jr., MD, Guilherme H. W. Ceccato, MD, Erico S. G. G. da Trindade, MD, and Luis A. B. Borba, MD, PhD
Department of Neurosurgery, Complexo Hospital de Clinicas—UFPR, Curitiba, PR, Brazil
Intracranial hemorrhage is the most common presentation of posterior fossa arteriovenous malformations (AVMs) and may have serious consequences. The authors present a case of a 7-year-old girl with headache, vomiting, dysmetria, and ataxia due to a ruptured cerebellar grade III AVM. After two sessions of embolization, the patient underwent total microsurgical resection through a suboccipital craniotomy. There were no additional postoperative deficits, and the patient improved progressively during 6 months of rehabilitation. These challenging lesions should be removed after rupture, especially in children with long-term cumulative risk of rebleeding. Multimodal treatment reduces the perioperative bleeding, allowing better outcomes for pediatric AVM.
https://thejns.org/doi/abs/10.3171/2020.10.FOCVID2064
**Intro music: "Daybreak" by Graeme Rosner
Usefulness of the middle cerebellar peduncle approach for microsurgical resection of lateral...
Shinsuke Tominaga, MD, PhD, Miyahito Kugai, MD, Kou Matsuda, MD, Keisho Yamazato, MD, Toshihiko Inui, MD, Masahiko Kitano, MD, PhD, and Hiroshi Hasegawa, MD, PhD
Department of Neurosurgery, Tominaga Hospital, Naniwa-ku, Osaka, Japan
Surgical treatment of brainstem arteriovenous malformation (AVM) is challenging and associated with a higher risk of complications and a lower rate of gross-total resection. The authors present their experience with the surgical management of lateral pontine AVM using the middle cerebellar peduncle approach. All cases presented with neurological deficits that were caused by hemorrhage before surgery. In all cases, the AVM was not visualized on postoperative angiography, and there was no deterioration of neurological symptoms. In this video, the authors report the treatment results of one case and describe the technique with a review of the literature.
https://thejns.org/doi/abs/10.3171/2020.10.FOCVID2063
**Intro music: "Daybreak" by Graeme Rosner
Suboccipital craniectomy with bilateral cerebellomedullary fissure dissection for resection of a...
Daniel M. S. Raper, MBBS, Kunal P. Raygor, MD, Caleb Rutledge, MD, Todd B. Dubnicoff, PhD, and Adib A. Abla, MD
Department of Neurological Surgery, University of California, San Francisco, California
Posterior fossa arteriovenous malformations (AVMs) in pregnant patients can present unique considerations for surgical treatment, including positioning to minimize pressure on the fetus, minimization of radiation exposure, and ethical considerations regarding emergency surgery. This video outlines surgical treatment of a ruptured tonsillar/vermian AVM performed in a staged fashion after emergent suboccipital craniotomy with posterior fossa decompression in the setting of a life-threatening infratentorial hemorrhage. Later, bilateral cerebellomedullary fissure dissection, exposure and dissection of the tela choroidea and inferior medullary velum, and disconnection of arterial feeders from the posterior inferior cerebellar artery (PICA) allowed resection of this AVM occupying the roof of the fourth ventricle.
This study was approved by the UCSF Human Research Protection Program IRB no. 18-26938.
https://thejns.org/doi/abs/10.3171/2020.10.FOCVID2059
**Intro music: "Daybreak" by Graeme Rosner
Microsurgical resection of previously embolized recurrent cerebellopontine angle AVM
Ehsan Dowlati, MD, Kelsi Chesney, MD, and Vikram V. Nayar, MD
Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC
This is the case of a ruptured Spetzler-Martin grade II arteriovenous malformation (AVM) located in the cerebellopontine angle and draining into the transverse sinus. The AVM was initially treated with staged embolization using Onyx (ev3 Neurovascular). However, recurrence was noted and treatment with microsurgical resection was undertaken. The authors present technical nuances of the approach and strategies for microsurgical resection of a previously embolized recurrent AVM with the aid of intraoperative indocyanine green angiography. Follow-up after endovascular treatment is critical, and curative treatment with microsurgical resection can be achieved with low morbidity in such AVMs as demonstrated by this case.
https://thejns.org/doi/abs/10.3171/2020.10.FOCVID2057
**Intro music: "Daybreak" by Graeme Rosner