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1.
World Neurosurg ; 133: 60-65, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31568903

RESUMO

BACKGROUND: Neurosurgical micropatties (also known as sponges or cottonoids) have been used in microsurgical procedures to protect the brain surface and aspirate cerebrospinal fluid and blood. We sought to describe unique applications of micropatties in neurosurgical interventions. METHODS: Various sizes of micropatties have been used in neurosurgical interventions including tumor, vascular, and skull base surgeries to enhance safe surgical procedures and clear the operative field. Their roles are divided into 3 types: tissue protectors, instrument assistants, and instruments in the microsurgical procedures. RESULTS: Appropriate use of micropatties provides a well-visualized operative field, easy identification of bleeding spots, effective tumor elevation from the cleavage layer, and precise procedures around critical structures. CONCLUSIONS: To achieve safe and successful neurovascular protective surgery, micropatties play an important role in any type of microsurgical procedure in their various applications.


Assuntos
Encéfalo/cirurgia , Microcirurgia/instrumentação , Procedimentos Neurocirúrgicos/instrumentação , Tampões de Gaze Cirúrgicos , Humanos
2.
World Neurosurg ; 133: e97-e104, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31505279

RESUMO

BACKGROUND: Intraspinal tumors are 10 to 15 times less common than brain tumors. The midline approach with extensive laminectomies represents the current gold-standard for resection, causing instability, muscle damage, and kyphosis among other well-known complications. Minimally invasive series reported their results using retractor-based systems. We analyzed a patient series treated with a non-expansile tubular approach, describing the technique, grade of resection, and clinical outcomes. METHODS: A series of consecutive cases operated between 2016 and October 2018 were analyzed retrospectively. The database included age, sex, clinical presentation, intraspinal location (intra/extradural), number of laminotomies, grade of resection, surgical time, bleeding, and follow-up. The initial and follow-up clinical condition was analyzed using the Frankel scale. RESULTS: A total of 13 patients underwent surgery: 3 intraspinal/extradural (23%), 8 intradural/extramedullary (61.5%), and 2 intramedullary tumors (15.3%); these were classified as 5 meningiomas (38.4%), 4 neurofibromas (30.7%), 2 schwannomas (15.3%), 1 hemangioblastoma (7.6%), and 1 astrocytoma (7.6%). Eleven (84.61%) patients had complete motor improvement, 1 patient had partial improvement, and 1 patient had no improvement (7.6% each). An 18-mm working channel tube was used for extramedullary lesions and 20-mm tubes for intramedullary injuries. Total tumor resection was achieved in 11 patients (84.6%) and subtotal in 2 patients (15.38%) corresponding to intramedullary tumors. CONCLUSIONS: Although this study consisted of a small series, we have shown the possibility of resecting intraspinal tumors (some intradural-intramedullary) with non-expansile tubes in a safe and effective way with no complications. Most of the patients had complete neurological improvement at the end of follow-up.


Assuntos
Descompressão Cirúrgica/métodos , Fixadores Internos , Microcirurgia/métodos , Neoplasias da Medula Espinal/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Adulto , Idoso , Descompressão Cirúrgica/instrumentação , Desenho de Equipamento , Feminino , Seguimentos , Humanos , Imagem por Ressonância Magnética , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/cirurgia , Meningioma/diagnóstico por imagem , Meningioma/cirurgia , Microcirurgia/instrumentação , Pessoa de Meia-Idade , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Neurofibroma/diagnóstico por imagem , Neurofibroma/cirurgia , Estudos Retrospectivos , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Adulto Jovem
3.
World Neurosurg ; 133: 283-290, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31505282

