A transparent sheath for endoscopic surgery and its application in surgical evacuation of spontaneous intracerebral hematomas

2000 ◽  
Vol 92 (6) ◽  
pp. 1053-1055 ◽  
Author(s):  
Tetsuhiro Nishihara ◽  
Akira Teraoka ◽  
Akio Morita ◽  
Keisuke Ueki ◽  
Keisuke Takai ◽  
...  
Keyword(s):  
Endoscopic Surgery ◽  
Brain Parenchyma ◽  
Bleeding Point ◽  
Content Type ◽  
Minimal Invasiveness ◽  
Surgical Evacuation ◽  
Endoscopic Evacuation ◽  
Surgical Field ◽  
The Brain ◽  
Fine Print

✓ The authors advocate the use of a transparent sheath for guiding an endoscope, a simple and unique tool for endoscopic surgery, and describe preliminary results of its application in the evacuation of hypertensive intracerebral hematomas. This sheath is a 10-cm-long tube made of clear acrylic plastic, which greatly improves visualization of the surgical field through a 2.7-mm nonangled endoscope inserted within. Between April 1997 and December 1998, the authors performed endoscopic evacuation of intracerebral hematomas by using this sheath inserted into the patients' heads through a burr hole. In nine consecutive cases in which the hematoma was larger than 40 ml in volume, nearly complete evacuation (86–100%) of the lesion was achieved without complication. Excellent visualization of the border between the brain parenchyma and the hematoma facilitated accurate intraoperative orientation, and also allowed easy identification of the bleeding point. Thus, this combination of sheath and endoscope achieves both minimal invasiveness and the maximum extent of hematoma removal with secure hemostasis. This tool will reduce the inherent disadvantage of endoscopic procedures and may expand their application in other areas of neurosurgical management.

Reevaluation of an experimental streptococcal canine brain abscess model

1987 ◽  
Vol 67 (5) ◽  
pp. 717-720 ◽  
Author(s):  
Henry Kurzydlowski ◽  
Cynthia Wollenschlager ◽  
Frank R. Venezio ◽  
Mona Ghobrial ◽  
Morris Marc Soriano ◽  
...  
Keyword(s):  
Brain Abscess ◽  
Antimicrobial Therapy ◽  
Brain Parenchyma ◽  
Antimicrobial Treatment ◽  
Histopathological Study ◽  
Bacterial Inoculation ◽  
Content Type ◽  
Treatment Regimens ◽  
The Brain ◽  
Fine Print

✓ An experimental cerebral abscess model in which alpha-hemolytic Streptococci were inoculated into the brain parenchyma of dogs was evaluated for assessment of antimicrobial therapy. Intracerebral ring-enhancing lesions were visualized by computerized tomography, but they resolved after time without therapeutic intervention. Histopathological study demonstrated evolution of the lesions into sterile granulomas. Quantitative cultures were performed and uniformly became sterile in the early cerebritis stage, approximately 3 days after bacterial inoculation. Therefore, this brain abscess model should not be utilized for the evaluation of new antimicrobial treatment regimens. Rather, other models which document persistent viable organisms within cerebral abscesses need to be developed.

Tuberculoma presenting as an en plaque meningioma

1996 ◽  
Vol 85 (4) ◽  
pp. 685-688 ◽  
Author(s):  
Jerry Bauer ◽  
Roger F. Johnson ◽  
Joseph M. Levy ◽  
Donald V. Pojman ◽  
John R. Ruge
Keyword(s):  
Magnetic Resonance ◽  
Computerized Tomography ◽  
Brain Parenchyma ◽  
Magnetic Resonance Images ◽  
Content Type ◽  
Multiple Lesions ◽  
Intracranial Tuberculoma ◽  
The Brain ◽  
Fine Print

✓ Intracranial tuberculomas generally present as either solitary or multiple lesions in the brain parenchyma. They are characterized by a ring-enhancing area on either computerized tomography scans or magnetic resonance images. A case is presented in which an intracranial tuberculoma was dural based and had an appearance similar to an en plaque meningioma.

