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Neurosurgical Techniques and Strategies
Published in David A. Walker, Giorgio Perilongo, Roger E. Taylor, Ian F. Pollack, Brain and Spinal Tumors of Childhood, 2020
Jonathan E. Martin, Ian F. Pollack, Robert F. Keating
Endoscopic biopsy is commonly employed in the management of pineal tumors. The endoscopic approach allows for both tissue diagnosis and, with synchronous endoscopic third ventriculostomy, direct treatment of associated hydrocephalus. The surgeon may employ either a flexible endoscope through a standard frontal approach33 or a rigid endoscope via a trajectory slightly anterior to Kocher’s point. Tumor hemorrhage is usually easily controlled, and the approach carries a primary risk of transient memory disturbance due to forniceal traction.
External ventricular drainage
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Anesthesia for Neurotrauma, 2018
The patient is adequately sedated and placed in a supine position, with the head of the bed elevated to 45°. The incision area is prepared by clipping the head, painting with chlorhexidine, and draping appropriately. The scalp is infiltrated with 1% lidocaine around the planned incision site. A linear incision is taken at the Kocher’s point with a scalpel and carried down to the skull. The periosteum is scraped and a burr hole made with a drill placed perpendicular to the skull, to penetrate the outer and inner tables of the skull. The dura is pierced with a scalpel and the ventricular catheter introduced with the stylet, up to 5 cm below the dura or 6 to 7 cm below the skull surface, to place the catheter just above the ipsilateral foramen of Monroe. The catheter trajectory is directed toward the contralateral medial canthus in the coronal plane21,22 and just anterior to the ipsilateral tragus in the sagittal plane. Once a spontaneous CSF flow is obtained after removal of the catheter stylet, the opening ICP may be obtained by transducing the pressure to an external gauge. The catheter is secured externally by tunnelling through the scalp 5 to 7 cm posteriorly and laterally to prevent infection. It is then connected to an external drainage system and an ICP measuring transducer.
Deep brain stimulation and other surgical modalities for the management of essential tremor
Published in Expert Review of Medical Devices, 2020
Kai-Liang Wang, Qianwei Ren, Shannon Chiu, Bhavana Patel, Fan-Gang Meng, Wei Hu, Aparna Wagle Shukla
Currently, for RF thalamotomy, a standard frontal burr hole near Kocher’s point is created under the stereotactic guidance. Followng this, an RF electrode is brought to create a lesion with electrocoagulation in the target identified with the guidance of Schaltenbrand-Wahren atlas and MRI imaging [21]. Impedance measurements guide the neurosurgeon as to whether the exposed tip of the electrode resides in the gray or the white matter. Microelectrode recording (MER) that encompasses a physiological mapping with the high-impedance electrode and macrostimulation if employed allows further Vim mapping and refined placement of the probe [14,22]. The temperature and time that are set for the RF procedure depend on the target, for eg, during lesioning of Vim the maximum temperature and time applied is 70°C and . Then the current is ramped up gradually to avoid bubble formation in the tissues and the peak size of the lesion is observed 24–72 hours after the procedure. In a sequential MRI study involving volumetric quantification of stereotactic lesions, although three concentric parts, representing the inner and middle zone (necrosis) and outer zone (edema) were identified [23] in the beginning, the residual lesion on T2 imaging was much reduced at 6 and 12 months after the procedure [23]. Thus, as the lesion size following thalamotomy decreases, there is a possibility of early relapse which causes concern. Another limitation is the incidence of asymptomatic hemorrhage that is reported to be as high as 29% [24,25] despite precautions and an ischemic infarction surrounded by perilesional edema shown in histological sections [24,26].
Endoscopic versus open microsurgery for colloid cysts of the third ventricle
Published in British Journal of Neurosurgery, 2023
Dan Farahmand, Johannes Stridh, Doerthe Ziegelitz, Magnus Tisell
In the MS group, the approach was performed through a transcallosal route in 29 patients and through a transcortical route in 5 patients. ES was performed by placement of a burr hole approximately 3 cm lateral to Kocher’s point on the right side. After opening the meninges a rigid endoscope was inserted transcortically to the frontal horn of the right ventricle where the colloid cyst was incised with scissors. Cyst content was aspirated through a thin catheter inserted through the endoscope. The remaining cyst capsule was then dissected from its attachment at the roof of the third ventricle and while grabbed with endoscopic forceps, the cyst was taken out with the endoscope.
Telemetric intracranial pressure monitoring: our experience with 22 patients investigated for intracranial hypertension
Published in British Journal of Neurosurgery, 2021
Stefanos I. Korfias, Stamatios Banos, Athanasia Alexoudi, Kostas Themistoklis, Efstathios Vlachakis, Panayiotis Patrikelis, Stergios Gatzonis, Damianos E. Sakas
The implantation of P-tel is performed either under general or local anesthesia. The ICP insertion point is the Kocher point: 12 cm from the mid pupillary line and 2.5 cm from the head midline or 2 cm in front of the coronary suture. After a 4 cm skin incision over the Kocher point, the telemetric device is implanted through a burr hole and opening of the dura, into the right frontal lobe parenchyma (Figure 4). The left frontal lobe (dominant side) could also be used if necessary. The wound is closed with skin sutures instead of surgical staples to avoid interferences during telemetric data transmission. P-tel removal after 3–6 months requires local anesthesia.