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Serrato-Avila JL, Paz Archila JA, Monroy-Sosa A, Alejandro SA, Costa MDSD, Cavalheiro S, Yagmurlu K, Lawton MT, Chaddad-Neto F. Resection of the quadrangular lobule of the cerebellum to increase exposure of the cerebellomesencephalic fissure: an anatomical study with clinical correlation. J Neurosurg 2024; 140:1160-1168. [PMID: 38564813 DOI: 10.3171/2023.7.jns222838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 07/20/2023] [Indexed: 04/04/2024]
Abstract
OBJECTIVE The lateral aspect of the cerebellomesencephalic fissure frequently harbors vascular pathology and is a common surgical corridor used to access the pons tegmentum, as well as the cerebellum and its superior and middle peduncles. The quadrangular lobule of the cerebellum (QLC) represents an obstacle to reach these structures. The authors sought to analyze and compare exposure of the cerebellar interpeduncular region (CIPR) before and after QLC resection and provide a case series to evaluate its clinical applicability. METHODS Forty-two sides of human brainstems were prepared with Klingler's method and dissected. The exposure area before and after resection of the QLC was measured and statistically studied. A case series of 59 patients who underwent QLC resection for the treatment of CIPR lesions was presented and clinical outcomes were evaluated at 1-year follow-up. RESULTS The anteroposterior surgical corridor of the CIPR increased by 10.3 mm after resection of the QLC. The mean exposure areas were 42 mm2 before resection of the QLC and 159.6 mm2 after resection. In this series, ataxia, extrapyramidal syndrome, and akinetic mutism were found after surgery. However, all these cases resolved within 1 year of follow-up. Modified Rankin Scale score improved by 1 grade, on average. CONCLUSIONS QLC resection significantly increased the exposure area, mainly in the anteroposterior axis. This surgical strategy appears to be safe and may help the neurosurgeon when operating on the lateral aspect of the cerebellomesencephalic fissure.
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Affiliation(s)
- Juan Leonardo Serrato-Avila
- 1Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Brazil
- 3Department of Neurosurgery, Hospital General de Tlahuac, ISSSTE, México City, México
- 3Department of Neurosurgery, Hospital General de Tlahuac, ISSSTE, México City, México
| | - Juan Alberto Paz Archila
- 1Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Brazil
- 2Laboratory of Microneurosurgery Anatomy, Universidade Federal de São Paulo, Brazil
| | - Alejandro Monroy-Sosa
- 3Department of Neurosurgery, Hospital General de Tlahuac, ISSSTE, México City, México
- 4Center for Research and Innovation in Neurosciences, Higher School of Medicine, National Polytechnic Institute, México City, México
| | - Sebastian Aníbal Alejandro
- 1Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Brazil
- 2Laboratory of Microneurosurgery Anatomy, Universidade Federal de São Paulo, Brazil
| | - Marcos Devanir Silva da Costa
- 1Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Brazil
- 2Laboratory of Microneurosurgery Anatomy, Universidade Federal de São Paulo, Brazil
| | - Sergio Cavalheiro
- 1Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Brazil
- 2Laboratory of Microneurosurgery Anatomy, Universidade Federal de São Paulo, Brazil
| | - Kaan Yagmurlu
- Departments of5Neurosurgery and
- 8Neuroscience, University of Virginia Health System, Charlottesville, Virginia
| | - Michael T Lawton
- 6Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona; and
| | - Feres Chaddad-Neto
- 1Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Brazil
- 2Laboratory of Microneurosurgery Anatomy, Universidade Federal de São Paulo, Brazil
- 7Department of Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, Brazil
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Mangham W, Lesha E, Nico E, Yagmurlu K, Golembeski CP, Portnoy DC, Weaver J. Rosai-Dorfman disease of the cauda equina: illustrative case. J Neurosurg Case Lessons 2024; 7:CASE23359. [PMID: 38252925 PMCID: PMC10805585 DOI: 10.3171/case23359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 11/21/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Rosai-Dorfman disease (RDD) is a rare, nonmalignant histiocytosis. It typically occurs in lymph nodes, skin, and soft tissues, but numerous reports of central nervous system involvement exist in the literature. The peripheral nervous system has rarely been involved. In this study, the authors present a case of RDD isolated to the cauda equina. The presentation, management, surgical technique, and adjunctive treatment strategy are described. OBSERVATIONS A 31-year-old female presented with 6 months of progressive left lower-extremity numbness involving the lateral aspect of the foot and weakness of the left toes. Magnetic resonance imaging of the lumbar spine demonstrated a homogeneously enhancing intradural lesion involving the cauda equina at the L2-3 levels. Histopathology after resection revealed a histiocytic infiltrate, positive for CD68 and S100, and emperipolesis consistent with RDD. No adjuvant therapy was administered, and the patient had full remission at the 1-year follow-up. Only five other cases of intradural RDD lesions of the cauda equina have been reported in the literature. LESSONS RDD of the cauda equina is an especially rare and challenging diagnosis that can mimic other dura-based lesions, such as meningiomas. A definitive diagnosis of RDD relies on pathognomonic histopathological and immunohistochemical findings.
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Affiliation(s)
- William Mangham
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
- Semmes Murphey Clinic, Memphis, Tennessee
| | - Emal Lesha
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
- Semmes Murphey Clinic, Memphis, Tennessee
| | - Elsa Nico
- University of Illinois College of Medicine at Chicago, Chicago, Illinois
| | - Kaan Yagmurlu
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
- Semmes Murphey Clinic, Memphis, Tennessee
| | - Christopher P Golembeski
- Department of Pathology, Baptist Memorial Hospital, Memphis, Tennessee
- Baptist Health Sciences University College of Osteopathic Medicine, Memphis, Tennessee; and
| | | | - Jason Weaver
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
- Semmes Murphey Clinic, Memphis, Tennessee
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Chaddad-Neto F, Centeno RS, da Costa MDS, Yagmurlu K, Ahumada-Vizcaino JC, Wuo-Silva R. Editorial: Vascular neurosurgery and microneuroanatomy. Front Surg 2023; 10:1229789. [PMID: 37435470 PMCID: PMC10332314 DOI: 10.3389/fsurg.2023.1229789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 06/13/2023] [Indexed: 07/13/2023] Open
Affiliation(s)
- Feres Chaddad-Neto
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Department of Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil
| | - Ricardo Silva Centeno
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Kaan Yagmurlu
- Departments of Neurological Surgery and Neuroscience, University of Virginia School of Medicine, Charlottesville, VA, United States
| | | | - Raphael Wuo-Silva
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Ballesteros-Herrera D, Yagmurlu K, Guinto-Nishimura GY, Ramirez-Stubbe V, Nathal-Vera E, Baldoncini M, Forlizzi V, Gomez-Amador JL, Moreno-Jiménez S, Vázquez-Gregorio R, Giotta Lucifero A, Campero A, Luzzi S. Photo-Stacking Technique for Neuroanatomical High-Definition Photography and 3D Modeling. World Neurosurg 2023:S1878-8750(23)00801-X. [PMID: 37331475 DOI: 10.1016/j.wneu.2023.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 06/09/2023] [Accepted: 06/10/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND three-dimensional neuroanatomical knowledge is vital in neurosurgery. Technological advances improved 3D anatomical perception, but they are usually expensive and not widely available. The aim of the present study was to provide a detailed description of the photo-stacking technique for high-resolution neuroanatomical photography and 3D modeling. METHODS The photo-stacking technique was described in a step-by-step approach. The time for image acquisition, file conversion, processing, and final production was measured using two processing methods. The toral number and file size of images are presented. Measures of central tendency and dispersion report the measured values. RESULTS Ten models were used in both methods achieving 20 models with high-definition images. The mean number of acquired images was 40.6 (14-67), image acquisition time 51.50 ± 18.8s, file conversion time 250 ± 134.6 s, processing time 50.46 ± 21.46 s and 41.97 ± 20.84 s, and 3D reconstruction time was 4.29 ± 0.74 s and 3.89 ± 0.60 s for methods B and C, respectively. The mean file size of RAW files is 1010 ± 452 MB and 101.06 ± 38.09 MB for JPG files after conversion. The mean size of the final image means size is 71.9 ± 0.126 MB, and the mean file size of the 3D model means is 37.4 ± 0.516 MB for both methods. The total equipment used was less expensive than other reported systems. CONCLUSION The photo-stacking technique is a simple and inexpensive method to create 3D models and high-definition images that could prove valuable in neuroanatomy training.
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Affiliation(s)
- Daniel Ballesteros-Herrera
- Neurosurgery department. Instituto Nacional de Neurología y Neurocirugía, MVS. Address: Insurgentes Sur 3877 Col. La Fama 14269, Mexico City, Mexico
| | - Kaan Yagmurlu
- Neurosurgery department University of Tennessee Health Science Center. Ut College Of Medicine, 920 Madison Avenue Suite C 50, Memphis Tennessee, 38163-0001. USA
| | - Gerardo Y Guinto-Nishimura
- Neurosurgery department. Instituto Nacional de Neurología y Neurocirugía, MVS. Address: Insurgentes Sur 3877 Col. La Fama 14269, Mexico City, Mexico
| | - Viviana Ramirez-Stubbe
- Neurosurgery department. Instituto Nacional de Neurología y Neurocirugía, MVS. Address: Insurgentes Sur 3877 Col. La Fama 14269, Mexico City, Mexico
| | - Edgar Nathal-Vera
- Neurosurgery department. Instituto Nacional de Neurología y Neurocirugía, MVS. Address: Insurgentes Sur 3877 Col. La Fama 14269, Mexico City, Mexico
| | - Matias Baldoncini
- Laboratory of Microsurgical Neuroanatomy, Second Chair of Gross Anatomy, School of Medicine, University of Buenos Aires/ Department of Neurological Surgery, Hospital San Fernando, Buenos Aires, Argentina
| | - Valeria Forlizzi
- Laboratory of Microsurgical Neuroanatomy, Second Chair of Gross Anatomy, School of Medicine, University of Buenos Aires/ Department of Neurological Surgery, Hospital San Fernando, Buenos Aires, Argentina
| | - Juan Luis Gomez-Amador
- Neurosurgery department. Instituto Nacional de Neurología y Neurocirugía, MVS. Address: Insurgentes Sur 3877 Col. La Fama 14269, Mexico City, Mexico
| | - Sergio Moreno-Jiménez
- Neurosurgery department. Instituto Nacional de Neurología y Neurocirugía, MVS. Address: Insurgentes Sur 3877 Col. La Fama 14269, Mexico City, Mexico
| | - Rafael Vázquez-Gregorio
- Pediatric Neurosurgery department. Instituto Nacional de Pediatría. Address: Insurgentes Sur 3700, Letra C, Coyoacán C.P. 04530. Mexico City, Mexico
| | - Alice Giotta Lucifero
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Alvaro Campero
- Department of Neurological Surgery, Hospital Padilla, Tucumán, Argentina
| | - Sabino Luzzi
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy; Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
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Afshangian F, Wellington J, Pashmoforoosh R, Farzadfard MT, Noori NK, Jaberi AR, Ostovan VR, Soltani A, Safari H, Abolhasani Foroughi A, Resid Onen M, Montemurro N, Chaurasia B, Akgul E, Freddi T, Ermis A, Amirifard H, Habibi SAH, Manzarinezad M, Bozkurt I, Yagmurlu K, Sirjani EB, Wagner AP. The impact of visual and motor skills on ideational apraxia and transcortical sensory aphasia. Appl Neuropsychol Adult 2023:1-11. [PMID: 37134206 DOI: 10.1080/23279095.2023.2204527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Patients with extensive left hemisphere damage frequently have ideational apraxia (IA) and transcortical sensory aphasia (TSA). Difficulty with action coordination, phonological processing, and complex motor planning may not be indicative of higher-order motor programming or higher-order complex formation. We report on the effects of IA and TSA on the visual and motor skill of stroke patients. PURPOSE The study aims to address the question of whether IA and TSA in bilingual individuals are the results of an error of motor function alone or due to a combined motor plus and cognitive dysfunction effect. METHOD Twelve bilingual patients (seven males, and five females) were diagnosed with IA and TSA, and are divided into two groups of six patients. Then, 12 healthy bilingual controls were evaluated for comparing with both groups. Bilingual aphasia testing (BAT) and appropriate behavioral evaluation were used to assess motor skills, including coordination, visual-motor testing, and phonological processing. RESULTS Findings (pointing skills) show that the performance of the L1 and L2 languages are consistently significant (p < 0.001) in healthy individuals compared to the IA and TSA groups. Command skills for L1 and L2 languages were significantly higher in healthy individuals compared to IA and TSA controls (p < 0.001). Further, the orthographic skills of IA and TSA vs controls in both groups were significantly reduced (p < 0.01). Visual skills in the L1 language were significantly improved (p < 0.05) in IA and TSA patients compared to healthy controls after 2 months. Unlike orthographic skills which were improved in IA and TSA patients, languages in bilingual patients did not simultaneously improve. CONCLUSION Dyspraxia is a condition that affects both motor and visual cognitive functions, and patients who have it often have less referred motor skills. The current dataset shows that accurate visual cognition requires both cognitive-linguistic and sensory-motor processes. Motor issues should be highlighted, and skills and functionality should be reinforced along with the significance of treatment between IA and TSA corresponding to age and education. This can be a good indicator for treating semantic disorders.