Intracerebral infusion of thrombin as a cause of brain edema

1995 ◽  
Vol 83 (6) ◽  
pp. 1045-1050 ◽  
Author(s):  
Kevin R. Lee ◽  
A. Lorris Betz ◽  
Richard F. Keep ◽  
Thomas L. Chenevert ◽  
Seoung Kim ◽  
...  
Keyword(s):  
Brain Edema ◽  
Brain Parenchyma ◽  
Thrombin Inhibitor ◽  
Neurosurgical Procedures ◽  
Edema Formation ◽  
Content Type ◽  
The Right ◽  
The Brain ◽  
Brain Water ◽  
Fine Print

✓ Purified thrombin from an exogenous source is a hemostatic agent commonly used in neurosurgical procedures. The toxicity of thrombin in the brain, however, has not been examined. This study was performed to assess the effect of thrombin on brain parenchyma, using the formation of brain edema as an indicator of injury. Ten µl of test solution was infused stereotactically into the right basal ganglia of rats. The animals were sacrificed 24 hours later, and the extent of brain edema and ion content were measured. Concentrations of human thrombin as low as 1 U/µl resulted in a significant increase in brain water content. Rats receiving 10 U/µl had a mortality rate of 33% compared to no mortality in the groups receiving smaller doses. Thrombin-induced brain edema was inhibited by a specific and potent thrombin inhibitor, hirudin. A medical grade of bovine thrombin commonly used in surgery also caused brain edema when injected at a concentration of 2 U/µl. Edema formation was prevented by another highly specific thrombin inhibitor, Nα-(2-Naphthalenesulfonylglycyl)-4-dl-phenylalaninepiperidide (α-NAPAP). Thrombininduced brain edema was accompanied by increases in brain sodium and chloride contents and a decrease in brain potassium content. Changes in brain ions were inhibited by both hirudin and α-NAPAP, corresponding to the inhibition of brain water accumulation. This study shows that thrombin causes brain edema when infused into the brain at concentrations as low as 1 U/µl, an amount within the range of concentrations used for topical hemostasis in neurosurgery.

A new expandable cannula system for endoscopic evacuation of intraparenchymal hemorrhages

2009 ◽  
Vol 111 (6) ◽  
pp. 1127-1130 ◽  
Author(s):  
Vicknes Waran ◽  
Narayanan Vairavan ◽  
Sheau Fung Sia ◽  
Basri Abdullah
Keyword(s):  
Intracranial Pressure ◽  
Endoscopic Surgery ◽  
Ct Scanning ◽  
Brain Parenchyma ◽  
Intracranial Pressure Monitoring ◽  
Pressure Monitoring ◽  
Endoscopic Evacuation ◽  
Microsurgical Techniques ◽  
The Brain

The authors describe a newly developed expandable cannula to enable a more efficient use of an endoscope in removing intraparenchymal spontaneous hypertensive intracerebral hematomas. The cannula is introduced like a conventional brain cannula, using neuronavigation techniques to reach the targeted hematoma accurately, and, once deployed, conventional microsurgical techniques are used under direct endoscopic visualization. This method was used in 6 patients, and, based on the results of intraoperative intracranial pressure monitoring and postoperative CT scanning, the authors were able to achieve good hematoma removal. They found that by using the expandable cannula, efficient endoscopic surgery in the brain parenchyma was possible.

Low incidence of delayed intracerebral hemorrhage secondary to ventriculoperitoneal shunt insertion

1999 ◽  
Vol 91 (1) ◽  
pp. 32-34 ◽  
Author(s):  
Martin H. Savitz ◽  
Lewis M. Bobroff
Keyword(s):  
Intracerebral Hemorrhage ◽  
Brain Parenchyma ◽  
Adult Patients ◽  
Vascular Lesions ◽  
Intracerebral Hematoma ◽  
Shunt Insertion ◽  
Content Type ◽  
Vp Shunt ◽  
The Brain ◽  
Fine Print

Object. Bleeding into the brain parenchyma or ventricles is an infrequently reported complication in adults who undergo insertion of a ventriculoperitoneal (VP) shunt. The purpose of this study was to establish the incidence of delayed intracerebral hemorrhage secondary to ventricular cannulation during shunting procedures.Methods. Over a 24-year period, in a series of 125 adult patients with hydrocephalus, postoperative computerized tomography scans were obtained in every case within 48 hours of shunt surgery performed by the same neurosurgeon. The rate of delayed intracerebral hematoma or intraventricular hemorrhage after VP shunt placement was documented by routine neuroradiological follow up to be 4%.Conclusions. In adult patients with no coagulopathy or occult vascular lesions, the rate of bleeding after VP shunt insertion may be low if the procedure is uncomplicated by multiple attempts at perforation, puncture of the choroid plexus, or improper placement of the tubing within the parenchyma of the brain.

