Category Archives: Neurosurgery

PUBLISHED: Emergent Right Frontal Camino Bolt Placement for Intracranial Pressure Monitoring for a GCS Under 8

Emergent Right Frontal Camino Bolt Placement for Intracranial Pressure Monitoring for a GCS Under 8
Nathaniel D. Sisterson, MD, MScBrian Hsueh, MD, PhD; Katherine H. Albutt, MD
Massachusetts General Hospital

Intracranial hypertension is a critical concern in traumatic brain injury (TBI), with elevated intracranial pressure (ICP) significantly impacting patient outcomes. ICP monitoring is an essential component in managing patients with various brain pathologies that can lead to dangerously elevated intracranial pressure. In neurosurgical practice, accurate monitoring and timely intervention are critical when dealing with the challenges of intracranial hypertension, and its timely resolution is crucial for preventing severe neurological sequelae and fatal outcomes.

The risk of Infections or hemorrhage of significance associated with ICP devices, which can lead to patient morbidity, usually do not outweigh the benefit of continuous ICP monitoring in TBI. Therefore, these should not deter the decision to monitor ICP.

This video provides step-by-step visual guidance for placing a right frontal Camino bolt to guide optimal patient care. In this clinical case a patient presents without prior opportunity for clinical exam and with reported signs of a cranial hemorrhage, coupled with a right occipital fracture, thereby requiring ICP monitoring to proceed with further neurosurgical care.

PUBLISHED: Anterior Skull Base Resection of Esthesioneuroblastoma (Endoscopic)

Anterior Skull Base Resection of Esthesioneuroblastoma (Endoscopic)
David W. Jang, MD¹; Ali R. Zomorodi, MD¹; Feras Ackall, MD¹; Josef Madrigal, BS²; C. Scott Brown, MD¹
¹Duke University Medical Center
²David Geffen School of Medicine at the University of California, Los Angeles

First described by Berger in 1924, esthesioneuroblastoma (ENB) remains a rare sinonasal tumor believed to originate from specialized sensory olfactory cells. To date, the literature includes 1,000 recorded cases of ENB. Patients with ENB often present with non-specific symptoms, most often chronic nasal obstruction or epistaxis. Careful examination may reveal a pink or brown polyploid mass in the nasal cavity. Overall, ENB may demonstrate various growth patterns ranging from slow, indolent progression to aggressive invasion with widespread metastasis.

Current literature indicates that ENB should be treated with a combination of surgical resection and postoperative radiation therapy with or without chemotherapy. However, significant controversy remains regarding the appropriate surgical approach. This video demonstrates a transnasal endoscopic approach, which has gained significant popularity over the previous two decades compared to classic “open” approaches. Although this approach demonstrates improved perioperative outcomes while still achieving oncologic margins, further work is required to evaluate long-term survival.

PREPRINT RELEASE: Middle Fossa Approach to Repair Cerebrospinal Fluid Leak

Middle Fossa Approach to Repair Cerebrospinal Fluid Leak
Duke University Medical Center
Calhoun D. Cunningham III, MD
C. Scott Brown, MD
Department of Surgery
Division of Head and Neck Surgery & Communication Sciences

Dr. Calhoun Cunningham III performs a repair of a cerebrospinal fluid leak into the mastoid cavity by way of a middle fossa craniotomy. His novel use of bone and fascia grafts allows for autologous closure. 

PREPRINT RELEASE: Intraventricular Tumor Resection

Intraventricular Tumor Resection
Charite Hospital Berlin
PD Dr. med. Marcus Czabanka

Neurosurgeon Marcus Czabanka treats an intraventricular tumor found in a patient with persistent headaches by resecting the tumor via an interhemispheric transcallosal approach.

PREPRINT RELEASE: Microsurgical Resection of an Intracranial Dural Arteriovenous Fistula

Microsurgical Resection of an Intracranial Dural Arteriovenous Fistula
Charite Hospital Berlin
PD Dr. med. Marcus Czabanka

A patient suffering from an AV fistula fed by the external carotid artery, who has failed occlusion via embolization, is being operated on by Dr. Czabanka to definitively treat the fistula. With the help of CT navigation and ICG angiography, Dr. Czabanka is able to microscopically devascularize the problematic malformation.

PREPRINT RELEASE: Extraventricular Drainage and Hematoma Evacuation to Treat Hydrocephalus Following Lysis of MCA Embolism

Extraventricular Drainage and Hematoma Evacuation to Treat Hydrocephalus Following Lysis of MCA Embolism
Charite Hospital Berlin
Dr. med. Vincent Prinz,

PD Dr. med. Marcus Czabanka

A patient develops signs of hydrocephalus after receiving systemic thrombolysis for a MCA embolism. Dr. Prinz and his team react to the increased intracranial pressure by placing an extraventricular drain followed by manual evacuation of the hematoma.

PREPRINT RELEASE: Resection of a Sphenoid Wing Meningioma

Resection of a Sphenoid Wing Meningioma
Charite Hospital Berlin
Marcus Czabanka PD Dr. Med.

Watch as Dr. Czabanka navigates delicate territory to expose and excise a meningioma from the sphenoid wing of a symptomatic patient. Use of the microscope becomes crucial to prevent damage to healthy tissue while devascularizing the tumor.