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Robotics in Cranial Neurosurgery

Key Concepts A robot is a machine that is capable of autonomously executing sets of programmed actions. Most robots in commercial use comprise interacting mechanical and electrical systems, often integrating feedback from one or more sensors, under the control of a computer that is programmed to guide the entire system through specific tasks. Robots provide the ability to execute diverse sets of programmed instructions reliably and…

Surgical Simulation

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 27.1 . Key Concepts Simulation often refers to a virtual three-dimensional (3D) visual model created with CT and MRI data. The role of simulation in neurosurgery is still being developed as a training tool, but it is used in everyday workflows through presurgical rehearsal and for understanding complex anatomic relationships. Advantages…

Positioning for Peripheral Nerve Surgery

This chapter includes an accompanying lecture presentation ( Video 26.1 ) that has been prepared by the author. As noted in the text, the author has also prepared 18 s ( Video 26.2, Video 26.3, Video 26.4, Video 26.5, Video 26.6, Video 26.7, Video 26.8, Video 26.9, Video 26.10, Video 26.11, Video 26.12, Video 26.13, Video 26.14, Video 26.15, Video 26.16, Video 26.17, Video 26.18, Video…

Positioning for Spine Surgery

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 25.1 . Key Concepts Prone positioning is likely the most common position in spine surgery, but it is associated with distinct physiologic changes (especially cardiopulmonary) and may carry the greatest risk for vertebral venous engorgement (and subsequent blood loss) in comparison with supine or lateral patient positioning. Proper positioning of patients…

Positioning for Cranial Surgery

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 24.1 . Key Concepts Optimal positioning provides the most direct safe trajectory to the surgical target; affords safety to the patient; eliminates the need for brain retraction; reduces intracranial pressure; and allows the surgeon to operate comfortably. Patient positioning for the majority of procedures should involve the most direct trajectory from…

Incisions and Closures

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 23.1 . This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 23.1 . Key Concepts An understanding of basic wound healing, scalp anatomy, and principles of reconstructive surgery are helpful to achieve consistent, well-healed wounds. There are three phases of wound healing: inflammatory, proliferative, and…

Avoidance of Complications in Neurosurgery

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 22.1 . This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 22.1. In all neurosurgical procedures, avoidance of complications is as important as treatment of disease. Complication avoidance requires making the correct diagnosis, choosing the appropriate procedure, and correctly selecting patients. This chapter reviews how…

Surgical Planning

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 21.1 . Key Concepts The preoperative evaluation must be done in a thorough manner to determine which patients necessitate surgical intervention as well as which surgical intervention is indicated. Moreover, the safety considerations that must be made during surgery will heavily depend on a patient’s history and physical examination, comorbidities, laboratory…

Peripheral Venous Disease in the Neurosurgery Patient

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 20.1 . Key Concepts Accurate diagnosis and management of venous thromboembolism (VTE) are dependent on a high clinical pretest probability (CPTP) to avoid unnecessary high-risk treatment. Neurosurgical patients are exceptionally prone to developing VTE. Mechanoprophylaxis should be used immediately, and chemoprophylaxis should be used as soon as it is safe, given…

Coagulation for the Neurosurgeon

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 18.1 . Key Concepts Hemostasis and thrombosis are critical physiologic mechanisms that neurosurgeons must understand to avoid hemorrhagic and thrombotic complications of surgery and to accurately assess the risks associated with emergent surgery in the era of modern anticoagulant and antiplatelet agents. Coagulation is not simply a cascade of steps that…

Neurourology

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 17.1 . This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 17.1 . Key Concepts Central nervous system disorders are a frequent cause of urologic symptoms and voiding dysfunction. The bladder, bladder neck, external urethral sphincter, and urethra must have coordinated activity to safely store…

Neurotology

This chapter includes an accompanying lecture presentation that has been prepared by the author: Video 16.1. Key Concepts In the otorhinolaryngologic subspecialty of otology, neurotology, and lateral skull base surgery, the focus is on the anatomy, physiology, and abnormalities of the three cranial nerves that traverse the temporal bone—the cochlear, vestibular, and facial nerves—as well as specific tests of their functions. There are two major reasons…

Neuro-ophthalmology

Key Concepts Many neurosurgical disorders affect the afferent visual system, efferent visual system, or both. Consequently, neuro-ophthalmic symptoms and signs can be the presenting feature of the disorder or the most sensitive measure for detecting progression or recurrence. Papilledema refers to optic disc edema caused by increased intracranial pressure. Patients with papilledema require monitoring with serial optic disc evaluation and formal perimetry, as papilledema can cause…

Diffusion Tensor Imaging

This chapter includes an accompanying lecture presentation that has been prepared by the author: Video 14.1 . Key Concepts The ability of diffusion tensor imaging (DTI) tractography to depict eloquent white matter structures such as the pyramidal tract, arcuate fasciculus, and optic radiation (geniculocalcarine tract) has reduced surgical morbidity and supported improved extent of resection for brain tumors. Longitudinal studies have shown that the accumulation of…

Molecular Imaging of the Brain with Positron Emission Tomography

This chapter includes an accompanying lecture presentation that has been prepared by the author: Video 13.1 . Key Concepts PET is a noninvasive imaging technique that allows for in vivo evaluation of biologic processes through (1) production of positron-emitting nuclei using a cyclotron; (2) radiochemical procedures to attach the radionuclide to a molecule of interest and increase purity; (3) injection into the body; (4) measurement of radioactivity…

Physiologic Evaluation of the Brain With Magnetic Resonance Imaging

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 12.1 . This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 12.1 . Key Concepts MRI provides valuable anatomic detail. Significant advancements in MRI allow for more improved imaging diagnostic ability. Diffusion-weighted imaging can provide information on the presence of ischemia and infarction among other…

Radiology of the Spine

Key Concepts The core imaging modalities for spinal imaging include radiographs, CT, and MRI. We discuss the advantages and disadvantages of each imaging modality as well as specialized techniques in CT and MRI that can be used in the diagnosis and treatment of neurological spinal disorders. Back pain, a common indication for performing imaging examinations, and its relationship to degenerative disk disease is poorly understood but…

Computed Tomography and Magnetic Resonance Imaging of the Brain

This chapter includes two accompanying lecture presentations that have been prepared by the authors: Video 10.1 and Video 10.2 . Key Concepts Fundamental physics behind computed tomography (CT) and magnetic resonance imaging (MRI). Current roles of CT imaging in the preoperative, postoperative, and follow-up imaging of a neurosurgical patient. Imaging findings, techniques, and applications of CT and MRI in the evaluation of patients with neoplastic, infectious,…

Classification Systems in Neurosurgery

This chapter includes an accompanying lecture presentation that has been prepared by the authors: Video 9.1 . Key Concepts Many classification systems have been described for use in neurosurgery. No classification system for these classification systems has previously been described. In evaluating a classification system, it is important to assess its consistency and validity as well as the strength of evidence supporting its utility. We introduce…