Search Results

You are looking at 1 - 10 of 24 items for

  • Author or Editor: Omar Choudhri x
  • All content x
Clear All Modify Search
Free access

Omar Choudhri and Michael T. Lawton

The middle tentorial incisural space, located lateral to the midbrain and medial to the temporal lobe, contains the ambient cistern through which courses the third, fourth, and fifth cranial nerves, posterior cerebral artery (PCA), superior cerebellar artery, and the choroidal arteries. Arteriovenous malformations (AVMs) in this compartment are supplied by the thalamogeniculate and posterior temporal branches of the PCA, and drain into tributaries of the basal vein of Rosenthal. We present a case of an AVM in this middle tentorial incisural space that persisted after embolization and radiosurgery, and was microsurgically resected through a subtemporal approach. This case demonstrates the anatomy of the middle incisural space and technical aspects in microsurgical resection of these rare AVMs.

The video can be found here: https://youtu.be/V-dIWh8ys3E.

Free access

Omar Choudhri and Steven D. Chang

Craniopharyngiomas are benign, partly cystic epithelial tumors that can rarely occur in a retrochiasmatic location with involvement of the third ventricle. The lamina terminalis is an important neurosurgical corridor to these craniopharyngiomas in the anterior portion of the third ventricle. We present a video case of a large midline suprasellar and third ventricular craniopharyngioma in a 32-year-old male with visual disturbances. The tumor was approached with a subfrontal translamina terminalis exposure, and a gross-total resection of the tumor was achieved. This surgery involved working through a lamina terminalis fenestration around the optic nerve, optic chiasm, optic tracts, and the anterior communicating artery complex. This video illustrates the techniques employed in performing a transbasal anterior skull base approach to the third ventricle and demonstrates vivid surgical anatomy of neurovascular structures around the lamina terminalis.

The video can be found here: https://youtu.be/fCYMgx8SnKs.

Free access

Omar Choudhri and Michael P. Marks

Tentorial dural arteriovenous fistulae are rare intracranial fistulae, in which the fistula pocket is present within the leaves of tentorium cerebelli. These tentorial fistulae can be rarely present near the galenic complex, where they can engorge the deep venous system and cause symptoms of venous hypertension. We present an interesting case of endovascular treatment of a galenic tentorial dural arteriovenous fistula in a patient with headaches and imbalance. The fistula was accessed through the artery of Davidoff and Schecter from the posterior cerebral artery supplying the fistula. The fistula was completely embolized using Onyx and with preservation of vein of Galen.

The video can be found here: http://youtu.be/igX2X5tfvrg.

Free access

Omar Choudhri and Gary K. Steinberg

Tentorial dural arteriovenous fistulae (TDAVFs) are complex lesions with the arteriovenous fistula located between the leaves of the tentorium cerebelli. While a large portion of dural arteriovenous fistulae are treated endovascularly, TDAVF may require additional microsurgical treatment given their high risk of hemorrhage and multitude of feeders. We describe the case of a 65-year-old male who presented with hemorrhage from a straight sinus and galenic TDAVF. The straight sinus portion of the fistula was obliterated by 3 endovascular treatments and 1 microsurgical treatment. The galenic component of the TDAVF persisted and was approached via a posterior interhemispheric approach in a lateral position. This video demonstrates surgical technique and anatomy associated with this rarely seen dural arteriovenous fistula.

The video can be found here: https://youtu.be/iOLzWOabLZ0.

Free access

Omar Choudhri and Steven D. Chang

Pinealoblastomas are WHO grade IV tumors of the pineal region and comprise up to 50% of all pineal parenchymal tumors. They are highly aggressive tumors that spread along the craniospinal axis and are most commonly seen in children. The standard of care involves maximal surgical resection and chemoradiation following tissue diagnosis. We present the rare case of a large pinealoblastoma in an 18-year-old girl who presented with headaches and Parinaud's syndrome from tectal compression. An attempt was made at endoscopic transventricular biopsy of the tumor at an outside hospital, but it was aborted given bleeding at the biopsy site. We performed a supracerebellar infratentorial approach in a sitting position to achieve a gross-total resection of the tumor. This video case illustrates techniques for setting up a sitting craniotomy and approaching a previously biopsied hemorrhagic pinealoblastoma. The venous conglomerate at the tentorial incisura was found to be enveloped by the tumor and a thickened arachnoid scar. Surgical anatomy of the third ventricle and the pineal region is illustrated in this case through the process of surgical dissection and tumor resection.

The video can be found here: https://youtu.be/CzB0lFQ7AyI.

Free access

Gregory Glauser, Tracy M. Flanders, and Omar Choudhri

This video is a presentation of technical tenets for the microsurgical clipping of a tentorial dural arteriovenous fistula presenting with thalamic venous hypertension. These cases are easily misdiagnosed and often supplied by the tentorial artery of Davidoff and Schecter. The cases shown in the video uniquely illustrate a supracerebellar infratentorial approach to identify and clip an arterialized tentorial vein utilizing intraoperative Doppler and fluorescein, with navigation and an intraoperative cerebral angiogram in a hybrid neuroangiography operative suite. Both patients were found to have thalamic edema on preoperative imaging, which significantly improved postoperatively.

The video can be found here: https://youtu.be/HmUO6Ye53QI.

Full access

Stanley Hoang, Omar Choudhri, Michael Edwards, and Raphael Guzman

A vein of Galen malformation is a rare intracranial vascular lesion affecting the pediatric population. Its poor prognosis has been significantly improved with the development of endovascular embolization. In this paper the authors review the developmental mechanisms, clinical pathophysiology, and the available data on the management and outcome of the disease.

Free access

Omar Choudhri, Jeremy Heit, and Huy M. Do

Traumatic dissecting pseudoaneurysms of the cervical and petrous internal carotid artery are often a result of blunt or penetrating trauma. These patients are at high risk for thromboembolic complications and are managed with antiplatelet agents. Patients who develop neurologic symptoms while on antiplatelet agents, or have interval enlargement of their pseudoaneurysms, may require repair of the vessel. We describe a case in which we performed an endovascular repair of an enlarging distal cervical internal carotid artery pseudoaneurysm, with placement of a covered stent.

The video can be found here: http://youtu.be/uCypcsBvOZ4.

Free access

Aatman Shah, Omar Choudhri, Henry Jung, and Gordon Li

In this review paper the authors analyze new therapeutic options for the embolization of meningiomas, as well as the future of meningioma treatment through recent relevant cohorts and articles. They investigate various embolic materials, types of meningiomas amenable to embolization, imaging techniques, and potential imaging biomarkers that could aid in the delivery of embolic materials. They also analyze perfusion status, complications, and new technical aspects of endovascular preoperative embolization of meningiomas. A literature search was performed in PubMed using the terms “meningioma” and “embolization” to investigate recent therapeutic options involving embolization in the treatment of meningioma. The authors looked at various cohorts, complications, materials, and timings of meningioma treatment. Liquid embolic materials are preferable to particle agents because particle embolization carries a higher risk of hemorrhage. Liquid agents maximize the effect of devascularization because of deeper penetration into the trunk and distal tumor vessels. The 3 main imaging techniques, MRI, CT, and angiography, can all be used in a complementary fashion to aid in analyzing and treating meningiomas. Intraarterial perfusion MRI and a new imaging modality for identifying biomarkers, susceptibility-weighted principles of echo shifting with a train of observations (SW-PRESTO), can relay information about perfusion status and degrees of ischemia in embolized meningiomas, and they could be very useful in the realm of therapeutics with embolic material delivery. Direct puncture is yet another therapeutic technique that would allow for more accurate embolization and less blood loss during resection.