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Praveen V. Mummaneni

This video supplement of Neurosurgery Focus is devoted to minimally invasive spine surgery. Minimally invasive spine surgery has gained popularity amongst patients and physicians over the past decade because it has been shown in select instances to lower blood loss and reduce length of hospital stay for appropriately selected candidates.

This supplement includes videos from many of the leaders in the field. Pioneers like Frank LaMarca, Paul Park, Cheerag Upadhyaya, Juan Uribe, and Mike Wang have all sent in videos depicting minimally invasive spinal deformity surgery options. The supplement also includes videos from several different countries, demonstrating how widespread and nuanced minimally invasive spinal procedures have become. Drs. Barbagallo, Certo, Sciacca, and Albanese from Italy; Drs. Gragnaniello and Seex from Australia; and Drs. Liao, Wu, Huang, Wang, Chang, Cheng, and Shih from Taiwan have all sent in nuanced surgical videos that will be of interest to many viewers.

I personally enjoyed viewing videos on lumbar degenerative disease surgery depicting unique surgical nuances to treat common problems. Dr. Beejal Amin, Dr. Harel Deutsch, Dr. Daniel Lu, and Dr. Adam Kanter have each submitted videos depicting lumbar decompression and/or fusion for lumbar degenerative stenosis and spondylosis.

This supplement also included videos depicting the minimally invasive treatment of uncommon spinal pathologies as well. Videos from Dr. Fred Geisler, Dr. John O'Toole, and Dr. Noel Perin covered topics as varied as sacroiliac joint dysfunction, spinal arteriovenous malformations, and sympathetic chain surgery.

I hope that you enjoy this issue of Neurosurgical Focus devoted to videos depicting the surgical nuances of minimally invasive spinal surgery. This video supplement has international appeal, and it has been an honor to be a guest editor on this superb supplement.

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Gene H. Barnett, Andrew E. Sloan and Claudio E. Tatsui

Laser ablation (also known as laser interstitial thermal therapy [LITT]) has emerged as an important new technology for treating various disorders of the brain and spine. As with any new or emerging technology, there is a learning curve for its optimal use, and video tutorials can be important learning tools to help bridge gaps in knowledge for those who wish to become more familiar with laser ablation. In this special supplement to Neurosurgical Focus, videos illustrate laser ablation’s use in the treatment of epilepsy and failed radiosurgery, as well as technical aspects of performing these procedures in eloquent brain and in the spine. We hope that these videos will enable you to enhance your understanding of the evolving use of laser ablation for disorders of the brain or spine. It is the editors’ sincere hope that this will be helpful either in your own practice or in determining whether to refer to a neurosurgical colleague experienced in this field.

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Robert M. Starke, Felipe C. Albuquerque and Michael T. Lawton

It is with great pleasure that we present this Neurosurgical Focus video supplement on supratentorial cerebral arteriovenous malformations (AVMs). We were privileged to view a remarkable number of outstanding videos demonstrating current state-of-the-art management of brain AVMs using endovascular and microsurgical modalities. Careful and critical review was required to narrow down the submitted videos to a workable volume for this supplement, which reflects the excellent work being done at multiple centers with these lesions.

This issue consists of videos that represent modern microsurgical and neuroendovascular techniques for the treatment of supratentorial cerebral AVMs. The videos demonstrate cutting-edge therapies as well as standard ones, which will be valuable to both novice and expert neurointerventionists and neurosurgeons. We are honored to be involved with this project and proud of its content and expert authors. We believe you will enjoy the video content of this supplement and hope that it will raise the collective expertise of our community of AVM surgeons.

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Johnny Delashaw and Marc Mayberg

It is with great pleasure and pride we submit this Neurosurgical Focus video supplement on surgical approaches to the CPA angle. We had the privilege of viewing a multitude of videos describing surgical pathology and technique for lesions within the cerebellar pontine angle. The quality of work was outstanding! Hours of review were required to narrow down the videos for this supplement. This issue consists of 23 videos that we feel offer unique surgical pearls to the viewer in clinical evaluation, surgical planning and surgery, and outcomes. The videos are of different clinical problems and offer education for both the novice and expert skull base surgeon. We enjoyed being a part of this project, and feel very proud of its content and authors. We are confident that you will enjoy this supplement.

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Ehab El Refaee, Marc Matthes and Henry W. S. Schroeder

We present the microsurgical technique in excision of intramedullary craniocervical ependymomas. A 27-year-old female came presenting with neck pain and parasthesia in her both arms and hands, where MRI was performed showing intramedullary lesion that extend in the medulla just beyond the foramen magnum to the level of C5–6 disc. Tumor was totally excised using irrigation-dissection microscopic technique with favorable outcome.

