Microneurosurgical Removal of a Globus Pallidus Tumor With Cottonoid-Guided Intraoperative Ultrasonography : 2-Dimensional Operative Video
Copyright © 2019 by the Congress of Neurological Surgeons..
Neuronavigation systems are standard for guiding neurosurgery. Intraoperative-ultrasonography (ioUSG), a real-time neuronavigation modality used for 40-yr in neurosurgery, is easily available, low cost, and does not require excessive preparation. It provides accurate real-time data, even after brain shift. However, even with ioUSG, defining the surgical trajectory is not easy, especially for deep-seated lesions. We used a cottonoid-patty as a marker for ioUSG to define the location of the lesion and best trajectory for safe removal, especially of deep-seated lesions. After obtaining the patient's consent, we report the case of a 10-yr-old male who presented with a 2-mo history of right hemiparesis, gait disturbance, and right central facial paresis from a left-sided globus pallidus tumor. We chose a contralateral approach because of the cortical venous anatomy, nondominant right hemisphere, and right-handed surgeon. After a right parasagittal frontal craniotomy and interhemispheric exploration, a cottonoid-patty was placed as a marker for ioUSG to determine the callosotomy location. To confirm the route, ioUSG was repeated with a second cottonoid-patty placed inside the incision at the lateral side of the thalamostriate and anterior caudate vein junction. After confirming the trajectory, the tumor was removed with microneurosurgical techniques. Total removal was confirmed with ioUSG and intraoperative-magnetic resonance imaging. Early postoperative examination revealed improved muscle strength on the right hemiparetic side. Histopathological studies revealed a mixed germ-cell tumor. ioUSG is an efficient and accurate neuronavigation modality. Using a cottonoid-patty as a marker for ioUSG is valid and reliable in determining the surgical route, especially for deep-seated midline tumors.
| Errataetall: |
CommentIn: Oper Neurosurg (Hagerstown). 2020 Aug 1;19(2):E155-E156. - PMID 31996922 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:19 |
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| Enthalten in: |
Operative neurosurgery (Hagerstown, Md.) - 19(2020), 2 vom: 01. Aug., Seite E154 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Keleş, Abdullah [VerfasserIn] |
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| Links: |
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| Themen: |
Case Reports |
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| Anmerkungen: |
Date Completed 21.06.2021 Date Revised 21.06.2021 published: Print CommentIn: Oper Neurosurg (Hagerstown). 2020 Aug 1;19(2):E155-E156. - PMID 31996922 Citation Status MEDLINE |
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| doi: |
10.1093/ons/opz348 |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM303709170 |
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| 520 | |a Copyright © 2019 by the Congress of Neurological Surgeons. | ||
| 520 | |a Neuronavigation systems are standard for guiding neurosurgery. Intraoperative-ultrasonography (ioUSG), a real-time neuronavigation modality used for 40-yr in neurosurgery, is easily available, low cost, and does not require excessive preparation. It provides accurate real-time data, even after brain shift. However, even with ioUSG, defining the surgical trajectory is not easy, especially for deep-seated lesions. We used a cottonoid-patty as a marker for ioUSG to define the location of the lesion and best trajectory for safe removal, especially of deep-seated lesions. After obtaining the patient's consent, we report the case of a 10-yr-old male who presented with a 2-mo history of right hemiparesis, gait disturbance, and right central facial paresis from a left-sided globus pallidus tumor. We chose a contralateral approach because of the cortical venous anatomy, nondominant right hemisphere, and right-handed surgeon. After a right parasagittal frontal craniotomy and interhemispheric exploration, a cottonoid-patty was placed as a marker for ioUSG to determine the callosotomy location. To confirm the route, ioUSG was repeated with a second cottonoid-patty placed inside the incision at the lateral side of the thalamostriate and anterior caudate vein junction. After confirming the trajectory, the tumor was removed with microneurosurgical techniques. Total removal was confirmed with ioUSG and intraoperative-magnetic resonance imaging. Early postoperative examination revealed improved muscle strength on the right hemiparetic side. Histopathological studies revealed a mixed germ-cell tumor. ioUSG is an efficient and accurate neuronavigation modality. Using a cottonoid-patty as a marker for ioUSG is valid and reliable in determining the surgical route, especially for deep-seated midline tumors | ||
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