RESUMO

BACKGROUND: Traditional manual retraction to access deep-seated brain lesions has been associated with complications related to vascular compromise of cerebral tissue. Various techniques have been developed over time to minimize injury, such as self-sustaining retractors, neuronavigation, and endoscopic approaches. Recently, tubular retractors, such as the ViewSite Brain Access System (VBAS), have been developed to reduce mechanical damage from retraction by dispersing the force of the retractor radially over the parenchyma. Therefore, we sought to review the current literature to accurately assess the indications, benefits, and complications associated with use of VBAS retractors. METHODS: A literature search for English articles published between 2005 and 2019 was performed using the MEDLINE database archive with the search terminology "Vycor OR ViewSite OR Brain-Access-System NOT glass." The VBAS website was also examined. Only articles detailing neurosurgical procedures using the VBAS tubular retractor system alone, or in combination with other retractors, were included. Postoperative morbidity and mortality were analyzed to estimate complications linked to using the retractor. RESULTS: Twelve publications (106 patients) met the inclusion criteria. The VBAS retractor was used for tumor resections, hematoma evacuations, cyst removal, foreign body extractions, and lesion resection in toxoplasmosis and multiple sclerosis. These cases were subdivided into groups based on lesion location, size, and resection volume for further analysis. Gross total resection was achieved in 63% of tumor excisions, and subtotal resection was achieved in 37%. Hematoma evacuation was successful in all cases. There were 3 short-term postoperative complications linked to the retractor, with an overall complication rate of 2.8%. CONCLUSIONS: This report is the first formal assessment of the VBAS, highlighting technical considerations of the retractor from the surgeon's perspective, patient outcomes, and complications. The retractor is a safe and efficacious tubular retraction system that can be used for tumor biopsy and resection, colloid cyst removal, hematoma evacuation, and removal of foreign bodies. However, further randomized controlled trials are indicated to accurately assess complication rates and outcomes.


Assuntos
Neoplasias Encefálicas/cirurgia , Microcirurgia/instrumentação , Procedimentos Neurocirúrgicos/instrumentação , Instrumentos Cirúrgicos , Humanos
4.
World Neurosurg ; 132: 188-196, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31476454

RESUMO

INTRODUCTION: Three-dimensional (3D) imaging and videos are a very useful tool in the neurosurgical training, although unfortunately the 3D systems available have a very high cost. The objective of this study is to describe a novel and low-cost 3D microsurgical video system. METHODS: To obtain the 3D videos we use a surgical microscope, 2 video adapters, 2 cameras, and an HDMI cable. A video editor program is used for processing the videos. For the projection we use a computer with PowerPoint (Microsoft, Inc, Redmond, WA) software, a video splitter, DVI cables, 2 projectors, 2 polarization filters, and a "silver screen" with polarized glasses. RESULTS: By using 2 equal cameras and video adaptors in each beam splitter port it was possible for us to obtain 2 videos that were equivalent to the images received by both surgeon's eyes. Using the video signal of both cameras during processing resulted in a 3D stereoscopic recording with Final Cut (Apple, Inc, Cupertino, CA) software. The polarized 3D format provided the best projection conditions. It does not alter the original colors of the videos and its prolonged visualization was more comfortable. The main advantage of this method is the ability to show in a realistic way the spatial relationships and the depth of the structures captured with the microscope. CONCLUSIONS: This paper presents in a clear and detailed way how to create and use a low-cost 3D surgical video system.


Assuntos
Microcirurgia/educação , Neurocirurgia/educação , Gravação em Vídeo , Humanos , Imagem Tridimensional , Microscopia , Microcirurgia/instrumentação , Software
5.
World Neurosurg ; 132: e545-e553, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31442653

RESUMO

OBJECTIVE: Currently, neurosurgical vascular surgery frequently uses indocyanine green (ICG)-videography (VG) to evaluate the blood flow in brain vessels. Although ICG-VG delineates intravascular ICG fluorescence as a high-intensity signal in gray-scale with dark background, it is hard to identify anatomical structures, including vasculature or surgical devices simultaneously. This report developed combination of a near-infrared (NIR) camera with particular sensitivity and an optical filter to observe the blood-flow conditions and anatomical structures. METHODS: To overcome the specific issues of ICG-VG, we applied a high-sensitivity camera with a 980-nm NIR component to delineate anatomical and fluorescence images, detecting signals between 830 and 1000 nm simultaneously during operation. We used a diluted ICG phantom to evaluate fluorescence signal changes by changing wavelength of the emission light. For clinical use, we used a high-sensitivity NIR camera with a high-pass filter on a surgical microscope. The new NIR system detected signals between 770 and 1000 nm, and the lighting system illuminated objects mainly at 980-nm wavelength. Both images with the blood flow and anatomical structures were projected to the smart glasses in real time. RESULTS: In the phantom experiment, we found that the emission light with wide band widths (575-800 nm) evoked various intensities of ICG fluorescence. This new NIR system allowed us to observe ICG fluorescence and anatomical structures without image fusion or time-delay. The both information of anatomy and fluorescence was projected on wearable smart glasses. Furthermore, the new NIR system detected ICG-fluorescence signals for a longer duration than the original camera, which allowed us to achieve careful and detailed observation of more vasculature and fine vessels. CONCLUSIONS: This study proposes a new NIR system and emphasizes simultaneous observation of anatomy and fluorescence signals during operation. It paves the way for further possibilities in the development of optical systems. To understand the natural phenomena and combination of different scientific and clinical fields, it might be important to understand and combine not only fluorescence, but also natural science, optics, and background pathology. This simple system would be available for neuroendoscope and robotic surgery.


