Journal of Neurosurgery Academy

Multilevel biportal endoscopic treatment for lumbar disc herniations: A case report and surgical video

Jose L. Sanmillan — 2024-09-30

We present a 61-year-old male suffering from longstanding back pain and newly developed left leg pain. Magnetic
resonance imaging revealed an extruded and down-migrated central disc herniation at the L3-4 level and a leftsided
subarticular L2-3 disc herniation. We decided to perform a left unilateral biportal endoscopic surgery to
assess both disc herniations. The case, the surgical video, and the fast recovery of the patient highlight the benefits
of applying the biportal endoscopic surgical techniques for treating multilevel lumbar pathology.

Carotid endarterectomy—Surgical nuances

Dwarakanath Srinivas — 2024-09-30

Carotid endarterectomy (CEA) is a crucial surgical intervention developed to prevent cerebrovascular accidents
in patients with significant carotid artery stenosis/narrowing. This procedure involves the removal of plaques
from the intimal surface of the carotid artery to restore adequate cerebral perfusion and reduce the risk of
embolic events. As one of the most common vascular surgeries, CEA requires strict adherence to surgical
protocols to minimize complications and ensure favorable patient outcomes. Typically performed under general
anesthesia, CEA necessitates precise anatomical visualization and careful dissection of the common, internal,
and external carotid arteries. This article provides an in-depth review of surgical considerations, including patient
positioning, arterial clamping, plaque removal, arterial closure techniques, and intraoperative shunting based on
neuromonitoring feedback. In addition, it outlines essential postoperative care to monitor and address potential
complications, aiming to offer neurosurgeons a comprehensive guide to achieving optimal outcomes in CEA.

Microsurgical resection of cerebellar AVM

Anil Kumar Sharma — 2024-09-30

Cerebellar arteriovenous malformations (AVMs) are complex vascular lesions of the posterior fossa of the brain
that have a high risk of hemorrhage and are usually associated with significantly high morbidity and mortality.
Their intricate angioarchitecture and proximity to critical brain structures require very careful management of
these lesions. AVM has been managed by various methods, a few of which include microsurgical resection and
endovascular treatment.

Microvascular decompression for trigeminal neuralgia: Pearls and technique for the classic procedure that stands the test of time

Arun Kumar Srivastava — 2024-09-30

Trigeminal neuralgia (TN) is a kind of neuropathic pain that is found to be persistent and classically has
sudden, excruciating pain in the facial area that is similar to electric shock or stabbing-like pain. Microvascular
decompression has consistently remained the predominant procedure for TN every year since 1992 and presently
constitutes over 90% of the surgical interventions carried out for neuropathic facial pain. This article describes
the technical aspects of the surgical planning and the procedure for microvascular decompression, along with
an operative video. In total, 75–80% of patients are known to have complete relief after the procedure, which
makes this classic procedure a must-have for the neurosurgeon in the arsenal of armaments in trigeminal
neuralgia management.

C2 neurofibroma excision: An illustrative video

Rajinder Kumar — 2024-09-30

Spinal neurofibromas are rare, benign tumors that can occur sporadically or in association with neurocutaneous
syndromes. These tumors may remain asymptomatic for extended periods, often growing to form a characteristic
dumbbell shape as they extend through intervertebral foramina. Dumbbell-shaped neurofibromas of the upper
cervical nerve roots pose a particular surgical challenge due to their proximity to critical structures like the vertebral
artery. This case report presents a 36-year-old male who developed progressive neck pain, upper limb weakness,
and worsening gait due to a large C2 dumbbell-shaped neurofibroma. C1–C2 laminectomy and near-total excision
of the lesion were done. Gradual recovery of motor function was observed over follow-up. This report underscores
the complexities of managing C2 nerve root neurofibromas, emphasizing their potential for significant neurological
deficits despite their benign nature.

Passion towards Neurosurgery

Kodeeswaran M. — 2024-10-05

Incidental left MCA aneurysm post minor head injury

Mihai Robert Danciut — 2024-09-30

Middle cerebral artery (MCA) aneurysms account for approximately 21% of cerebral aneurysms. The most
frequent location for MCA aneurysms is the M1–M2 bifurcation, while less commonly, they may arise near the
lenticulostriate arteries or anterior temporal branch origin. In cases of bilateral MCA aneurysms, determining the
ruptured aneurysm can be challenging. This study highlights factors influencing rupture, including the ratio of
perpendicular height to neck diameter, flow angle, and the angular relationship between M1 and M2 segments.
Due to their relatively superficial position in the Sylvian fissure, MCA aneurysms are more accessible than other
aneurysms, although their neck-to-dome ratio complicates treatment. Given that MCA branches may arise from
the sac or neck, surgical clipping is often preferred over coil embolization. This report underscores the need for
neurosurgeons to engage in comprehensive research on the unique characteristics, treatment approaches, and
intraoperative considerations for managing MCA aneurysms.