Today: Neurosurgical Approaches to the Cranial Compartments

Neurosurgical Approaches to the Cranial Compartments

This course is aimed at ST3-ST8 level trainees and subspecialty (skull base and cerebrovascular) fellows. Teaching of the approaches are tailored to the specific needs and experience of the individual trainee. This workshop is co-organised by the east and west of Scotland training programs. The program includes complex surgical procedures which cannot be performed by trainees without prior cadaveric exposure.

It covers the whole armamentarium of intracranial approaches and provides fundamental insight to very complex procedures. The focus is on enabling trainees to safely approach superficial and deep seated vascular and benign intracranial lesions arising from or being in proximity to the cranial vault or skull base. Trainees will gain a heightened appreciation of the critical structures encountered through these approaches.

Suitability

ST3-ST8 and subspecialty (skull base and cerebrovascular) fellows. Teaching of the approaches will be tailored to the specific needs and experience of the individual trainee.

Relevant Grades: ST3, ST4, ST5, ST6, ST7, ST8, SpR, SAS

Course Format

Introductory Lectures followed by hands on Cadaveric workshops. Commonly performed techniques such as pterional, bifrontal, middle fossa and retrosigmoid craniotomies will be covered as well as more complex approaches to the third ventricle, pineal region, antero-lateral brainstem and C1/C2 complex. State of the art Pentero Zeiss microscopes, Integra Mayfield clamps, Codman microinstruments, and Anspach high speed drills will be readily available in all stations (two participants per station – one faculty member per station)

Course Objectives

Familiarize trainees with the surgical anatomy pertinent to common as well as complex neurosurgical procedures, which will be comprehensively taught. Identify anatomical avenues for the safe exposure of both superficial and deeper intracranial structures. Expose trainees to microsurgical principles (appropriate application of the operating microscope, high speed drill, and microdissection).

Learning Outcomes

Upon completion of the course, participants should be able to:

  • Enable trainees to safely approach superficial and deep seated vascular and benign intracranial lesions arising from or being in proximity to the cranial vault or skull base.
  • Trainees will have a heightened appreciation of the critical structures encountered through these approaches.

Medical Management of Neurosurgical Patients

Medical Management of Neurosurgical Patients

by Rene Daniel and Catriona M Harrop

List Price: $74.95

Buy

Emerging as a new sub-specialization within the hospitalist community, the neurosurgery hospitalist provides preoperative risk stratification, advises on managing pre- and postoperative complications, and helps doctors make decisions about when to involve specialists other than neurosurgeons. This collaborative approach to the neurosurgery patient has been shown to offer effective care since hospitalists can be better attuned than specialists to multiple medical problems that most patients have.

Medical Management of Neurosurgical Patients is a first of its kind textbook providing a standardized source of information for neurosurgery hospitalists in order to establish a common ground and improve their knowledge and training. The work will focus on the management of CNS infections, management of bleeding in the context of CNS surgery (a potentially catastrophic complication), management of sodium and blood glucose levels including steroid-induced hyperglycemia, perioperative pain control, and management of pressure injuries and rehabilitation in the context of CNS injury.

Webinar- Utilizing the exoscope in neurosurgical oncology

Utilizing the exoscope in neurosurgical oncology

Explained by Dr. Nader Sanai

see Video here

The following time-stamps will guide you to certain key points & examples during this webinar:

At 1:30: “Moving from a pure optical platform to a digital platform is something that we are going to see increasingly in our operating rooms”

At 3:10: “As a tumor surgeon, we have multiple information chains, we have the structural MRI, functional MRI, tractography, MR spectroscopy, MAG imaging, fluorescence-guided surgery, intraoperative navigation and all of these things have to be integrated in our brains and extrapolated through our actions with the tumor. I think what this platform (ZEISS KINEVO 900) is enabling us to do, is give us the ability to integrate a lot of this in real-time so that we do not have to do this ourselves and we do not have to be swiveling our heads to look at this scan or that scan as we are operating.”

At 6:01: “Now, the PointLock concept is really one where you want to specifically focus on a particular target in three-dimensional space. But you want to be able to pivot around it without having to find it again. We all do that in the OR and while it may take only few seconds, those are precious seconds where you lose your chain of thoughts. [..] Achieving this at a functional level… and by that I mean the ability where the robot does it for you and you do not have to adjust at all in terms of fine tuning the focus or fine tuning the special referencing [..] I have used it in the OR, really without any training on it and it is something very intuitive.”

At 7:17: “Many of us use MRI spectroscopy (for example) to identify hotspots where we will perform biopsy. For example, in a low grade tumor we want to decrease the chance of missing a focus of transformation. By bookmarking those sites on the microscope, we can make sure that we can go directly to that spot without worrying about aligning the navigation and all of the other anatomical information around it.”

At 9:06: “In brain tumor operations there are many dimensions of the tumor that we need to work along and we often operate – move the microscope – operate. This platform enables you to continuously operate as you are moving. And, if you are using it as an exoscope function (particularly), you, yourself don’t have to move at all. Effectively, the microscope moves and you stay still. [..] it is an important distinction when you are doing a multi-hour operation and you are able to stay in a position of comfort and stability [..] instead of moving around your torso to accommodate the dimension.”

At 11:03: “The next generation of microscope will be something that is not so much part of you but is working in parallel with you. [..] For example, in a far-lateral type approach for lower cranial schwannoma, there are issues in positioning and the angle of view. But here we can operate in a relatively neutral position using 3D 4K visualization.“

At 13:13: Case explanation for Retrosigmoid Crainiotomy for Petrous Face Meningioma using the combination of exoscopic visualization and robotics.

At 13:54: “This is at the point where one can transition to the exoscope. Because the angles of approach that you want as you are trying to pull this tumor away from the brain tumor margins, really can be quite extreme. You can see in the inset where the angle of the microscope head is relative to my head. If I had to stretch to get to that angle I’m going to be relatively uncomfortable and less stable ergonomically with my hands and torso.”

At 15:12: “I would also add that the learning curve for this is not very steep. It is a relatively simple device to adopt into your workflow because many of us have already gotten used to using the foot pedal for basic robotic movements of the microscope head. What this does is: add these additional dimensions of moving in an angle and pivoting around a point. So, it is really like a real-time surveillance image happening as you operate.

At 16.31: “The digital integration of real-time functional imaging, real-time tractography, real-time stimulation mapping data into the cortex will basically make it seamless.”

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