Table Of Content

Fundamentals of Operative Techniques in Neurosurgery Second Edition Fundamentals of Operative Techniques in Neurosurgery Second Edition E. Sander Connolly, Jr., MD Tanvir F. Choudhri, MD Bennett M. Stein Professor and Co-Director, Neurosurgical Spine Vice-Chairman for Clinical Affairs Program Department of Neurological Surgery Assistant Professor of Director, Cerebrovascular Research Neurosurgery Laboratory Mount Sinai Medical Center Surgical Director, Neuro-Intensive New York, New York Care Unit Columbia University Medical Center Ricardo J. Komotar, MD New York, New York Chief Resident, Neurological Surgery The Neurological Institute of Guy M. McKhann, II, MD New York Florence Irving Associate Professor Columbia University Medical Center of Neurological Surgery New York, New York Department of Neurological Surgery Columbia University Medical Center J Mocco, MD, MS New York, New York Assistant Professor of Neurosurgery and Radiology Judy Huang, MD Co-Director of Neurological Intensive Associate Professor of Neurosurgery Care Unit Johns Hopkins University School of Director of Neurosurgery Stroke Medicine Research Laboratory Associate Residency Program Director University of Florida Gainesville Division of Cerebrovascular Gainesville, Florida Neurosurgery The Johns Hopkins Hospital Vice Chair and Chief of Cerebrovascular Neurosurgery Johns Hopkins Bayview Medical Center Baltimore, Maryland Thieme New York • Stuttgart Thieme Medical Publishers, Inc. 333 Seventh Ave. New York, NY 10001 Executive Editor: Kay Conerly Managing Editor: Dominik Pucek Editorial Director, Clinical Reference: Michael Wachinger International Production Director: Andreas Schabert Production Editor: Heidi Grauel, Maryland Composition Medical Illustrator: Anthony M. Pazos Vice President, International Marketing and Sales: Cornelia Schulze Chief Financial O(cid:806) cer: James W. Mitos President: Brian D. Scanlan Compositor: Maryland Composition Printer: Transcontinental Printing Library of Congress Cataloging-in-Publication Data Fundamentals of operative techniques in neurosurgery / edited by E. Sander Connolly Jr. ... [et al.]. -- 2nd ed. p. ; cm. Includes bibliographical references and index. ISBN 978-1-58890-500-0 1. Nervous system--Surgery. 2. Surgery, Operative. I. Connolly, E. Sander. [DNLM: 1. Neurosurgical Procedures. WL 368 F981 2010] RD593.F865 2010 617.4’8--dc22 2009053348 Copyright © 2010 by Thieme Medical Publishers, Inc. This book, including all parts thereof, is legally protected by copyright. Any use, exploitation, or commercialization outside the narrow limits set by copyright legislation without the publisher’s consent is illegal and liable to prosecution. This applies in particular to photostat reproduction, copying, mimeo- graphing or duplication of any kind, translating, preparation of microfi lms, and electronic data processing and storage. Important note: Medical knowledge is ever-changing. As new research and clinical experi- ence broaden our knowledge, changes in treatment and drug therapy may be required. The authors and editors of the material herein have consulted sources believed to be reliable in their e(cid:805) orts to provide information that is complete and in accord with the standards accepted at the time of publication. However, in view of the possibility of human error by the authors, editors, or publisher of the work herein or changes in medical knowledge, neither the authors, editors, nor publisher, nor any other party who has been involved in the preparation of this work, warrants that the information contained herein is in every respect accurate or complete, and they are not responsible for any errors or omissions or for the results obtained from use of such information. Readers are encouraged to confi rm the information contained herein with other sources. For example, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this publication is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs. Some of the product names, patents, and registered designs referred to in this book are in fact registered trademarks or proprietary names even though specifi c reference to this fact is not always made in the text. Therefore, the appearance of a name without designation as proprietary is not to be construed as a representation by the publisher that it is in the public domain. Printed in Canada 978-1-58890-500-0 Contents Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xix Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xxi Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xxiii I CRANIAL Approaches 1 General Operating Room Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Anthony Louis D’Ambrosio 2 General Craniotomy Techniques. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Khan Li 3 Endoscopic Fundamentals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 George Jallo 4 Frontal Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Judy Huang 5 Pterional Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Judy Huang 6 Orbitozygomatic Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 James Frazier and Judy Huang 7 Dolenc Approach. