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Pankaj A. Gore, Peter Nakaji, Vivek Deshmukh and Harold L. Rekate

essential in performing this disconnection. Using standard endoscopic biopsy forceps, the volume of tissue that can be resected with each grasping action is limited. Resecting large lesions in this manner is extremely tedious. The Suros device can be used to resect and aspirate tissue rapidly in a very controlled manner while applying little traction to adjacent tissue. The Suros device is especially ideal when applied to avascular lesions such as hypothalamic hamartomas. 6 By intersecting the endoscopic and microsurgical operative trajectories in Case 3, complete

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Michael A. Mooney, Aqib H. Zehri, Joseph F. Georges and Peter Nakaji

brain neoplasms at the cellular level can be gathered in the operating room. In this review, we provide a background on intraoperative confocal devices and fluorophore technology, describe the application of this technology in both animal models and human studies, and discuss the future directions and potential applications of confocal endomicroscopy in neurosurgery. Technical Considerations: Confocal Endoscopes and Fluorophores Laser scanning confocal microscopy (LSCM) is an optical fluorescence imaging modality used for imaging thick in vivo and ex vivo

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Aristotelis S. Filippidis, M. Yashar S. Kalani, Peter Nakaji and Harold L. Rekate

the CSF leak that was presumed to be the cause of his pseudomeningocele. Thereafter, the patient underwent a shunt revision to a programmable ventriculoatrial shunt at 30 mm H 2 O without an antisiphon device. He recovered well. According to the charts, the last follow-up was 2 months after the last intervention. At this time point the patient was readmitted due to a shunt infection without any indications of previous episodes of negative-pressure hydrocephalus or headaches. Case 2 This 67-year-old man had a history of a vermian cavernous malformation

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L. Fernando Gonzalez, Dixie L. Patterson, Gregory P. Lekovic, Peter Nakaji and Robert F. Spetzler


The radial artery is a common conduit used for high-flow bypasses. Until now the radial artery has been harvested using a long incision in the forearm that follows the course of the artery. The authors present an endoscopic technique that has been used during coronary bypass surgery but is not yet widespread in the neurosurgical arena.


From October 2006 to October 2007, the authors used the radial artery as a graft in 6 patients during the treatment of complex cerebral aneurysms. The artery was harvested via an endoscopic technique.

The radial artery was exposed distally at the wrist. Using the VasoView vessel harvesting system, the endoscope was inserted into the arm. The radial artery was dissected from its surrounding tissues endoscopically. With direct current energy via the HemoPro device, the side branches were coagulated and cut. The artery was transected at the wrist, then retrieved through a counterincision at the proximal forearm.


There were no neurological or bleeding complications in the hand or forearm.


Endoscopic harvesting of the radial artery is feasible, faster, and produces a more aesthetically pleasing result than standard open harvesting. The learning curve associated with the endoscope can be overcome by practice on cadavers and by collaboration with a cardiac surgical team.

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Timothy Uschold, Adib A. Abla, David Fusco, Ruth E. Bristol and Peter Nakaji

instrumentation and continued miniaturization are likely to support additional advances. 14 Conclusions The current series supports the contention that the endoscopically controlled SCIT approach is a safe, feasible, and effective alternative for the fenestration and/or resection of symptomatic pineal cysts, as well as appropriately selected solid tumors of the pineal region. Disclosure Dr. Bristol owns stock in Advanced Medical Devices, and she is a consultant for ev3, Inc. Dr. Nakaji serves as a consultant for Aesculap USA. Drs. Uschold, Abla, and Fusco report no

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Sam Safavi-Abbasi, Hai Sun, Mark E. Oppenlander, Peter Nakaji, M. Yashar S. Kalani, Joseph M. Zabramski and Robert F. Spetzler

Intraoperative rupture of an intracranial aneurysm is a potentially devastating but controllable complication. The authors have successfully used the previously described cotton-clip technique to repair tears at the necks of aneurysms. A tear on the neck of the aneurysm is covered with a piece of cotton and held in place with a suction device. The cotton is then clipped onto the tear with an aneurysm clip, using the cotton as a bolster. This simple, effective method has been useful in repairing a partial avulsion of the neck of an aneurysm.,

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M. Yashar S. Kalani, John E. Wanebo, Nikolay L. Martirosyan, Peter Nakaji, Joseph M. Zabramski and Robert F. Spetzler

bipolar forceps and suction devices ( Fig. 2 ). FIG. 1. The “keyhole” concept and tailored minimally invasive skull base approaches. The keyhole concept is based on the premise that minimizing trauma to structures in the operative path of the surgeon facilitates performance of a safe and effective operation. However, the association of the keyhole concept with small craniotomies is a misconception. A keyhole approach provides the smallest, most meticulous opening necessary to perform an operation. A: Artist's illustration showing examples of keyhole approaches. A

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R. Loch Macdonald

, Nakagawa K , Naravetla B , Moheet AM , : Accuracy of neurovascular fellows' prognostication of outcome after subarachnoid hemorrhage . Stroke 43 : 702 – 707 , 2012 9 Stroke CDE Working Group : Stroke CDE Instrument Recommendations by Outcome Domain and Classification NINDS Common Data Elements 2013 10 US Food and Drug Administration : Guidance for Industry and FDA Staff—Pre-Clinical and Clinical Studies for Neurothrombectomy Devices ( ) [Accessed April 25

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Michael A. Mooney, Elias D. Simon, Scott Brigeman, Peter Nakaji, Joseph M. Zabramski, Michael T. Lawton and Robert F. Spetzler

O , Henkes H , Aguilar Pérez M : Flow diversion for the treatment of MCA bifurcation aneurysms—a single centre experience . Front Neurol 8 : 20 , 2017 28210239 10.3389/fneur.2017.00020 3 Briganti F , Leone G , Cirillo L , de Divitiis O , Solari D , Cappabianca P : Postprocedural, midterm, and long-term results of cerebral aneurysms treated with flow-diverter devices: 7-year experience at a single center . Neurosurg Focus 42 ( 6 ): E3 , 2017 10.3171/2017.3.FOCUS1732 4 Cho YD , Lee WJ , Kim KM , Kang HS , Kim JE , Han

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Francisco A. Ponce, Robert F. Spetzler, Patrick P. Han, Scott D. Wait, Brendan D. Killory, Peter Nakaji and Joseph M. Zabramski

clinical trial . J Neurosurg 89 : 81 – 86 , 1998 8 Fiorella D , Kelly ME , Albuquerque FC , Nelson PK : Curative reconstruction of a giant midbasilar trunk aneurysm with the pipeline embolization device . Neurosurgery 64 : 212 – 217 , 2009 9 Gonski A , Acedillo AT , Stacey RB : Profound hypothermia in the treatment of intracranial aneurysms . Aust N Z J Surg 56 : 639 – 643 , 1986 10 Groff MW , Adams DC , Kahn RA , Kumbar UM , Yang BY , Bederson JB : Adenosine-induced transient asystole for management of a basilar