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Affiliation(s)
- Fazlallah Afshangian
- Department of English, Faculty of Foreign Languages, Rodaki Institute of Higher Education, Tonekabon, Iran
| | - Jack Wellington
- Cardiff University School of Medicine, Cardiff University, Cardiff, UK
| | | | | | | | | | - Vahid Reza Ostovan
- Department of Neurology, Shiraz University of Medical Science, Shiraz, Iran
| | - Ahmad Soltani
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hosein Safari
- Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran
| | - Amin Abolhasani Foroughi
- Department of Radiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- iMedical Imaging Research Center , Shiraz University of Medical Sciences , Shiraz , Iran
| | | | - Nicola Montemurro
- Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, Pisa, Italy
| | | | - Erol Akgul
- Radiology Department, International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Tomas Freddi
- Radiology, Faculty of Medicine, Sao Paulo University, Sao Paulo, Brazil
| | - Abdulkadir Ermis
- Department of Neurology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Hamed Amirifard
- Department of Neurology, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Ismail Bozkurt
- Department of Neurosurgery, Medical Park Ankara Hospital, Ankara, Turkey
| | - Kaan Yagmurlu
- Department of Neuroscience, University Virginia Health System, Charlottesville, VA, USA
| | - Ehsan Baradran Sirjani
- Research Development Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Aurel Popa Wagner
- Center for Clinical and Experimental Medicine, University of Medicine and Pharmacy, Craiova, Romania
- Dementia and Ageing Research, Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Norat P, Sokolowski JD, Gorick CM, Soldozy S, Kumar JS, Chae Y, Yagmurlu K, Nilak J, Sharifi KA, Walker M, Levitt MR, Klibanov AL, Yan Z, Price RJ, Tvrdik P, Kalani MYS. Intraarterial Transplantation of Mitochondria After Ischemic Stroke Reduces Cerebral Infarction. Stroke Vasc Interv Neurol 2023; 3:e000644. [PMID: 37545759 PMCID: PMC10399028 DOI: 10.1161/svin.122.000644] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 01/03/2023] [Indexed: 08/08/2023]
Abstract
Background- Transplantation of autologous mitochondria into ischemic tissue may mitigate injury caused by ischemia and reperfusion. Methods- Using murine stroke models of middle cerebral artery occlusion, we sought to evaluate feasibility of delivery of viable mitochondria to ischemic brain parenchyma. We evaluated the effects of concurrent focused ultrasound activation of microbubbles, which serves to open the blood-brain barrier, on efficacy of delivery of mitochondria. Results- Following intra-arterial delivery, mitochondria distribute through the stroked hemisphere and integrate into neural and glial cells in the brain parenchyma. Consistent with functional integration in the ischemic tissue, the transplanted mitochondria elevate concentration of adenosine triphosphate in the stroked hemisphere, reduce infarct volume and increase cell viability. Additional of focused ultrasound leads to improved blood brain barrier opening without hemorrhagic complications. Conclusions- Our results have implications for the development of interventional strategies after ischemic stroke and suggest a novel potential modality of therapy after mechanical thrombectomy.
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Affiliation(s)
- Pedro Norat
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Jennifer D. Sokolowski
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Catherine M. Gorick
- Department of Biomedical Engineering, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Sauson Soldozy
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Jeyan S. Kumar
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Youngrok Chae
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Kaan Yagmurlu
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Joelle Nilak
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Khadijeh A. Sharifi
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
- Department of Neuroscience, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Melanie Walker
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Michael R. Levitt
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Alexander L. Klibanov
- Cardiovascular Division, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Zhen Yan
- Robert M. Berne Cardiovascular Research Center, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Richard J. Price
- Department of Biomedical Engineering, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Petr Tvrdik
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
- Department of Neuroscience, University of Virginia School of Medicine, Charlottesville, Virginia
| | - M. Yashar S. Kalani
- St. John’s Neuroscience Institute and the University of Oklahoma School of Medicine, Tulsa, Oklahoma
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Parikh KA, Yagmurlu K, Michael LM. Commentary: Transcavernous Surgical Approach for the Treatment of Carotid-Cavernous Fistula: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 24:e216-e217. [PMID: 36701553 DOI: 10.1227/ons.0000000000000575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 01/27/2023] Open
Affiliation(s)
- Kara A Parikh
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kaan Yagmurlu
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Semmes Murphey Clinic, Memphis, Tennessee, USA
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Soldozy S, Dalzell C, Skaff A, Ali Y, Norat P, Yagmurlu K, Park MS, Kalani MYS. Reperfusion injury in acute ischemic stroke: Tackling the irony of revascularization. Clin Neurol Neurosurg 2023; 225:107574. [PMID: 36696846 DOI: 10.1016/j.clineuro.2022.107574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 12/12/2022] [Accepted: 12/23/2022] [Indexed: 01/06/2023]
Abstract
Reperfusion injury is an unfortunate consequence of restoring blood flow to tissue after a period of ischemia. This phenomenon can occur in any organ, although it has been best studied in cardiac cells. Based on cardiovascular studies, neuroprotective strategies have been developed. The molecular biology of reperfusion injury remains to be fully elucidated involving several mechanisms, however these mechanisms all converge on a similar final common pathway: blood brain barrier disruption. This results in an inflammatory cascade that ultimately leads to a loss of cerebral autoregulation and clinical worsening. In this article, the authors present an overview of these mechanisms and the current strategies being employed to minimize injury after restoration of blood flow to compromised cerebral territories.
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Affiliation(s)
- Sauson Soldozy
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA; Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
| | - Christina Dalzell
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Anthony Skaff
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Yusuf Ali
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Pedro Norat
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Kaan Yagmurlu
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Min S Park
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - M Yashar S Kalani
- Department of Surgery, University of Oklahoma, and St. John's Neuroscience Institute, Tulsa, OK, USA.
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Serrato-Avila JL, Archila JAP, da Costa MDS, Biol PRR, Marques SR, de Moraes LOC, Yagmurlu K, Lawton MT, Cavalheiro S, Chaddad-Neto F. Microsurgical Anatomy of the Cerebellar Interpeduncular Entry Zones. World Neurosurg 2022; 166:e933-e948. [PMID: 35948221 DOI: 10.1016/j.wneu.2022.07.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The cerebellar interpeduncular region, particularly the middle cerebellar peduncle (MCP) and interpeduncular sulcus (IPS) are significant surgical relevance areas due to the high prevalence of vascular and tumoral pathologies, such as cavernomas, arteriovenous malformations, and gliomas. We defined safer access areas of the MCP and the IPS, according to the surface anatomy, involved vessels, and fiber tracts of the cerebellar interpeduncular region. METHODS Fifteen formalin-fixed and silicone-injected cadaveric heads and 23 human brainstems with attached cerebellums prepared with the Klingler's technique were bilaterally dissected to study the vascular and intrinsic anatomy. RESULTS Surface anatomy: The mean length of the IPS was 12.73 mm (standard deviation [SD],2.15 mm), and the average measured angle formed by the IPS and the lateral mesencephalic sulcus was 144.53°. The mean distance from the uppermost point of the IPS to cranial nerve IV was 2.63 mm (SD, 2.84 mm). Vascular anatomy: The perforating branches of the superior cerebellar peduncle, IPS, and MCP originated predominantly from the caudal trunk of the superior cerebellar artery. The inferior third of the superior cerebellar peduncle and IPS was the third most pierced by perforating arteries, and for the MCP, was its superior third. Crossing vessels: The branches of the pontotrigeminal vein and the caudal trunk of the superior cerebellar artery crossed the IPS mostly. The superior third of the IPS was the most crossed by arteries and veins. CONCLUSIONS The middle thirds of the IPS and MCP as entry zones might be safer than their superior and inferior thirds due to fewer perforating branches, arterial trunks, and veins crossing the sulcus as fewer eloquent tracts.
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Affiliation(s)
- Juan Leonardo Serrato-Avila
- Department of Neurology and Neurosurgery, Universidade Federal de Sao Paulo, Sao Paulo, Brazil; Laboratory of Microneurosurgery Anatomy, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Juan Alberto Paz Archila
- Department of Neurology and Neurosurgery, Universidade Federal de Sao Paulo, Sao Paulo, Brazil; Laboratory of Microneurosurgery Anatomy, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Marcos Devanir Silva da Costa
- Department of Neurology and Neurosurgery, Universidade Federal de Sao Paulo, Sao Paulo, Brazil; Laboratory of Microneurosurgery Anatomy, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Paulo Ricardo Rocha Biol
- Laboratory of Microneurosurgery Anatomy, Universidade Federal de Sao Paulo, Sao Paulo, Brazil; Department of Morphology and Genetics, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Sergio Ricardo Marques
- Department of Morphology and Genetics, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | | | - Kaan Yagmurlu
- Departments of Neurosurgery and Neuroscience, University of Virginia, Health System, Charlottesville, Virginia, USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Sergio Cavalheiro
- Department of Neurology and Neurosurgery, Universidade Federal de Sao Paulo, Sao Paulo, Brazil; Laboratory of Microneurosurgery Anatomy, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Feres Chaddad-Neto
- Department of Neurology and Neurosurgery, Universidade Federal de Sao Paulo, Sao Paulo, Brazil; Laboratory of Microneurosurgery Anatomy, Universidade Federal de Sao Paulo, Sao Paulo, Brazil; Department of Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil.
