Core Techniques in Operative Neurosurgery

Arachnoid Cyst Fenestration

Indications Fenestration of arachnoid cysts is indicated in cysts that show significant increase in size or associated clinical symptoms. The size of an arachnoid cyst typically remains stable or increases over time, and associated symptoms are unlikely to resolve spontaneously.…

Encephalocele Repair

Indications The presence of an encephalocele is an indication for surgical repair. Encephaloceles are typically diagnosed at birth, although many are now identified in utero by ultrasound. Indications for the immediate repair of an encephalocele include open exposure to any…

Endoscopic Colloid Cyst Removal

Indications Symptomatic cysts. Symptoms may range from visual obscurations and loss of consciousness to positional headache, sensory disturbance, and short-term memory decline. Symptoms of hydrocephalus, such as urinary incontinence, dementia, and ataxia, may also be present. Secondary hydrocephalus or unilateral…

Endoscopic Transsphenoidal Approach

Indications Indications for the transsphenoidal approach have significantly increased with the addition of the endoscope. Using a team approach with a skilled endoscopic rhinologist has rendered the endoscopic transsphenoidal approach a valid minimal-access method for exposing various midline skull base…

Cranioplasty (Autogenous, Cadaveric, and Alloplastic)

Additional videos for this topic are available online at . Indications In general, we prefer to use autologous calvarial bone grafts as the primary material for cranioplasty and skull reconstruction. Autogenous graft material typically has a low incidence of…

Retrosigmoid Craniotomy for Microvascular Decompression

Indications Clinical confirmation of trigeminal neuralgia, hemifacial spasms, or glossopharyngeal neuralgia with an offending vessel seen on magnetic resonance imaging (MRI). MRI with FIESTA sequences are helpful in detailing the relationship of the brainstem vessels to the cranial nerves. You’re…

Occipital and Supraorbital Nerve Stimulator Placement

Indications Peripheral nerve stimulation (PNS) is indicated for patients with chronic, medically refractory, severe neuropathic pain that involves distribution of the nerve to be stimulated. Occipital nerve stimulation (ONS) is indicated primarily for treatment of occipital neuralgia, including posttraumatic and…

Motor Cortex Stimulator Placement

Indications Motor cortex stimulation (MCS) may be considered for patients with medically refractory deafferentation or neuropathic pain, including central pain syndromes related to stroke or, rarely, trauma or multiple sclerosis; trigeminal neuropathic pain (anesthesia dolorosa and postherpetic neuralgia); glossopharyngeal neuralgia;…

Deep Brain Stimulation

Indications Medically refractory, dopamine-responsive Parkinson disease. Medically refractory essential tremors. Medically refractory dystonia. Rare, off-label uses include treatment of chronic pain and of epilepsy. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles…