Amin Amini

Glioblastoma multiforme of the pineal region

Glioblastoma multiforme (GBMs) tumors are exceedingly rare tumors in the pineal region. We present three cases in which patients presented with a pineal/posterior third ventricular region mass and review all the previously reported cases in the literature. Pineal region GBM seems to be a very aggressive tumor with a high rate of leptomeningeal and ependymal metastatic disease. Patients usually present with signs and symptoms of hydrocephalus and Parinaud’s syndrome. The clinical and radiological characteristics of pineal GBM do not differentiate it from other malignancies of this region, thus surgical biopsy is generally required for definitive diagnosis. Glioblastoma should be considered in the differential diagnosis of the pineal region tumors, especially when evidence of leptomeningeal or ependymal metastatic disease is present.

Thoracoscopic vertebral body replacement with an expandable cage after ventral spinal canal decompression.

OBJECTIVE Minimally invasive thoracic anterior surgery using a thoracoscopic approach has evolved to include spinal biopsy, debridement, discectomy, decompressive corpectomy, interbody fusions, and internal fixations. Minimal access techniques can potentially decrease surgical access morbidity and also reduce the time required for recovery and healing. The thoracoscopic approach for decompression, stabilization, and anterior vertebral reconstruction of thoracolumbar fractures is described. METHODS In this article and video, we discuss patient selection, surgical positioning, port placement, thoracic level localization, exposure and removal of fractured vertebral bodies, anterior vertebral column reconstruction using an expandable cage, instrumentation, and postoperative management. RESULTS The potential advantages of using a minimally invasive thoracoscopic approach include direct trajectory to anterior spine pathology, minimal tissue and rib retraction, and decreased postoperative pain and length of hospital stay. The associated disadvantages include the steep learning curve for the surgeon, the need to operate with two-dimensional visual information and long instruments, and the requirement that one have an experienced surgical assistant. CONCLUSION Minimally invasive surgery using a thoracoscopic approach for vertebral body replacement with an expandable cage can be performed safely. Expandable cages facilitate the vertebral body reconstruction via minimal access surgery.

Submandibular-infratemporal interpositional carotid artery bypass for cranial base tumors and giant aneurysms.

OBJECTIVE: Cerebral revascularization is an important strategy in the surgical management of some complex cranial base tumors and unclippable aneurysms. A high-flow bypass may be necessary in planned carotid occlusion or sacrifice. The cervical-to-supraclinoid internal carotid artery bypass or cervical carotid-to-middle cerebral artery bypass are useful procedures to bypass lesions at the base of the cranium. We describe technical modifications of the submandibular-infratemporal interpositional saphenous vein (or radial artery) graft bypass technique specifically designed to avoid removal of the zygoma. METHODS: The saphenous vein or radial artery interpositional graft is tunneled through a burr hole created in the floor of the middle fossa via a submandibular-infratemporal route avoiding removal of zygoma and attachments of the masseter or temporalis muscles. RESULTS: The technique is demonstrated in one patient with removal of a malignant cavernous sinus tumor and in another patient with an unclippable giant carotid bifurcation aneurysm. CONCLUSION: The advantages of this approach include preservation of the facial anatomy and creation of a short and safe route for passage of the saphenous vein or radial artery graft.

Thoracoscopic debridement and stabilization of pyogenic vertebral osteomyelitis.

The role of surgical debridement and internal fixation in treatment of vertebral osteomyelitis has been evolving. The standard surgical approach to thoracolumbar vertebral osteomyelitis requiring extensive thoracotomy or retroperitoneal exposure carries significant associated morbidity and postoperative pain. Minimally invasive thoracoscopic spine surgery is designed to improve postoperative morbidity associated with the traditional open surgery. We report a case of a 70-year-old man who developed T11-T12 pyogenic vertebral osteomyelitis 3 months after undergoing posterior laminectomy and microsurgical excision of a herniated thoracic disc. The patient underwent minimally invasive thoracoscopic radical debridement and anterior spinal reconstruction and fusion. Patients with vertebral osteomyelitis may benefit from the decreased postoperative morbidity that is associated with minimally invasive thoracoscopic spinal surgery.

Delayed post-traumatic saccular aneurysm of PICA in an adolescent

Delayed traumatic intracranial aneurysms of the posterior circulation caused by nonpenetrating head injury are rare, especially in pediatric patients. The true incidence and natural history of these aneurysms are poorly understood. We report a case of a 15-year-old boy who initially presented with subarachnoid hemorrhage of the posterior fossa without any evidence of associated aneurysm. On a routine computed tomography of the head, however, he was found to have a saccular aneurysm of the proximal posterior inferior cerebellar artery. The patient was treated successfully by microsurgical clipping and PICA/PICA bypass.