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Tomasi SO, Umana GE, Scalia G, Rubio-Rodriguez RL, Raudino G, Rechberger J, Geiger P, Chaurasia B, Yagmurlu K, Lawton MT, Winkler PA. Corrigendum: Perforating Arteries of the Lemniscal Trigone: A Microsurgical Neuroanatomic Description. Front Neuroanat 2022; 15:835799. [PMID: 35069131 PMCID: PMC8767094 DOI: 10.3389/fnana.2021.835799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 12/03/2022] Open
Affiliation(s)
- Santino Ottavio Tomasi
- Department of Neurological Surgery - Christian Doppler Klinik, Salzburg, Austria
- Department of Neurosurgery, Paracelsus Medical University Salzburg, Salzburg, Austria
- Laboratory for Microsurgical Neuroanatomy - Christian Doppler Klinik, Salzburg, Austria
- *Correspondence: Santino Ottavio Tomasi ;
| | - Giuseppe Emmanuele Umana
- Department of Neurosurgery, Cannizzaro Hospital, Trauma Center, Gamma Knife Center, Catania, Italy
| | - Gianluca Scalia
- Neurosurgery Unit, Highly Specialized Hospital and of National Importance “Garibaldi”, Catania, Italy
| | - Roberto Luis Rubio-Rodriguez
- Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, San Francisco, CA, United States
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Giuseppe Raudino
- Department of Neurosurgery - Humanitas, Istituto Clinico Catanese, Catania, Italy
| | - Julian Rechberger
- Department of Neurosurgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Philipp Geiger
- Department of Neurosurgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
| | - Kaan Yagmurlu
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, United States
| | - Michael T. Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States
| | - Peter A. Winkler
- Department of Neurological Surgery - Christian Doppler Klinik, Salzburg, Austria
- Department of Neurosurgery, Paracelsus Medical University Salzburg, Salzburg, Austria
- Laboratory for Microsurgical Neuroanatomy - Christian Doppler Klinik, Salzburg, Austria
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11
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Umana GE, Scalia G, Yagmurlu K, Mineo R, Di Bella S, Giunta M, Spitaleri A, Maugeri R, Graziano F, Fricia M, Nicoletti GF, Tomasi SO, Raudino G, Chaurasia B, Bellocchi G, Salvati M, Iacopino DG, Cicero S, Visocchi M, Strigari L. Multimodal Simulation of a Novel Device for a Safe and Effective External Ventricular Drain Placement. Front Neurosci 2021; 15:690705. [PMID: 34194297 PMCID: PMC8236630 DOI: 10.3389/fnins.2021.690705] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 05/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background External ventricular drain (EVD) placement is mandatory for several pathologies. The misplacement rate of the EVD varies widely in literature, ranging from 12.3 to 60%. The purpose of this simulation study is to provide preliminary data about the possibility of increasing the safety of one of the most common life-saving procedures in neurosurgery by testing a new device for EVD placement. Methods We used a novel guide for positioning the ventricular catheter (patent RM2014A000376). The trajectory was assessed using 25 anonymized head CT scans. The data sets were used to conduct three-dimensional computer-based and combined navigation and augmented reality-based simulations using plaster models. The data set inclusion criteria were volumetric head CT scan, without midline shift, of patients older than 18. Evans' index was used to quantify the ventricle's size. We excluded patients with slit ventricles, midline shift, skull fractures, or complex skull malformations. The proximal end of the device was tested on the cadaver. Results The cadaveric tests proved that a surgeon could use the device without any external help. The multimodal simulation showed Kakarla grade 1 in all cases but one (grade 2) on both sides, after right and left EVD placement. The mean Evans' index was 0.28. The geometric principles that explain the device's efficacy can be summarized by studying the properties of circumference and chord. The contact occurs, for each section considered, at the extreme points of the chord. Its axis, perpendicular to the plane tangent to the spherical surface at the entry point, corresponds to the direction of entry of the catheter guided by the instrument. Conclusion According to our multimodal simulation on cadavers, 3D computer-based simulation, 3D plaster modeling, 3D neuronavigation, and augmented reality, the device promises to offer safer and effective EVD placement. Further validation in future clinical studies is recommended.
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Affiliation(s)
- Giuseppe Emmanuele Umana
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Gianluca Scalia
- Department of Neurosurgery, Highly Specialized Hospital and of National Importance "Garibaldi," Catania, Italy
| | - Kaan Yagmurlu
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, United States
| | - Rosalia Mineo
- MT Ortho Srl, Aci Sant'Antonio, Catania, Italy.,DICAR, University of Catania, Catania, Italy
| | - Simone Di Bella
- MT Ortho Srl, Aci Sant'Antonio, Catania, Italy.,DICAR, University of Catania, Catania, Italy
| | | | - Angelo Spitaleri
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Rosario Maugeri
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone," Palermo, Italy
| | - Francesca Graziano
- Department of Neurosurgery, Highly Specialized Hospital and of National Importance "Garibaldi," Catania, Italy.,Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone," Palermo, Italy
| | - Marco Fricia
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Giovanni Federico Nicoletti
- Department of Neurosurgery, Highly Specialized Hospital and of National Importance "Garibaldi," Catania, Italy
| | - Santino Ottavio Tomasi
- Department of Neurosurgery, Christian-Doppler-Klinik, Paracelsus Private Medical University, Salzburg, Austria
| | - Giuseppe Raudino
- Department of Neurosurgery, Humanitas University, Catania, Italy
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
| | - Gianluca Bellocchi
- Department of Otorhinolaryngology, San Camillo Forlanini Hospital, Rome, Italy
| | - Maurizio Salvati
- Department of Neurosurgery, Policlinico Tor Vergata, Rome, Italy
| | - Domenico Gerardo Iacopino
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Postgraduate Residency Program in Neurological Surgery, Neurosurgical Clinic, AOUP "Paolo Giaccone," Palermo, Italy
| | - Salvatore Cicero
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Massimiliano Visocchi
- Craniovertebral Junction Operative Unit, Master CVJ Surgical Approach Research Center, Institute of Neurosurgery, Policlinic "A. Gemelli", Catholic University, Rome, Italy
| | - Lidia Strigari
- Department of Medical Physics, IRCCS University Hospital of Bologna, Bologna, Italy
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12
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Karadag A, Bozkurt B, Yagmurlu K, Ozcan AI, Moen S, Grande AW. Microsurgical Management of the Middle Cerebral Artery Bifurcation Aneurysms: An Anatomic Feasibility Study. ORL J Otorhinolaryngol Relat Spec 2021; 83:187-195. [PMID: 33721866 DOI: 10.1159/000514177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 12/28/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The proper head positioning decreases the surgical complications by enabling a better surgical maneuverability. Middle cerebral artery (MCA) bifurcation aneurysms have been classified by Dashti et al. [Surg Neurol. 2007 May;67(5):441-56] as the intertruncal, inferior, lateral, insular, and complex types based on dome projection. Our aim was to identify the optimum head positions and to explain the anatomic variables, which may affect the surgical strategy of MCA bifurcation aneurysms. METHODS The lateral supraorbital approach bilaterally was performed in the 4 cadaveric heads. All steps of the dissection were recorded using digital camera. RESULTS The distal Sylvian fissure (SF) dissection may be preferred for insular type and the proximal SF dissection may be preferred for all other types. Fifteen degrees head rotation was found as the most suitable position for the intertruncal, lateral type and subtype of complex aneurysms related with superior trunk. Thirty degrees head rotation was found the most suitable position for the inferior type, insular type, and subtype of complex aneurysms related with inferior trunk. CONCLUSIONS The head positioning in middle cerebral bifurcation aneurysms surgery is a critical step. It should be tailored according to the projection and its relationship with the parent vessels of the middle cerebral bifurcation.
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Affiliation(s)
- Ali Karadag
- Department of Neurosurgery, Health Science University, Tepecik Research and Training Hospital, Izmir, Turkey,
| | - Baran Bozkurt
- Department of Neurosurgery, Acibadem University, Istanbul, Turkey
| | - Kaan Yagmurlu
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | | | - Sean Moen
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Andrew W Grande
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
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13
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Soldozy S, Skaff A, Soldozy K, Sokolowski JD, Norat P, Yagmurlu K, Sharifi KA, Tvrdik P, Park MS, Kalani MYS, Jane JA, Syed HR. From Bench to Bedside, the Current State of Oncolytic Virotherapy in Pediatric Glioma. Neurosurgery 2020; 87:1091-1097. [PMID: 32542365 DOI: 10.1093/neuros/nyaa247] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/10/2020] [Indexed: 12/26/2022] Open
Abstract
Glioma continues to be a challenging disease process, making up the most common tumor type within the pediatric population. While low-grade gliomas are typically amenable to surgical resection, higher grade gliomas often require additional radiotherapy in conjunction with adjuvant chemotherapy. Molecular profiling of these lesions has led to the development of various pharmacologic and immunologic agents, although these modalities are not without great systemic toxicity. In addition, the molecular biology of adult glioma and pediatric glioma has been shown to differ substantially, making the application of current chemotherapies dubious in children and adolescents. For this reason, therapies with high tumor specificity based on pediatric tumor cell biology that spare healthy tissue are needed. Oncolytic virotherapy serves to fill this niche, as evidenced by renewed interest in this domain of cancer therapy. Initially discovered by chance in the early 20th century, virotherapy has emerged as a viable treatment option. With promising results based on preclinical studies, the authors review several oncolytic viruses, with a focus on molecular mechanism and efficacy of these viruses in tumor cell lines and murine models. In addition, current phase I clinical trials evaluating oncolytic virotherapy in the treatment of pediatric glioma are summarized.