Assuntos
Aneurisma Intracraniano/cirurgia , Neuroimagem/instrumentação , Neuroimagem/métodos , Imagem Óptica/instrumentação , Imagem Óptica/métodos , Angiografia/métodos , Humanos , Verde de Indocianina , Microscopia de Fluorescência/instrumentação , Microscopia de Fluorescência/métodos , Microscopia de Vídeo/instrumentação , Microscopia de Vídeo/métodos , Microcirurgia/instrumentação , Microcirurgia/métodos , Imagens de Fantasmas , Procedimentos Cirúrgicos Vasculares/instrumentação , Procedimentos Cirúrgicos Vasculares/métodos
6.
J Clin Neurosci ; 68: 329-332, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31327587

RESUMO

Intrathalamic aneurysms are a cause of patient morbidity and mortality. Aneurysms in this location can be accessed microsurgically when they cannot be accessed endovascularly. Care must be taken to avoid critical white matter tracts when approaching the thalamus microsurgically. Use of a tubular retractor can offer safe brain retraction during the approach. A 53-year-old female with a history of hypertension and cerebrovascular accidents presented with slurred speech, altered mental status, and right-sided weakness. CT demonstrated an acute parenchymal hemorrhage within the left thalamus and the internal capsule. CT angiography demonstrated a left dorsal thalamic aneurysm. Following angiography with consideration for embolization, the patient was taken to the operating room for microsurgical clip ligation with the use of minimally invasive techniques. The aneurysm was accessed using a contralateral transventricular approach with a tubular retractor for microsurgical clip ligation. Postoperative imaging demonstrated successful interval clipping of the aneurysm within the thalamus. This is the first report using our described surgical approach for treatment of a dorsal intrathalamic aneurysm. We combined the use of diffusion tensor imaging with a tubular retractor to clip a dorsal thalamic aneurysm.


Assuntos
Aneurisma Roto/cirurgia , Aneurisma Intracraniano/cirurgia , Microcirurgia/métodos , Procedimentos Neurocirúrgicos/métodos , Feminino , Humanos , Ligadura/métodos , Microcirurgia/instrumentação , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/instrumentação , Instrumentos Cirúrgicos
7.
Khirurgiia (Mosk) ; (6): 5-10, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31317935

RESUMO

AIM: To analyze own experience of coronary artery bypass grafting (CABG) using microsurgical technique and operating microscope. MATERIAL AND METHODS: There were 100 patients with coronary artery disease who underwent CABG in the Petrovsky Russian Research Center for Surgery for the period from April 2017 to December 2018. Mean age of patients was 59.7 ± 8.9 years. Triple-vessel disease was noted in 83 (83%) patients, two-vessel - in 17 (17%) patients. Stenosis of left main coronary artery was observed in 34 (34%) patients. On-pump myocardial revascularization using microsurgical technique was performed in all patients. RESULTS: A total of 360 distal anastomoses with coronary arteries were formed in 100 patients using surgical microscope. Revascularization index was 3.6 ± 0.8, mean CPB time - 104 ± 24 min, aoric cross-clamping time - 72 ± 16 min. In-hospital mortality was absent. There were no cases of resternotomy for bleeding, infectious complications of postoperative wounds. One (1%) patient had intraoperative myocardial infarction. CONCLUSION: CABG using microsurgical technique and operating microscope may be appropriate in patients with multiple-vessel coronary lesion and small diameter of coronary arteries.


