Importance of Arachnoid Dissection in Arteriovenous Malformation Microsurgery: A Technical Note

Rodríguez, Rony Gómez; Agyemang, Kevin; Arias, Sally Allinson Marte; Cearns, Michael; Chaddad-Neto, Feres

doi:10.1016/j.wneu.2023.02.028

Cited by 3 publications

(3 citation statements)

References 7 publications

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“…[1][2][3][4][5][6][7][8] Techniques of splitting Sylvian could be divided into two categories: sharp dissection by microscissors and blunt dissection by spreading the tip of bipolar forceps or probing with a microdissector. 9,10 Splitting Sylvian fissure widely has many benefits such as brain relaxation and wide surgical corridor, which lead to safer surgery, less periprocedural complications, and better neurological outcomes. [11][12][13] Arachnoid dissection is vital to untangle the complex structures within the Sylvian fissure.…”

Section: Introductionmentioning

confidence: 99%

Training in Sylvian Arachnoid Dissection: The Art of Using Kamiyama Scissors and a Simple Novel Model for Practice Sylvian Arachnoid Dissection Using Cotton Fiber with Brain Model

Ariyaprakai,

Kusdiansah,

Degollado-García

et al. 2024

Asian J Neurosurg

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Background Transsylvian approach is one of the main approaches for a variety of vascular, tumor, and skull-base lesions. Sylvian fissure harbors a lot of critical structures including the middle cerebral artery and many venous structures. If not done properly, the transsylvian approach could cause several complications. Up to now, there is no simple training model for practicing Sylvian fissure dissection. In this article, we describe the technique of using microscissors for the sharp dissection of arachnoid trabeculae. We also propose a new model for practicing Sylvian arachnoid dissection using a three-dimensional (3D) brain model with cotton fiber. Method We inserted cotton fiber into the Sylvian fissure of the brain model (aneurysm box from UpsurgeOn) and covered the Sylvian fissure with a cotton sheet, then sprayed the water over it. We dissected this model under a microscope by using Kamiyama scissors in the right hand and suction in the left hand. Result Under the microscope, our model appears comparable with the real Sylvian fissure. We can use this model for practicing arachnoid dissection with Kamiyama scissors. Conclusion The arachnoid dissection model by using a 3D brain model with cotton fiber is a simplified and novel approach for practicing the Sylvian fissure dissection.

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Section: Introductionmentioning

confidence: 99%

Training in Sylvian Arachnoid Dissection: The Art of Using Kamiyama Scissors and a Simple Novel Model for Practice Sylvian Arachnoid Dissection Using Cotton Fiber with Brain Model

Ariyaprakai,

Kusdiansah,

Degollado-García

et al. 2024

Asian J Neurosurg

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“…6 A good understanding of the anatomy of the far-lateral approach and brainstem entry zones is critical to their successful use in brainstem cavernoma surgery. [7][8][9][10][11] The patient was a female in her 20s, with no family history of CCM, prior radiation, or other comorbid conditions. She presented after a 3-week history of progressive headaches associated with left-sided hemisensory disturbance.…”

mentioning

confidence: 99%

“…A good understanding of the anatomy of the far-lateral approach and brainstem entry zones is critical to their successful use in brainstem cavernoma surgery. 7-11…”

mentioning

confidence: 99%

Technical Nuances of Using the Peritrigeminal and Infrafacial Entry Zones in Brainstem Cavernoma Surgery: 2-Dimensional Operative Video

Rodríguez,

Agyemang,

Cearns

et al. 2023

Operative Neurosurgery

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Cerebral cavernomas (CCMs) are among the most common intracranial vascular lesions and are present in 0.4%-0.9% of the population. 1,2 Clinically significant hemorrhagic sequelae is the most concerning outcome seen in up to 24% of newly diagnosed brainstem cavernoma. [3][4][5] Conservative management is accepted by expert consensus to be a reasonable management strategy except after multiple, life-threatening hemorrhage or in young patients where most favour surgery. 6 A good understanding of the anatomy of the far-lateral approach and brainstem entry zones is critical to their successful use in brainstem cavernoma surgery. [7][8][9][10][11] The patient was a female in her 20s, with no family history of CCM, prior radiation, or other comorbid conditions. She presented after a 3-week history of progressive headaches associated with left-sided hemisensory disturbance. The patient consented to the procedure and to the publication of her image. MRI revealed a cystic lesion consistent with recent subacute hemorrhage, with a pontine CCM intimately related to the cavity and a contralateral CCM. The CCMs were associated with a type 3 developmental venous anomaly (DVA) with a prominent draining vein draped over the dorsal aspect of the hematoma. The cavernoma was resected after 2 surgical attempts. The peritrigeminal entry zone initially was chosen to avoid the DVA but failed to provide safe access in the absence of an endoscope. Complete resection of the CCM with preservation of the DVA was achieved through the infrafacial corridor at a second surgery. We discuss the technical nuances of using 2 different brainstem entry zones to resect a brainstem cavernoma.

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Letter to the Editor Regarding "Importance of Arachnoid Dissection in Arteriovenous Malformation Microsurgery: A Technical Note"

Brunasso,

Di Bonaventura,

Albanese

2024

World Neurosurgery

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Importance of Arachnoid Dissection in Arteriovenous Malformation Microsurgery: A Technical Note

Cited by 3 publications

References 7 publications

Training in Sylvian Arachnoid Dissection: The Art of Using Kamiyama Scissors and a Simple Novel Model for Practice Sylvian Arachnoid Dissection Using Cotton Fiber with Brain Model

Training in Sylvian Arachnoid Dissection: The Art of Using Kamiyama Scissors and a Simple Novel Model for Practice Sylvian Arachnoid Dissection Using Cotton Fiber with Brain Model

Technical Nuances of Using the Peritrigeminal and Infrafacial Entry Zones in Brainstem Cavernoma Surgery: 2-Dimensional Operative Video

Letter to the Editor Regarding "Importance of Arachnoid Dissection in Arteriovenous Malformation Microsurgery: A Technical Note"

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