In neurosurgery, brain biopsy is an essential tool for providing adequate histological sampling in neoplastic and non-tumorous lesions. There are two main techniques in obtaining tissue samples: open biopsy requiring craniotomy or needle biopsy. Needle biopsies allow for minimally-invasive tissue diagnosis with less risk of operative morbidity for the patient. This video article show a frameless needle biopsy of a cerebellar lesion using the Brainlab varioguide system.
This video outlines the surgical steps involved in the microsurgical resection of an intracranial dural arteriovenous fistula (dAVF) in a 74-year-old male patient, highlighting the importance of meticulous planning, intraoperative imaging, and precise dissection techniques. The patient has previously undergone embolization, but recurrence occurred despite the initial treatment, and patient symptoms liked headaches and weakness restarted. A decision was made to perform microsurgical resection of dAVF. The video provides a comprehensive illustration of this procedure, emphasizing the value of microsurgery as a definitive treatment modality for these challenging clinical scenarios.
Intraventricular Tumor Resection Tyler N. Adams1; Marcus Czabanka, MD2 1Louisiana State University School of Medicine 2Charite Hospital Berlin
This is a case of a 49-year-old patient who presented with persistent headaches with no focal neurologic deficit. An MRI was performed which revealed an intraventricular tumor. The lesion was seen entering the third ventricle and potentially compressing both foramina of Monro. This was further confirmed through coronal reconstruction. The proposed method for tumor removal is an interhemispheric, transcallosal approach.
Central nervous system (CNS) tumors, such as this, are uncommon neoplasms that often present with symptoms like headache, nausea, vomiting, ataxia, vertigo, and papilledema. There is also the possibility of hydrocephalus, as the tumor can obstruct cerebrospinal fluid (CSF) outflow, and the development of seizures. These tumors often grow slowly and can be managed with surgical resection, chemotherapy, and/or stereotactic radiosurgery. For intraventricular tumor resection, the surgical approach can vary based on the tumor location, experience, and preference of the surgeon.
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.
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.
Subdural hematoma (SDH) is a type of intracranial bleeding that occurs between the dura and the arachnoid membrane surrounding the brain. This video is a step-by-step demonstration of a hematoma evacuation by craniotomy performed on an elderly female patient with an acute-on-chronic SDH.
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.
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.
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.
Neurosurgeon Marcus Czabanka treats an intraventricular tumor found in a patient with persistent headaches by resecting the tumor via an interhemispheric transcallosal approach.