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Charles J. Prestigiacomo 8 Superior Parietal Lobule Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Je(cid:806) rey N. Bruce 9 Convexity and Parasagittal Approaches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Je(cid:806) rey N. Bruce 10 Transcallosal Approach. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Michael B. Sisti 11 Subtemporal Approach. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Christopher E. Mandigo and Je(cid:806) rey N. Bruce 12 Temporal Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Robert R. Goodman 13 Presigmoid Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 David Gordon and Chandranath Sen 14 Retrosigmoid Approach (Vestibular Schwannomas). . . . . . . . . . . . . . . . . . 58 Michael B. Sisti 15 Far Lateral Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 David Gordon and Chandranath Sen 16 Supracerebellar-Infratentorial Approach. . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Je(cid:806) rey N. Bruce v vi Contents 17 Occipital and Transtentorial Approaches. . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Omar N. Syed, Ricardo J. Komotar, and Je(cid:806) rey N. Bruce 18 Transsphenoidal Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Edward R. Laws Jr., Paul T. Boulos, and John Jane Jr. 19 Reoperative Craniotomy Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Kevin Walter 20 Trauma Flap/Hemicraniectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Gregory G. Heuer, Michael F. Stiefel, and Peter D. LeRoux Vascular Lesions 21 Anterior Communicating Artery Aneurysms . . . . . . . . . . . . . . . . . . . . . . . . 96 Andrew L. Ko and Gavin W. Britz 22 Posterior Communicating Artery Aneurysms . . . . . . . . . . . . . . . . . . . . . . 101 Christopher C. Getch and H. Hunt Batjer 23 Ophthalmic Artery Aneurysms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Brian L. Hoh and Christopher S. Ogilvy 24 Middle Cerebral Artery Aneurysms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Ian F. Dunn, Kevin Ju, and Robert M. Friedlander 25 Surgical Treatment of Vertebral Artery Aneurysms . . . . . . . . . . . . . . . . . 121 Ricardo J. Komotar, Maxwell B. Merkow, and Marc L. Otten 26 Basilar Artery Aneurysms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 Nader Sanai and Michael T. Lawton 27 Distal Berry and Nonberry Aneurysms . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 Howard A. Riina and Ilya Laufer 28 Surgical Treatment of Cortical Arteriovenous Malformations. . . . . . . . 138 Ricardo J. Komotar, Robert M. Starke, and Marc L. Otten 29 Subcortical Arteriovenous Malformations . . . . . . . . . . . . . . . . . . . . . . . . . 144 Jacques J. Morcos and Taro Kaibara 30 Surgical Treatment of Dural Arteriovenous Fistulas (Lateral Sinus). . . 149 Charles J. Prestigiacomo 31 Supratentorial Cavernous Malformations . . . . . . . . . . . . . . . . . . . . . . . . . . 153 Jennifer Moliterno and Murat Gunel 32 Infratentorial Cavernous Malformations . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 Michael L. DiLuna and Murat Gunel 33 Carotid Endarterectomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 Eli M. Baron, Darric E. Baty, and Christopher M. Loftus 34 Superfi cial Temporal Artery—Middle Cerebral Artery Bypass . . . . . . . . 167 John A. Cowan Jr. and B. Gregory Thompson 35 Reversed Saphenous Vein Bypass. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 Marc L. Otten, Matthew C. Garrett, and Ricardo J. Komotar 36 Intracerebral Hematoma Evacuation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177 J Mocco and E. Sander Connolly, Jr. Contents vii 37 Minimally Invasive Surgery for Intracerebral Hemorrhage. . . . . . . . . . . 180 Chiraz Chaalala and Mario Zuccarello Neoplastic Lesions 38 Convexity and Parasagittal Meningiomas . . . . . . . . . . . . . . . . . . . . . . . . . . 183 Michael Lim 39 Foramen Magnum Meningiomas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186 Michael Lim and James Frazier 40 Sphenoid Wing Meningiomas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189 James E. Conway and Alfredo Quinones-Hinojosa 41 Tuberculum Sellae and Olfactory Groove Meningiomas . . . . . . . . . . . . . 195 James E. Conway and Alfredo Quinones-Hinojosa 42 Tentorial Meningiomas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201 Je(cid:806) rey N. Bruce and Michael Lim 43 Frontal Gliomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205 Hasan Zaidi and Alfredo Quinones-Hinojosa 44 Temporal Gliomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209 Daniel L. Silbergeld and Arthur A. Ward Jr. 45 Occipital Gliomas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212 Omar N. Syed and Ricardo J. Komotar 46 Brain Stem Gliomas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215 William J. Mack 47 Hypothalamic Region Gliomas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218 Andrew F. Ducruet 48 Optic Nerve Gliomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221 Andrew F. Ducruet 49 Acoustic Neuromas (Vestibular Schwannomas). . . . . . . . . . . . . . . . . . . . . 