The Experts below are selected from a list of 1533 Experts worldwide ranked by ideXlab platform
Noel I Perin - One of the best experts on this subject based on the ideXlab platform.
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video assisted thoracoscopic surgery combined with a Tubular Retractor system for minimally invasive thoracic discectomy
Neurosurgery, 2011Co-Authors: Daniel S Yanni, Cliff P Connery, Noel I PerinAbstract:BACKGROUND: Several approaches have been proposed for the treatment of thoracic disc herniations. Posterior approaches include transpedicular, costotransversectomy, and lateral extracavitary; anterior approaches include retropleural and transpleural thoracotomy and thoracoscopy. OBJECTIVE: We present a novel minimally invasive approach to thoracic discectomies, combining thoracoscopy and a Tubular Retractor system. We discuss the utility and safety of this technique. METHODS: The patient is placed in a lateral decubitus position, with a double-lumen endotracheal tube for single-lung ventilation, With use of thoracoscopic techniques, the disc space is identified; approximately 2 cm of the head and neck of the rib is removed to expose the pedicle of the lower vertebral body. The Tubular Retractor is deployed with continuous thoracoscopic visualization and a trough is created anterior to the canal by drilling the adjacent vertebral bodies straddling the disc space. The operative microscope is utilized to dissect the disc, pulling it anteriorly into the trough. RESULTS: There were 5 patients in the past 9 months who were candidates for anterior thoracic discectomy. Disc herniations from T3-4 to T10-11 were treated without any significant complications. Patients were followed up clinically and radiographically. CONCLUSION: Combining thoracoscopy with the Tubular Retractors allows continuous monitoring of the lung, aorta, and vena cava during the placement of the Retractors. Additionally, use of the Tubular Retractors, as opposed to a complete thoracoscopic discectomy reduces the working distance and allows the use of the microscope with 3-dimensional visualization, thus enhancing the safety of this approach.
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video assisted thoracoscopic surgery combined with a Tubular Retractor system for minimally invasive thoracic discectomy
Neurosurgery, 2011Co-Authors: Daniel S Yanni, Cliff P Connery, Noel I PerinAbstract:BACKGROUND: Several approaches have been proposed for the treatment of thoracic disc herniations. Posterior approaches include transpedicular, costotransversectomy, and lateral extracavitary; anterior approaches include retropleural and transpleural thoracotomy and thoracoscopy. OBJECTIVE: We present a novel minimally invasive approach to thoracic discectomies, combining thoracoscopy and a Tubular Retractor system. We discuss the utility and safety of this technique. METHODS: The patient is placed in a lateral decubitus position, with a double-lumen endotracheal tube for single-lung ventilation, With use of thoracoscopic techniques, the disc space is identified; approximately 2 cm of the head and neck of the rib is removed to expose the pedicle of the lower vertebral body. The Tubular Retractor is deployed with continuous thoracoscopic visualization and a trough is created anterior to the canal by drilling the adjacent vertebral bodies straddling the disc space. The operative microscope is utilized to dissect the disc, pulling it anteriorly into the trough. RESULTS: There were 5 patients in the past 9 months who were candidates for anterior thoracic discectomy. Disc herniations from T3-4 to T10-11 were treated without any significant complications. Patients were followed up clinically and radiographically. CONCLUSION: Combining thoracoscopy with the Tubular Retractors allows continuous monitoring of the lung, aorta, and vena cava during the placement of the Retractors. Additionally, use of the Tubular Retractors, as opposed to a complete thoracoscopic discectomy reduces the working distance and allows the use of the microscope with 3-dimensional visualization, thus enhancing the safety of this approach.
Daniel S Yanni - One of the best experts on this subject based on the ideXlab platform.
