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Choque-Velasquez J, Colasanti R, Muhammad S, Chioffi F, Hernesniemi J. Vascular Lesions of the Pineal Region: A Comprehensive Review of the Therapeutic Options. World Neurosurg 2022; 159:298-313. [PMID: 35255631 DOI: 10.1016/j.wneu.2021.09.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/12/2021] [Accepted: 09/13/2021] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Vascular lesions of the pineal region comprise aneurysms of the pineal region, arteriovenous malformations, cavernous malformations, and vein of Galen malformations. In the present report, we have offered an extensive review of each vascular pineal region lesion. METHODS We performed an extensive literature review, focusing on the current therapeutic options available for the different vascular lesions of the pineal region. RESULTS Vascular lesions of the pineal region are rare. Microneurosurgery remains a valid treatment of cavernomas, arteriovenous malformations, and aneurysms. Endovascular treatments seem to be the first option for the vein of Galen malformations, followed by microneurosurgery. Radiosurgery seems beneficial for small-size arteriovenous malformations. Complex and large vascular lesions will require a combination of multiple treatments. CONCLUSIONS Vascular lesions of the pineal region are complex, uncommon diseases. Thus, definitive therapeutic modalities for these lesions require further research.
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Affiliation(s)
- Joham Choque-Velasquez
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Neurosurgery, University Hospital Düsseldorf, Düsseldorf, Germany.
| | - Roberto Colasanti
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy; Department of Neurosurgery, Padua University Hospital, Padua, Italy
| | - Sajjad Muhammad
- Department of Neurosurgery, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Franco Chioffi
- Department of Neurosurgery, Padua University Hospital, Padua, Italy
| | - Juha Hernesniemi
- Juha Hernesniemi International Center for Neurosurgery, Henan Provincial People's Hospital, Zhengzhou, China
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Simultaneous Craniotomies for Multiple Intracranial Aneurysm Clippings-One-Stage Surgery with Multiple Craniotomies. World Neurosurg 2021; 158:e689-e696. [PMID: 34800734 DOI: 10.1016/j.wneu.2021.11.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The treatment of multiple intracranial aneurysms (MIAs) involves various modalities and sometimes requires staged operations. This study aimed to prove the efficacy and safety of one-stage multiple craniotomies (OSMC) for multiple cerebral aneurysms. METHODS We retrospectively reviewed the medical records of the patients who underwent treatment for intracranial aneurysms between May 2003 and April 2020. The surgical results, complications, and lengths of hospital stay were compared between the patients who underwent OSMC and those who underwent multistage multiple craniotomies. RESULTS The demographic characteristics of the OSMC and multistage multiple craniotomies groups (n = 82 and 43, respectively) were similar. There were no statistically significant differences between the 2 groups when the amount of blood transfused, complications, and surgical results were compared (P = n.s. for all); however, the operation time and hospitalization period (353.9 minutes vs. 490.3 minutes and 12.3 days vs. 21.8 days, respectively; P = 0.001 for both) were shorter in the OSMC group. The treatment cost (17,000 USD vs. 22,000 USD, P = 0.001) was lower in the OSMC group. CONCLUSIONS OSMC for aneurysm clipping in patients with MIAs is a relatively safe and economical method. Furthermore, it has good clinical outcomes. This new surgical method is worthwhile in that it can be applied to patients who are afraid to undergo multiple surgeries, and we suggest that it is an efficient, low-cost option for the treatment of MIAs.
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Rajagopal N, Yamada Y, Balaji A, Kawase T, Kato Y. Rare cases of multiple unruptured intracranial aneurysms: Illustrative report and review on management options. INTERDISCIPLINARY NEUROSURGERY 2019. [DOI: 10.1016/j.inat.2019.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Rajagopal N, Balaji A, Yamada Y, Kawase T, Kato Y. Etiopathogenesis, clinical presentation and management options of mirror aneurysms: A comparative analysis with non-mirror multiple aneurysms. INTERDISCIPLINARY NEUROSURGERY 2019. [DOI: 10.1016/j.inat.2019.100535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Rajagopal N, Yamada Y, Balaji A, Kawase T, Kato Y. Multiples of multiple: Case series of mirror aneurysms and review of literature. Int J Surg Case Rep 2019; 61:141-146. [PMID: 31362238 PMCID: PMC6675932 DOI: 10.1016/j.ijscr.2019.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 07/14/2019] [Indexed: 11/29/2022] Open
Abstract
Incidentally detected unruptured mirror intracranial aneurysms are on the rise due to advanced imaging modalities. Further studies are required to elucidate theories of development, inheritance pattern and the need for screening of 1st-degree relatives with twin aneurysms. Treatment strategy for mirror aneurysms should be customised based on the location, size, morphology and clinical manifestations of each patient. Randomised control trials that compare [single/multistage] clipping and coiling of mirror aneurysms are necessary to decide the best intervention strategy.