225 Andrew T. Parsa and Michael E. Sughrue 50 Craniopharyngiomas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230 George Jallo 51 Pineal Region Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234 Andrew T. Parsa and Isaac Yang 52 Colloid Cysts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238 Edward S. Ahn 53 Esthesioneuroblastomas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243 James E. Conway and Gary L. Gallia 54 Metastatic Tumor Resection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 248 Ganesh Rao, Khan Li, and Raymond Sawaya 55 Superfi cial Frameless Stereotactic Biopsy . . . . . . . . . . . . . . . . . . . . . . . . . . 253 Michael Lim 56 Deep Stereotactic Biopsy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255 Michael Lim and Gustavo Pradilla viii Contents Functional Procedures 57 Temporal Lobectomy and Selective Amygdalohippocampectomy . . . . 258 Devin K. Binder and Johannes Schramm 58 Subdural Grid Placement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265 Robert R. Goodman 59 Stereotactic Placement of Temporal Depth Electrodes. . . . . . . . . . . . . . . 271 Dimitris G. Placantonakis and Theodore H. Schwartz 60 Awake Craniotomies and Functional Mapping. . . . . . . . . . . . . . . . . . . . . . 275 Daniel L. Silbergeld 61 Extratemporal Nonlesional Epilepsy Surgery. . . . . . . . . . . . . . . . . . . . . . . 279 Sean J. Nagel and William E. Bingaman 62 Transsylvian Functional Hemispherectomy . . . . . . . . . . . . . . . . . . . . . . . . 283 Devin K. Binder and Johannes Schramm 63 Anatomic Hemispherectomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289 Jorge Gonzalez-Martinez 64 Corpus Callosotomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297 Robert R. Goodman 65 Deep Brain Stimulation of the Subthalamic Nucleus for Parkinson Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301 Ali R. Rezai, Hooman Azmi, and Andre Machado Trauma 66 Epidural Hematoma Evacuation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305 Chetan Bettegowda 67 Subdural Hematoma Evacuation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 308 Chetan Bettegowda 68 Repair of Cerebrospinal Fluid Leaks (Cranial). . . . . . . . . . . . . . . . . . . . . . . 313 Khan Li 69 Repair of Skull Fractures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317 Khan Li 70 Gunshot Wounds to the Head. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 322 Clinton J. Baird 71 Missile Injuries to the Brain. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325 James Waldron, Guy Rosenthal, and Geo(cid:806) rey T. Manley 72 Cranial Stab Wounds. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329 Guy Rosenthal, Shirley I. Stiver, and Geo(cid:806) rey T. Manley Infection 73 Infected Bone Flap and Subdural or Epidural Abscess (Empyema). . . . 333 Chetan Bettegowda 74 Intracranial Abscess. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 335 Clinton J. Baird Contents ix 75 Neurocysticercosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 338 Violette Renard Recinos 76 Toxoplasmosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341 Violette Renard Recinos CSF Diversion 77 Stereotactic Endoscopic Third Ventriculostomy . . . . . . . . . . . . . . . . . . . . 343 George Jallo 78 Ventriculoperitoneal Shunt—Primary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 348 Violette Renard Recinos 79 Ventriculoperitoneal Shunt—Revision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353 Violette Renard Recinos 80 Ventriculoatrial Shunt. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 357 Pablo F. Recinos and Violette Renard Recinos 81 Ventriculopleural Shunt. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 362 Violette Renard Recinos 82 Shunt Externalization. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 367 Violette Renard Recinos 83 External Ventricular Drain (Ventriculostomy). . . . . . . . . . . . . . . . . . . . . . 371 Daniel Sciubba 84 Ventricular Access Device . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 376 Daniel Sciubba Miscellaneous 85 Scalp Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 380 Daniel Sciubba 86 Skull Defects: Cranioplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383 Daniel Sciubba II SPINAL Approaches, Decompression, and Fusion 87 Transoral Approach/Decompression. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 389 K. Michael Webb and Volker K. H. Sonntag 88 Retropharyngeal Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393 Haroon F. Choudhri 89 Odontoid Screw Placement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 396 Haroon F. Choudhri 90 Suboccipital Approach to Foramen Magnum . . . . . . . . . . . . . . . . . . . . . . . 399 Steve J. McAnany, Harshpal Singh, and Tanvir F. Choudhri 91 Occipitocervical Stabillization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403 K. Michael Webb and Volker K. H. Sonntag 92 Atlantoaxial Stabilization. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 406 Mark G. Burnett and Volker K. H. Sonntag