Content from the Journal of the American Neurological Surgeons.
Introduction Balloon catheters have two principal applications in peripheral endoluminal procedures. Therapeutic or angioplasty ballooning is the forceful inflation of a balloon to dilate stenotic/occlusive lesions in a vessel. This is accomplished using noncompliant balloons, constructed of material that resists deformation when subjected to pressure; the more noncompliant (i.e. stiffer) the balloon material, the greater…
Patient Selection Indications for endovascular repair of the abdominal aortic aneurysm are: Patients with asymptomatic abdominal aortic aneurysm greater than 5 cm in an orthogonal projection or larger than twice the size of the normal abdominal aorta or an aneurysm diameter of 4–5 cm, which has also increased in size by 0.5 cm in last…
Patient Selection Indications for endovascular repair of the thoracic aortic aneurysm (Figure 1) are: Figure 1: The three-dimension reconstruction (Medical Metrx Solutions, West Lebanon, NH) off the aortic-centerline from a contrast-enhanced high-resolution computer tomography scan showing an “ideal candidate” for TEVAR. Patients with an asymptomatic descending aortic aneurysm larger than twice the size of the…
Patient Selection Indications for endovascular repair of the iliac artery are: Stenosis or (short-segment) occlusion of iliac artery (TASC type A and B, TASC C lesions are controversial) with ipsilateral lower extremity ischemia (lifestyle-limiting, progressive claudication, rest pain, gangrene). Patients with asymptomatic aneurysm greater than 4 cm in diameter. An iliac aneurysm which has also…
Patient Selection Renal artery stenosis (RAS) of >70% of one or both renal arteries AND poorly controlled hypertension despite multiple antihypertensive regimen, or chronic renal insufficiency related to RAS Dialysis dependent renal failure in patients without another definite cause Recurrent congestive heart failure or flash pulmonary edema not attributed to active ischemia Renal artery aneurysm…
In 1932, the radiologist Henry Pancoast first described a superior pulmonary sulcus tumor (SST) as a carcinoma (of uncertain origin) developing in the apex of the chest. Patient Selection In 1932, the radiologist Henry Pancoast (Figure 1) first described a superior pulmonary sulcus tumor (SST) as a carcinoma (of uncertain origin) developing in the apex of…
STSA Surgical Motion Picture 2009 Annual Meeting Type IV paraesophageal hernia can be a complicated problem which may be managed from various surgical approaches. This video describes the technical aspects of a laparascopic approach and the necessity of adhering to the surgical principles required for a successful repair. Hernia sac excision and reduction of its…
VATS Lobectomy Training and Instruction For purposes of this survey, participants were asked to assume that they consulted on an otherwise healthy middle aged patient who had a peripheral 2 cm right upper lobe adenocarcinoma, clinical stage Ia, not amenable to wedge resection or segmentectomy. There were no contraindications to lobectomy. The vast majority…
A number of prosthetic materials, including GORE-TEX® and Marlex Mesh sandwiched with methylmethacrylate cement, have been described to restore the rigid chest wall contour. We discuss the role of a new rigid system for chest-wall reconstruction, consisting in moldable titanium bars and rib clips used in combination with a biological patch. Introduction Primary tumors and congenital…
Editor’s Note CTSNet seeks, through the Expert’s Techniques Section, to provide information on the latest techniques in use by surgeons working at the forefront of the field. However, presentation on the web site should not be considered an endorsement of the techniques used. Unlike mitral valve repair, where the superiority and durability of the techniques…
This article describes the different techniques of pericardial reconstruction after partial pericardiectomy in thoracic surgery. Emphasis is put on reconstruction using synthetic meshes. Patient Selection Pericardial reconstruction after partial pericardiectomy is performed for the prophylaxis of cardiac herniation. Pericardial defects that require reconstruction result after lung resections with partial pericardiectomy, extrapleural pneumonectomy for diffuse malignant…
This video demonstrates the technical details of videothoracoscopic parietal pleurectomy and decortication performed through three ports for tuberculosis empyema. The patient is a 24-year old male patient suffering from dyspnea. Five years earlier the patient presented with left sided pleural tuberculosis and was given anti-tuberculosis treatment, partially reducing the pleural effusion. Decortication was planned at…
Healing complications after cardiac surgery such as dehiscence, osteomyelitis, mediastinitis, and superficial wound infection may occur. This video shows a new and potentially superior method of sternal closure with thermoreactive NITINOL clips that provide semirigid fixation. NITINOL belongs to a family of intermetallic materials that contain a nearly equal mixture of nickel and titanium. Nitinol…
Management of Thymoma For purposes of this survey, participants were asked to assume that they were consulting on a middle aged patient who had findings on CT compatible with a small (2 cm) encapsulated thymoma. The patient had no symptoms related to the abnormality. The patient was otherwise healthy and had no symptoms of…
Attitudes regarding surgeon performance and operating room environment The survey on “Attitudes regarding surgeon performance and operating room environment” engendered the largest response to a survey to date. Whether this is a result of increased awareness of the surveys or whether the subject matter was of greater interest will be evident as more surveys are…
Patient Selection Patients with non-metastatic thymoma or thymic carcinoma or with myasthenia gravis (with or without thymoma) are candidates for thymectomy. Treatment for myasthenia gravis is initiated by a neurologist, who recommends surgical treatment when indicated. Some of the common indications are: failure of medical treatment; young patients with short duration of symptoms; and patients…