Introduction Mirror aneurysms are a rare subtype of multiple aneurysms, located in identical or adjacent arterial segment bilaterally. We report a case series of 3 such patients amongst whom one of them had 3 sets of mirror aneurysms and the other patient had 2 sets of mirror aneurysm on the same arterial segment which has not been reported till date. Methods A retrospective analysis of 3 patients with incidentally detected multiple mirror aneurysms, who were treated with microsurgical clipping and coiling, was conducted. A systematic search was performed using the PUBMED database and relevant articles were reviewed with particular attention to incidence, associated conditions, risk factors and management strategies. Written informed consent was obtained from all of the patients for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request. This research work has been reported in line with the PROCESS criteria (Agha et al., 2018). Results All the 3 patients were females with incidentally detected multiple mirror aneurysms. All the 3 patients were known Hypertensives. All the aneurysms were successfully clipped by a multistage, bilateral craniotomy except the one in the cavernous ICA, for which an endovascular procedure is planned. All of them had an uneventful postoperative course with the CT angiogram showing obliteration of all the clipped aneurysms except the one in the cavernous ICA. Conclusions Multiple mirror aneurysms represent a rare occurrence of a diverse pathology. Both these described types of cases have not been reported so far in the literature. The treatment strategy for mirror aneurysms should be determined individually based on the location, size, and morphology of the aneurysms, as well as, on the clinical manifestations of each patient.
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Affiliation(s)
- Niranjana Rajagopal
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India.
| | - Yasuhiro Yamada
- Department of Neurosurgery, Fujita Health University, Banbuntane Hotokukai Hospital, Nagoya, Japan
| | - Arun Balaji
- Department of Neurosurgery, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | - Tsukasa Kawase
- Department of Neurosurgery, Fujita Health University, Banbuntane Hotokukai Hospital, Nagoya, Japan
| | - Yoko Kato
- Department of Neurosurgery, Fujita Health University, Banbuntane Hotokukai Hospital, Nagoya, Japan
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Rychen J, Croci D, Roethlisberger M, Nossek E, Potts MB, Radovanovic I, Riina HA, Mariani L, Guzman R, Zumofen DW. Keyhole approaches for surgical treatment of intracranial aneurysms: a short review. Neurol Res 2018; 41:68-76. [PMID: 30311865 DOI: 10.1080/01616412.2018.1531202] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: To clarify the reported experience with keyhole approaches for the treatment of intracranial aneurysms. Methods: The PubMed and Embase databases were searched up to December 2017 for full-text publications that report the treatment of aneurysms with the eyebrow variant of the supraorbital craniotomy (SOC), the minipterional craniotomy, or the eyelid variant of the SOC. The anatomical distribution of aneurysms, the postoperative aneurysm occlusion rate, and the type and rate of complications were examined using univariate analysis. Results: Sixty-seven publications covering treatment of 5770 aneurysms met the eligibility criteria. The reported experience was the largest for the eyebrow variant of the SOC (69.4% of aneurysms), followed by the minipterional approach (28.2%), and the eyelid variant of the SOC (2.4%). The anterior communicating artery (ACoA) was the most frequent aneurysm location for the SOC (eyebrow variant: 33.2%; eyelid variant: 31.2%). The middle cerebral artery (MCA) was the most frequent aneurysm location in the minipterional cohort (55.2%). In the eyelid variant of the SOC cohort, the rate of complete aneurysm occlusion was the lowest (eyelid variant: 90.8%; eyebrow variant: 97.8%, p < 0.001; minipterional approach: 97.9%, p < 0.001), and the postoperative infarction rate was the highest (eyelid variant: 7.2%; eyebrow variant: 3.5%, p = 0.025; minipterional approach: 2.6%, p = 0.003). Conclusion: Each approach has a specific safety and efficacy profile. Surgeons selected the eyebrow variant of the SOC for many aneurysm locations including in particular the ACoA. There is a recent tendency however to opt for the minipterional approach above all for MCA aneurysms. Abbreviations: SOC: Supraorbital Craniotomy; MPT: Minipterional; MCA: Middle Cerebral Artery; ACoA: Anterior Communicating Artery; PCoA: Posterior Communicating Artery; aSAH: Aneurysmal Subarachnoid Hemorrhage; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; MINORS: Methodological Index For Non-Randomized Studies.
