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At least 541 records · Page 30Linked to original sources
PubMed2004

Thoracoscopic repair of H-type tracheoesophageal fistula in the newborn: a technical case report.

H-type tracheoesophageal fistula (H-TEF) without esophageal atresia makes up 4% to 5% of esophageal congenital abnormalities. The authors present the thoracoscopic treatment of a 2.47-kg newborn boy with a fistula between the second and third thoracic vertebrae diagnosed by esophagography. Four trocars were used for fistula closure, and tracheal and esophageal suturing were accomplished without intraoperative incident. Five days after surgery, results of a barium swallow excluded anastomotic leaks. The chest tube was removed, and oral feeding was initiated.

Humans↗
PubMed2005

Application of multichannel near-infrared spectroscopic topography to physiological monitoring of the cortex during cortical mapping: technical case report.

BACKGROUND: Cortical stimulation via a subdural grid electrode (SGE) is one of the most reliable methods for identifying eloquent areas before surgery. However, the physiological conditions of the cortex during stimulation cannot be monitored electrophysiologically because of electrical artifacts. In the present case, we tested whether or not multichannel near-infrared spectroscopy (NIRS) topography, a noninvasive optical imaging technique, is applicable for monitoring the physiological conditions of the stimulated cortex. CASE DESCRIPTION: The patient (a 27-year-old right-handed man) suffered from glioma in the left frontal lobe. For preoperative cortical mapping, SGEs were implanted over the left motor cortex before tumor resection. Employing NIRS topography, we undertook 2 dimensional imaging of the changes in oxyhemoglobin (Oxy-Hb) and deoxyhemoglobin (Deoxy-Hb) concentration during electrical stimulation. Five-hertz stimulation with 5 mA at the left-hand area produced a localized increase in Oxy-Hb and a decrease in Deoxy-Hb, associated with slight twitching of the right hand. In contrast, 50-Hz stimulation produced significant increases in both Oxy-Hb and Deoxy-Hb at the stimulation site, and the area with such cerebral blood oxygenation (CBO) changes propagated beyond the hand area associated with prominent muscle contractions of the right upper extremity, suggesting that 50-Hz stimulation caused epileptic discharge. CONCLUSION: Near-infrared spectroscopy topography may represent a useful tool for imaging the degree and extent of the physiological effects of electrical stimulation on the cortex, and permits safe and accurate cortical mapping.

Adult↗
PubMed2005

Reoperation of a recurrent temporal lobe epilepsy: a technical case report.

BACKGROUND: The indications for the reoperation of a recurrent temporal lobe epilepsy, the risks, and outcome have not been well documented. The invasive video electroencephalogram (EEG) monitoring and magnetic resonance imaging (MRI) techniques can reveal the residual tissues and their epileptogenic activity so that a reoperation decision can be made. CASE DESCRIPTION: A 30-year-old patient who had recurrent temporal lobe epilepsy and had undergone 2 operations at the same temporal region is presented. After both of these operations, approximately 6 months later, seizures relapsed. Postoperative neuroimaging studies showed residual mesiotemporal tissues at the operative site. The invasive video EEG monitoring revealed epileptogenic activity originating from these residual tissues. After all of these investigations, it was thought that a third operation was indicated, and the patient was operated. Postoperative course was uneventful. No postoperative deficit was observed. Pathological examination was reported as hippocampal sclerosis. He is seizure-free at his third postoperative year. CONCLUSIONS: Complete resection of epileptogenic mesiotemporal structures at the first operation can prevent the necessity for reoperation in defined cases. The MRI and invasive video EEG monitoring techniques can reveal the residual tissues and their epileptogenic activity in a recurrent epilepsy case.

Adult↗
PubMed2006

Halo traction in basilar invagination: technical case report.

