Austin Rahman Annotated bibliography on neurosurgery 2/23/14 Annotated bibliography on Neurosurgery

In my annotated bibliography I have chosen to write about the new and ongoing field of neurosurgery and its use of microsurgery. Neurosurgery is a improving and important field in medicine as it can treat many different CNS(central nervous system) ailments that were once considered fatal, but now due to many advances in technology and research, there is new hope in the field. Due to the fact that many of the advances in neurosurgery are recent, all of the articles are fairly recent; oldest being 2002, while the most recent 2013. It is important to note that, Neurosurgery is mainly composed of Microsurgery, which is surgery that is meant to be both minimally invasive and effective. Microsurgery is the new and preferred method of surgery to the Central nervous system (brain and spinal cord), since many of the nerves and tissues are highly intricate and deep within organs and tissues. Microsurgery can be interchangeably be called stereotactic surgery, as they both utilize the microscope and/or endoscopy both of which are cameras used for navigation and surgical ease, you will find both of these words prevalent in the articles that are quoted. Those that will benefit from this bibliography are Medical students that are in their residency phase and are learning about microsurgery and the purpose of it. Microsurgery is a fairly new advancement in the medicine world, and therefore it is imperative for newer medical students who wish to specialize in neurosurgery to become familiar with the methodology at an early stage. Another group that

may be able to benefit from the bibliography are university upper classman(junior to seniors) that have taken their required science courses and have goals pertaining to neurology. The articles that are listen in this annotated bibliography all are academic journals that are published in prestigious medical journals such as European Journal of Neurology, European Journal of Neurology , and Neurology India.

1. Lacoangeli, Maurizio, Fabrizio Salvinelli, Alessandro Di Rienzo, Maurizio Gladi, Lorenzo Alvaro, Fabio Greco, Massi Millano, and Messimo Serrati. "Microsurgical Endoscopy-assisted Presigmoid Retrolabyrinthine Approach as a Minimally Invasive Surgical Option for the Treatment of Medium to Large Vestibular Schwannomas."European Journal of Neurology. 663-70. Academic Search Premier. Web. 3 Mar. 2014. A group of Italian doctors most notably; Doctor Maurizio Lacoangeli , was able to demonstrate how microsurgery to the brain can be used successfully to remove vestibular schwannomas(nerve tumour to the ears) without major repercussions. His surgery and abstract was published into The European Journal of Neurosurgery. Dr. Lacoangeli, was able to perform the surgery on 10 different patients who suffered from some type of this tumor. The surgery procedure itself is known as endoscopy-assisted presigmoid retrolabyrinthine approach

(EAPRA)(663). The surgery is rather simple, it begins with the patient fully anesthetized, the patient is laid down with the affected side facing the doctors (in this case either left or right depending on the affected ear). The doctor(s) than proceed to made small incisions until the cranial skull is exposed; this is followed by the doctors shaving down the bone, finally a endoscopy is inserted and used to find the tumor. The tumor itself is than extracted by the endoscopic instrument, finally fat, that is collected from the patients abdomen is than packed into where the tumor once was. This surgery itself was found successful on all ten patients, although 2 patients did have complications with the surgery, the surgery nonetheless was deemed successful(666).

2. Berhouma, Moncef, Hongyang Ni, and Bernard Vallee. "The Endoscopic Intraventricular Management of Pineal Cysts: A Minimally Invasive Modus Operandi." Acta Neurochir (2013): 1901-905. Academic Search Premier. Web. 27 Feb. 2014. Doctors Moncef Berhouma, Hongyang Ni, and Bernard Valle who are a part of the Department of Neurology at the Pierre Wertheimer Neurological and Neurosurgical Hospital located in France, were able to find a new surgical method to deal with pineal cysts. Pineal cysts which are small cysts that form on the pineal gland of the brain, are nuisance in the neurological field, as they rarely show up on MRI's. The way to remove the cyst is a highly debatable topic, but the method that Dr. Berhouma was able to discover is rather short and minimally invasive(1901). The surgery is performed with the patient under general anesthesia, with the patient sitting up and the head locked into a holder, unlike most neurosurgeries the head is not shaved, and the hair is instead treated with iodine. A small incision is made, followed by a drilling of 20-25mm, and