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Affiliation(s)
- Jonathan Rychen
- a Department of Neurosurgery , Basel University Hospital, University of Basel , Basel , Switzerland.,b Department of Neurosurgery , Bern University Hospital, University of Bern , Bern , Switzerland
| | - Davide Croci
- a Department of Neurosurgery , Basel University Hospital, University of Basel , Basel , Switzerland
| | - Michel Roethlisberger
- a Department of Neurosurgery , Basel University Hospital, University of Basel , Basel , Switzerland
| | - Erez Nossek
- c Division of Neurosurgery, Department of Surgery , Maimonides Medical Center , Brooklyn , NY , USA.,d Department of Neurosurgery , Donald and Barbara Zucker School of Medicine at Hofstra/Northwell , New York , NY , USA
| | - Matthew B Potts
- e Department of Neurosurgery , Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - Ivan Radovanovic
- f Division of Neurosurgery, Toronto Western Hospital, University Health Network and Department of Surgery , University of Toronto , Toronto , ON , Canada
| | - Howard A Riina
- g Department of Neurosurgery , New York University School of Medicine , New York , NY , USA
| | - Luigi Mariani
- a Department of Neurosurgery , Basel University Hospital, University of Basel , Basel , Switzerland
| | - Raphael Guzman
- a Department of Neurosurgery , Basel University Hospital, University of Basel , Basel , Switzerland
| | - Daniel W Zumofen
- a Department of Neurosurgery , Basel University Hospital, University of Basel , Basel , Switzerland.,h Division of Diagnostic and Interventional Neuroradiology, Department of Radiology , Basel University Hospital, University of Basel , Basel , Switzerland
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Choque-Velasquez J, Colasanti R, Resendiz-Nieves JC, Raj R, Lindroos AC, Jahromi BR, Hernesniemi J. Venous air embolisms and sitting position in Helsinki pineal region surgery. Surg Neurol Int 2018; 9:160. [PMID: 30159204 PMCID: PMC6094495 DOI: 10.4103/sni.sni_128_18] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 06/18/2018] [Indexed: 11/04/2022] Open
Abstract
Background Nowadays, the sitting position has lost favor among neurosurgeons partly due to assumptions of increased complications, such as venous air embolisms (VAEs) and hemodynamic disturbances. The aim of our study is to describe the importance of some anesthetic considerations and the utility of antigravity trousers as well, together with a skillful neurosurgery and an imperative proper teamwork, in order to prevent the risk of severe VAE during pineal region surgery. We routinely use them for the variant of the sitting position we developed, the "praying position." Methods A retrospective review of 51 pineal lesions operated on in the "praying position" using antigravity trousers was carried out. In the "praying position" the legs of the patient are kept parallel to the floor. Hence, antigravity trousers are used to generate an adequate cardiac preload. Results VAE associated to persistent hemodinamic changes was nonexistent in our series. The rate of VAE was 35.3%. VAEs were diagnosed mainly by monitoring of the end-tidal CO2 (83.33%). A venous system lesion was the cause in most of the cases. When VAE was suspected, an inmediate reaction based on a good teamwork was imperative. No cervical spine cord injury nor peripheral nerve damage were reported. The average microsurgical time was 48 ± 33 min. Conclusions The risks of severe VAE during pineal region surgery in the "praying-sitting position" may be effectively prevented by some essential anesthetic considerations and the use of antigravity trousers together with a skillful neurosurgery, and an imperative proper teamwork.
