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

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

TLIF- T-PAL

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

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

C1-2 Fusion

Operation: C1-2 dorsal internal fixation and fusion- Harms-Goel Technique Introduction- C1 lateral mass screws and C2 pedicle screws is a technique originally described by Goel (1994) and later popularized by Harms and Melcher (2001). Positioning Mayfield pins- you want the pins below the equator and anteriorly placed so that the patient is (a) resting in pins and (b) you have …

Joseph MillerC1-2 Fusion

Baclofen Pumps

  Introduction- Baclofen pumps are placed in children and adults for control of spasticity. Spasticity is a condition in which there is a cerebral or spinal cord injury resulting in increased muscle tone.  The increased tone can be incredibly painful and debilitating. Treatment alternatives. Oral baclofen- GABA agonist that crosses BBB Dantrolene- inhibits release of sodium from SR Benzos- diazepam …

Joseph MillerBaclofen Pumps

Carpal tunnel release

Operation: Carpal tunnel release Introduction- Carpal tunnel syndrome is a result of median nerve entrapment as it course underneath the transverse carpal ligament (ie the flexor retinaculum). It is the most common entrapment neuropathy and is more prevalent in women. The most common presenting symptom is dysesthesias in the distribution of the median nerve. Weakness or loss of fine motor …

Joseph MillerCarpal tunnel release

Pterional craniotomy for Posterior Communicating Artery Aneurysm

  Introduction- The posterior communicating artery aneurysm is an aneurysm that neurosurgeons are very familiar with but as Dr. Lawton warns “it’s not just a PComm”. This aneurysm needs to be taken seriously and approached thoughtfully Anatomy- The posterior communicating artery (PComm) originates from the posterior wall of the internal carotid artery (ICA) and divides the carotid into ophthalmic and …

Joseph MillerPterional craniotomy for Posterior Communicating Artery Aneurysm

ACDF

Operation: Anterior cervical discectomy and fusion Introduction- The anterior cervical discectomy and fusion (ACDF) is the most commonly performed cervical operation and one of the most common operations that neurosurgeons perform. The ACDF is one of the workhorse operations of neurosurgery in that it can be utilized for a myriad of pathologic process. ACDF can play a role in cervical …

Joseph MillerACDF