then a endoscopic instrument is place into the head, once the cyst has been found, it is then pulled out and "popped" and washed out with warm saline; the procedure is than concluded with stapes and the hole is filled with titanium plates(1902). Although this surgery is short and straightforward, this surgery is actually a advanced technique, that can have drastic complications if not done correctly, for example pulling on the cyst to hard can cause a hemorrhage to the brain.

3. Wang, Chao, Guoqiang Han, Chao Yuo, Chuangxi Liu, Jun Wang, and Yunbiao Xiong. "Individual Surgical Treatment of Intracranial Arachnoid Cyst in Pediatric Patients."Neurologyindia 61.4 (2013): 400-05. Academic Search Premier. Web. 27 Feb. 2014. Doctor Chao Wang and his affiliates, are neuro-physician for the Provincial Peoples hospital in China. These doctors were able to do a full surgical study on arachnid cysts found primarily in children. This particular study had 81 participants with a mean age of 9 and was published in neurologyindia.com as a resource to doctors . The arachnid cyst is filled with cerebrospinal fluid that pushes against the brain, resulting in extreme headaches epilepsy, gait disturbances, cognitive disturbances, focal deficits, weakness, and local or general enlargement of head (401). The only known cure to remove the arachnid cyst is through microsurgery that involves endoscopy; this article does not go in full depth of the surgical procedures. The follow up for the surgery was mainly successful with no casualties, and 84% having been cured of all symptoms,

and 16% that showed noticeable difference (403). The last paragraph of the article emphasizes the importance of microsurgery as it allows ease and accuracy for the doctors, while being minimally invasive for the patients. 4. Tripathy, Pradipta, and Yashbir Dewan. "Endoscopic-assisted Microscopic Decompression of Adenoid Cystic Carcinoma of Paranasal Sinus Extending to the Sella: A Case Report and Review of Literature." Neurology India 57.2 (2009): 197-99. Academic Search Premier. Web. 27 Feb. 2014. This particular article is a case study that was done by Doctors Pradipta Tripathy, and Yashbir Dewan, both of which are neurosurgeons for the Ludhiana Hospital located in Punjab, India. This article was published to neurologyindia.com in 2009. This case study is particularly important as the doctors were able to use microsurgery to remove a nasal tumor that was connected to the brain. The subject was a 28 year old male that suffered from random spontaneous nasal discharge, with his left side vision being very blurry. The subject finally told his general physician after 2 years of the symptoms. upon a MRI the doctors were able to find a cyst in the nasal cavity that had rooted itself into the pineal gland(paraseller region). The doctors than performed the microsurgery, with the help of endoscopy. first they decompressed the cyst by inserting a endoscope into the nasal cavity, this was followed by a incision to the cheekbone that fully removed the cyst, the doctors than did a biopsy on the cyst and found it to be cancerous. The surgery itself was successful, and the doctors followed up by stating that if the tumor had not been removed, it would have spread. The doctors made a important note stating that because of the endoscopic-microsurgery "they were able to remove for better differentiation of the tumor and normal pituitary tissue, which helps in the complete removal of its supra and

parasellar extension"(199) the endoscopy also allows "Complex maneuvering is made through the microscope, and the endoscope allows identication of inaccessible regions, which improves the outcome of the surgery."(198)