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Affiliation(s)
| | - Roberto Colasanti
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy.,Department of Neurosurgery, Ospedali Riuniti Marche Nord, Pesaro, Italy
| | | | - Rahul Raj
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
| | - Ann-Christine Lindroos
- Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Juha Hernesniemi
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
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Choque-Velasquez J, Miranda-Solis F, Colasanti R, Ccahuantico-Choquevilca LA, Hernesniemi J. Modified Pure Endoscopic Approach to Pineal Region: Proof of Concept of Efficient and Inexpensive Surgical Model Based on Laboratory Dissections. World Neurosurg 2018; 117:195-198. [PMID: 29935314 DOI: 10.1016/j.wneu.2018.06.080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE In recent decades endoscopic techniques have been increasingly used in neurosurgery as they may offer a valuable close-up view of the working area through a minimally invasive surgical corridor. Herein, we present an inexpensive and efficient endoscopic surgical model using a borescope, which was used for a "modified pure endoscopic approach" to the pineal region. METHODS A borescope video camera was connected to a 16-inch personal computer monitor. A standard midline suboccipital craniotomy was performed on 2 cadaveric heads in the Concorde position. Then, a "borescopic" supracerebellar infratentorial approach was executed, thus reaching the pineal region, which was exposed through an extensive arachnoid dissection. RESULTS Using the previously described model, we were able to provide excellent exposure of the main neurovascular structures of the pineal region, as shown by the intraoperative videos. In 1 specimen we identified an incidental pineal cyst that was meticulously dissected and removed. CONCLUSIONS Our proposed "borescopic" surgical model may represent an inexpensive and efficient alternative to conventional endoscopic techniques and could be used for training purposes, as well as even for clinical procedures, after a proper validation, particularly in economically challenging environments.
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Affiliation(s)
- Joham Choque-Velasquez
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland; Alto Andina Anatomy and Physiology Research Center, National University of San Antonio Abad, Cusco, Italy.
| | - Franklin Miranda-Solis
- Alto Andina Anatomy and Physiology Research Center, National University of San Antonio Abad, Cusco, Italy; Microneuroanatomy Laboratory, University Andina, National University of San Antonio Abad, Cusco, Italy
| | - Roberto Colasanti
- Umberto I General Hospital, Politechnic University of Marche, Ancona, Italy; Ospedali Riuniti Marche Nord, Pesaro, Italy
| | | | - Juha Hernesniemi
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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Choque-Velasquez J, Colasanti R, Resendiz-Nieves JC, Gonzáles-Echevarría KE, Raj R, Jahromi BR, Goehre F, Lindroos AC, Hernesniemi J. Praying Sitting Position for Pineal Region Surgery: An Efficient Variant of a Classic Position in Neurosurgery. World Neurosurg 2018; 113:e604-e611. [PMID: 29499423 DOI: 10.1016/j.wneu.2018.02.107] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 02/16/2018] [Accepted: 02/17/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND The sitting position has lost favor among neurosurgeons partly owing to assumptions of increased complications, such as venous air embolisms and hemodynamic disturbances. Moreover, the surgeon must assume a tiring posture. We describe our protocol for the "praying position" for pineal region surgery; this variant may reduce some of the risks of the sitting position, while providing a more ergonomic surgical position. METHODS A retrospective review of 56 pineal lesions operated on using the praying position between January 2008 and October 2015 was performed. The praying position is a steeper sitting position with the upper torso and the head bent forward and downward. The patient's head is tilted about 30° making the tentorium almost horizontal, thus providing a good viewing angle. G-suit trousers or elastic bandages around the lower extremities are always used. RESULTS Complete lesion removal was achieved in 52 cases; subtotal removal was achieved in 4. Venous air embolism associated with persistent hemodynamic changes was nonexistent in this series. When venous air embolism was suspected, an immediate reaction based on good teamwork was imperative. No cervical spine cord injury or peripheral nerve damage was reported. The microsurgical time was <45 minutes in most of the cases. Postoperative pneumocephalus was detected in all patients, but no case required surgical treatment. CONCLUSIONS A protocolized praying position that includes proper teamwork management may provide a simple, fast, and safe approach for proper placement of the patient for pineal region surgery.