Extradural anterior clinoidectomy

2005 ◽  
Vol 102 (5) ◽  
pp. 945-950 ◽  
Author(s):  
Akio Noguchi ◽  
Vijayabalan Balasingam ◽  
Yoshiaki Shiokawa ◽  
Sean O. McMenomey ◽  
Johnny B. Delashaw
Keyword(s):  
Skull Base ◽  
Basilar Artery ◽  
Anatomical Variations ◽  
Anterior Clinoid Process ◽  
Content Type ◽  
Anterior Clinoidectomy ◽  
Small Structure ◽  
Surgical Field ◽  
The Brain ◽  
Fine Print

✓ The anterior clinoid process (ACP), located on the skull base, is a relatively small structure, although its removal provides enormous gain in facilitating the management of lesions—either tumors or aneurysms—in the paraclinoid region and upper basilar artery. The extensive surgical field gained contributes to safer exposure of the neurovascular elements in the vicinity while avoiding excessive and hazardous retraction of the brain. In this report the authors present a technically simpler avenue for performing an extradural anterior clinoidectomy after reviewing the anatomy of the ACP and its anatomical variations. Additionally, the original Dolenc procedure and its subsequent derivatives are compared and contrasted to the authors' simpler and less laborious technique. Different clinical situations in which to use the procedure are described based on the authors' experience from 60 cases (40 aneurysm cases and 20 tumor cases) during a 4-year period.

Microvascular pathological features of immediate perinidal parenchyma in cerebral arteriovenous malformations: giant bed capillaries

2003 ◽  
Vol 98 (4) ◽  
pp. 823-827 ◽  
Author(s):  
Walid Attia ◽  
Tsuyoshi Tada ◽  
Kazuhiro Hongo ◽  
Hisashi Nagashima ◽  
Toshiki Takemae ◽  
...  
Keyword(s):  
Brain Tissue ◽  
Arteriovenous Malformations ◽  
Brain Parenchyma ◽  
Pathological Features ◽  
Hemodynamic Changes ◽  
Content Type ◽  
Pericapillary Space ◽  
Hematoxylin And Eosin ◽  
The Brain ◽  
Fine Print

Object. The behavior of brain tissue in cases of arteriovenous malformations (AVMs) is a matter of debate. The authors believe that the local microvascular environment in the AVM bed shares the hemodynamic changes influencing that behavior in one way or another. The purpose of this study was to investigate the microvascular pathological features in the immediate perinidal brain tissue. Methods. This retrospective study was conducted using excised AVM specimens obtained in 35 patients, from which the authors selected 20 specimens that fulfilled the criteria for sufficient brain tissue around the excised nidus. Specimens were stained with hematoxylin and eosin, and the immediate perinidal microvascular environment was examined using light microscopy. Conclusions. Eighty-five percent of the AVMs studied showed the presence of huge, dilated capillaries, and 65% showed severe congestion of these capillaries. The authors have named these capillaries “giant bed capillaries.” In this study capillary bleeding was shown in AVMs, and a pericapillary space was seen around some vessels. The brain parenchyma containing AVMs with these findings proved to be significantly ischemic.

Radiosurgery for patients with recurrent small cell lung carcinoma metastatic to the brain: outcomes and prognostic factors

2005 ◽  
Vol 102 (Special_Supplement) ◽  
pp. 247-254 ◽  
Author(s):  
Jason Sheehan ◽  
Douglas Kondziolka ◽  
John Flickinger ◽  
L. Dade Lunsford
Keyword(s):  
Lung Cancer ◽  
Brain Metastases ◽  
Lung Carcinoma ◽  
Small Cell Lung Carcinoma ◽  
Small Cell ◽  
Small Cell Lung ◽  
Cell Lung Carcinoma ◽  
Content Type ◽  
The Brain ◽  
Fine Print

Object. Lung carcinoma is the leading cause of death from cancer. More than 50% of those with small cell lung cancer develop a brain metastasis. Corticosteroid agents, radiotherapy, and resection have been the mainstays of treatment. Nonetheless, median survival for patients with small cell lung carcinoma metastasis is approximately 4 to 5 months after cranial irradiation. In this study the authors examine the efficacy of gamma knife surgery for treating recurrent small cell lung carcinoma metastases to the brain following tumor growth in patients who have previously undergone radiation therapy, and they evaluate factors affecting survival. Methods. A retrospective review of 27 patients (47 recurrent small cell lung cancer brain metastases) undergoing radiosurgery was performed. Clinical and radiographic data obtained during a 14-year treatment period were collected. Multivariate analysis was utilized to determine significant prognostic factors influencing survival. The overall median survival was 18 months after the diagnosis of brain metastases. In multivariate analysis, factors significantly affecting survival included: 1) tumor volume (p = 0.0042); 2) preoperative Karnofsky Performance Scale score (p = 0.0035); and 3) time between initial lung cancer diagnosis and development of brain metastasis (p = 0.0127). Postradiosurgical imaging of the brain metastases revealed that 62% decreased, 19% remained stable, and 19% eventually increased in size. One patient later underwent a craniotomy and tumor resection for a tumor refractory to radiosurgery and radiation therapy. In three patients new brain metastases were demonstrating on follow-up imaging. Conclusions. Stereotactic radiosurgery for recurrent small cell lung carcinoma metastases provided effective local tumor control in the majority of patients. Early detection of brain metastases, aggressive treatment of systemic disease, and a therapeutic strategy including radiosurgery can extend survival.