BACKGROUND: In the management of basilar invagination, traction therapy may help by pulling down the odontoid process away from the brain stem that may result in clinical and radiological improvement. We aimed to discuss the role of the halo vest apparatus traction on the reduction of severe anterior compression pathologies in basilar invagination. CASE DESCRIPTION: We describe a simple and safe cervical traction method by the halo vest apparatus that is followed by rigid posterior occipitocervical fixation and foramen magnum decompression in a patient who presented with basilar invagination and symptoms of severe brain stem compression. An MR-suitable halo vest apparatus was used for reduction of the deformity. The reduction of the basilar invagination was achieved gradually by distracting the halo crown in stages. CONCLUSION: The halo vest apparatus can be safely used in complex craniocervical junction anomalies. An effective cervical traction can be performed in basilar invagination, and reduction of the deformity may be achieved without the risk of overdistraction. In some cases, even partial reduction of the deformity may facilitate brain stem and spinal cord relief without any need of posterior decompression. Patients may benefit from ambulatory functions because bed rest is eliminated in this procedure. Neurovascular structures and the degree of the reduction can be observed on MRIs when an MR-suitable device is used.

Atlanto-Axial Joint↗
PubMed2006

Intraoperative dynamic angiography to detect resolution of Bow Hunter's syndrome: Technical case report.

BACKGROUND: Bow Hunter's syndrome is a rare form of vertebrobasilar insufficiency that may be successfully treated by surgical intervention. Use of intraoperative dynamic transcranial Doppler ultrasound for surgical treatment of vertebrobasilar insufficiency has been described in literature. However, this technique was inconsistent and unreliable in some patients. We present a case of a patient with Bow Hunter's syndrome treated surgically and emphasize the valuable addition of intraoperative dynamic angiography to determine resolution of vertebral artery compromise. CASE DESCRIPTION: The patient was a 58-year-old man with complaints of dizziness, vertigo, and near-syncopal episodes that occurred when he rotated his head to the left. Imaging revealed compromise of the dominant left vertebral artery with leftward head rotation. An anterior cervical approach with decompression of the left subaxial vertebral artery was performed. Significant osteophyte formation was observed. Removal of bone and decompression of the vertebral artery was performed. Intraoperative dynamic angiography confirmed resolution of vertebral artery compression and minimized the amount of decompression. No further intervention was required. CONCLUSION: Intraoperative dynamic angiography is a definitive test to determine hemodynamic resolution of Bow Hunter's syndrome. It offers real-time feedback of vertebral artery decompression, potentially minimizes the amount of decompression, and can be performed safely.

Axis, Cervical Vertebra↗
PubMed2003

Combining MEG and MRI with neuronavigation for treatment of an epileptiform spike focus in the precentral region: a technical case report.

BACKGROUND: Epileptic foci are often located in the vicinity but not necessarily within the boundaries of intra-axial brain tumors. Resection of these tumors is based on two major goals: first, maximizing tumor removal without provoking new neurologic deficits, and second, minimizing epileptic seizure activity. Magnetic source imaging (MSI) depicts the generators of magnetic fields overlaid on individual magnetic resonance (MR) images. Established application areas are lesions located adjacent to or partly within the sensory and motor cortex, or in the depth of the brain, necessitating a surgical approach through functionally highly relevant cortical regions. Magnetoencephalography (MEG) is also applicable for epileptiform spike foci recording during interictal activity. CASE DESCRIPTION: A patient with a recurrent glioma close to the Rolandic cortex scheduled for epilepsy and tumor surgery was investigated with MSI. The MSI data showed an epileptiform spike focus outside the tumor boundaries. The resulting MSI images were integrated into our neuronavigation system. This procedure allowed for the preoperative identification of the sensory and motor cortex, the precise localization of the epileptiform spike focus, and careful planning of the surgical procedure. In this case, we were able to safely resect the recurrent tumor and the epileptiform spike focus under general anesthesia using MSI-based neuronavigational guidance but no conventional intraoperative mapping techniques. CONCLUSION: Magnetic source imaging can be a valuable, noninvasive method for planning and performing tumor resections in high-risk brain regions, especially if an epileptiform spike focus has to be localized and included into the resection strategy.

Brain Neoplasms↗
PubMed2003

Angioplasty and coiling of ruptured aneurysm with symptomatic vasospasm: technical case report.