Assuntos
Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/cirurgia , Idoso , Ponte de Artéria Coronária/instrumentação , Estenose Coronária , Humanos , Microcirurgia/instrumentação , Pessoa de Meia-Idade
8.
Khirurgiia (Mosk) ; (6): 80-87, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31317945

RESUMO

Microsurgical approach implies a special technique of operation under operating microscope with the use of special tools and ultra-thin atraumatic sutures. This method may be used in coronary artery bypass surgery in order to improve conventional technique, its quality and outcomes. The report summarizes information about technical features, capabilities and results of microsurgical coronary artery bypass grafting. The problem of popularizing microsurgical technologies in coronary bypass surgery is also discussed.


Assuntos
Ponte de Artéria Coronária/métodos , Microcirurgia/métodos , Ponte de Artéria Coronária/instrumentação , Humanos , Microcirurgia/instrumentação , Suturas
9.
Neurosurg Rev ; 42(3): 777-781, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31270705

RESUMO

Surgical clipping of an internal carotid artery (ICA)-posterior communicating artery (ICPC) aneurysm is often difficult in cases involving limited space to insert a clip at the proximal aneurysm neck hidden by the tent. In such cases, we perform incision of the anterior petroclinoidal fold to secure the proximal space for clip insertion. Between April 2013 and March 2018, we treated 89 ICPC aneurysm cases by clipping. Incision of the anterior petroclinoidal fold was performed in 15 of the 89 cases (16.8%). Fast imaging employing steady-state acquisition (FIESTA) magnetic resonance imaging (MRI) can indicate the locations of the aneurysm and tent and can help assess the need for tent incision. We widely dissected the distal sylvian fissure and sufficiently exposed around the aneurysmal space. We coagulated and cut the anterior petroclinoidal fold supra between the ICA and proximal neck of the aneurysm using a low-power bipolar system and needles or micro-scissors with care to avoid injury around structures such as the ICA, aneurysm, and oculomotor nerve. When using this strategy, we often select the Yasargil FT717 clip that has a curve along the skull base because of easy insertion. All cases showed complete aneurysm exclusion on three-dimensional computed tomography angiography, and there was no cerebral infarction, neurological deficit (such as hemiparesis), or oculomotor nerve palsy. Therefore, our strategy of incision of the anterior petroclinoidal fold during clipping for securing the proximal space of an ICA aneurysm is effective and safe.


Assuntos
Artéria Carótida Interna , Círculo Arterial do Cérebro , Aneurisma Intracraniano/cirurgia , Microcirurgia/métodos , Idoso , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Imagem por Ressonância Magnética , Microcirurgia/instrumentação , Estudos Retrospectivos , Instrumentos Cirúrgicos
10.
World Neurosurg ; 131: 339-345, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31284061

RESUMO

Cylindrical tubular ports are among the most innovative dynamic tools added to the neurosurgery armamentarium. The rationale behind the use of tubular systems lies in the knowledge that damage to surrounding tissues is minimized with the equal pressure exerted by the walls of the cylinder. A microscope or an endoscope is used for visualization in the tubular ports. Neuronavigation is an essential adjuvant to ensure avoiding injury to essential brain tracts and parenchyma. In the present report, we focused on 3 commonly used cylindrical retractor systems, including the ViewSite, BrainPath, and syringe port. The custom-made syringe port system is used by us and is cost effective. It costs only the price of a syringe. The efficacy and safety of tubular port systems have been shown in limited studies. The complications associated with the port system have been minimal, and injury to the brain has been reduced by the equal pressure exerted by the walls of the port.


