Aneurysmal Subarachnoid Hemorrhage

Critical Care Management of Aneurysmal Subarachnoid Hemorrhage I.         Introduction: A ruptured aneurysm is a neurosurgical emergency. But, most often you will not rush these patients to the operating room. Instead, you can save their lives by: (1) treating hydrocephalus (2) preventing re-rupture (3) avoiding hyponatremia (4) preventing/treating vasospasm (5) avoiding comorbidities (DVT, pneumonia, UTI, seizure). II.         Initial Exam Outline ABC …

Joseph MillerAneurysmal Subarachnoid Hemorrhage

Superior parietal lobule approach

Superior parietal lobule Approach Introduction- The superior parietal lobule provides a surgical corridor between the motor and visual pathways. This approach should be well known to neurosurgeons for evacuation of hematomas, vascular malformations, and neoplasms. Anatomy- The SPL is posterior to the postcentral gyrus and postcentral sulcus. o   Anterior Border- Post central sulcus o   Lateral Border- Intraparietal sulcusThe SPL extends …

Joseph MillerSuperior parietal lobule approach

Upcoming Podcast #3

We are going to mix things up a little bit with podcast #3. Last week we discussed arteriovenous malformations and Schmalzy went on a diatribe about BlueCross/ARUBA trying to kill patients with AVMs. This week will be more practical and we will discuss aneurysmal subarachnoid hemorrhage. The basic scenario we will be addressing is you have a 42 yo with …

Joseph MillerUpcoming Podcast #3

Chiari decompression

Chiari Decompression   Introduction- “there are Chiaris and then there ARE Chiaris”. The key to a successful Chiari operation is to properly define the patients that will benefit the most from a suboccipital craniectomy, C1 laminectomy, and duraplasty. Patients with a Chiari 1 malformation present with a multitude of symptoms and for the large part all have headaches. The characteristic …

Joseph MillerChiari decompression

Mature Teratoma

Joseph MillerMature Teratoma

Maximally Invasive Teaching

Resident surgical education Tonight at Surgical Grand Rounds we had an interesting talk by Debra DaRosa. She is a PhD that specializes in resident surgical education and gives a compelling lecture. Her lecture was centered on several concepts. The basic idea was that people don’t learn if you just throw information at them. Like I mentioned in the introductory podcast, …

Joseph MillerMaximally Invasive Teaching


Open TLIF using the T-PAL (Synthes) Introduction- The T-PAL is a Synthes TLIF system that is kidney shaped PEEK implant. The supposed benefits of a TLIF are less nerve root retraction though most TLIF’s are performed in much the same way as a PLIF Positioning Prone, Open Jackson table Prep and Landmarks Identify: Midline Incision and approach Incision: Extend you …

Joseph MillerTLIF- T-PAL

Upcoming AVM Podcast

Tomorrow we will be posting a new podcast. Podcast Topic: Arteriovenous Malformations Recommended Reading: AVM Pre-test    

Joseph MillerUpcoming AVM Podcast

Arteriovenous Malformations

  Four Types of Intracranial vascular malformations Arteriovenous malformations Capillary telangiectasias Cavernous angiomas Venous angiomas Introduction AVM are rare, complex vascular structures that can occur within the parenchyma (ie pial malformations), dura, or both. Most commonly patients present with seizures or symptoms resulting from seizures.. Epidemiology: 0.005-0.6% in the general population Most commonly present between 20-40yo (Mean 31.2yo) ¼ hemorrhage …

Joseph MillerArteriovenous Malformations

Decompressive craniectomy for stroke

  Introduction Basics: The role of decompressive craniectomy for stroke is controversial and the postoperative morbidity and mortality is significant. Large ischemic strokes can exert significant mass effect through swelling that normally occurs 24-72 hours from symptom onset in about 10% of patients. Ischemic strokes are not felt to produce clinically significant global elevation in ICPd but causes delayed deterioration …

Joseph MillerDecompressive craniectomy for stroke