BACKGROUND: Treating a ruptured cerebral aneurysm during symptomatic vasospasm is very difficult. We describe the successful endovascular treatment of such a case and discuss its efficacy. CASE PRESENTATION: A 34-year-old man had a sudden onset of severe headache. One week later, he was referred to our institute with gradually progressing right hemiparesis and global aphasia. Cerebral angiography demonstrated severe vasospasm of the left internal carotid artery system and an anterior communicating artery aneurysm. With the patient under general anesthesia, 90% occlusion of the aneurysm was achieved with detachable coils after successful dilatation of the spastic vessels. The patient had an uneventful postoperative course and his neurologic symptoms were improved. Seven months after the endovascular treatment, the enlarged neck remnant of the aneurysm was successfully clipped without difficulty. CONCLUSION: The simultaneous treatment of a ruptured aneurysm and vasospasm with percutaneous transluminal angioplasty and coils can produce a better outcome for the patient.

Adult↗
PubMed2004

Small petrosal approach to the middle portion of the mediobasal temporal region: technical case report.

BACKGROUND: The mediobasal temporal region has been divided into three portions: anterior, middle, and posterior. Surgical access, especially to the middle portion, presents a formidable challenge to neurosurgeons, and much controversy still exists regarding the selection of the surgical approach to this region. CASE REPORT: We used the small petrosal approach to the middle portion of the mediobasal temporal region in a patient with intractable seizures caused by a cavernous angioma in this region. Using this approach, we selectively removed the lesion without postoperative deficits. CONCLUSIONS: The small petrosal approach was found to be useful and safe as an alternative technique for selective removal of the lesion in the middle portion of the mediobasal temporal region.

Adult↗
PubMed1996

CT angiographic-guided frameless stereotactic-assisted clipping of a distal posterior inferior cerebellar artery aneurysm: technical case report.

BACKGROUND: The development of frameless stereotaxis allows for repetitive intraoperative localization with millimeter accuracy. High-resolution computed tomographic (CT) angiography provides multiplanar, three-dimensional imaging of cerebral vascular lesions. The image data set generated during CT angiography can be used for localization in frameless stereotaxis when performed with appropriate fiducials in place. METHODS: The feasibility of melding these two technologies was tested on a patient with a small (5 mm), distal ruptured posterior inferior cerebellar artery aneurysm, which was visualized by CT angiography and localized by frameless stereotaxis. RESULTS: Visualization by CT angiography and intraoperative localization by frameless stereotaxis were successful. CONCLUSIONS: The practical application of this technology meld is demonstrated in this sample case. Applications to distal anterior cerebral artery aneurysms, abnormal flow-related aneurysms associated with arteriovenous malformations, and mycotic aneurysms are discussed.

Angiography↗
PubMed1999

The use of an external-internal shunt in the treatment of extracranial internal carotid artery saccular aneurysms: technical case report.

BACKGROUND: Extracranial internal carotid artery aneurysms (EICAA) are rare lesions. Resection and grafting is the preferred method of management. However, the details of shunt use in surgery for this type of aneurysm has been described in few articles. We describe an external-internal shunt with intra-aneurysmal trans-orifice insertion. CASE REPORT: A 55-year-old woman presented with a 5-year history of a progressively enlarging pulsatile neck mass. An examination revealed no neurological deficit. Right carotid angiogram showed a saccular EICAA involving the ICA distal to the bifurcation, with kinking of the internal carotid artery (ICA). The dome of the EICAA extended from the upper border of C4 to the midportion of C2 and the maximum diameter was 4 cm. RESULTS: Using the shunt technique, we successfully removed the aneurysm and reconstructed the ICA. The end-to-end anastomosis was easy because the shunt was involved only in the distal free end of the ICA, but not in the proximal free end of the ICA. CONCLUSION: This technique could be an option for the treatment of EICCA when a shunt is needed to maintain the cerebral circulation.

Anastomosis, Surgical↗
PubMed2001

Eyebrow incision using tattoo for anterior fossa lesions: technical case reports.

Some Korean women draw tattoo in their eyebrow to cover the scant hair. If a patient has a tattoo in her eyebrow, lesions of anterior cranial fossa can be easily managed with this small eyebrow skin incision through a small unilateral supraorbital craniotomy. By this technique, 7 cases of anterior cranial fossa lesions were successfully treated without any major complications. This leads to less facial scar, less operation time and an earlier return to social adaptation.