Assuntos
Encefalopatias/cirurgia , Neuroendoscopia/instrumentação , Remoção de Dispositivo/métodos , Humanos , Imagem por Ressonância Magnética , Microcirurgia/instrumentação , Microcirurgia/métodos , Neuroendoscópios , Neuroendoscopia/métodos , Neuronavegação/instrumentação , Instrumentos Cirúrgicos , Seringas
11.
World Neurosurg ; 130: e160-e165, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31203069

RESUMO

OBJECTIVE: Considerable effort has been made in order to reduce surgical invasiveness while maintaining optimal exploiting of the operative space in aneurysm surgery. One aspect of this evolution is represented by the Lazic (Peter Lazic GmbH, Tuttlingen, Germany) aneurysm clip system. The purpose of this study was to illustrate the new generation clip system in practiced aneurysm surgery. METHODS: A retrospective analysis of all aneurysm surgeries in our departments between December 2015 and January 2018 using the new D-Clip system was performed. Evaluation included standardized retrospective review of the main surgeon, the nursing staff, as well as an analysis of surgical video documentation by objective reviewers. RESULTS: Forty-five patients with 50 intracranial aneurysms underwent surgical clipping using the D-Clip system. A total of 64 permanent and 19 temporary D-Clips were applied. Nine clips needed to be replaced. All aneurysms could be occluded totally. Surgeons considered handling and manoeuvrability of clip application as feasible and good in all cases (100%), even under impaired visibility circumstances (14%). Objective video analysis revealed comparable results. Nursing staff scored handling and practicability of D-Clips equivalent to the preceding L-Clip generation. There were no intraoperative complications. Surgery-related postoperative morbidity was 6.7%. CONCLUSIONS: The new D-Clip system combines an attenuated design for minimally invasive clipping procedures with traditional mechanisms of common clip systems. It therefore appears to be highly versatile in the context of variable different aneurysm morphologies and locations while maintaining high standard surgical safety and efficacy.


Assuntos
Aneurisma Intracraniano/cirurgia , Microcirurgia/instrumentação , Procedimentos Neurocirúrgicos/instrumentação , Instrumentos Cirúrgicos , Procedimentos Cirúrgicos Vasculares/instrumentação , Feminino , Humanos , Masculino , Microcirurgia/métodos , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Estudos Retrospectivos , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/métodos
12.
Cir. plást. ibero-latinoam ; 45(2): 169-173, abr.-jun. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-184224

RESUMO

Los cordomas son tumores malignos de crecimiento lento derivados de la notocorda. Habitualmente se localizan en el clivus y se presentan en mujeres en la tercera o cuarta décadas de la vida. La resección quirúrgica es su tratamiento de elección, pudiendo asociarse en casos selectos a radioterapia. En cordomas pequeños el tratamiento de elección es el abordaje endoscópico transnasal, transesfenoidal y para las lesiones extensas se prefiere el abordaje máxilo-mandibular con glosotomía. Para la reconstrucción, al igual que en otras áreas anatómicas, las ventajas de los tejidos óseos vascularizados sobre los no vascularizados son: la rápida consolidación, la resistencia a la infección, la reacción hipertrófica originada por la carga mecánica y la tolerancia a niveles terapéuticos de radiación. Presentamos el caso de una mujer de 24 años de edad con diagnóstico de cordoma en C2-C3, a quien se le realizó corpectomía C2-C3 y exéresis marginal de la lesión, seguida de reconstrucción con colgajo libre de peroné


Chordoma neoplasms are malignant tumors with a generally slow growth. They are usually located in the clivus. The most common presentation is in young women (third and fourth decades of life). Surgical resection is the main line of treatment, occasionally radiotherapy may be needed. As for small chordomas, transnasal endoscopical resection can be performed, however, for larger tumors a maxillo-mandibular surgical approach may be needed. For reconstruction purposes, the main advantages of using vascularized tissues are: rapid consoloditation, higher infection resistance and a hypertrophic reaction secondary to the mechanical stress. We present the case of a 24 years old female patient with a C2-C3 chordom; corpectomy and marginal resection of the tumor were performed, as well as reconstruction with a free fibula flap


Assuntos
Humanos , Feminino , Adulto , Cordoma/cirurgia , Cordoma/diagnóstico por imagem , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/cirurgia , Microcirurgia/instrumentação , Retalhos de Tecido Biológico , Faringe/patologia , Faringe/cirurgia , Fíbula/cirurgia
13.
Medicine (Baltimore) ; 98(18): e15451, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31045817