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Affiliation(s)
- Sauson Soldozy
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia.,Deparment of Neuroscience, University of Virginia Health System, Charlottesville, Virginia
| | - Anthony Skaff
- Deparment of Neuroscience, University of Virginia Health System, Charlottesville, Virginia
| | - Kamron Soldozy
- Princeton Neuroscience Institute, Princeton University, Princeton, New Jersey
| | - Jennifer D Sokolowski
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia.,Deparment of Neuroscience, University of Virginia Health System, Charlottesville, Virginia
| | - Pedro Norat
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia.,Deparment of Neuroscience, University of Virginia Health System, Charlottesville, Virginia
| | - Kaan Yagmurlu
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia.,Deparment of Neuroscience, University of Virginia Health System, Charlottesville, Virginia
| | - Khadijeh A Sharifi
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia.,Deparment of Neuroscience, University of Virginia Health System, Charlottesville, Virginia
| | - Petr Tvrdik
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia.,Deparment of Neuroscience, University of Virginia Health System, Charlottesville, Virginia
| | - Min S Park
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - M Yashar S Kalani
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia.,Deparment of Neuroscience, University of Virginia Health System, Charlottesville, Virginia
| | - John A Jane
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Hasan R Syed
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
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14
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Kearns KN, Chen CJ, Yagmurlu K, Capek S, Buell TJ, Taylor DG, Pomeraniec IJ, Park MS, Kalani MY. Hemorrhage Risk of Untreated Isolated Cerebral Cavernous Malformations. World Neurosurg 2019; 131:e557-e561. [DOI: 10.1016/j.wneu.2019.07.222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 07/29/2019] [Accepted: 07/30/2019] [Indexed: 11/28/2022]
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15
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Yagmurlu K, Norat P, Park M, Kalani MYS. Suboccipital Craniotomy for Resection of a Dorsal Medullary Cerebral Cavernous Malformation: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2019; 17:E11. [PMID: 30649553 DOI: 10.1093/ons/opy412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 01/05/2019] [Indexed: 11/13/2022] Open
Abstract
This video illustrates the case of a patient with familial cerebral cavernous malformation syndrome with a history of multiple symptomatic hemorrhages attributable to a medullary malformation. The patient had swallowing difficulties and gait instability that was progressively worsening. Informed consent was obtained for surgical exploration. The lesion was noted to abut the floor of the fourth ventricle and was approached using a suboccipital craniotomy. Several safe-entry zones on the floor of the fourth ventricle have been described. For lesions that abut the floor, or those that are exophytic, a direct point of entry into the lesion is selected. When possible, the opening into the floor of the fourth ventricle should be placed off midline. The technique of piecemeal resection of the lesion from the brainstem and preservation of normal, hemosiderin-stained brain is presented. Careful patient selection and respect for normal anatomy are of paramount importance in obtaining excellent outcomes in operations within or adjacent to the brainstem. This medullary lesion was resected completely.
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Affiliation(s)
- Kaan Yagmurlu
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Pedro Norat
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Min Park
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - M Yashar S Kalani
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
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16
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Kearns KN, Yagmurlu K, Chen CJ, Jane J, Park MS, Kalani MYS. Deletion of 6p25.3 Is Associated with Cerebrovascular Dolichoectasia: Report of 2 Cases. Pediatr Neurosurg 2019; 54:196-200. [PMID: 30889612 DOI: 10.1159/000497148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 01/21/2019] [Indexed: 11/19/2022]
Abstract
Developmental dolichoectasia of the intracranial vessels is a rare occurrence. The authors report 2 sibling pediatric patients who were born with 6p25.3 deletion, associated with carotid and vertebrobasilar dolichoectasia. MRI imaging of both children showed asymptomatic elongation and dilation of the vertebrobasilar system and "kissing" carotid arteries. A microarray analysis was also performed for both patients, which identified a 1.5-Mb deletion of 6p25.3 covering 15 genes including FOXC1, which has been implicated in defects in vascular morphogenesis.
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Affiliation(s)
- Kathryn N Kearns
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Kaan Yagmurlu
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Ching-Jen Chen
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - John Jane
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Min S Park
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - M Yashar S Kalani
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA,
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17
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Prada F, Kalani MYS, Yagmurlu K, Norat P, Del Bene M, DiMeco F, Kassell NF. Applications of Focused Ultrasound in Cerebrovascular Diseases and Brain Tumors. Neurotherapeutics 2019; 16:67-87. [PMID: 30406382 PMCID: PMC6361053 DOI: 10.1007/s13311-018-00683-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Oncology and cerebrovascular disease constitute two of the most common diseases afflicting the central nervous system. Standard of treatment of these pathologies is based on multidisciplinary approaches encompassing combination of interventional procedures such as open and endovascular surgeries, drugs (chemotherapies, anti-coagulants, anti-platelet therapies, thrombolytics), and radiation therapies. In this context, therapeutic ultrasound could represent a novel diagnostic/therapeutic in the armamentarium of the surgeon to treat these diseases. Ultrasound relies on mechanical energy to induce numerous physical and biological effects. The application of this technology in neurology has been limited due to the challenges with penetrating the skull, thus limiting a prompt translation as has been seen in treating pathologies in other organs, such as breast and abdomen. Thanks to pivotal adjuncts such as multiconvergent transducers, magnetic resonance imaging (MRI) guidance, MRI thermometry, implantable transducers, and acoustic windows, focused ultrasound (FUS) is ready for prime-time applications in oncology and cerebrovascular neurology. In this review, we analyze the evolution of FUS from the beginning in 1950s to current state-of-the-art. We provide an overall picture of actual and future applications of FUS in oncology and cerebrovascular neurology reporting for each application the principal existing evidences.
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Affiliation(s)
- Francesco Prada
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
- Department of Neurological Surgery, University of Virginia Health Science Center, Charlottesville, Virginia, USA.
- Focused Ultrasound Foundation, Charlottesville, Virginia, USA.
| | - M Yashar S Kalani
- Department of Neurological Surgery, University of Virginia Health Science Center, Charlottesville, Virginia, USA
| | - Kaan Yagmurlu
- Department of Neurological Surgery, University of Virginia Health Science Center, Charlottesville, Virginia, USA
| | - Pedro Norat
- Department of Neurological Surgery, University of Virginia Health Science Center, Charlottesville, Virginia, USA
| | - Massimiliano Del Bene
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Department of Experimental Oncology, IRCCS European Institute of Oncology, Milan, Italy
| | - Francesco DiMeco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Department of Neurological Surgery, Johns Hopkins Medical School, Baltimore, Maryland, USA
| | - Neal F Kassell
- Focused Ultrasound Foundation, Charlottesville, Virginia, USA
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18
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Norat P, Yagmurlu K, Park MS, Kalani MYS. Keyhole, Trans-Sylvian, Trans-Sulcal Resection of an Insular Cerebral Cavernous Malformation: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2018; 17:E18. [DOI: 10.1093/ons/opy326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 11/15/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Pedro Norat
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Kaan Yagmurlu
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Min S Park
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - M Yashar S Kalani
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
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19
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Belykh EG, Zhao X, Cavallo C, Bohl MA, Yagmurlu K, Aklinski JL, Byvaltsev VA, Sanai N, Spetzler RF, Lawton MT, Nakaji P, Preul MC. Laboratory Evaluation of a Robotic Operative Microscope - Visualization Platform for Neurosurgery. Cureus 2018; 10:e3072. [PMID: 30280067 PMCID: PMC6166902 DOI: 10.7759/cureus.3072] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background We assessed a new robotic visualization platform with novel user-control features and compared its performance to the previous model of operative microscope. Methods In a neurosurgery research laboratory, we performed anatomical dissections and assessed robotic, exoscopic, endoscopic, fluorescence functionality. Usability and functionality were tested in the operating room over 1 year. Results The robotic microscope showed higher sensitivity for fluorescein sodium, higher detail in non-fluorescent background, and recorded/presented pictures with color quality similar to observation through the oculars. PpIX visualization was comparable to the previous microscope. Near-infrared indocyanine green imaging 3-step replay allowed for more convenient accurate assessment of blood flow. Point lock and pivot point functions were used in dissections to create 3D virtual reality microsurgical anatomy demonstrations. Pivot point control was particularly useful in deep surgical corridors with dynamic retraction. 3D exoscopic function was successfully used in brain tumor and spine cases. Endoscopic assistance was used for around-the-corner views in minimally invasive approaches. We present illustrative cases highlighting utility and new ways to control the operative microscope. Conclusion Improvements of the robotic visualization platform include intraoperative fluorescence visualization using FNa, integrated micro-inspection tool, improved ocular imaging clarity, and exoscopic mode. New robotic movements positively assist the surgeon and provide improved ergonomics and a greater level of intraoperative comfort, with the potential to increase the viewing quality. New operational modes also allow significant impact for anatomy instruction. With the increasing number and complexity of functions, surgeons should receive additional training in order to avail themselves of the advantages of the numerous novel features.
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Affiliation(s)
- Evgenii G Belykh
- Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, USA
| | - Xiaochun Zhao
- Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, USA
| | - Claudio Cavallo
- Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, USA
| | - Michael A Bohl
- Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, USA
| | - Kaan Yagmurlu
- Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix , USA
| | - Joseph L Aklinski
- Neurosurgery, Barrow Neurological Institute/St. Joseph's Hospital and Medical Center, Phoenix, USA
| | | | - Nader Sanai
- Neurosurgery, Barrow Neurological Institute/St. Joseph's Hospital and Medical Center, Phoenix, USA
| | - Robert F Spetzler
- Neurosurgery, Barrow Neurological Institute/St. Joseph's Hospital and Medical Center, Phoenix, USA
| | - Michael T Lawton
- Neurosurgery, Barrow Neurological Institute/St. Joseph's Hospital and Medical Center, Phoenix, USA
| | - Peter Nakaji
- Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, USA
| | - Mark C Preul
- Neurosurgery, Barrow Neurological Institute/St. Joseph's Hospital and Medical Center, Phoenix, USA
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20
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Kalani MYS, Yagmurlu K, Martirosyan NL, Nakaji P. Keyhole Contralateral Interhemispheric Endoscopic-Assisted Resection of an Ependymoma of the Third Ventricle. Oper Neurosurg (Hagerstown) 2018; 14:203. [PMID: 29351681 DOI: 10.1093/ons/opx078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Yashar S Kalani
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Kaan Yagmurlu
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Nikolay L Martirosyan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Peter Nakaji
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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21
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Belykh E, Yagmurlu K, Martirosyan NL, Lei T, Izadyyazdanabadi M, Malik KM, Byvaltsev VA, Nakaji P, Preul MC. Laser application in neurosurgery. Surg Neurol Int 2017; 8:274. [PMID: 29204309 PMCID: PMC5691557 DOI: 10.4103/sni.sni_489_16] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 08/18/2017] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Technological innovations based on light amplification created by stimulated emission of radiation (LASER) have been used extensively in the field of neurosurgery. METHODS We reviewed the medical literature to identify current laser-based technological applications for surgical, diagnostic, and therapeutic uses in neurosurgery. RESULTS Surgical applications of laser technology reported in the literature include percutaneous laser ablation of brain tissue, the use of surgical lasers in open and endoscopic cranial surgeries, laser-assisted microanastomosis, and photodynamic therapy for brain tumors. Laser systems are also used for intervertebral disk degeneration treatment, therapeutic applications of laser energy for transcranial laser therapy and nerve regeneration, and novel diagnostic laser-based technologies (e.g., laser scanning endomicroscopy and Raman spectroscopy) that are used for interrogation of pathological tissue. CONCLUSION Despite controversy over the use of lasers for treatment, the surgical application of lasers for minimally invasive procedures shows promising results and merits further investigation. Laser-based microscopy imaging devices have been developed and miniaturized to be used intraoperatively for rapid pathological diagnosis. The multitude of ways that lasers are used in neurosurgery and in related neuroclinical situations is a testament to the technological advancements and practicality of laser science.