5. Gutierrez-Gonza Lez, R., A. Gil, C. Serna, and L. Lo Pez- Ibor. "Combined Staged Therapy of Complex Arteriovenous Malformations: Initial Experience." Acta Neurol Scandinavica. By Boto-g Rodriguez. 260-67. Academic Search Premier. Web. 3 Mar. 2014. This scholarly article was researched and done at the Department of Neurology in the University Hospital of Madrid, Spain. The doctors in this article wanted to see the outcome of patients that underwent microsurgery and embolization to help with supratentorial arteriovenous malformations(an abnormal connection between arteries and veins in the brain), . The research was done on thirteen different patients who all suffered from either brain hemorrhaging, seizures, headache, or all of the symptoms. Before surgery was attempted, the doctors used embolization a procedure that is a form of microsurgery; to block off blood flow to the malformation(s), doctors used this step to prevent post-hemorrhaging. After embolization, the doctors perform the surgery removing the malformation, but leave one vein behind to make sure there is no brain swelling, they use microclips to fasten the vein and watch for 5 minutes for abnormalities(262), once the final vein is removed the surgery is complete, and the patient is sedated for 18 hours and vital signs are watched. The results of this study was 100% cure rate(264).

6. Shao-wu, Ou, Jun Wang, Yun-jie Wang, Tao Jun, and Xin-guo Li. "Microsurgical Management of Cerebral Parenchymal Cysticercosis." Clinical Neurology & Neurosurgery. 114.4 (2012): 385-88. Web. Academic Search Premier. Web. 3 Mar. 2014. In this article, which was done by the China Medical University by doctors: Ou Shao-wu, Wang Jun, Wang Yun-jie, Tao Jun, Li Xin-guo. The doctors wanted to see how the alternative surgical method which used microsurgery did on patients that were diagnosed with cerebral parenchymal cysticercosis; a parasitic infection that affects the central nervous system, it is a direct result of a tapeworm larvae infestation. The research was done on 20 different patients, through the span of 1997 all the way to 2010, the article itself which composed of all these surgeries was finally published in 2011 to Elsevier.com. The patients consisted of 12 males, and 8 females with; average age of 42(385). Before surgery each patient was given a CT scanning that showed lesions as a result of the infection. The surgery than took place with two goals in mind: 1) removal of the parasite, and 2) removal of the cystic wall while not harming normal functioning brain tissue ( 387). The patients were then put into critical care units, followed by a second(post) CT scan to confirm removal of the cysticercosis (results showed lesions but of smaller diameters). The results of the surgery were profound, with no deaths related to the surgery and all symptoms improved. Patients however will have to do follow ups for the next 10 years as a result of the surgery. In the discussion part of this article it is noted that although microsurgery is an optional way to diagnose this disease, it is mentioned that patients with late-stage neurocysticercosis should undergo microsurgery (388).

7. Lazorthes, Y., J-C Sol, B. Sallerin, and J-C Verdie. "The Surgical Management of Spasticity."European Journal of Neurology (2002): 35-41. Web. Academic Search Premier. Web. 3 Mar. 2014. This academic article deals specifically with ways on how to deal with spasticity( abnormal tightness in the muscles) . This article was very detailed and through, and was done by three doctors (Dr. Lazorthes, Dr. Sol and Dr. Verdie) of the University of Paul Sabatier in Toulouse,France. The article was published to the European Journal of Neurology in 2002. The article starts with a historical background of neurosurgery and the massive progress that it has made to become what it is now. These doctors used a form of Microsurgery known as DREZotomy (dorsal root entry zone) to help relieve severe spasticity, this form of microsurgery is fairly new and was tested to compare against intrathecal baclofen(ITB) a form of surgery where a drug-pump is inserted into the spinal cord). The main difference between the two is that ITB is reversible( it is a pump that can be removed from the body) but HIGHLY conservative while DREZotomy is irreversible. To have participated in this study, candidates must go through a rigorous and clinical assessment to make sure the spasticity qualifies, as the DREZotomy surgery is irreversible(35). In this article, the breakdown of the surgerys is very complex as spasticity itself is generic and can include any muscle. The principle used in DREZotomy is however, straightforward; the doctors use anesthesia with drugs that are longlasting and block the motor neurons, this followed by micro-dissection with the nerves being stimulated until the right nerve is found(36), it is important to find the right nerve as cutting the wrong/too many of nerves can cause neurogenic pain. ITB however, did not have a breakdown

of how the surgery was done. The end results was that DREZotomy should be used when spasticity is extensive, and when all other treatments fail (including ITB).