RESUMO

BACKGROUND: Lumbar decompressive surgery is a standard surgical technique for lumbar spinal stenosis. Many new surgical techniques have been introduced, ranging from open surgery to minimally invasive procedures. Minimally invasive surgical techniques are preferred because patients experience less postoperative pain and shorter hospital stays. However, the success rate of minimally invasive techniques have been controversial. The object of this study was to assess the feasibility of spinal decompression using biportal technique/endoscopic surgery compared with microscopic surgery. METHODS: Seventy lumbar spinal stenosis patients undergoing laminectomy were included in this study. A number table was used to randomize the patients into two groups: a biportal technique/endoscopic surgery group (BG-36) and a microscopic surgery group (OG-34). One surgeon performed either biportal technique/endoscopic decompression or microscopic decompression using a tubular retractor, depending on the group to which the patient was randomized. Perioperative data and clinical outcomes at postoperative 6 months were collected and analyzed. RESULTS: The demographic data and level of surgery were comparable between the two groups. A shorter operation time (36 ±â€Š11 vs 54 ±â€Š9 min), less hemovac drain output (25.5 ±â€Š15.8 vs 53.2 ±â€Š32.1 ml), less opioid usage (2.3 ±â€Š0.6 vs 6.5 ±â€Š2.5 T) and shorter hospital stay (1.2 ±â€Š0.3 vs 3.5 ±â€Š0.8 days) were shown in BG. The BG experienced no significant differences in clinical outcomes compared with OG. Favorable clinical outcomes were shown at 6 months after surgery in both groups. CONCLUSION: Lumbar decompressive surgery using biportal technique/endoscopy showed favorable clinical outcomes, less pain and a shorter hospital stay compared to microscopic surgery in patients with lumbar spinal stenosis.


Assuntos
Endoscopia/métodos , Laminectomia/métodos , Vértebras Lombares/cirurgia , Microcirurgia/métodos , Estenose Espinal/cirurgia , Idoso , Endoscopia/instrumentação , Feminino , Humanos , Laminectomia/instrumentação , Masculino , Microcirurgia/instrumentação , Pessoa de Meia-Idade , Duração da Cirurgia , Dor Pós-Operatória/etiologia , Estudos Prospectivos , Resultado do Tratamento
15.
World Neurosurg ; 126: 497, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30928583

RESUMO

Video 1 describes the technique of microsurgery removal of acoustic neuromas (ANs) using new technologies. The Flexible 2µ-Thulium hand-held laser fiber (Revolix jr, LISA laser products, 7 OHG, Berlin, Germany) and Sonopet Ultrasound Aspirator (Stryker, Kalamazoo, Michigan, USA) can be used for a safe and facilitated opening of the internal auditory canal (IAC). We illustrate the operative technique used on a surgical series of 111 cases operated on during the past 8 years, from July 2010 to July 2018. We studied 170 consecutive patients suffering from ANs who were operated on with a microsurgical technique by the key-hole retrosigmoid approach. In 111 cases the "Sonopet" Ultrasound Aspirator was used to open the IAC and a 2µ-Thulium laser fiber was used for cutting the dura mater of the posterior aspect of petrous bone and the IAC, and it was also used to perform tumor capsule incision. From December 2017 we started to check the removal of tumor inside the IAC with a flexible endoscope 4 mm × 65 cm, (Karl Storz GmbH, Tuttlingen, Germany) in order to detect possible tumoral residue and achieve a radical tumor resection in the fundus. The use of these new technologies seems to be safe and subjectively facilitates the opening of the IAC in AN microsurgery.


Assuntos
Orelha Interna/cirurgia , Terapia a Laser/métodos , Microcirurgia/métodos , Neuroma Acústico/cirurgia , Procedimentos Neurocirúrgicos/métodos , Terapia por Ultrassom/métodos , Humanos , Microcirurgia/instrumentação , Procedimentos Neurocirúrgicos/instrumentação , Túlio , Resultado do Tratamento
16.
World Neurosurg ; 127: 24, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30947002

