Webinar – Formations en ligne

The Columbia University Medical Center Department of Neurological Surgery faculty will lead you through a bilateral frontotemporal decompressive craniectomy. A 27 year-old male with no medical history presents with a GCS of 3 immediately after a high speed motorcycle accident. A head CT showed bilateral contusions and an ICP parenchymal monitor was placed. A repeat head CT showed diffuse cerebral edema and blossoming contusions. Presented by Ricardo Komotar, MD; Christopher Kellner, MD; Marc Otten, MD; E. Sander Connolly Jr., MD; and Guy McKahnn, II, MD.

The Columbia University Medical Center Department of Neurological Surgery faculty will lead you through surgical techniques of an Occipital Transtenorial Approach. The patient is a 35 year-old woman presenting with 1 month of ataxia. An MRI was performed and showed a cerebellar lesion. Presented by Ricardo Komotar, MD; Christopher Kellner, MD; Marc Otten, MD; E. Sander Connolly Jr., MD; and Michael Sisti, MD, FACS.

The Columbia University Medical Center Department of Neurological Surgery faculty will lead you through the production of a Neurosurgery Online Curriculum (NOC) video. Presented by Ricardo Komotar, MD; Christopher Kellner, MD; Marc Otten, MD; and E. Sander Connolly Jr., MD.

The Columbia University Medical Center Department of Neurological Surgery faculty will lead you through a pterional craniotomy. Presented by Ricardo Komotar, MD; Christopher Kellner, MD; Marc Otten, MD; and E. Sander Connolly Jr., MD.

The Columbia University Medical Center Department of Neurological Surgery faculty will lead you through a retrosigmoid craniectomy. Presented by Ricardo Komotar, MD; Christopher Kellner, MD; Marc Otten, MD; E. Sander Connolly, Jr., MD; and Michael Sisti, MD, FACS.

This video will present the anatomical basis of the incision, principles of sterile technique, patient positioning, and the operative pause.

This video will include a summary of neurosurgical resident responsibilities as it relates to patient safety, communication, documentation (admission & consult, consent, operative/procedures, discharge summaries), patient care and education (between the physician, patient, family and health care partners), avoiding malpractice, hand-offs, billing and coding, and avoiding conflicts.

This video will provide descriptions of a variety of spinal injuries and fractures and identifies when spinal imaging after trauma is necessary.

This video explains professionalism as well as interpersonal and communication skills during neurosurgical residency. ACGME core competencies are also referenced.

Faculty from Vanderbilt University, Department of Neurosurgery, will present surgical options for treatment of trigeminal neuralgia.

Carefully crafted over many years by internationally renowned surgeon and educator Dr. Albert Rhoton Jr., this meticulously prepared lecture discusses the fourth ventricle and cerebellopontine angle.

Carefully crafted over many years by internationally renowned surgeon and educator Dr. Albert Rhoton Jr., this meticulously prepared lecture discusses the cavernous sinus and middle fossa.

Carefully crafted over many years by internationally renowned surgeon and educator Dr. Albert Rhoton Jr., this meticulously prepared lecture discusses the cavernous sinus and middle fossa.

Carefully crafted over many years by internationally renowned surgeon and educator Dr. Albert Rhoton Jr., this meticulously prepared lecture discusses the far lateral approach and jugular foramen.

Carefully crafted over many years by internationally renowned surgeon and educator Dr. Albert Rhoton Jr., this meticulously prepared lecture discusses the far lateral approach and jugular foramen.

Carefully crafted over many years by internationally renowned surgeon and educator Dr. Albert Rhoton Jr., this meticulously prepared lecture covers the temporal bone.

Carefully crafted over many years by internationally renowned surgeon and educator Dr. Albert Rhoton Jr., this meticulously prepared lecture covers the temporal bone.

Carefully crafted over many years by internationally renowned surgeon and educator Dr. Albert Rhoton Jr., this meticulously prepared lecture covers the temporal bone.

The first installment of Dr. Albert Rhoton Jr. discussing the anterior skull base.

Dr. Albert Rhoton Jr. continues his discussion of the anterior skull base.

Carefully crafted over many years by internationally renowned surgeon and educator Dr. Albert Rhoton Jr., this meticulously prepared lecture discusses the fourth ventricle and cerebellopontine angle. The presentation is provided in 3D format. Viewers will need red-cyan 3D glasses when viewing this footage to receive the full 3D experience.

Carefully crafted over many years by internationally renowned surgeon and educator Dr. Albert Rhoton Jr., this meticulously prepared lecture discusses the cavernous sinus and middle fossa. The presentation is provided in 3D format. Viewers will need red-cyan 3D glasses when viewing this footage to receive the full 3D experience.

Carefully crafted over many years by internationally renowned surgeon and educator Dr. Albert Rhoton Jr., this meticulously prepared lecture discusses the cavernous sinus and middle fossa. The presentation is provided in 3D format. Viewers will need red-cyan 3D glasses when viewing this footage to receive the full 3D experience.

Carefully crafted over many years by internationally renowned surgeon and educator Dr. Albert Rhoton Jr., this meticulously prepared lecture discusses the far lateral approach and jugular foramen. The presentation is provided in 3D format. Viewers will need red-cyan 3D glasses when viewing this footage to receive the full 3D experience.

Carefully crafted over many years by internationally renowned surgeon and educator Dr. Albert Rhoton Jr., this meticulously prepared lecture discusses the far lateral approach and jugular foramen. The presentation is provided in 3D format. Viewers will need red-cyan 3D glasses when viewing this footage to receive the full 3D experience.

Carefully crafted over many years by internationally renowned surgeon and educator Dr. Albert Rhoton Jr., this meticulously prepared lecture covers the temporal bone. The presentation is provided in 3D format. Viewers will need red-cyan 3D glasses when viewing this footage to receive the full 3D experience.

Carefully crafted over many years by internationally renowned surgeon and educator Dr. Albert Rhoton Jr., this meticulously prepared lecture covers the temporal bone. The presentation is provided in 3D format. Viewers will need red-cyan 3D glasses when viewing this footage to receive the full 3D experience.

Carefully crafted over many years by internationally renowned surgeon and educator Dr. Albert Rhoton Jr., this meticulously prepared lecture covers the temporal bone. The presentation is provided in 3D format. Viewers will need red-cyan 3D glasses when viewing this footage to receive the full 3D experience.

Carefully crafted over many years by internationally renowned surgeon and educator Dr. Albert Rhoton Jr., this meticulously prepared lecture is the first installment discussing the anterior skull base. The presentation is provided in 3D format.

Carefully crafted over many years by internationally renowned surgeon and educator Dr. Albert Rhoton Jr., this meticulously prepared lecture concludes the discussion of the anterior skull base. The presentation is provided in 3D format.

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 microsurgical resection of vermian arteriovenous malformation: operative video and technical nuances

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 malformation

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 arteriovenous malformation resection

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 cerebellar AVM

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 trigeminal neuralgia

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 endovascular and microsurgical techniques

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 pontine arteriovenous malformation

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 ruptured tonsillar/vermian AVM occupying the roof of the fourth ventricle in a pregnant patient

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