SUMMARY: Dr. Abdul Hadi Al-Khalili, who is an honored and highly recognized neurosurgeon. in the Middle East and around the world is interviewed by Dr. Ausman. Dr. Al Khalili describes his 50-year career in coming from a 6-generation family of Iraqi Medicine physicians overcoming multiple obstacles along the way, to graduating medical school in Baghdad, learning ophthalmology in the UK changing to neurosurgery, attaining a Master’s Degree in Philosophy. He received more experience and training in centers throughout the world with leaders in Germany, Canada, Switzerland, and US. He returned to Iraq and established many innovative programs, the only orbital surgery center at the time, and trained many leading neurosurgeons in Iraq practicing today. Because of his leadership successes which were threatening to others, he was abducted and ransomed and left Iraq for the USA where he continues to work to help his country. He is a Role Model for everyman and physicians in his determination to succeed and his accomplishments. His success is rooted in a moral Muslim background and a desire to provide compassionate care for his patients. This interview is profound and should be watched or heard by all in its entirety to the end for its message for life, which is meaningful to all. 60 minutes plus Introduction and Close. (JIA)

SUMMARY: Dr. Gary Steinberg describes how he treats deep brainstem cavernous malformations with Drs.Eric Nussbaum and James Ausman as Co-Discussants. Dr. Steinberg presents a series of cases of brainstem cavernous malformations that are in deep locations, which were formerly untreatable. Using meticulous surgical technique and detailed preplanning with MR imaging and tractography, and after choosing a neuro-navigation pathway, he approaches these lesions through a 3 mm incision in the brainstem to reach the lesion. Using a unique needle shaped laser which coagulates small vessels, he removes these lesions. Patients may awake with some deficits related to the location but improve rapidly so that he obtains good clinical results.

He then discusses how he removes AVMs in sensitive locations using intra-operative stimulation to locate the white matter tracts.

He discusses his views on the future of neurosurgery groups as interdisciplinary and multi-specialty including basic to clinical scientists and how these teams will help recovery of neurological function. A very stimulating and interesting discussion among the three neurosurgeons. Good for Video but the images should be seen if Podcast are chosen. 57 minutes. (JIA)

SUMMARY From the SubSaharan African Ground Rounds,  Dr. Al-hassan Dasana Andani, a resident neurosurgeon in the Greater Accra Regional Hospital in Accra, Ghana, makes a wonderful presentation of a challenging case they saw in their Department of Neurosurgery of a patient with a multi-cystic thalamic mass in a deteriorating young patient. What should be done. Dr. Andani reviews the details of the presentation, laboratory values and imaging on this patient. He also reviews the literature on the management of these difficult lesions. What should be done In Africa with economic limitations and in countries that are have more resources. Does any of that matter?  He descirbes the surgical approaches for the anatomy of the thalamic region. And there is an extensive interesting discussion by member of the international audience about what should be done. The Discussion is very informative and covers the history of the treatment of these types of lesions. You will hear the answer at the end of the discussion about the pathology. What would you do with this clinical problem?  Can better results be obtained with more resources?  An outstanding prevention and case discussion from our colleagues in Ghana.  

This video is about pure endoscopic microvascular decompression of trigeminal nerve.

Short attacks of lancinating electric like pain, triggers and evidence of neurovascular conflict in MRA imaging constitute basics for MVD indication.

Endoscope enables close, side and angled view and enhances identification of neurovascular conflict.

The patient is operated on in supine position, the head rotated to the contralateral side and slightly elevated. The endoscope was held by an assistant.

The 12-15 mm burrhole is drilled with a diamond ball exactly in the corner between transversus and sigmoid sinus. The blue lines at superior and lateral margins in the hole should be visible when dura is exposed. Two small triangular flaps are flipped up and lateral to expose cerebellar cortex in the angle between Transversus and Sigmoid sinus. With the use of cottonoid strip, the the cerebellum is gently pushed down and medially, exposing tentorium up and the corner between tentorium and posterior pyramidal wall. Once CSF is released, everything becomes easier and more spacious. Normal anatomy is then presented: internal auditory canal with seventh and eight nerve (and labyrinthine artery), sixth nerve entering Dorello’s canal, the petrous vein, trigeminal nerve from brainstem to the dural entrance (ostium) into cavum Meckeli. The fourth nerve floats along the tentorial margin. The axilla of the trigeminal nerve is explored first from inferior and superior aspect for any arterial, venous or arachnoid band contact with the nerve.  The whole length of the nerve should be checked.

In this case, the conflict was found in the superior aspect of the nerve in a form of two parallel arteries, most probably from superior cerebellar artery. These were relocated and secured in new position away from the nerve  with Tachosil and Teflon patch (not shown in this video).  

Enjoy the anatomy.

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You may also see Neurosurgery: Trigeminal neuralgia - endoscope-assisted microvascular decompression - Dr. Bosnjak (April 2013)

SUMMARY: Dr. Russell Blaylock provides a short update in Autism Spectrum. Disorders, a disease now commonly seen in young children with no previous known causes. Robert F. Kennedy, Jr , Secretary of Health and Human Services has made a priority of solving this disease that affects 1/12 young children. Dr. Blaylock has studied this disease for over 20 years because of his interest in the biochemical basis of human disease. He proposed in multiple publications and on SNI Digital® Investigative Reports that the disease is a result of the over reaction of he "primed microglia" in the CNS to toxins and trauma, producing a degeneration of the CNS Neurons after repeated injuries, similar to the Parkinson's disease found in football and boxing sports. He named the process as "Immuno- Excito-Toxicity" reported recently in SNI Digital®. Recently, Tylenol has been implicated as a toxic agent for this disease. Immuno-excito-toxicity is a fundamental factor in the production of CNS Degernative diseases as Alzhemirer's, ALS, Parkinsons and MS as reported by Dr. Blaylock. For Video and Podcast. 24 minutes.

 SUMMARY: Dr. Juan Bosco Gonzalez Torres from Guatemala describes his experience with a subset of craniopharyngeomas that are intrventricular. He uses an endoscope to reach the lesion through the Foramen of Monro and removes the easily resectable portion the tumor. Some he could remove completely but others were calcified and he left some of those portions. His patients did well. What this shows is another route to the removal or partial removal of these very complex tumors which can be very difficult to remove completely. For me, craniopharyngeoma  is a "sucker's tumor", which makes the surgeon think it can be removed and that is when complications occur, as it invades the surrounding tissues. Quality of life vs extent of surgical resection is the challenge for the neurosurgeon.  There is a recent paper in the NEngJMed 2023 389:118-126 (DOI:m10.1056/NEJMoa2213329) which describes the molecular, biochemical success in the experimental treatment of papillary craniopharyngeomas that provides hope for the future. (JIA)

How would you like to have surgery and lose your hearing or vision as a result? Not good. How does that happen? Dr. Nancy Epstein describes how these complications can happen with the solutions used in preparing the patient for surgery. They act while you are doing surgery and the patients wake up blind or deaf. Chlorhexidine Gluconate (CHG), Hibiclens, and Chloraprep (i.e. CHG-based solutions) are often used as skin preparations near the face/eyes/spine (i.e., particularly anterior/posterior cervical procedures). However, if these solutions come in contact with the eyes, corneal irritation, abrasions, and even blindness may result. Alternatively, PI non-detergent solutions demonstrate safety/minimal oculotoxicity/ototoxicity, while frequently showing comparable efficacy against surgical site infections. These are unacceptable life changing complictations of surgery. (40 minutes) Good for Video and Podcast