RESUMO

This video case illustrates key surgical steps required in safe management of a giant recurrent previously coiled middle cerebral artery (MCA) aneurysm (Video 1). The patient described in this case was a 68-year-old man who presented with sudden-onset severe headache and dizziness. The patient had a history of a prior coil embolization of a 12-mm left middle cerebral artery aneurysm at an outside hospital. Imaging demonstrated recurrence now of a giant left middle cerebral artery aneurysm with coil compaction and left temporal lobe edema. Magnetic resonance imaging further demonstrated thrombus in the aneurysm and aneurysm wall enhancement concerning for impending rupture. Given the aneurysm size, imaging features, and mass effect, the aneurysm was treated with microsurgical clipping. This case is valuable to the literature with a clear video case illustration of aneurysm dome excision, aneurysm endarterectomy, and picket fence aneurysm neck reconstruction. Aneurysm dome excision is critical for treatment of giant aneurysms causing mass effect and was only used in this case because thrombus and coil mass did not allow for direct clipping across the neck without compromise of the MCA M2 branch. Hence, this video highlights key technical tenets, such as safe thrombus removal and adequate cleaning of the endoluminal surface and preparedness for bypass in challenging cases.


Assuntos
Aneurisma Intracraniano/cirurgia , Procedimentos Neurocirúrgicos/métodos , Idoso , Embolização Terapêutica , Humanos , Masculino , Microcirurgia/instrumentação , Microcirurgia/métodos , Procedimentos Neurocirúrgicos/instrumentação , Instrumentos Cirúrgicos
17.
World Neurosurg ; 126: 398, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30898737

RESUMO

These video cases present some unique technical tenets for microsurgical clipping of proximal internal carotid artery aneurysms (Video 1). The first patient is a 49-year-old woman with a history of a prior ruptured and treated right middle cerebral artery aneurysm who was found to have growth of known left middle cerebral artery and left internal carotid artery ophthalmic segment aneurysms on radiographic studies. An intradural clinoidectomy with Sonopet, with proximal control at cervical carotid and wide sylvian fissure exposure with ample sharp dissection of the aneurysm anatomy, allowed safe clipping of the ophthalmic aneurysm in this case. The second patient is a 39-year-old woman with a history of a prior left middle cerebral artery M2 occlusion with recent mechanical thrombectomy. The patient was found to have a 6-mm incidental, unruptured right internal cerebral artery paraophthalmic segment and 3-mm right posterior communicating artery aneurysm on radiographic studies. This patient underwent microsurgical clipping given unique patient factors. A similar controlled intradural clinoidectomy, with proximal cervical ICA control and aneurysmal segment trapping, allowed safe aneurysm exclusion. For patients with multiple aneurysms such as in these cases, the deeper proximal aneurysm should generally be treated first. The videos illustrate some key technical points in this regard.


Assuntos
Artéria Carótida Interna/cirurgia , Aneurisma Intracraniano/cirurgia , Microcirurgia/métodos , Procedimentos Neurocirúrgicos/métodos , Artéria Oftálmica/cirurgia , Adulto , Artéria Carótida Interna/patologia , Feminino , Humanos , Microcirurgia/instrumentação , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/instrumentação , Artéria Oftálmica/patologia , Instrumentos Cirúrgicos
18.
World Neurosurg ; 126: e1343-e1351, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30898743

RESUMO

BACKGROUND: The number of elderly patients with unruptured intracranial aneurysms is increasing with time in aging populations; however, the choice of the proper treatment method remains inconclusive. The goal of the study is to evaluate the possible complications and treatment outcome among elderly patients with unruptured intracranial aneurysm. METHODS: We analyzed 139 patients >65 years old, hospitalized between 2007 and 2017 in the high-volume neurosurgical center and diagnosed with unruptured intracranial aneurysm. From their medical records, we obtained medical history and aneurysm characteristics. Patients functional status was measured by modified Rankin Scale score on admission and at discharge. RESULTS: Seventy-two patients (55.97%) underwent aneurysm clipping and 39 (27.04%) coiling. Eighteen patients (11.90%) required stent assisted coiling and 4 (5.00%) had a single stent placement. A total of 133 patients (95.71%) had good treatment outcomes (modified Rankin Scale score 0-3, surgical 0.32 ± 1.03 vs. endovascular group 0.40 ± 1.12, P = 0.65). Complete or near-complete occlusion in the endovascular group was achieved in 83% directly after treatment and in 89% at 6-12 months after procedure. The microsurgical group presented 100% occlusion at follow-up. CONCLUSIONS: Despite the high prevalence of comorbidities in the age group >65 years old, the vast majority of patients in our series treated invasively for unruptured intracranial aneurysms presented with good treatment outcomes. Based on our results, among elderly patients, modern microsurgical as well as endovascular management of brain aneurysms in a high-volume center seems to be a safe and effective method of treatment.


