This is a clinical case of an elderly female patient who developed signs of hydrocephalus after receiving systemic thrombolysis for a middle cerebral artery (MCA) embolism, which was followed by intra-arterial thrombolysis a day before. The procedures were assessed as successful. Later on, despite the initial success, she was found exhibiting impaired consciousness. A follow-up head computed tomography (CT) revealed hemorrhaging of the cerebellum leading to the compression of the fourth ventricle and subsequent hydrocephalus.
A decision was made to place an external ventricular drain (EVD), followed by a suboccipital craniotomy and evacuation of the cerebellar hematoma. An EVD is a temporary catheter specifically designed to drain cerebrospinal fluid (CSF) and facilitate the monitoring of intracranial pressure (ICP). This video provides a detailed overview of the key steps involved in the EVD placement and hematoma evacuation, offering critical insights from skin incision to wound closure.
An open colectomy is the resection of all or part of the colon, typically through a midline incision in the abdomen. This procedure is often indicated for the treatment of colonic diseases such as bowel obstruction, diverticulitis, inflammatory bowel disease, and colon cancer. The patient in this case was a C6 quadriplegic male who presented with colon cancer near the splenic flexure. He also suffered from colonic dysmotility and severe constipation. He was treated with an open left colectomy through an upper midline laparotomy.
Regarding the procedure, once the abdomen was entered, the peritoneal cavity was explored, and the tumor was identified. The colon was mobilized, starting with the transverse colon, which was extended laterally to take down the hepatic flexure followed by mobilization of the right colon in a lateral-to-medial fashion. Next, the splenic flexure was mobilized followed by the descending colon, again in a lateral-to-medial fashion. Once mobilized, the margins of transection were identified, and the intervening mesocolon was ligated in a cut and tie fashion. The colon was then transected using and ILA stapler to include the distal transverse, descending, and proximal sigmoid colon. Finally, the proximal cut end of the transverse colon was brought up through a left-sided end colostomy. In this video, the key steps of the procedure are demonstrated, and analysis regarding intraoperative decision making is provided.
This is the case of a 31-year-old female with a history of juvenile rheumatoid arthritis and uveitis who presented with a leg-length discrepancy and low back pain refractory to conservative management. She underwent a shortening osteotomy on her left femur around an intramedullary nail that went on to nonunion.
She underwent exchange nailing with a magnetic intramedullary nailing with autologous bone graft harvest from her affected femoral reamings. The magnetic intramedullary nail was extended 2 cm prior to insertion, and then implanted in the usual fashion with immediate compression in the operating room. Postoperatively the patient underwent a compressive program using the magnetic nail and went on to heal her osteotomy site.
The submandibular approach, also known as the Risdon approach, is a well-established extraoral surgical technique employed for the treatment of complex mandibular fractures and pathologies. Despite the increasing popularity of intraoral approaches for open reduction and internal fixation, the submandibular approach remains a valuable option in the arsenal of maxillofacial surgeons. This approach offers several advantages, including superior access and visualization of the mandibular body and angle, facilitating better manipulation and reduction of fracture fragments. Furthermore, the submandibular approach enables direct access to the submandibular gland, facilitating its management in cases of pathology or injury. By providing a comprehensive understanding of this technique through cadaveric exploration, this video aims to contribute to the training and education of maxillofacial surgeons, ultimately enhancing patient care and outcomes.
Bilateral axillo-breast approach (BABA) is a contemporary technique for remote-access thyroidectomy. BABA robotic thyroidectomy (RT) offers a number of benefits over other remote-access thyroidectomy techniques, such as provision of a three-dimensional symmetric view of bilateral thyroid lobes and optimal visualization of important anatomical landmarks, including the recurrent laryngeal nerve (RLN), thyroidal vessels, parathyroid glands, and the trachea.
