Search Results

You are looking at 1 - 10 of 47 items for

  • Author or Editor: Joseph Maroon x
Clear All Modify Search
Full access

Joseph C. Maroon

The author outlines the history of skull base surgery and describes the new paradigm emerging with increasing use of endoscopic microneurosurgery.

Restricted access

Surgical approaches to the orbit

Indications and techniques

Joseph C. Maroon and John S. Kennerdell

✓ The authors review their experience with over 300 patients with orbital tumors, and summarize their surgical techniques and indications for each surgical approach. A fronto-orbital approach is described which is used for tumors with intracranial extension and for those located in the orbital apex and deep medial orbital compartment. Lateral micro-orbitotomy is used for tumors located in the superior, temporal, or inferior compartment of the orbit and those in the lateral apex. A medial microsurgical approach is used for tumors located medial to the optic nerve but not deep in the apex. By thus approaching tumors directly, optimal exposure is obtained and functional deficits are minimized. The pertinent surgical anatomy is illustrated and the technique of fine-needle aspiration biopsy is discussed.

Restricted access

Joseph C. Maroon and John S. Kennerdell

✓ A surgical technique is described for radical decompression of the orbit for dysthyroid exophthalmopathy. The operation should be considered in a patient with proptosis greater than 30 mm bilaterally or one with unilateral proptosis of 10 mm or more greater than the opposite eye. Such exophthalmos is frequently associated with corneal exposure and ulceration, extreme cosmetic disfigurement, and optic neuropathy. The surgical procedure is performed through a 35-mm lateral skin incision and a lateral canthotomy with subconjunctival dissection. All four walls of the orbit are partially removed. This panorbital decompression procedure has been performed on five patients, with reduction of preoperative proptosis by as much as 17 mm. Complications were minimal. A review of the effectiveness of other orbital decompressive procedures is presented. It appears that the four-wall decompressive procedure offers the maximum degree of orbital reduction.

Restricted access

Joseph C. Maroon and Gary Onik

✓ A new technique for percutaneous lumbar disc removal is described. The specially designed 2-mm blunt-tipped suction/cutting probe (nucleotome) is similar to the automated vitrectomy instrumentation used by ophthalmic surgeons. The procedure is performed under local anesthesia, with the patient in the prone position and with fluoroscopic guidance. The nucleotome is inserted into the appropriate disc space with specially designed instrumentation, guided by landmarks similar to those used in needle placement for chemonucleolysis.

The technique has been evaluated in 20 patients with herniated discs (one at the L3-4 level and 19 at the L4-5 level) confirmed by myelography and/or computerized tomography scans after all conservative therapy for primarily radicular pain had failed. From 1 to 7 gm of disc material was removed in an average total operative time of approximately 1 hour. Eighty percent of the patients had good to excellent results in a short-term follow-up period of 6 months. Four patients subsequently required standard surgical excision of free disc fragments. No significant complications occurred. The procedure is contraindicated in patients with extruded or free fragments of disc in the spinal canal or in patients with herniations at the L5-S1 level pending development of additional instrumentation for insertion at that level. More extensive long-term studies are needed to further evaluate this procedure.

Restricted access

Joseph C. Maroon and John S. Kennerdell

✓ The authors describe their microsurgical lateral orbital approach to intraorbital tumors. In seven patients ultrasonic scanning, computerized axial tomography, polytomography, orbital venography, and arteriography have allowed precise intraorbital tumor localization relative to the optic nerve. The authors believe that circumscribed tumors superior, lateral, or inferior to the optic nerve can be safely and completely removed through a 30–35-mm lateral skin incision with microsurgical dissecting techniques. A combined neurosurgical-ophthalmological team approach is emphasized.

Restricted access

Stephen J. Haines, Joseph C. Maroon and Peter J. Jannetta

✓ Five cases of supratentorial intracerebral hemorrhage following posterior fossa surgery are reported. Possible etiologies are discussed, but in only one case can a definite etiology (hypertension) be found. The differential diagnosis of declining level of consciousness after posterior fossa surgery must include supratentorial intracerebral hemorrhage, and computerized tomography seems to be the diagnostic method of choice.

Full access

Introduction

Sports-related neurosurgical injuries

Julian Bailes, Joseph Maroon and Shenandoah Robinson

Restricted access

Joseph C. Maroon and R. M. Peardon Donaghy

✓ Autogenous saphenous arterial or venous grafts were anastomosed between the commond carotid and the middle cerebral artery in 14 dogs with the aid of microsuturing techniques and a new type of microtourniquet. Four of the six saphenous artery grafts were patent when studied angiographically 4 to 70 days postoperatively. Three of the eight venous grafts were patent when studied 1, 3, and 18 days following surgery. The patency rate with arterial grafts was better than that with venous grafts because of the ease of handling due to the thicker wall, the reduced tendency toward redundancy and kinking, and the better graft-to-host-artery ratio. Obvious technical factors were found that accounted for all graft failures. Faulty suture placement; failure to remove an elliptical segment of the host artery; twisting, angulation and kinking of vein grafts; intimal flaps or adventitia caught in the suture line; and cerebral laceration and subsequent infarction were all causes of failure. Successful cerebral revascularization occurred only when these technical factors were surmounted and a satisfactory graft-to-host-artery ratio obtained.

Restricted access

Jack McCallum, Joseph C. Maroon and Peter J. Jannetta

✓ The authors report the details of the successful treatment of 11 of 12 patients with postoperative cerebrospinal fluid fistulas. Continuous lumbar or ventricular fluid drainage was used.