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Affiliation(s)
| | - Roberto Colasanti
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland; Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | | | | | - Rahul Raj
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
| | | | - Felix Goehre
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland; Department of Neurosurgery, Stroke Center, Bergmannstrost Hospital Halle, Halle, Germany
| | | | - Juha Hernesniemi
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
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Supracerebellar Infratentorial Paramedian Approach in Helsinki Neurosurgery: Cornerstones of a Safe and Effective Route to the Pineal Region. World Neurosurg 2017; 105:534-542. [DOI: 10.1016/j.wneu.2017.06.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 05/31/2017] [Accepted: 06/01/2017] [Indexed: 11/22/2022]
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Choque-Velasquez J, Colasanti R, Kozyrev DA, Hernesniemi J, Kawashima A. Moyamoya Disease in an 8-Year-Old Boy: Direct Bypass Surgery in a Province of Peru. World Neurosurg 2017; 108:50-53. [PMID: 28844915 DOI: 10.1016/j.wneu.2017.08.112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 08/15/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pediatric moyamoya cases may be very arduous, even more so in a developing country, where access to specialized centers may be prevented by different factors. CASE DESCRIPTION Herein we report a challenging case, which was managed in the new Neurosurgical Center of Trujillo, regarding the direct anastomosis between the left superficial temporal artery and a cortical branch of the left middle cerebral artery in a 8-year-old Peruvian boy with moyamoya disease. Postoperatively, the patient's motor deficits and aphasia improved. To the best of our knowledge, this is the first performance of a direct revascularization for a pediatric moyamoya case in Peru. CONCLUSIONS The creation of highly specialized neurosurgical centers in the main strategic places of developing countries may allow optimal treatment of neurosurgical patients with complex diseases.
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Affiliation(s)
- Joham Choque-Velasquez
- Neurosurgical Unit, Es-Salud Trujillo Hospital, La Libertad, Peru; Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
| | - Roberto Colasanti
- Neurosurgical Unit, Es-Salud Trujillo Hospital, La Libertad, Peru; Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland; Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Danil A Kozyrev
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Juha Hernesniemi
- Neurosurgical Unit, Es-Salud Trujillo Hospital, La Libertad, Peru; Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Akitsugu Kawashima
- Neurosurgical Unit, Es-Salud Trujillo Hospital, La Libertad, Peru; Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
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Choque-Velasquez J, Kozyrev DA, Colasanti R, Thiarawat P, Intarakhao P, Jahromi BR, Hernesniemi J. The open access video collection project "Hernesniemi's 1001 and more microsurgical videos of Neurosurgery": A legacy for educational purposes. Surg Neurol Int 2017; 8:188. [PMID: 28868200 PMCID: PMC5569399 DOI: 10.4103/sni.sni_158_17] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 06/06/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Neurosurgical educational programs and courses are helpful to improve the quality of training. Moreover, nowadays, online activities may represent a very useful tool to globally enhance neurosurgical education. The "Hernesniemi's 1001 and more microneurosurgical videos" project aims to show the microsurgical style developed by the senior author and his TEAMs in more than 40 years of experience. METHODS More than 1100 high-definition videos of microneurosurgical operations performed by the senior author were carefully edited. These videos illustrate the philosophy of "simple, clean, fast and preserving the normal anatomy" while offering a step by step guide of different neurosurgical procedures. RESULTS All the aforementioned material is well organized in an electronic videobook, freely available in Surgical Neurology International. The book also includes comments of great current neurosurgeons and writings of the authors and editors. CONCLUSION We are sure that our project will be able to instill in and spread across the neurosurgical community the microneurosurgical style of the senior author, thus representing an efficient educational tool for surgeons all around the world.
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Affiliation(s)
| | - Danil A. Kozyrev
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
| | - Roberto Colasanti
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | | | | | | | - Juha Hernesniemi
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
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Developing the First Highly Specialized Neurosurgical Center of Excellence in Trujillo, Peru: Work in Progress—Results of the First Four Months. World Neurosurg 2017; 102:334-339. [DOI: 10.1016/j.wneu.2017.01.063] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 01/11/2017] [Accepted: 01/16/2017] [Indexed: 11/22/2022]
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