8. Grunert, P., K. Darabi, J. Espinosa, and R. Filippi. "Computer-aided Navigation in Neurosurgery." Neurological Review 26.2 (2003): 73-99. Academic Search Premier. Web. 3 Mar. 2014. This scholarly article, unlike the other articles that are mentioned in this annotated bibliography, does not have to do with surgical procedures/diagnoses but rather the history and the making of the instruments that are used as navigation devices in todays neurosurgery. The article is composed of three different parts: 1st History, 2nd The math behind the navigation, and 3rd the applied usage of navigation in microsurgery. The Authors states that neurosurgery is based on the principle of intracranial localization, and therefore CT and MRI proved a critical point in the history of neurosurgery(74), CT scans paved the way for creating stereotactic and computer aided technology that proved extremely useful for the microsurgeries as they were able to correctly pinpoint the location of illness (74). The authors make constant references to Homers Epics such as the Odyssey and Iliad, The concept of robots preceded its technical realization by 2,700 years and was described by Homer in the18th chapter of the Iliad, when Thetis was visiting the god Hephaistos in Olympus to ask for new armor for her son Achilles (Grunert et al 75), the author does this to reinforce the idea that robotics has long been a part of history. The second part of the article emphasizes that the instruments used in microsurgery/neurosurgery are based on maps that are devised on mathematical formulas that are either one of the three: Fiducial-based paired-point transformation, Surface contour matching, Hybrid transformation (76). The authors emphasize the importance of mathematics, as accuracy and precision are both

critical in surgery. Finally, in the third part of the article the authors explain the significance of applied navigation in neurosurgery. Navigation can used to correctly locate tumors, skull based surgerys, endoscopic procedures to remove cysts, and spinal surgeries. The article ends with a conclusion stating microsurgery becomes even more powerful with the help of navigational devices, the article proves this with statistics that show less hospital time and operating time (91). We can already state that navigation reduces risksand hazards during operation and hinders neurosurgical interventions(93).

9. Cote, Matin, Ricky Kalra, Taylor Wilson, Richard R. Orlandi, and William Couldwell. "Surgical Fidelity: Comparing the Microscope and the Endoscope." Acta Neurochirurgica 155.12 (2013): 2299-003. Academic Search Premier. Web. 9 Mar. 2014. In this article, the authors compare two crucial instruments in microsurgery: the endoscope and microscope; both which are cameras that allow the surgeon to see in small and deep fields(2299). Like the article that was done on navigation, this article also highlights the importance of using some type navigation in small intricate surgical areas(neurosurgery) as the naked eye can only see so much (2299). The author used a test to measure the accuracy and precision of both instruments, and the participants of the test were Jr Neurological surgeons (nave to microsurgery) and two experiences surgeons (2300). The tests included: drawing a spiral, touch 10 dots, dotted line drawing, touch 10 dots in 3-D. The results concluded that new surgeons should use the microscope instrument as it gives a 3D visualization, and a wide view of the surgical area, but as the surgeons experience grows, eventually an endoscope will work in

his/her favor as the illumination of the camera is a very important advantage. The author also mentions eventually there may be a 3D endoscope that will merge the gap (2302).