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video assisted thoracoscopic surgery combined with a Tubular Retractor system for minimally invasive thoracic discectomy
Neurosurgery, 2011Co-Authors: Daniel S Yanni, Cliff P Connery, Noel I PerinAbstract:BACKGROUND: Several approaches have been proposed for the treatment of thoracic disc herniations. Posterior approaches include transpedicular, costotransversectomy, and lateral extracavitary; anterior approaches include retropleural and transpleural thoracotomy and thoracoscopy. OBJECTIVE: We present a novel minimally invasive approach to thoracic discectomies, combining thoracoscopy and a Tubular Retractor system. We discuss the utility and safety of this technique. METHODS: The patient is placed in a lateral decubitus position, with a double-lumen endotracheal tube for single-lung ventilation, With use of thoracoscopic techniques, the disc space is identified; approximately 2 cm of the head and neck of the rib is removed to expose the pedicle of the lower vertebral body. The Tubular Retractor is deployed with continuous thoracoscopic visualization and a trough is created anterior to the canal by drilling the adjacent vertebral bodies straddling the disc space. The operative microscope is utilized to dissect the disc, pulling it anteriorly into the trough. RESULTS: There were 5 patients in the past 9 months who were candidates for anterior thoracic discectomy. Disc herniations from T3-4 to T10-11 were treated without any significant complications. Patients were followed up clinically and radiographically. CONCLUSION: Combining thoracoscopy with the Tubular Retractors allows continuous monitoring of the lung, aorta, and vena cava during the placement of the Retractors. Additionally, use of the Tubular Retractors, as opposed to a complete thoracoscopic discectomy reduces the working distance and allows the use of the microscope with 3-dimensional visualization, thus enhancing the safety of this approach.
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video assisted thoracoscopic surgery combined with a Tubular Retractor system for minimally invasive thoracic discectomy
Neurosurgery, 2011Co-Authors: Daniel S Yanni, Cliff P Connery, Noel I PerinAbstract:BACKGROUND: Several approaches have been proposed for the treatment of thoracic disc herniations. Posterior approaches include transpedicular, costotransversectomy, and lateral extracavitary; anterior approaches include retropleural and transpleural thoracotomy and thoracoscopy. OBJECTIVE: We present a novel minimally invasive approach to thoracic discectomies, combining thoracoscopy and a Tubular Retractor system. We discuss the utility and safety of this technique. METHODS: The patient is placed in a lateral decubitus position, with a double-lumen endotracheal tube for single-lung ventilation, With use of thoracoscopic techniques, the disc space is identified; approximately 2 cm of the head and neck of the rib is removed to expose the pedicle of the lower vertebral body. The Tubular Retractor is deployed with continuous thoracoscopic visualization and a trough is created anterior to the canal by drilling the adjacent vertebral bodies straddling the disc space. The operative microscope is utilized to dissect the disc, pulling it anteriorly into the trough. RESULTS: There were 5 patients in the past 9 months who were candidates for anterior thoracic discectomy. Disc herniations from T3-4 to T10-11 were treated without any significant complications. Patients were followed up clinically and radiographically. CONCLUSION: Combining thoracoscopy with the Tubular Retractors allows continuous monitoring of the lung, aorta, and vena cava during the placement of the Retractors. Additionally, use of the Tubular Retractors, as opposed to a complete thoracoscopic discectomy reduces the working distance and allows the use of the microscope with 3-dimensional visualization, thus enhancing the safety of this approach.
Theodore H. Schwartz - One of the best experts on this subject based on the ideXlab platform.
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Tubular brain tumor biopsy improves diagnostic yield for subcortical lesions
Journal of Neuro-Oncology, 2019Co-Authors: Evan D Bander, Theodore H. Schwartz, Samuel H Jones, David Pisapia, Rajiv Magge, Howard Fine, Rohan RamakrishnaAbstract:Purpose Molecular data has become an essential part of the updated World Health Organization (WHO) grading of central nervous system tumors. However, stereotactic needle biopsies provide only small volume specimens and limit the extent of histologic and molecular testing that can be performed. We assessed the use of a Tubular Retractor-based minimally invasive biopsy technique to provide improved tissue yield and diagnostic data compared to needle biopsy. Methods Eighteen patients underwent an open transTubular biopsy compared to 146 stereotactic biopsies during the years of 2010–2018. Results Tubular biopsies resulted in a higher volume of tissue provided to the pathologist than needle biopsies (1.26 cm^3 vs. 0.3 cm^3; p
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utility of Tubular Retractors to minimize surgical brain injury in the removal of deep intraparenchymal lesions a quantitative analysis of flair hyperintensity and apparent diffusion coefficient maps
Journal of Neurosurgery, 2016Co-Authors: Evan D Bander, Samuel H Jones, Ilhami Kovanlikaya, Theodore H. SchwartzAbstract:OBJECT Brain retraction systems are frequently required to achieve surgical exposure of deep-seated brain lesions. Spatula-based systems can be associated with injury to the cortex and deep white matter, particularly adjacent to the sharp edges, which can result in uneven pressure on the parenchyma over the course of a long operation. The use of Tubular Retractor systems has been proposed as a method to overcome these limitations. There have been no studies assessing the degree of brain injury associated with the use of Tubular Retractors. METHODS Twenty patients were retrospectively identified at Weill Cornell Medical College who underwent resection of deep-seated brain lesions between 2005 and 2014 with the aid of a METRx Tubular Retractor system. Using the Brainlab software, pre- and postoperative images were analyzed to assess volume, depth, extent of resection, and change in postoperative MR FLAIR hyperintensity and restricted diffusion on diffusion-weighted imaging (DWI). RESULTS The mean preoperati...