Adult↗
PubMed2003

Contralateral inferior petrosal sinus approach for transvenous embolization of a dural arteriovenous fistula at isolated jugular bulb. Technical case report.

A contralateral inferior petrosal sinus approach is described for the successful treatment of a case of a dural arteriovenous fistula at an isolated right jugular bulb presenting with chemosis. A microcatheter could be inserted into the right jugular bulb from the left jugular bulb through the left inferior petrosal sinus, basilar sinus on the dorsum sellae, and the right inferior petrosal sinus. This unusual approach represents an alternative route to the jugular bulb.

Central Nervous System Vascular Malformations↗
PubMed1997

Endoscopic management of a pineal and suprasellar germinoma with associated hydrocephalus: technical case report.

A patient with a synchronous pineal and suprasellar germinoma and symptomatic hydrocephalus underwent a minimally invasive endoscopic biopsy and third ventriculostomy. We performed multiple biopsies of both tumors and fenestration of the floor of the third ventricle with a flexible fiberoptic endoscope through a single burr hole. Postoperative quantitative cine-mode magnetic resonance imaging (MRI) confirmed the patency of the fenestration. Selected pineal/posterior third ventricle region tumors, especially radiosensitive germinomas, could be treated with this approach thereby obviating the need for either stereotactic or craniotomy/open biopsy and the subsequent placement of a permanent cerebrospinal fluid (CSF) shunt. The endoscopic approach to tumors in the pineal/posterior third ventricle region provides an accurate straightforward, and safe method of obtaining a diagnosis and treating the associated increased intracranial pressure.

Adult↗
PubMed2003

Anterior endoscopic treatment of a huge anterior sacral meningocele: technical case report.

OBJECTIVE AND IMPORTANCE: Anterior endoscopic treatment of a huge anterior sacral meningocele, a rare example of spinal dysraphism, is described. CLINICAL PRESENTATION: A 43-year-old woman presented with severe headache and fever, increasing abdominal pain, and a several-year history of right lower-extremity radicular pain. She exhibited meningeal irritation signs and Currarino's triad. Lumbosacral myelograms and magnetic resonance imaging scans revealed a huge anterior sacral cyst connected with the spinal subarachnoid space. INTERVENTION: A straight rigid endoscope was introduced into the meningocele through a small abdominal incision. The fistula between the meningocele and the spinal subarachnoid space was obliterated with multiple fat grafts harvested from the abdomen. CONCLUSION: An anterior endoscopic procedure is an alternative for the treatment of a huge anterior sacral meningocele.

Adult↗
PubMed1996

Use of the extreme lateral approach in the surgical treatment of an intradural ventral cervical spinal cord vascular malformation: technical case report.

Vascular malformations on the ventral aspect of the spinal cord are difficult to access surgically. Recently, selected lesions have been treated with endovascular embolization. However, embolization using currently approved agents may not be permanently effective, and recanalization rates range from 25 to 83% in the literature. Additionally, many of these lesions are not amenable to endovascular treatment because of the inadequate diameter, tortuosity, or lack of collateral flow of the anterior spinal artery from which the feeding arteries arise. Surgical approaches to these lesions have been posterolateral or anterior. The posterolateral approach requires division of the dentate ligaments and occasionally the adjacent nerve root and then rotation of the cord itself to allow visualization of the lesion. The anterior approach involves a multilevel corpectomy requiring subsequent bone grafting and stabilization. Certain lesions are not readily approachable by either method. We describe the use of the extreme lateral approach to successfully access and obliterate a Type IVa perimedullary fistula located adjacent to the midline ventrally at the C1-C2 level in a 72-year-old woman who had suffered a subarachnoid hemorrhage. The extreme lateral approach was originally designed to access neoplasms located ventral to the cord and brain stem; as a result of the posterior displacement of the spinal cord by the neoplasm, intraoperative visualization is improved. No posterior displacement was present with this malformation. Even without such cord displacement, the extreme lateral approach allowed excellent visualization of and access to the arteriovenous fistula, preserved important anatomic structures, and required essentially no rotation or compression of the spinal cord to successfully obliterate the lesion.

Aged↗