Relief of facial pain after combined removal of precentral and postcentral cortex

1971 ◽  
Vol 34 (4) ◽  
pp. 537-543 ◽  
Author(s):  
Richard A. Lende ◽  
Wolff M. Kirsch ◽  
Ralph Druckman
Keyword(s):  
Facial Pain ◽  
The Other ◽  
Precentral Gyrus ◽  
Nerve Section ◽  
Content Type ◽  
Burning Pain ◽  
Cortical Localization ◽  
The Brain ◽  
Fine Print ◽  
Frontal Lobotomy

✓ Cortical removals which included precentral and postcentral facial representations resulted in relief of facial pain in two patients. Because of known failures following only postcentral (SmI) ablations, these operations were designed to eliminate also the cutaneous afferent projection to the precentral gyrus (MsI) and the second somatic sensory area (SmII). In one case burning pain developed after a stroke involving the brain stem and was not improved by total fifth nerve section; prompt relief followed corticectomy and lasted until death from heart disease 20 months later. In the other case persistent steady pain that developed after fifth rhizotomy for trigeminal neuralgia proved refractory to frontal lobotomy; relief after corticectomy was immediate and has lasted 14 months. Cortical localization was established by stimulation under local anesthesia. Each removal extended up to the border of the arm representation and down to the upper border of the insula. Such a resection necessarily included SmII, and in one case responses presumably from SmII were obtained before removal. The suggestions of Biemond (1956) and Poggio and Mountcastle (1960) that SmII might be concerned with pain sensibility may be pertinent in these cases.

Thymidine kinase-mediated killing of rat brain tumors

1993 ◽  
Vol 79 (5) ◽  
pp. 729-735 ◽  
Author(s):  
David Barba ◽  
Joseph Hardin ◽  
Jasodhara Ray ◽  
Fred H. Gage
Keyword(s):  
Gene Therapy ◽  
Brain Tumors ◽  
Tumor Cells ◽  
Wild Type ◽  
Cns Disorders ◽  
Content Type ◽  
Potential Applications ◽  
Ganciclovir Treatment ◽  
The Brain ◽  
Fine Print

✓ Gene therapy has many potential applications in central nervous system (CNS) disorders, including the selective killing of tumor cells in the brain. A rat brain tumor model was used to test the herpes simplex virus (HSV)-thymidine kinase (TK) gene for its ability to selectively kill C6 and 9L tumor cells in the brain following systemic administration of the nucleoside analog ganciclovir. The HSV-TK gene was introduced in vitro into tumor cells (C6-TK and 9L-TK), then these modified tumor cells were evaluated for their sensitivity to cell killing by ganciclovir. In a dose-response assay, both C6-TK and 9L-TK cells were 100 times more sensitive to killing by ganciclovir (median lethal dose: C6-TK, 0.1 µg ganciclovir/ml; C6, 5.0 µg ganciclovir/ml) than unmodified wild-type tumor cells or cultured fibroblasts. In vivo studies confirmed the ability of intraperitoneal ganciclovir administration to kill established brain tumors in rats as quantified by both stereological assessment of brain tumor volumes and studies of animal survival over 90 days. Rats with brain tumors established by intracerebral injection of wild-type or HSV-TK modified tumor cells or by a combination of wild-type and HSV-TK-modified cells were studied with and without ganciclovir treatments. Stereological methods determined that ganciclovir treatment eliminated tumors composed of HSV-TK-modified cells while control tumors grew as expected (p < 0.001). In survival studies, all 10 rats with 9L-TK tumors treated with ganciclovir survived 90 days while all untreated rats died within 25 days. Curiously, tumors composed of combinations of 9L and 9L-TK cells could be eliminated by ganciclovir treatments even when only one-half of the tumor cells carried the HSV-TK gene. While not completely understood, this additional tumor cell killing appears to be both tumor selective and local in nature. It is concluded that HSV-TK gene therapy with ganciclovir treatment does selectively kill tumor cells in the brain and has many potential applications in CNS disorders, including the treatment of cancer.

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