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Affiliation(s)
- Evgenii Belykh
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
- School of Life Sciences, Arizona State University, Tempe, Arizona, USA
| | - Kaan Yagmurlu
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Nikolay L. Martirosyan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Ting Lei
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Mohammadhassan Izadyyazdanabadi
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
- School of Life Sciences, Arizona State University, Tempe, Arizona, USA
| | - Kashif M. Malik
- University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Vadim A. Byvaltsev
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
| | - Peter Nakaji
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Mark C. Preul
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Yagmurlu K, Safavi-Abbasi S, Belykh E, Kalani MYS, Nakaji P, Rhoton AL, Spetzler RF, Preul MC. Quantitative anatomical analysis and clinical experience with mini-pterional and mini-orbitozygomatic approaches for intracranial aneurysm surgery. J Neurosurg 2017; 127:646-659. [DOI: 10.3171/2016.6.jns16306] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe aim of this investigation was to modify the mini-pterional and mini-orbitozygomatic (mini-OZ) approaches in order to reduce the amount of tissue traumatization caused and to compare the use of the 2 approaches in the removal of circle of Willis aneurysms based on the authors' clinical experience and quantitative analysis.METHODSThree formalin-fixed adult cadaveric heads injected with colored silicone were examined. Surgical freedom and angle of attack of the mini-pterional and mini-OZ approaches were measured at 9 anatomical points, and the measurements were compared. The authors also retrospectively reviewed the cases of 396 patients with ruptured and unruptured single aneurysms in the circle of Willis treated by microsurgical techniques at their institution between January 2006 and November 2014.RESULTSA significant difference in surgical freedom was found in favor of the mini-pterional approach for access to the ipsilateral internal carotid artery (ICA) and middle cerebral artery (MCA) bifurcations, the most distal point of the ipsilateral posterior cerebral artery (PCA), and the basilar artery (BA) tip. No statistically significant differences were found between the mini-pterional and mini-OZ approaches for access to the posterior clinoid process, the most distal point of the superior cerebellar artery (SCA), the anterior communicating artery (ACoA), the contralateral ICA bifurcation, and the most distal point of the contralateral MCA. A trend toward increasing surgical freedom was found for the mini-OZ approach to the ACoA and the contralateral ICA bifurcation. The lengths exposed through the mini-OZ approach were longer than those exposed by the mini-pterional approach for the ipsilateral PCA segment (11.5 ± 1.9 mm) between the BA and the most distal point of the P2 segment of the PCA, for the ipsilateral SCA (10.5 ± 1.1 mm) between the BA and the most distal point of the SCA, and for the contralateral anterior cerebral artery (ACA) (21 ± 6.1 mm) between the ICA bifurcation and the most distal point of the A2 segment of the ACA. The exposed length of the contralateral MCA (24.2 ± 8.6 mm) between the contralateral ICA bifurcation and the most distal point of the MCA segment was longer through the mini-pterional approach. The vertical angle of attack (anteroposterior direction) was significantly greater with the mini-pterional approach than with the mini-OZ approach, except in the ACoA and contralateral ICA bifurcation. The horizontal angle of attack (mediolateral direction) was similar with both approaches, except in the ACoA, contralateral ICA bifurcation, and contralateral MCA bifurcation, where the angle was significantly increased in the mini-OZ approach.CONCLUSIONSThe mini-pterional and mini-OZ approaches, as currently performed in select patients, provide less tissue traumatization (i.e., less temporal muscle manipulation, less brain parenchyma retraction) from the skin to the aneurysm than standard approaches. Anatomical quantitative analysis showed that the mini-OZ approach provides better exposure to the contralateral side for controlling the contralateral parent arteries and multiple aneurysms. The mini-pterional approach has greater surgical freedom (maneuverability) for ipsilateral circle of Willis aneurysms.
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Affiliation(s)
- Kaan Yagmurlu
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Sam Safavi-Abbasi
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Evgenii Belykh
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - M. Yashar S. Kalani
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Peter Nakaji
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Albert L. Rhoton
- 2Department of Neurological Surgery, University of Florida, Gainesville, Florida
| | - Robert F. Spetzler
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Mark C. Preul
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
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23
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Bozkurt B, Yagmurlu K, Middlebrooks EH, Cayci Z, Cevik OM, Karadag A, Moen S, Tanriover N, Grande AW. Fiber Connections of the Supplementary Motor Area Revisited: Methodology of Fiber Dissection, DTI, and Three Dimensional Documentation. J Vis Exp 2017. [PMID: 28570516 DOI: 10.3791/55681] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The purpose of this study is to show the methodology for the examination of the white matter connections of the supplementary motor area (SMA) complex (pre-SMA and SMA proper) using a combination of fiber dissection techniques on cadaveric specimens and magnetic resonance (MR) tractography. The protocol will also describe the procedure for a white matter dissection of a human brain, diffusion tensor tractography imaging, and three-dimensional documentation. The fiber dissections on human brains and the 3D documentation were performed at the University of Minnesota, Microsurgery and Neuroanatomy Laboratory, Department of Neurosurgery. Five postmortem human brain specimens and two whole heads were prepared in accordance with Klingler's method. Brain hemispheres were dissected step by step from lateral to medial and medial to lateral under an operating microscope, and 3D images were captured at every stage. All dissection results were supported by diffusion tensor imaging. Investigations on the connections in line with Meynert's fiber tract classification, including association fibers (short, superior longitudinal fasciculus I and frontal aslant tracts), projection fibers (corticospinal, claustrocortical, cingulum, and frontostriatal tracts), and commissural fibers (callosal fibers) were also conducted.
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Affiliation(s)
- Baran Bozkurt
- Department of Neurosurgery, University of Minnesota;
| | - Kaan Yagmurlu
- Department of Neurosurgery, Barrow Neurological Institute, St. Josephs Hospital and Medical Center
| | | | - Zuzan Cayci
- Department of Radiology, University of Minnesota
| | | | - Ali Karadag
- Department of Neurosurgery, Tepecik Training and Research Hospital
| | - Sean Moen
- Department of Neurosurgery, University of Minnesota
| | - Necmettin Tanriover
- Department of Neurosurgery, Cerrahpasa Medical School, University of Istanbul
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Kalani Y, Yagmurlu K, Martirosyan N, Spetzler R. The Interpeduncular Fossa Approach for Resection of Centromedian Midbrain Lesions. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Yashar Kalani
- University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Kaan Yagmurlu
- Barrow Neurological Institute, Phoenix, Arizona, United States
| | | | - Robert Spetzler
- Barrow Neurological Institute, Phoenix, Arizona, United States
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25
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Yagmurlu K, Kalani Y, Martirosyan N, Spetzler R. The Superior Fovea Triangle Approach for Dorsal Pontine Lesions at the Level of the Facial Colliculus. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Kaan Yagmurlu
- Barrow Neurological Institute, Phoenix, Arizona, United States
| | - Yashar Kalani
- University of Utah School of Medicine, Salt Lake City, Utah, United States
| | | | - Robert Spetzler
- Barrow Neurological Institute, Phoenix, Arizona, United States
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Safavi-Abbasi S, Kalani MYS, Frock B, Sun H, Yagmurlu K, Moron F, Snyder LA, Hlubek RJ, Zabramski JM, Nakaji P, Spetzler RF. Techniques and outcomes of microsurgical management of ruptured and unruptured fusiform cerebral aneurysms. J Neurosurg 2017; 127:1353-1360. [PMID: 28186451 DOI: 10.3171/2016.9.jns161165] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Fusiform cerebral aneurysms represent a small portion of intracranial aneurysms; differ in natural history, anatomy, and pathology; and can be difficult to treat compared with saccular aneurysms. The purpose of this study was to examine the techniques of treatment of ruptured and unruptured fusiform intracranial aneurysms and patient outcomes. METHODS In 45 patients with fusiform aneurysms, the authors retrospectively reviewed the presentation, location, and shape of the aneurysm; the microsurgical technique; the outcome at discharge and last follow-up; and the change in the aneurysm at last angiographic follow-up. RESULTS Overall, 48 fusiform aneurysms were treated in 45 patients (18 male, 27 female) with a mean age of 49 years (median 51 years; range 6 months-76 years). Twelve patients (27%) had ruptured aneurysms and 33 (73%) had unruptured aneurysms. The mean aneurysm size was 8.9 mm (range 6-28 mm). The aneurysms were treated by clip reconstruction (n = 22 [46%]), clip-wrapping (n = 18 [38%]), and vascular bypass (n = 8 [17%]). The mean (SD) hospital stay was 19.0 ± 7.4 days for the 12 patients with subarachnoid hemorrhage and 7.0 ± 5.6 days for the 33 patients with unruptured aneurysms. The mean follow-up was 38.7 ± 29.5 months (median 36 months; range 6-96 months). The mean Glasgow Outcome Scale score for the 12 patients with subarachnoid hemorrhage was 3.9; for the 33 patients with unruptured aneurysms, it was 4.8. No rehemorrhages occurred during follow-up. The overall annual risk of recurrence was 2% and that of rehemorrhage was 0%. CONCLUSIONS Fusiform and dolichoectatic aneurysms involving the entire vessel wall must be investigated individually. Although some of these aneurysms may be amenable to primary clipping and clip reconstruction, these complex lesions often require alternative microsurgical and endovascular treatment. These techniques can be performed with acceptable morbidity and mortality rates and with low rates of early rebleeding and recurrence.
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Affiliation(s)
- Sam Safavi-Abbasi
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - M Yashar S Kalani
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Ben Frock
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Hai Sun
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Kaan Yagmurlu
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Felix Moron
- 2Department of Neurological Surgery, HIGA Vicente Lopez y Planes, Gral Rodriguez, Buenos Aires, Argentina
| | - Laura A Snyder
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Randy J Hlubek
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Joseph M Zabramski
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Peter Nakaji
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Robert F Spetzler
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
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Abstract
The authors describe a safe entry zone, the superior fovea triangle, on the floor of the fourth ventricle for resection of deep dorsal pontine lesions at the level of the facial colliculus. Clinical data from a patient undergoing a suboccipital telovelar transsuperior fovea triangle approach to a deep pontine cavernous malformation were reviewed and supplemented with 6 formalin-fixed adult human brainstem and 2 silicone-injected adult human cadaveric heads using the fiber dissection technique to illustrate the utility of this novel safe entry zone. The superior fovea has a triangular shape that is an important landmark for the motor nucleus of the trigeminal, abducens, and facial nerves. The inferior half of the superior fovea triangle may be incised to remove deep dorsal pontine lesions through the floor of the fourth ventricle. The superior fovea triangle may be used as a safe entry zone for dorsally located lesions at the level of the facial colliculus.
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Affiliation(s)
- Kaan Yagmurlu
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - M Yashar S Kalani
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Mark C Preul
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Robert F Spetzler
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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28
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Elhadi AM, Zaidi HA, Yagmurlu K, Ahmed S, Rhoton AL, Nakaji P, Preul MC, Little AS. Infraorbital nerve: a surgically relevant landmark for the pterygopalatine fossa, cavernous sinus, and anterolateral skull base in endoscopic transmaxillary approaches. J Neurosurg 2016; 125:1460-1468. [DOI: 10.3171/2015.9.jns151099] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Endoscopic transmaxillary approaches (ETMAs) address pathology of the anterolateral skull base, including the cavernous sinus, pterygopalatine fossa, and infratemporal fossa. This anatomically complex region contains branches of the trigeminal nerve and external carotid artery and is in proximity to the internal carotid artery. The authors postulated, on the basis of intraoperative observations, that the infraorbital nerve (ION) is a useful surgical landmark for navigating this region; therefore, they studied the anatomy of the ION and its relationships to critical neurovascular structures and the maxillary nerve (V2) encountered in ETMAs.