The video can be found here: http://youtu.be/Yj1yvZOaz58.

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James K. Liu and Robert W. Jyung

Large acoustic neuromas, greater than 3 cm, can be technically challenging tumors to remove because of their intimate relationship with the brainstem and surrounding cranial nerves. Successful tumor resection involves functional preservation of the facial nerve and neurovascular structures. The translabyrinthine approach is useful for surgical resection of acoustic neuromas of various sizes in patients with poor preoperative hearing. The presigmoid surgical corridor allows direct exposure of the tumor in the cerebellopontine angle without any fixed cerebellar retraction. Early identification of the facial nerve at the fundus facilitates facial nerve preservation. Large acoustic tumors can be readily removed with a retractorless translabyrinthine approach using dynamic mobilization of the sigmoid sinus. In this operative video atlas report, the authors demonstrate their operative nuances for resection of a large acoustic neuroma via a translabyrinthine approach using a retractorless technique. Facial nerve preservation is achieved by maintaining a plane of dissection between the tumor capsule and the tumor arachnoid so that a layer of arachnoid protects the blood supply to the facial nerve. Multilayered closure is achieved with a fascial sling technique in which an autologous fascia lata graft is sutured to the dural defect to suspend the fat graft in the mastoidectomy defect. We describe the step-by-step technique and illustrate the operative nuances and surgical pearls to safely and efficiently perform the retractorless translabyrinthine approach, tumor resection, facial nerve preservation, and multi-layered reconstruction of the skull base dural defect to prevent postoperative cerebrospinal fluid leakage.

The video can be found here: http://youtu.be/ros98UxqVMw.

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Tyler S. Cole, Sirin Gandhi, Justin R. Mascitelli, Douglas Hardesty, Claudio Cavallo and Michael T. Lawton

Venous interruption through surgical clip ligation is the gold standard treatment for ethmoidal dural arteriovenous fistula (e-dAVF). Their malignant natural history is attributable to the higher predilection for retrograde cortical venous drainage. This video illustrates an e-dAVF in a 70-year-old man with progressive tinnitus and headache. Angiogram revealed bilateral e-dAVFs (Borden III–Cognard III) with one fistula draining into cavernous sinus and another to the sagittal sinus. A bifrontal craniotomy was utilized for venous interruption of both e-dAVFs. Postoperative angiography confirmed curative obliteration with no postoperative anosmia. Bilateral e-dAVFs are rare but can be safely treated simultaneously through a single craniotomy.

The video can be found here: https://youtu.be/666edwKHGKc.

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Jonathan A. Forbes, Matthew L. Carlson, Saniya S. Godil, Marc L. Bennett, George B. Wanna and Kyle D. Weaver

In this publication, video format is utilized to review the operative technique of retrosigmoid craniotomy for resection of acoustic neuroma with attempted hearing preservation. Steps of the operative procedure are reviewed and salient principles and technical nuances useful in minimizing complications and maximizing efficacy are discussed.

The video can be found here: http://youtu.be/PBE5rQ7B0Ls.

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James K. Liu

Intramedullary spinal cord cavernous malformations account for approximately 5% of all intraspinal lesions. These lesions can present with either acute neurological compromise secondary to hemorrhage inside the spinal cord, or with chronic progressive myelopathy due to repeated microhemorrhages. Surgical resection of spinal cord cavernous malformations remains the definitive treatment strategy for symptomatic lesions. Because of the intimate relationship with surrounding eloquent neural tissue, these lesions can be technically challenging to remove with a significant risk for morbidity. In this operative video, the author demonstrates an illustrative step-by-step technique for microsurgical resection of a large intramedullary spinal cord cavernous malformation at C4–5 causing progressive myelopathy. Complete resection was achieved without neurologic compromise. The operative technique and surgical nuances, including the surgical approach, intradural cavernoma removal, and spinal stabilization are illustrated.

The video can be found here: http://youtu.be/3FUjGSyrKO0.

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Kheng Hin Lee and Peter Y. K. Hwang

S ympathectomy for palmar hyperhidrosis had been performed by a variety of methods, including open surgery via the posterior, 4, 9, 11, 23 cervical, 1, 3, 5, 20 and transaxillary approaches, 10, 20, 25 as well as by percutaneous radiofrequency coagulation 7, 28, 29 and nonvideo-assisted endoscopic techniques. 6, 15, 17, 18, 21, 27 In recent years, video-assisted endoscopic sympathectomy has emerged as a simple and effective way to treat palmar hyperhidrosis. 13, 22 We report our experience in 82 patients in whom we performed 164 sympathectomies, using