10. Elsharkawy, Ahmed, Mika Niemel, Martin Leheka, Hana, Behnam Jahromi, Felix Geohre, Riku Kivissari, and Juha Hernesnieme. "Focused Opening of the Sylvian Fissure for Microsurgical Management of MCA Aneurysms." Acta Neurochirurgica 156.1 (2014): 17-25. Academic Search Premier. Web. 9 Mar. 2014. In this article, that was written by doctors(Elsharkawy et al) of the Helsinki Central Hospital in Finland. The doctors explain and show a step by step surgical procedure on how to open the Sylvain fissure through the contemporary microsurgery method for access to remove aneurysms. It is important to do this surgery right, as multiple surgeries or a failed attempt can lead to iatrogenic injury to the brain and neurovascular structures(17). The procedure that the authors mention is credited to Dr. Ahmed Elsharkawy who has done 1,097 aneurysm surgeries in the past 13 years (17). One special note about this article that differs from other surgical articles, is the subheading that deals with surgical planning, Dr.Elsharawy states An appropriate surgical plan is the key to minimize brain and vessel manipulation by discarding unnecessary intraoperative navigation and by selecting the most direct and safest approach for the MCA aneurysm. (18). In the surgical technique, the author makes use of detailed visual pictures as well as through written instructions, however the basic principles are (1) planning and accurate placement of the opening, (2) slack/relaxed brain to work on (3) High magnification from a microscope, and (4) complete understanding of the microanatomy of the clipping field(21). Another prominent and unique subheading found in this article is a troubleshooting guide incase the aneurysm ruptures, or if the surgical clips needed to hold the surgical field get entangled with

each other. The author concludes by stating that microsurgical management of aneurysms is much better than the classic macro opening of the Sylvain fissure, stating that The main advantage of this technique is minimizing the area of brain and vessel manipulation, while maintaining safety and efficacy of the procedure. (24).

11. Harati, Ali, Lydia Mahler, Romain Billon-Grand, Ahmed Elsharkawy, and Juha Hernesniemi. "Early Microsurgical Treatment for Spinal Hemangioblastomas Improves Outcome in Patients with Von Hippel-Lindau Disease." Surgical Neurology International(2012): 6. Academic Search Premier. Web. 11 Mar. 2014. This article is a case study done on a rare fatal-spinal tumor known as hemangioblastomas(HB), this tumor is often associated with von Hippel-Landau Disease(VNS)(6), a life-threatening inherited disease that causes outbreaks of both benign and malicious tumors in the CNS. The case study was performed to see the results of early surgery done on spinal tumors with patients diagnosed with von Hippel-Landau disease. In this case study 17 patients were chosen and underwent microsurgery at the Helsinki University hospital located in Finland. Although all 17 patient(s) surgeries were deemed successful and symptoms improved, 15 patients were not able to regain full function of their CNS, two however (patient 3 and 13, both male, gained full function of their bodies post-surgery). This case study is important for the development of both microsurgery and von Hippel-landau disease, because the author(s) note that, patients that were afflicted with VNS should not have their tumors operated on until it was deemed "necessary", but " Improvements in microsurgical techniques, including the addition of intraoperative ICG and temporary arterial occlusion, make complete tumor removal without neurological deterioration feasible. " (Harati et al 6). The authors also have a sub-section that deals with with

other operative techniques, and they state "microsurgical resection remains the gold standard for spinal HB"(Harati et al 6). A interesting fact that is also worth mentioning is that, Dr. Elsharkawy is present in this case study; he is the author of the article on surgical procedures on Sylvain Fissures.

12. Olabe, Jon, Javiar Olabe, and Javiar Rosa. "Microsurgical Cerebral Aneurysm Training Porcine Model." Microsurgical Cerebral Aneurysm Training Porcine Model. 59.1 (2011): 78-81. Academic Search Premier. Web. In this article that was published to Neurology India, a group of doctors create a repeatable cerebral aneurysm model to train on. According to the article the chief aim of this model is "create a life-like microsurgical aneurysm training system." (Olabe 78 et al). The authors state that this model is important because training of this technique is on the downfall but the complexity and technicality of this surgical procedure is demanding. The model is created of the basis of swine, in this article they used 10 different swine(1-2 months old) that were put down by potassium chloride, once the pigs are killed, the doctors are able to synthesize a authentic brain aneurysm by fusing two arteries and a vein with glue(79). With the 10 swine, 22 different aneurysms were created. The authors note that this these types of reproducible training models are especially important since "...training models will play an increasingly important role in the development of neurosurgical residents."(81), however, the authors also mention that this is no substitute for real microsurgical experience, but rather a supplement.