METHODS
Endoscopic anatomical dissections were performed bilaterally in 5 silicone-injected, formalin-fixed cadaveric heads (10 sides). Endonasal transmaxillary and direct transmaxillary (Caldwell-Luc) approaches were performed, and anatomical correlations were analyzed and documented. Stereotactic imaging of each specimen was performed to correlate landmarks and enable precise measurement of each segment.
RESULTS
The ION was readily identified in the roof of the maxillary sinus at the beginning of the surgical procedure in all specimens. Anatomical dissections of the ION and the maxillary branch of the trigeminal nerve (V2) to the cavernous sinus suggested that the ION/V2 complex has 4 distinct segments that may have implications in endoscopic approaches: 1) Segment I, the cutaneous segment of the ION and its terminal branches (5–11 branches) to the face, distal to the infraorbital foramen; 2) Segment II, the orbitomaxillary segment of the ION within the infraorbital canal from the infraorbital foramen along the infraorbital groove (length 12 ± 3.2 mm); 3) Segment III, the pterygopalatine segment within the pterygopalatine fossa, which starts at the infraorbital groove to the foramen rotundum (13 ± 2.5 mm); and 4) Segment IV, the cavernous segment from the foramen rotundum to the trigeminal ganglion (15 ± 4.1 mm), which passes in the lateral wall of the cavernous sinus. The relationship of the ION/V2 complex to the contents of the cavernous sinus, carotid artery, and pterygopalatine fossa is described in the text.
CONCLUSIONS
The ION/V2 complex is an easily identifiable and potentially useful surgical landmark to the foramen rotundum, cavernous sinus, carotid artery, pterygopalatine fossa, and anterolateral skull base during ETMAs.
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Affiliation(s)
- Ali M. Elhadi
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Hasan A. Zaidi
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Kaan Yagmurlu
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Shah Ahmed
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Albert L. Rhoton
- 2Department of Neurological Surgery, University of Florida, Gainesville, Florida
| | - Peter Nakaji
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Mark C. Preul
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Andrew S. Little
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
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Bozkurt B, da Silva Centeno R, Chaddad-Neto F, da Costa MDS, Goiri MAA, Karadag A, Tugcu B, Ovalioglu TC, Tanriover N, Kaya S, Yagmurlu K, Grande A. Transcortical selective amygdalohippocampectomy technique through the middle temporal gyrus revisited: An anatomical study laboratory investigation. J Clin Neurosci 2016; 34:237-245. [DOI: 10.1016/j.jocn.2016.05.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 05/16/2016] [Accepted: 05/25/2016] [Indexed: 11/26/2022]
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Martirosyan NL, Carotenuto A, Patel AA, Kalani MYS, Yagmurlu K, Lemole GM, Preul MC, Theodore N. The Role of microRNA Markers in the Diagnosis, Treatment, and Outcome Prediction of Spinal Cord Injury. Front Surg 2016; 3:56. [PMID: 27878119 PMCID: PMC5099153 DOI: 10.3389/fsurg.2016.00056] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 09/29/2016] [Indexed: 12/14/2022] Open
Abstract
Spinal cord injury (SCI) is a devastating condition that affects many people worldwide. Treatment focuses on controlling secondary injury cascade and improving regeneration. It has recently been suggested that both the secondary injury cascade and the regenerative process are heavily regulated by microRNAs (miRNAs). The measurement of specific biomarkers could improve our understanding of the disease processes, and thereby provide clinicians with the opportunity to guide treatment and predict clinical outcomes after SCI. A variety of miRNAs exhibit important roles in processes of inflammation, cell death, and regeneration. These miRNAs can be used as diagnostic tools for predicting outcome after SCI. In addition, miRNAs can be used in the treatment of SCI and its symptoms. Significant laboratory and clinical evidence exist to show that miRNAs could be used as robust diagnostic and therapeutic tools for the treatment of patients with SCI. Further clinical studies are warranted to clarify the importance of each subtype of miRNA in SCI management.
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Affiliation(s)
- Nikolay L Martirosyan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA; Division of Neurosurgery, University of Arizona, Tucson, AZ, USA
| | | | - Arpan A Patel
- College of Medicine - Phoenix, University of Arizona , Phoenix, AZ , USA
| | - M Yashar S Kalani
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center , Phoenix, AZ , USA
| | - Kaan Yagmurlu
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center , Phoenix, AZ , USA
| | - G Michael Lemole
- Division of Neurosurgery, University of Arizona , Tucson, AZ , USA
| | - Mark C Preul
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center , Phoenix, AZ , USA
| | - Nicholas Theodore
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center , Phoenix, AZ , USA
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Sun G, Yagmurlu K, Belykh E, Lei T, Preul MC. Management Strategy of a Transorbital Penetrating Pontine Injury by a Wooden Chopstick. World Neurosurg 2016; 95:622.e7-622.e15. [DOI: 10.1016/j.wneu.2016.07.104] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 07/25/2016] [Accepted: 07/27/2016] [Indexed: 12/01/2022]
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Belykh E, Martirosyan NL, Yagmurlu K, Miller EJ, Eschbacher JM, Izadyyazdanabadi M, Bardonova LA, Byvaltsev VA, Nakaji P, Preul MC. Intraoperative Fluorescence Imaging for Personalized Brain Tumor Resection: Current State and Future Directions. Front Surg 2016; 3:55. [PMID: 27800481 PMCID: PMC5066076 DOI: 10.3389/fsurg.2016.00055] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 09/12/2016] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Fluorescence-guided surgery is one of the rapidly emerging methods of surgical "theranostics." In this review, we summarize current fluorescence techniques used in neurosurgical practice for brain tumor patients as well as future applications of recent laboratory and translational studies. METHODS Review of the literature. RESULTS A wide spectrum of fluorophores that have been tested for brain surgery is reviewed. Beginning with a fluorescein sodium application in 1948 by Moore, fluorescence-guided brain tumor surgery is either routinely applied in some centers or is under active study in clinical trials. Besides the trinity of commonly used drugs (fluorescein sodium, 5-aminolevulinic acid, and indocyanine green), less studied fluorescent stains, such as tetracyclines, cancer-selective alkylphosphocholine analogs, cresyl violet, acridine orange, and acriflavine, can be used for rapid tumor detection and pathological tissue examination. Other emerging agents, such as activity-based probes and targeted molecular probes that can provide biomolecular specificity for surgical visualization and treatment, are reviewed. Furthermore, we review available engineering and optical solutions for fluorescent surgical visualization. Instruments for fluorescent-guided surgery are divided into wide-field imaging systems and hand-held probes. Recent advancements in quantitative fluorescence-guided surgery are discussed. CONCLUSION We are standing on the threshold of the era of marker-assisted tumor management. Innovations in the fields of surgical optics, computer image analysis, and molecular bioengineering are advancing fluorescence-guided tumor resection paradigms, leading to cell-level approaches to visualization and resection of brain tumors.
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Affiliation(s)
- Evgenii Belykh
- Department of Neurosurgery, St. Joseph’s Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, USA
- School of Life Sciences, Arizona State University, Tempe, AZ, USA
- Laboratory of Neurosurgery, Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russia
- Irkutsk State Medical University, Irkutsk, Russia
| | - Nikolay L. Martirosyan
- Department of Neurosurgery, St. Joseph’s Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, USA
- School of Life Sciences, Arizona State University, Tempe, AZ, USA
| | - Kaan Yagmurlu
- Department of Neurosurgery, St. Joseph’s Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Eric J. Miller
- University of Arizona College of Medicine – Phoenix, Phoenix, AZ, USA
| | - Jennifer M. Eschbacher
- Department of Neurosurgery, St. Joseph’s Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Mohammadhassan Izadyyazdanabadi
- Department of Neurosurgery, St. Joseph’s Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, USA
- School of Life Sciences, Arizona State University, Tempe, AZ, USA
| | - Liudmila A. Bardonova
- Department of Neurosurgery, St. Joseph’s Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, USA
- Laboratory of Neurosurgery, Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russia
- Irkutsk State Medical University, Irkutsk, Russia
| | - Vadim A. Byvaltsev
- Laboratory of Neurosurgery, Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russia
- Irkutsk State Medical University, Irkutsk, Russia
| | - Peter Nakaji
- Department of Neurosurgery, St. Joseph’s Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Mark C. Preul
- Department of Neurosurgery, St. Joseph’s Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, USA
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Belykh E, Lei T, Safavi-Abbasi S, Yagmurlu K, Almefty RO, Sun H, Almefty KK, Belykh O, Byvaltsev VA, Spetzler RF, Nakaji P, Preul MC. Low-flow and high-flow neurosurgical bypass and anastomosis training models using human and bovine placental vessels: a histological analysis and validation study. J Neurosurg 2016; 125:915-928. [DOI: 10.3171/2015.8.jns151346] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE
Microvascular anastomosis is a basic neurosurgical technique that should be mastered in the laboratory. Human and bovine placentas have been proposed as convenient surgical practice models; however, the histologic characteristics of these tissues have not been compared with human cerebral vessels, and the models have not been validated as simulation training models. In this study, the authors assessed the construct, face, and content validities of microvascular bypass simulation models that used human and bovine placental vessels.
METHODS
The characteristics of vessel segments from 30 human and 10 bovine placentas were assessed anatomically and histologically. Microvascular bypasses were performed on the placenta models according to a delineated training module by “trained” participants (10 practicing neurosurgeons and 7 residents with microsurgical experience) and “untrained” participants (10 medical students and 3 residents without experience). Anastomosis performance and impressions of the model were assessed using the Northwestern Objective Microanastomosis Assessment Tool (NOMAT) scale and a posttraining survey.
RESULTS
Human placental arteries were found to approximate the M2–M4 cerebral and superficial temporal arteries, and bovine placental veins were found to approximate the internal carotid and radial arteries. The mean NOMAT performance score was 37.2 ± 7.0 in the untrained group versus 62.7 ± 6.1 in the trained group (p < 0.01; construct validity). A 50% probability of allocation to either group corresponded to 50 NOMAT points. In the posttraining survey, 16 of 17 of the trained participants (94%) scored the model's replication of real bypass surgery as high, and 16 of 17 (94%) scored the difficulty as “the same” (face validity). All participants, 30 of 30 (100%), answered positively to questions regarding the ability of the model to improve microsurgical technique (content validity).
CONCLUSIONS
Human placental arteries and bovine placental veins are convenient, anatomically relevant, and beneficial models for microneurosurgical training. Microanastomosis simulation using these models has high face, content, and construct validities. A NOMAT score of more than 50 indicated successful performance of the microanastomosis tasks.
