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Innovative Neurosurgery

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2193-5238
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Part II: an evaluation of an integrated systems approach using diffusion-weighted, image-guided, exoscopic-assisted, transulcal radial corridors

Amin B. Kassam
  • Corresponding author
  • Aurora Neuroscience Innovation Institute, Aurora St. Luke’s Medical Center, Milwaukee, WI, USA
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  • Other articles by this author:
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/ Mohamed A. Labib
  • Aurora Neuroscience Innovation Institute, Aurora St. Luke’s Medical Center, Milwaukee, WI, USA
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  • De Gruyter OnlineGoogle Scholar
/ Mohammed Bafaquh / Diana Ghinda / Melanie B. Fukui
  • Aurora Neuroscience Innovation Institute, Aurora St. Luke’s Medical Center, Milwaukee, WI, USA
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  • De Gruyter OnlineGoogle Scholar
/ Thanh Nguyen / Martin Corsten
  • Aurora Neuroscience Innovation Institute, Aurora St. Luke’s Medical Center, Milwaukee, WI, USA
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2015-03-24 | DOI: https://doi.org/10.1515/ins-2014-0012

Abstract

Background: Subcortical injury resulting from the surgical access and management of lesions in the sensorimotor area is associated with a high degree of cognitive and functional morbidity.

Methods: We used a systems approach integrating the six core competencies of the 6 Pillar approach: 1) image interpretation and trajectory planning; 2) dynamic navigation; 3) radial transulcal access and cannulation; 4) exoscopic high-definition optics; 5) resection with automated nonthermal mechanical instrumentation; and 6) regenerative medicine. We describe the application of the 6 Pillar approach to 13 consecutive patients with lesions in the sensorimotor area.

Results: Eight females and five males with lesions in the sensorimotor area were treated using the 6 Pillar approach. There were eight tumors, one abscess, and four primary intracranial hemorrhages. Fifteen procedures were performed. Postoperatively, seven patients improved neurologically (three tumors, one abscess, and three ICHs), five remained unchanged, and one patient died. There was no worsening of pre-existing deficits.

Conclusion: The integration of the 6 Pillar approach provides a safe and effective parafascicular minimally invasive corridor to subcortical lesions involving the sensorimotor area. Future studies will be needed to determine long-term efficacy, durability, and degree of resection within each category.

Keywords: 6 Pillar approach; glioma; intracranial hemorrhage; sensorimotor; tissue preservation; transulcal radial access

References

  • [1]

    Ausprunk DH, Folkman J. Migration and proliferation of endothelial cells in preformed and newly formed blood vessels during tumor angiogenesis. Microvasc Res. 1977;14:53–65.CrossrefPubMedGoogle Scholar

  • [2]

    Beaulieu C. The basis of anisotropic water diffusion in the nervous system-a technical review. NMR Biomed. 2002;15:435–55.CrossrefPubMedGoogle Scholar

  • [3]

    Goldman M, Boxerman JL, Rogg JM, Noren G. Utility of apparent diffusion coefficient in predicting the outcome of Gamma Knife-treated brain metastases prior to changes in tumor volume: a preliminary study. J Neurosurg. 2006;105:175–82.Google Scholar

  • [4]

    Kassam A, Snyderman CH, Mintz A, Gardner P, Carrau RL. Expanded endonasal approach: the rostrocaudal axis. Part II. Posterior clinoids to the foramen magnum. Neurosurg Focus. 2005;19:E4.PubMedGoogle Scholar

  • [5]

    Kassam AB, Prevedello DM, Carrau RL, Snyderman CH, Thomas A, Gardner P, et al. Endoscopic endonasal skull base surgery: analysis of complications in the authors’ initial 800 patients. J Neurosurg. 2011;114:1544–68.Google Scholar

  • [6]

    Kawamata T, Iseki H, Okada Y, Hori T. Clinical application of an ultrasonically activated scalpel in neurosurgery. Neurol Res. 2001;23:64–6.Google Scholar

  • [7]

    Kelly PJ, Kall BA, Goerss S, Earnest F 4th. Computer-assisted stereotaxic laser resection of intra-axial brain neoplasms. J Neurosurg. 1986;64:427–39.CrossrefPubMedGoogle Scholar

  • [8]

    Ogura K, Tachibana E, Aoshima C, Sumitomo M. New microsurgical technique for intraparenchymal lesions of the brain: transcylinder approach. Acta Neurochirurgica. 2006;148:779–85; discussion 85.Google Scholar

  • [9]

    Recinos PF, Raza SM, Jallo GI, Recinos VR. Use of a minimally invasive tubular retraction system for deep-seated tumors in pediatric patients. J Neurosurg Pediatr. 2011;7:516–21.Web of ScienceCrossrefPubMedGoogle Scholar

  • [10]

    Trinh VT, Fahim DK, Shah K, Tummala S, McCutcheon IE, Sawaya R, et al. Subcortical injury is an independent predictor of worsening neurological deficits following awake craniotomy procedures. Neurosurgery. 2013;72:160–9.Web of ScienceGoogle Scholar

  • [11]

    Yasargil MG. Microneurosurgery. Surgical concerns. 3B. New York:Thieme; 1988. p. 25–53.Google Scholar

About the article

Corresponding author: Dr. Amin B. Kassam, Aurora Neuroscience Innovation Institute, Neurosurgery – Aurora St. Luke’s Medical Center, Suite 630, 2801 West Kinnickinnic River Pkwy, Milwaukee, WI 53215, USA, Tel.: +414-385-1814, Fax: +414-385-1899, E-mail:


Received: 2014-10-29

Accepted: 2015-02-02

Published Online: 2015-03-24

Published in Print: 2015-06-01


Citation Information: Innovative Neurosurgery, Volume 3, Issue 1-2, Pages 25–33, ISSN (Online) 2193-5238, ISSN (Print) 2193-522X, DOI: https://doi.org/10.1515/ins-2014-0012.

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