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Stereotactic minimally invasive Tubular Retractor system for deep brain lesions
Neurosurgery, 2008Co-Authors: Jeffrey P. Greenfield, William S. Cobb, A John Tsouris, Theodore H. SchwartzAbstract:Objective Deep-seated supratentorial intraparenchymal and intraventricular brain lesions can be difficult to access without causing significant trauma to the overlying cortex and intervening white matter tracts. Traditional brain Retractors use multiple blades, which do not exert pressure in an equally distributed fashion. Tubular Retractors offer an advantage. Although a commercially available frame-based Tubular Retractor system is on the market (COMPASS; Compass, Inc., Rochester, MN), we modified existing off-the-shelf equipment at our institution into a frameless Tubular brain Retractor. Methods We used 14- to 22-mm METRx (Medtronic, Minneapolis, MN) Tubular Retractors in combination with a frameless stereotactic navigation system to remove 10 deep lesions. Histological findings included 6 periventricular metastases, 1 insular glioblastoma multiforme, 1 periventricular glioblastoma multiforme, 1 intraventricular meningioma, and 1 hippocampal cavernous malformation. Results Radiographic gross total resection was achieved in all patients. One patient experienced a transient worsening of an existing preoperative Wernicke's aphasia; otherwise, there were no intra- or postoperative complications. One patient with radiographic gross total resection of a metastatic lesion experienced a local recurrence of disease, requiring stereotactic radiosurgery. Conclusion A frameless stereotactic Tubular Retractor system for deep brain lesions can be assembled with equipment already available at many institutions. Use of this system can decrease incision and craniotomy size, decrease Retractor-induced trauma to overlying cortex, and help prevent damage to underlying white matter tracts.
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Stereotactic minimally invasive Tubular Retractor system for deep brain lesions.
Neurosurgery, 2008Co-Authors: Jeffrey P. Greenfield, William S. Cobb, A John Tsouris, Theodore H. SchwartzAbstract:Deep-seated supratentorial intraparenchymal and intraventricular brain lesions can be difficult to access without causing significant trauma to the overlying cortex and intervening white matter tracts. Traditional brain Retractors use multiple blades, which do not exert pressure in an equally distributed fashion. Tubular Retractors offer an advantage. Although a commercially available frame-based Tubular Retractor system is on the market (COMPASS; Compass, Inc., Rochester, MN), we modified existing off-the-shelf equipment at our institution into a frameless Tubular brain Retractor. We used 14- to 22-mm METRx (Medtronic, Minneapolis, MN) Tubular Retractors in combination with a frameless stereotactic navigation system to remove 10 deep lesions. Histological findings included 6 periventricular metastases, 1 insular glioblastoma multiforme, 1 periventricular glioblastoma multiforme, 1 intraventricular meningioma, and 1 hippocampal cavernous malformation. Radiographic gross total resection was achieved in all patients. One patient experienced a transient worsening of an existing preoperative Wernicke's aphasia; otherwise, there were no intra- or postoperative complications. One patient with radiographic gross total resection of a metastatic lesion experienced a local recurrence of disease, requiring stereotactic radiosurgery. A frameless stereotactic Tubular Retractor system for deep brain lesions can be assembled with equipment already available at many institutions. Use of this system can decrease incision and craniotomy size, decrease Retractor-induced trauma to overlying cortex, and help prevent damage to underlying white matter tracts.
Cliff P Connery - One of the best experts on this subject based on the ideXlab platform.