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Affiliation(s)
- Evgenii Belykh
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
- 2Laboratory of Neurosurgery, Irkutsk Scientific Center of Surgery and Traumatology; and
| | - Ting Lei
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Sam Safavi-Abbasi
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Kaan Yagmurlu
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Rami O. Almefty
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Hai Sun
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Kaith K. Almefty
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Olga Belykh
- 3Irkutsk State Medical University, Irkutsk, Russia
| | - Vadim A. Byvaltsev
- 2Laboratory of Neurosurgery, Irkutsk Scientific Center of Surgery and Traumatology; and
- 3Irkutsk State Medical University, Irkutsk, Russia
| | - Robert F. Spetzler
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Peter Nakaji
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Mark C. Preul
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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Affiliation(s)
- M Yashar S Kalani
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Kaan Yagmurlu
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Nikolay L Martirosyan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Daniel D Cavalcanti
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Robert F Spetzler
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
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Baydin S, Yagmurlu K, Tanriover N, Gungor A, Rhoton AL. Microsurgical and Fiber Tract Anatomy of the Nucleus Accumbens. Oper Neurosurg (Hagerstown) 2016; 12:269-288. [DOI: 10.1227/neu.0000000000001133] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 10/04/2015] [Indexed: 11/19/2022] Open
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Belykh E, Malik K, Simoneau I, Yagmurlu K, Lei T, Cavalcanti DD, Byvaltsev VA, Theodore N, Preul MC. Monsters and the case of L. Joseph: André Feil's thesis on the origin of the Klippel-Feil syndrome and a social transformation of medicine. Neurosurg Focus 2016; 41:E3. [DOI: 10.3171/2016.3.focus15488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
André Feil (1884–1955) was a French physician best recognized for his description, coauthored with Maurice Klippel, of patients with congenital fusion of cervical vertebrae, a condition currently known as Klippel-Feil syndrome. However, little is known about his background aside from the fact that he was a student of Klippel and a physician who took a keen interest in describing congenital anomalies. Despite the relative lack of information on Feil, his contributions to the fields of spinal disease and teratology extended far beyond science to play an integral role in changing the misguided perception shrouding patients with disfigurements, defects, deformities, and so-called monstrous births. In particular, Feil's 1919 medical school thesis on cervical abnormalities was a critical publication in defying long-held theory and opinion that human “monstrosities,” anomalies, developmental abnormalities, and altered congenital physicality were a consequence of sinful behavior or a reversion to a primitive state. Indeed, his thesis on a spinal deformity centering on his patient, L. Joseph, was at the vanguard for a new view of a patient as nothing less than fully human, no matter his or her physicality or appearance.
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Affiliation(s)
- Evgenii Belykh
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix
- 2Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russia
| | - Kashif Malik
- 3University of Arizona College of Medicine, Tucson
| | | | - Kaan Yagmurlu
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix
| | - Ting Lei
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix
| | - Daniel D. Cavalcanti
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix
| | | | - Nicholas Theodore
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix
| | - Mark C. Preul
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix
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Lei T, Belykh E, Dru AB, Yagmurlu K, Elhadi AM, Nakaji P, Preul MC. Chen Jingrun, China's famous mathematician: devastated by brain injuries on the doorstep to solving a fundamental mathematical puzzle. Neurosurg Focus 2016; 41:E11. [DOI: 10.3171/2016.2.focus1595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Chen Jingrun (1933–1996), perhaps the most prodigious mathematician of his time, focused on the field of analytical number theory. His work on Waring's problem, Legendre's conjecture, and Goldbach's conjecture led to progress in analytical number theory in the form of “Chen's Theorem,” which he published in 1966 and 1973. His early life was ravaged by the Second Sino-Japanese War and the Chinese Cultural Revolution. On the verge of solving Goldbach's conjecture in 1984, Chen was struck by a bicyclist while also bicycling and suffered severe brain trauma. During his hospitalization, he was also found to have Parkinson's disease. Chen suffered another serious brain concussion after a fall only a few months after recovering from the bicycle crash. With significant deficits, he remained hospitalized for several years without making progress while receiving modern Western medical therapies. In 1988 traditional Chinese medicine experts were called in to assist with his treatment. After a year of acupuncture and oxygen therapy, Chen could control his basic bowel and bladder functions, he could walk slowly, and his swallowing and speech improved. When Chen was unable to produce complex work or finish his final work on Goldbach's conjecture, his mathematical pursuits were taken up vigorously by his dedicated students. He was able to publish Youth Math, a mathematics book that became an inspiration in Chinese education. Although he died in 1996 at the age of 63 after surviving brutal political repression, being deprived of neurological function at the very peak of his genius, and having to be supported by his wife, Chen ironically became a symbol of dedication, perseverance, and motivation to his students and associates, to Chinese youth, to a nation, and to mathematicians and scientists worldwide.
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Affiliation(s)
- Ting Lei
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix; and
| | - Evgenii Belykh
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix; and
| | | | - Kaan Yagmurlu
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix; and
| | - Ali M. Elhadi
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix; and
| | - Peter Nakaji
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix; and
| | - Mark C. Preul
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix; and
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Reis C, Yagmurlu K, Elhadi A, Dru A, Lei T, Gusmão S, Tazinaffo U, Zabramski J, Spetzler R, Preul M. The Anterolateral Limit of the Occipital Lobe: An Anatomical and Imaging Study. Skull Base Surg 2016; 77:491-498. [DOI: 10.1055/s-0036-1584093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 03/29/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Cassius Reis
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
| | - Kaan Yagmurlu
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
| | - Ali Elhadi
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
| | - Alexander Dru
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
| | - Ting Lei
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
| | | | | | - Joseph Zabramski
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
| | - Robert Spetzler
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
| | - Mark Preul
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
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Abstract
OBJECT The aim of this study was to examine the arcuate (AF) and superior longitudinal fasciculi (SLF), which together form the dorsal language stream, using fiber dissection and diffusion imaging techniques in the human brain. METHODS Twenty-five formalin-fixed brains (50 hemispheres) and 3 adult cadaveric heads, prepared according to the Klingler method, were examined by the fiber dissection technique. The authors' findings were supported with MR tractography provided by the Human Connectome Project, WU-Minn Consortium. The frequencies of gyral distributions were calculated in segments of the AF and SLF in the cadaveric specimens. RESULTS The AF has ventral and dorsal segments, and the SLF has 3 segments: SLF I (dorsal pathway), II (middle pathway), and III (ventral pathway). The AF ventral segment connects the middle (88%; all percentages represent the area of the named structure that is connected to the tract) and posterior (100%) parts of the superior temporal gyri and the middle part (92%) of the middle temporal gyrus to the posterior part of the inferior frontal gyrus (96% in pars opercularis, 40% in pars triangularis) and the ventral premotor cortex (84%) by passing deep to the lower part of the supramarginal gyrus (100%). The AF dorsal segment connects the posterior part of the middle (100%) and inferior temporal gyri (76%) to the posterior part of the inferior frontal gyrus (96% in pars opercularis), ventral premotor cortex (72%), and posterior part of the middle frontal gyrus (56%) by passing deep to the lower part of the angular gyrus (100%). CONCLUSIONS This study depicts the distinct subdivision of the AF and SLF, based on cadaveric fiber dissection and diffusion imaging techniques, to clarify the complicated language processing pathways.
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Affiliation(s)
| | | | - Necmettin Tanriover
- Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Turkey
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Belykh EG, Lei T, Oliveira MM, Almefty RO, Yagmurlu K, Elhadi AM, Sun G, Bichard WD, Spetzler RF, Preul MC, Nakaji P. Carotid Endarterectomy Surgical Simulation Model Using a Bovine Placenta Vessel. Neurosurgery 2015; 77:825-9; discussion 829-30. [DOI: 10.1227/neu.0000000000000924] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Abstract
BACKGROUND:
Carotid endarterectomy (CEA) is a common, well-developed surgical procedure. Although surgical simulation is gaining in importance for residency training, CEA practice opportunities for surgical residents are limited.
OBJECTIVE:
To describe a new haptic CEA model.
METHODS:
Six bovine placentas were used to create the model. Each placenta provided about 6 large arterial and venous bifurcations. In total, 36 large-vessel bifurcations were dissected and prepared for the CEA simulation. Bovine placenta vessels were arranged to simulate the common carotid artery (CCA), internal carotid artery (ICA), and external carotid artery (ECA). The diameters and wall thicknesses were measured and compared with human CCA, ICA, and ECA parameters.
RESULTS:
All bovine placentas provided vessels suitable for modeling carotid artery bifurcations and CEA training. Mean ± SD diameters of simulated CCAs, ECAs, and ICAs were 11.2 ± 1.8, 4.3 ± 0.5, and 9.8 ± 3.0 mm, respectively, from nondilated veins and 8.7 ± 1.4, 4.4 ± 1.3, and 7.2 ± 1.7 mm, respectively, from nondilated arteries. Mean vessel wall thicknesses were 2.0 ± 0.6 mm for arteries and 1.4 ± 0.5 mm for veins. Placental vessel tissue had dimensions and handling characteristics similar to those of human carotid arteries. The CEA procedure and its subtasks, including vessel-tissue preparation and surgical skills performance, could be reproduced with high fidelity.
CONCLUSION:
A bovine placenta training model for CEA is inexpensive and readily available and closely resembles human carotid arteries. The model can provide a convenient and valuable simulation and practice addition for vascular surgery training.
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Affiliation(s)
- Evgenii G. Belykh
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
- Scientific Center of Reconstructive and Restorative Surgery, Laboratory of Neurosurgery, Scientific Center of Reconstructive and Restorative Surgery, Siberian Branch of the Russian Academy of Medical Sciences, Irkutsk, Russia
| | - Ting Lei
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Magaldi M. Oliveira
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
- Department of Surgery, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Rami O. Almefty
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Kaan Yagmurlu
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Ali M. Elhadi
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Guozhu Sun
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - William D. Bichard
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Robert F. Spetzler
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Mark C. Preul
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Peter Nakaji
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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Abstract
BACKGROUND The fiber tracts of the cerebrum may be a more important determinant of resection limits than the cortex. Better knowledge of the 3-dimensional (3-D) anatomic organization of the fiber pathways is important in planning safe and accurate surgery for lesions within the cerebrum. OBJECTIVE To examine the topographic anatomy of fiber tracts and subcortical gray matter of the human cerebrum and their relationships with consistent cortical, ventricular, and nuclear landmarks. METHODS Twenty-five formalin-fixed human brains and 4 whole cadaveric heads were examined by fiber dissection technique and ×6 to ×40 magnification. The fiber tracts and central core structures, including the insula and basal ganglia, were examined and their relationships captured in 3-D photography. The depth between the surface of the cortical gyri and selected fiber tracts was measured. RESULTS The topographic relationships of the important association, projection, and commissural fasciculi within the cerebrum and superficial cortical landmarks were identified. Important landmarks with consistent relationships to the fiber tracts were the cortical gyri and sulci, limiting sulci of the insula, nuclear masses in the central core, and lateral ventricles. The fiber tracts were also organized in a consistent pattern in relation to each other. The anatomic findings are briefly compared with functional data from clinicoradiological analysis and intraoperative stimulation of fiber tracts. CONCLUSION An understanding of the 3-D anatomic organization of the fiber tracts of the brain is essential in planning safe and accurate cerebral surgery.