This educational video is a thorough demonstration of BABA RT performed on a young female patient diagnosed with a left-sided thyroid nodule in her early thirties. The thyroid fine needle aspiration biopsy of the 4-cm nodule was indeterminate. Additional molecular testing of the specimen had revealed one of the mutations associated with thyroid cancer. Therefore, a diagnostic thyroid lobectomy was planned. The patient had expressed a strong desire to avoid an obvious neck scar, and therefore, the BABA RT was offered.
The middle fossa approach is indicated for procedures requiring access to the internal auditory canal, structures within the temporal bone, and adjacent structures. This is one of the three main approaches for the surgical repair of tegmental defects causing cerebrospinal fluid (CSF) leak. The middle fossa approach allows for an optimal view of the middle fossa floor for larger or multiple defects, ease of graft placement, and avoidance of the removal of ossicle to access the tegmen.
Surgical intervention for CSF leak is indicated when conservative management fails or when spontaneous closure of a defect is unlikely. In this case, a middle fossa approach is used to surgically close a tegmen defect causing CSF otorrhea refractory to conservative management. This case highlights the step-by-step surgical techniques involved in this procedure including the surgical approach to expose the tegmen defect, repair of the tegmen defect using temporalis fascia and a bone graft, and craniotomy repair and closure.
Knot tying is a fundamental skill in the surgical field, essential for securing sutures, ligating vessels, and creating secure anastomoses. The art of knot tying requires precision, dexterity, and a thorough understanding of suture materials and techniques. This video article aims to provide a comprehensive overview of surgical knot tying for beginners.
Sphenoid wing meningiomas are typically benign, slow-growing tumors that may be identified incidentally on imaging or due to a symptomatic presentation from compression of a nearby structure. Located along the sphenoid wing, these tumors may infiltrate or compress the optic nerve, oculomotor nerve, cavernous sinus, or internal carotid artery, causing neurologic deficits such as visual disturbances, headache, paresis, and diplopia.
Surgical resection is considered the first-line treatment for a symptomatic meningioma, but is often challenging due to tumor proximity to these critical neurovascular structures. The most important prognostic factor for recurrence is the completeness of the surgical removal of the tumor, but this goal must be adapted to preserve neurologic function based on individual tumor location and invasion. Here we present a case of a 43-year-old patient diagnosed with a sphenoid wing meningioma after presenting with episodic difficulty speaking and aura-like symptoms who underwent total neurosurgical resection of the tumor via craniotomy.
Stapedotomy (Endaural) David M. Kaylie, MD, MS1; Trey A. Thompson2; C. Scott Brown, MD1 1Duke University Medical Center 2University of Washington School of Medicine
Otosclerosis is a condition characterized by abnormal bone growth that inhibits the movement of the stapes, leading to a gradual conductive hearing loss. The treatment options encompass observation, the use of hearing aids, and surgical intervention. If the patient opts for surgery, either a stapedotomy or a stapedectomy can be executed to liberate the stapes from the sclerotic bone.
In the case of a stapedotomy performed with an endaural approach, access to the middle ear is gained through a minor incision extending from the anterior ear canal to the incisura, also known as the intertragal notch. The surgeon then proceeds to remove the superstructure of the stapes, create an opening in the footplate of the stapes, and subsequently place a prosthesis into the opening, which is then connected to the incus. The outcomes of this procedure are generally positive, with 90–95% of patients experiencing an improvement in hearing.
Minor lower extremity amputations typically involve either toe or ray resections. The first ray is an essential component in the normal anatomy and biomechanics of the foot. By definition, the first ray consists of the hallux and the first metatarsal. The surgical procedure discussed in this educational video is a left first toe ray amputation on a cadaver. Toe amputation is a significant predictor of future limb loss. Ray amputation appears to be preferred over finger amputation in selected cases. However, the literature does not provide precise indications on when to consider a ray over a toe amputation. The choice is therefore left to the operating surgeon, based on their clinical expertise and the patient’s conditions and expectations, taking into account the underlying pathology.