13. Huan Chih, Wang, Rachel J. Chang, and Furen Xiao. "Hypofractionated Stereotactic Radiotherapy for Large Arteriovenous Malformations." Surgical Neurology International 3.3 (2012): 105. Academic Search Premier. Web. 12 Mar. 2014. The researchers for this particular academic article are affiliated with the National Taiwan Universitiy department of neurology. The main purpose of the research done behind these studies was to see how patients with Cerebral arteriovenous malformations (AVMs) respond to two microsurgerical treatments. AVMs are classfied as abnormal fusions between arteries and viens, a rare mutation that happens only 1 in 100,000. AVMs were once thought to be inoperable but due to technological advances in microsurgery, hospitals are now able to treat them(Huan-Chih et al 105). The two methods that most doctors tend to agree on to operate on AVMs is Hypofractionated stereotactic radiotherapy (HST) or Single-fraction stereotactic radiosurgery(SRS). Since this mutation is random, AVMs can both be small or large, and are sized according to to Spetzler-Martin; small is less than 3cm,medium is 3-6cm, and large is greather than 6cm (Huan-chih et al 105). The doctors concluded that AVMs that are large/medium should be dealt with HST that will shrink the lesion and allow complete removal with microsurgery or even SRS, however this can result in complications such as hemorrhaging later on in life(due to large doses of radiotherapy), small AVMS should be dealt with SRS as this surgery has a 85-100% chance of obliteration (Huan-chich et al 105). This article did not have a breakdown of surgical techniques or a telling of how many patients were operated on.

14. Chen Li-Hua, Chen Ling, Liu Li-xu. Microsurgical management of tuberculum sellae meningiomas by the frontolateral approach: Surgical technique and visual outcome.Clinical Neurology and Neurosurgery:39-47. Academic Search Premier. Web. 12 Mar. 2014. This academic article is a breakdown of the surgical procedure of Tuberculum sellae meningiomas (TSMs) and its potential outcomes. TSM is a tumor that grows on the optic nerves and extends into both optic canals(39), because of the way that the tumor is positioned and structured it becomes a surgical challenge, and can cause visual impairment later on in life. The doctors in this study wanted to see the results of a surgical technique that utilizes microsurgery (38). This study was done on a total of 67 patients (39 female, and 28 male); average age of 49, who suffered from some type of symptom of TSM( blindness, visual disturbances, seizures). The surgery involved only the front of the skull, a small hole was drilled into the skull (the optic canal) where the tumor is located, once the tumor is located fore-grips are used to cauterize the tumor and most of the tumor is removed, however a small portion remains to watch for hemorrhaging(bleeding), it especially is important to watch for bleeding as excessive bleeding can cause permanent visual impairment. Finally, once doctors presume its safe the tumor is fully removed and pieces of bone wax are used to control the bleeding. The results of the surgery deemed successful, as no patients suffered from worsening of eyesight and 23 patients with improved vision (43). The doctors concluded that: We consider the frontolateral approach to be of great clinical value. This minimally invasive approach allows rapid access to the tumor and high rates of total tumor removal(46).

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8. http://linksource.ebsco.com.ezproxy.net.ucf.edu/FullText.aspx?linkout=http%3a%2f%2fezproxy. net.ucf.edu%2flogin%3furl%3dhttp%3a%2f%2flink.springer.com%2fopenurl.asp%3fgenre%3da rticle%26issn%3d0344-5607%26volume%3d26%26issue%3d2%26spage%3d73 9. http://web.b.ebscohost.com.ezproxy.net.ucf.edu/ehost/detail?vid=7&sid=578eb920-5ea64865-96550e87e6759a01%40sessionmgr113&hid=117&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db =aph&AN=91992934 10. http://web.b.ebscohost.com.ezproxy.net.ucf.edu/ehost/detail?vid=11&sid=578eb9205ea6-4865-96550e87e6759a01%40sessionmgr113&hid=117&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d% 3d#db=aph&AN=93392163

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