Assuntos
Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Aneurisma Intracraniano/terapia , Procedimentos Neurocirúrgicos/métodos , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Eletivos/instrumentação , Procedimentos Cirúrgicos Eletivos/métodos , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Masculino , Microcirurgia/instrumentação , Microcirurgia/métodos , Procedimentos Neurocirúrgicos/instrumentação , Resultado do Tratamento
19.
Int J Comput Assist Radiol Surg ; 14(6): 945-954, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30887423

RESUMO

PURPOSE: Retinal microsurgery requires highly dexterous and precise maneuvering of instruments inserted into the eyeball through the sclerotomy port. During such procedures, the sclera can potentially be injured from extreme tool-to-sclera contact force caused by surgeon's unintentional misoperations. METHODS: We present an active interventional robotic system to prevent such iatrogenic accidents by enabling the robotic system to actively counteract the surgeon's possible unsafe operations in advance of their occurrence. Relying on a novel force sensing tool to measure and collect scleral forces, we construct a recurrent neural network with long short-term memory unit to oversee surgeon's operation and predict possible unsafe scleral forces up to the next 200 ms. We then apply a linear admittance control to actuate the robot to reduce the undesired scleral force. The system is implemented using an existing "steady hand" eye robot platform. The proposed method is evaluated on an artificial eye phantom by performing a "vessel following" mock retinal surgery operation. RESULTS: Empirical validation over multiple trials indicates that the proposed active interventional robotic system could help to reduce the number of unsafe manipulation events. CONCLUSIONS: We develop an active interventional robotic system to actively prevent surgeon's unsafe operations in retinal surgery. The result of the evaluation experiments shows that the proposed system can improve the surgeon's performance.


Assuntos
Microcirurgia/instrumentação , Procedimentos Cirúrgicos Oftalmológicos/instrumentação , Retina/cirurgia , Procedimentos Cirúrgicos Robóticos/instrumentação , Humanos
20.
Niger J Clin Pract ; 22(3): 370-374, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30837425

RESUMO

Objective: This experimental study was aimed to assess the use of basket shaped biopsy microseparator. In this study, it was aimed to evaluate the protection of brain tissue during neurosurgery of the brain tissue, clinical usage, and suitability. Materials and Methods: Thirty cadaveric cow brains were used in this experimental feasibility study. Experimental materials were divided into two groups: In Group I, the microsurgical separation of the intrinsic brain parenchyma was performed by using the retraction of microsurgical basket separator. In Group II, the same microsurgical dissections were performed without microsurgical basket separator. The difficulty and suitability of the procedure was divided as three degree: very easy, easy, and difficult. Results: In Group I (n = 30), 20% fresh cadaveric cow brains, the difficulty of the dissection was evaluated as difficult; 60% of the brains were dissected with easy procedure. The remaining 20% of the brain dissection was evaluated as very easy. In Group II (n = 30), 40% fresh cadaveric cow brains, the difficulty of the dissection was evaluated as difficult; 53.33% of the brains were dissected with easy procedure. The remaining 6.67% of the brains were evaluated as very easy. The significance level was set at a P value of <0.046 in all statistical analyses. Conclusion: This study showed that easily performing biopsy procedure and protecting the brain tissue with using of biopsy basket microseparator are feasible. It is thought that this instrument may make a contribution to the practical microsurgery in the protecting brain tissue and adequately performing of biopsy.


Assuntos
Biópsia/instrumentação , Encéfalo/cirurgia , Dissecação/instrumentação , Microcirurgia/instrumentação , Procedimentos Neurocirúrgicos/instrumentação , Animais , Bovinos , Estudos de Viabilidade
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