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Affiliation(s)
- Kaan Yagmurlu
- Department of Neurosurgery, University of Florida, College of Medicine, Gainesville, Florida
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Komune N, Yagmurlu K, Matsuo S, Miki K, Abe H, Rhoton AL. Auditory brainstem implantation: anatomy and approaches. Neurosurgery 2015; 11 Suppl 2:306-20; discussion 320-1. [PMID: 25793729 DOI: 10.1227/neu.0000000000000736] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Auditory brainstem implantation at the cochlear nuclei used mainly for neurofibromatosis type 2 patients with bilateral loss of the cochlear nerves has more recently been extended to the inferior colliculus. OBJECTIVE To examine the microsurgical and endoscopic anatomy of the cochlear nuclei and inferior colliculus as seen through the translabyrinthine and retrosigmoid approaches used for cochlear nuclei and inferior collicular implantation. METHODS Ten cerebellopontine angles of formalin-fixed adult cadaveric heads were examined with the aid of the surgical microscope and endoscope. The ascending auditory pathways between the cochlear nuclei and inferior colliculi and above were examined by the fiber dissection technique. RESULTS Both the translabyrinthine and retrosigmoid routes provide sufficient exposure for concurrent tumor removal and implantation at either the cochlear nuclei or inferior colliculus. The position of the inferior colliculus in the auditory pathways and its accessibility in the infratentorial supracerebellar exposure directed through either the translabyrinthine or retrosigmoid approach makes it an alternative site for electrode placement if the cochlear nuclei are not functionally or structurally suitable for implantation. Endoscopic assistance may aid the exposure and electrode placement at either site. CONCLUSION The translabyrinthine or retrosigmoid approaches provide access to the cochlear nuclei for implantation and also to the inferior colliculus through the translabyrinthine or retrosigmoid infratentorial supracerebellar route. The endoscope may aid in exposing either site.
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Affiliation(s)
- Noritaka Komune
- *Department of Neurosurgery, University of Florida, College of Medicine, Gainesville, Florida; ‡Department of Neurosurgery, Fukuoka University, Fukuoka, Japan
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Abstract
OBJECT Fissure dissection is routinely used in the supratentorial region to access deeply situated pathology while minimizing division of neural tissue. Use of fissure dissection is also practical in the posterior fossa. In this study, the microsurgical anatomy of the 3 cerebellar-brainstem fissures (cerebellomesencephalic, cerebellopontine, and cerebellomedullary) and the various procedures exposing these fissures in brainstem surgery were examined. METHODS Seven cadaveric heads were examined with a microsurgical technique and 3 with fiber dissection to clarify the anatomy of the cerebellar-brainstem and adjacent cerebellar fissures, in which the major vessels and neural structures are located. Several approaches directed along the cerebellar surfaces and fissures, including the supracerebellar infratentorial, occipital transtentorial, retrosigmoid, and midline suboccipital approaches, were examined. The 3 heads examined using fiber dissection defined the anatomy of the cerebellar peduncles coursing in the depths of these fissures. RESULTS Dissections directed along the cerebellar-brainstem and cerebellar fissures provided access to the posterior and posterolateral midbrain and upper pons, lateral pons, floor and lateral wall of the fourth ventricle, and dorsal and lateral medulla. CONCLUSIONS Opening the cerebellar-brainstem and adjacent cerebellar fissures provided access to the brainstem surface hidden by the cerebellum, while minimizing division of neural tissue. Most of the major cerebellar arteries, veins, and vital neural structures are located in or near these fissures and can be accessed through them.
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Affiliation(s)
- Ken Matsushima
- Department of Neurological Surgery, University of Florida, Gainesville, Florida; and.,Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan
| | - Kaan Yagmurlu
- Department of Neurological Surgery, University of Florida, Gainesville, Florida; and
| | - Michihiro Kohno
- Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan
| | - Albert L Rhoton
- Department of Neurological Surgery, University of Florida, Gainesville, Florida; and
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Yagmurlu K, Rhoton AL, Tanriover N, Bennett JA. Three-dimensional microsurgical anatomy and the safe entry zones of the brainstem. Neurosurgery 2015; 10 Suppl 4:602-19; discussion 619-20. [PMID: 24983443 DOI: 10.1227/neu.0000000000000466] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There have been no studies of the structure and safe surgical entry zones of the brainstem based on fiber dissection studies combined with 3-dimensional (3-D) photography. OBJECTIVE To examine the 3-D internal architecture and relationships of the proposed safe entry zones into the midbrain, pons, and medulla. METHODS Fifteen formalin and alcohol-fixed human brainstems were dissected by using fiber dissection techniques, ×6 to ×40 magnification, and 3-D photography to define the anatomy and the safe entry zones. The entry zones evaluated were the perioculomotor, lateral mesencephalic sulcus, and supra- and infracollicular areas in the midbrain; the peritrigeminal zone, supra- and infrafacial approaches, acoustic area, and median sulcus above the facial colliculus in the pons; and the anterolateral, postolivary, and dorsal medullary sulci in the medulla. RESULTS The safest approach for lesions located below the surface is usually the shortest and most direct route. Previous studies have often focused on surface structures. In this study, the deeper structures that may be at risk in each of the proposed safe entry zones plus the borders of each entry zone were defined. This study includes an examination of the relationships of the cerebellar peduncles, long tracts, intra-axial segments of the cranial nerves, and important nuclei of the brainstem to the proposed safe entry zones. CONCLUSION Fiber dissection technique in combination with the 3-D photography is a useful addition to the goal of making entry into the brainstem more accurate and safe.
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Affiliation(s)
- Kaan Yagmurlu
- *Department of Neurosurgery, University of Florida, College of Medicine, Gainesville, Florida; ‡Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey; §Department of Radiology, University of Florida, College of Medicine, Gainesville, Florida
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Abstract
OBJECT
The purpose of this study was to describe the location of each white matter pathway in the area between the inferior limiting insular sulcus (ILS) and temporal horn that may be crossed in approaches through the temporal stem to the medial temporal lobe.
METHODS
The fiber tracts in 14 adult cadaveric cerebral hemispheres were examined using the Klingler technique. The fiber dissections were completed in a stepwise manner, identifying each white matter pathway in different planes and describing its position in relation to the anterior end of the ILS.
RESULTS
The short-association fibers from the extreme capsule, which continue toward the operculae, are the most superficial subcortical layer deep to the ILS. The external capsule fibers are found deeper at an intermediate layer and are formed by the uncinate fasciculus, inferior frontooccipital fasciculus, and claustrocortical fibers in a sequential anteroposterior disposition. The anterior commissure forms the next deeper layer, and the optic radiations in the sublenticular part of the internal capsule represent the deepest layer. The uncinate fasciculus is found deep to the anterior third of the ILS, whereas the inferior frontooccipital fasciculus and optic radiations are found superficial and deep, respectively, at the posterior two-thirds of this length.
CONCLUSIONS
The authors' findings suggest that in the transsylvian approach, a 6-mm incision beginning just posterior to the limen insula through the ILS will cross the uncinate fasciculus but not the inferior frontooccipital fasciculus or optic radiations, but that longer incisions carry a risk to language and visual functions.
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Affiliation(s)
- Eduardo Carvalhal Ribas
- 1Department of Neurosurgery, University of Florida, Gainesville, Florida; and
- 2Division of Neurosurgery, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Kaan Yagmurlu
- 1Department of Neurosurgery, University of Florida, Gainesville, Florida; and
| | - Hung Tzu Wen
- 2Division of Neurosurgery, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Albert L. Rhoton
- 1Department of Neurosurgery, University of Florida, Gainesville, Florida; and
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Kucukyuruk B, Yagmurlu K, Tanriover N, Uzan M, Rhoton AL. Microsurgical Anatomy of the White Matter Tracts in Hemispherotomy. Oper Neurosurg (Hagerstown) 2014; 10 Suppl 2:305-24; discussion 324. [DOI: 10.1227/neu.0000000000000288] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Abstract
BACKGROUND:
Hemispherotomy is a surgical procedure performed for refractory epileptic seizures due to wide hemispheric damage.
OBJECTIVE:
To describe the microanatomy of the white matter tracts transected in a hemispherotomy and the relationship of the surgical landmarks used during the intraventricular callosotomy.
METHODS:
The cortical and subcortical structures were examined in 32 hemispheres.
RESULTS:
Incision of the temporal stem along the inferior limiting sulcus crosses the insulo-opercular fibers, uncinate, inferior occipitofrontal and middle longitudinal fasciculi, anterior commissure, and optic and auditory radiations. The incision along the superior limiting sulcus transects insulo-opercular fibers and the genu and posterior limb of internal capsule. The incision along the anterior limiting sulcus crosses the insulo-opercular fibers, anterior limb of the internal capsule, anterior commissure, and the anterior thalamic bundle. The disconnection of the posterior part of the corpus callosum may be incomplete if the point at which the last cortical branch of the anterior cerebral artery (ACA) turns upward and disappears from the view through the intraventricular exposure is used as the landmark for estimating the posterior extent of the callosotomy. This ACA branch turns upward before reaching the posterior edge of the splenium in 85% of hemispheres. The falx, followed to the posterior edge of the splenium, is a more reliable landmark for completing the posterior part of an intraventricular callosotomy.
CONCLUSION:
The fiber tracts disconnected in hemispherotomy were reviewed. The falx is a more reliable guide than the ACA in completing the posterior part of the intraventricular callosotomy.
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Affiliation(s)
- Baris Kucukyuruk
- Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Kaan Yagmurlu
- Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Necmettin Tanriover
- Department of Neurosurgery, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Mustafa Uzan
- Department of Neurosurgery, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Albert L. Rhoton
- Department of Neurosurgery, University of Florida, Gainesville, Florida
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Dagıstan Y, Karaca I, Bozkurt ER, Ozar E, Yagmurlu K, Toklu A, Bilir A. Combination hyperbaric oxygen and temozolomide therapy in C6 rat glioma model. Acta Cir Bras 2013; 27:383-7. [PMID: 22666755 DOI: 10.1590/s0102-86502012000600005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 04/12/2012] [Indexed: 01/17/2023] Open
Abstract
PURPOSE Temozolomide (TMZ) has anti-tumor activity in patients with malignant glioma. Hyperbaric oxygen (HBO) may enhance the efficacy of certain therapies that are limited because of the hypoxic tumor microenvironment. We examined the combined effects of TMZ-HBO in a rat glioma model. METHODS After stereotactic injection of C6/LacZ rat glioma cells into the Wistar rats brain, the rats were randomly assigned to three treatment groups [group 1, control treatment; group 2, TMZ alone; group 3, a combination of TMZ and HBO]. Rats were sacrificed 18 days after treatment, and number of intra-/peri-tumoral vessels, microendothelial proliferations, immunohistochemistry and necrotic area were evaluated. RESULTS Tumoral tissue was stained only sparsely with GFAP. Temozolomide treatment was significantly decreased in tumor tissue intratumoral vessel number / total tumor area level. The level of Ki67 was significantly decreased in the tumor tissue of the group 3. Additionally, the total necrotic area / total tumor volume (%) was decreased significantly in tumor tissue of the group 3 rats compared to group 1 and 2. CONCLUSION The combination of hyperbaric oxygen with temozolomide produced an important reduction in glioma growth and effective approach to the treatment of glioblastoma.
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Affiliation(s)
- Yaşar Dagıstan
- Department of Neurosurgery, Izzet Baysal Hospital, Bolu, Turkey.
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