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video assisted thoracoscopic surgery combined with a Tubular Retractor system for minimally invasive thoracic discectomy
Neurosurgery, 2011Co-Authors: Daniel S Yanni, Cliff P Connery, Noel I PerinAbstract:BACKGROUND: Several approaches have been proposed for the treatment of thoracic disc herniations. Posterior approaches include transpedicular, costotransversectomy, and lateral extracavitary; anterior approaches include retropleural and transpleural thoracotomy and thoracoscopy. OBJECTIVE: We present a novel minimally invasive approach to thoracic discectomies, combining thoracoscopy and a Tubular Retractor system. We discuss the utility and safety of this technique. METHODS: The patient is placed in a lateral decubitus position, with a double-lumen endotracheal tube for single-lung ventilation, With use of thoracoscopic techniques, the disc space is identified; approximately 2 cm of the head and neck of the rib is removed to expose the pedicle of the lower vertebral body. The Tubular Retractor is deployed with continuous thoracoscopic visualization and a trough is created anterior to the canal by drilling the adjacent vertebral bodies straddling the disc space. The operative microscope is utilized to dissect the disc, pulling it anteriorly into the trough. RESULTS: There were 5 patients in the past 9 months who were candidates for anterior thoracic discectomy. Disc herniations from T3-4 to T10-11 were treated without any significant complications. Patients were followed up clinically and radiographically. CONCLUSION: Combining thoracoscopy with the Tubular Retractors allows continuous monitoring of the lung, aorta, and vena cava during the placement of the Retractors. Additionally, use of the Tubular Retractors, as opposed to a complete thoracoscopic discectomy reduces the working distance and allows the use of the microscope with 3-dimensional visualization, thus enhancing the safety of this approach.
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video assisted thoracoscopic surgery combined with a Tubular Retractor system for minimally invasive thoracic discectomy
Neurosurgery, 2011Co-Authors: Daniel S Yanni, Cliff P Connery, Noel I PerinAbstract:BACKGROUND: Several approaches have been proposed for the treatment of thoracic disc herniations. Posterior approaches include transpedicular, costotransversectomy, and lateral extracavitary; anterior approaches include retropleural and transpleural thoracotomy and thoracoscopy. OBJECTIVE: We present a novel minimally invasive approach to thoracic discectomies, combining thoracoscopy and a Tubular Retractor system. We discuss the utility and safety of this technique. METHODS: The patient is placed in a lateral decubitus position, with a double-lumen endotracheal tube for single-lung ventilation, With use of thoracoscopic techniques, the disc space is identified; approximately 2 cm of the head and neck of the rib is removed to expose the pedicle of the lower vertebral body. The Tubular Retractor is deployed with continuous thoracoscopic visualization and a trough is created anterior to the canal by drilling the adjacent vertebral bodies straddling the disc space. The operative microscope is utilized to dissect the disc, pulling it anteriorly into the trough. RESULTS: There were 5 patients in the past 9 months who were candidates for anterior thoracic discectomy. Disc herniations from T3-4 to T10-11 were treated without any significant complications. Patients were followed up clinically and radiographically. CONCLUSION: Combining thoracoscopy with the Tubular Retractors allows continuous monitoring of the lung, aorta, and vena cava during the placement of the Retractors. Additionally, use of the Tubular Retractors, as opposed to a complete thoracoscopic discectomy reduces the working distance and allows the use of the microscope with 3-dimensional visualization, thus enhancing the safety of this approach.
Sundaravadhanan Shashivadhanan - One of the best experts on this subject based on the ideXlab platform.
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Transparent Tubular Retractor in Cranial Surgery: A Retrospective Analysis
Indian Journal of Neurosurgery, 2019Co-Authors: Sundaravadhanan ShashivadhananAbstract:Abstract Introduction The fourth Industrial Revolution has touched nearly all aspects of neurosurgery and the newer Tubular Retractor systems are a testimony to this fact. They aid in providing better visualization with minimal damage to those neural structures, which happen to be innocent bystanders overlying the path of deep-seated lesions. In addition to providing better patient outcomes they are surgeon friendly with their ergonomic design and improved stability, thereby causing minimal fatigue, and aid in procedures requiring precision and perseverance. A retrospective study conducted at a single institute analyzed the efficacy of transparent Tubular Retractors during cranial surgery for deep-seated lesions. Materials and Methods This retrospective study was conducted between April 2015 and July 2018 in a single institute wherein 22 patents with various deep-seated intracranial lesions were operated using the transparent Tubular Retractor, View Site Brain Access System (VBAS, Vycor Medical Inc.). Observation Of the 22 cases, 45% were of spontaneous intracerebral hemorrhage; 27% were high-grade gliomas; and the rest were colloid cyst, cystic tumors, and metastatic tumors in equal proportion. Total tumor excision was achieved in 27%, while 90% excision was achieved in 45% cases. The overall complication rate was 13%. Conclusion The transparent Tubular Retractors contribute to minimal invasiveness by causing uniform distribution of retraction pressure and minimal disruption of fiber tracts. Their use has a definite role in improving surgical outcomes for deep-seated intracranial lesions.
