This is the first of four volumes that together elaborate on an advanced minimally invasive neurosurgery (MIN) technique for cerebral hemorrhages, which makes it possible to prevent secondary injury by the hematoma and to preserve neurological function and accelerate neuropsychological recovery after the evacuation.
It describes in detail the theoretical, technical and training procedures necessary to carry out successful intracerebral hemorrhage evacuations using MIN techniques. A combination of mouth-tracked microsurgery, neuro-sonography, neuro-endoscopy, LASER and sealing makes highly effective, minimally invasive evacuation of all types of hematomas possible. The MIN Key Concept, an advanced new model based on the Keyhole Concept and MIN techniques is also presented. Lastly, the scientific basics of MIN are discussed and summarized.
A historical curriculum vitae is included in memory of the main pioneer of innovative MIN techniques, Prof. Axel Perneczky, to whom this book is dedicated.
Author(s): Klaus Dieter Maria Resch
Series: Key Concepts in MIN
Publisher: Springer
Year: 2021
Language: English
Pages: 396
City: Cham
Foreword
Foreword
Foreword
Preface
Contents
About the Author
1: Dedication to My Great Teacher Prof. Dr. Dr. h. c. Axel Perneczky
1.1 The Perneczky Era 1988–2009 (Graph 1.1)
1.1.1 Summary
1.1.2 History
1.2 In Memoriam Prof. Dr. Dr. h. c. Axel Perneczky/Obituaries
1.2.1 Guest Contributions I
1.2.1.1 Axel Perneczky
1.2.1.2 In Memoriam, Axel Perneczky
1.2.2 Guest Contributions II
1.2.3 Guest Obituaries
1.2.3.1 Tribute to Axel Perneczky
1.2.3.2 Minimally Invasive Keyhole Concept in Spinal Tumor Surgery
1.2.3.3 Abstract
1.2.3.4 Keywords
1.2.3.5 Introduction
1.2.3.6 Axel Perneczky’s Concept in Minimally Invasive Spinal Tumor Surgery
1.2.3.7 Illustrative Cases
Case I: Epidural Schwannoma
Case II: Intramedullary Situated Ependymoma C6/8
1.2.3.8 Discussion
1.2.3.9 Minimally Invasive Neurosurgical Treatments (MINT)
Development of the Neuro-Fibro-Endoscope
Dime-Size Keyhole Microsurgery: Microvascular Transposition (MVT) for Hemifacial Spasm, Trigeminal Neuralgia and Glossopharyngeal Neuralgia
Development of a Mini Craniotomy and a Lateral Supra-Orbital Keyhole Approach
References
1.2.3.10 The “Marburg” Concept of Minimally Invasive Endoscopic Neurosurgery (MIEN) (1988-2008) A Historical Reflections
1.2.3.11 “The True Perfection of Man Lies not in What Man has, but in What Man is.”
2: Evolution of the Key-Hole Concept: The MIN-Key Concept
2.1 Recent Roots of MIN
2.1.1 Origins of the Keyhole Concept: M.G. Yasargil and A Perneczky
2.1.1.1 M.G. Yasargil
2.1.1.2 Perneczky
2.1.2 Further Development of the Keyhole Concept to the “MIN-Key Concept”
2.1.2.1 The MIN-Key Concept
2.2 The Importance of Ergonomics for the Conceptual Development of MIN
2.2.1 Three Areas of Ergonomics: Spatial, Procedural and Mental
2.2.1.1 Spatial Ergonomics: The Ergonomic Zone Model (Gestalt-Theory) (Graph 2.13)
2.2.1.2 Procedural Ergonomics: The Chaos Model (Graph 2.14)
2.2.1.3 Mental Ergonomics: The Neuropsychological Model (Graphs 2.15, 2.16, 2.17, and 2.18)
Operative Suit Design and Future Neurosurgery
Primate of Ergonomics
Ergonomics Future of MIN
Suggested Reading
3: Key Techniques of MIN: Mouth-Tracked High-Zoomed Microneurosurgery and The “Ergo-Tool”
3.1 Evolution of Visualization
3.1.1 History
3.2 Visualization and Ergonomics
3.2.1 Mental Navigation
3.2.2 Micro Zooming of the ROI (Region of Interest)
3.2.3 Zoom and Focus Range
3.2.4 Burr-Hole Focus-Levels in MIN
3.2.5 Adjustment of the Balance System
3.2.6 Adjustment of the Oculars
3.2.7 Adjustment of Mouth-Switch
3.2.8 Testing the Microscope: Focus and Field of View and Floating
3.2.9 Evolution of the Mouth-Piece
3.3 Features on MIN Evolution in the Past and Near Future
3.3.1 Evolution of Visualization
3.3.2 Different Visualization Settings and Tools
3.4 Chaos in the OR-Environment
3.5 Laboratory Settings
3.5.1 The PICO EU-Project (2004–2007)
3.5.2 First Exoscope
3.5.3 The Actual Situation in Microsurgery and Visualization
3.6 Structure of MIN Evolution
3.6.1 Concepts and Schools (Graph 3.15)
3.6.2 Key-Techniques (Graph 3.16)
3.7 Evaluation of Exoscope-Systems According to Ergonomics for MIN: The “Ergo-Tool” (s. Chap. 2.2)
Suggested Reading
4: Key Techniques of MIN: Ultrasound for Neurosurgery
4.1 General Information
4.1.1 Bedside Sono-CT
4.1.1.1 Reduction of CT/MR Examinations by Highend-Neurosonography
4.2 Special Imaging Conditions of Neuro-Sonography
4.3 Equipment
4.3.1 Starting the Machine
4.3.2 Sono-Probes
4.4 Modes
4.4.1 Functions: (Optimation of Image)
4.4.1.1 Advanced Functions
4.5 Scan Geometry
4.6 Clinical Neuro-Sono Anatomy
4.6.1 Axial
4.6.1.1 Midbrain Level
4.6.1.2 Hypothalamic Level
4.6.1.3 Thalamus Level
4.6.1.4 Ventricular Level
4.6.1.5 Supraventricular Level
4.6.1.6 Subcortical Level
4.6.2 Coronar
4.6.2.1 Frontal Level
4.6.2.2 Tentorial Path Level
4.6.2.3 Parietal Level
4.6.2.4 Sagittal Paramed. Level (Graph 4.18)
4.6.2.5 CTA Axial Midbrain Level
4.6.2.6 CTA Axial Hypothalamic Level
4.6.2.7 Insular Vessels
4.6.2.8 Briging Veins Level
4.6.2.9 CTA Coronar Levels
4.6.2.10 CTA Coronar Basilar Level
CTA Sagittal Paramed Insular Levels (Fig. 4.43)
CTA Oblique Med.-Sag. Level
4.6.3 History of Neurosonography (Fig. 4.48)
4.6.4 CTA axial
4.6.5 CTA coronal
4.6.6 CTA sagittal (Graph 4.22)
4.7 Examination Principles (Graph 4.23)
4.8 History of Neurosonography (Graph 4.24)
4.9 Result of Imaging (Graph 4.25)
4.10 Cases (Graph 4.26, 4.27, 4.28, 4.29, 4.30, 4.31, 4.32, 4.33 and 4.34)
4.11 Trans-endoscopic Ultrasound for Neurosurgery
4.11.1 History of Trans-endoscopic Ultrasound
4.11.2 Imaging Properties
4.11.2.1 ENS-Anatomy
4.11.3 ENS Anatomy
4.11.3.1 Per-nasal ENS
4.11.3.2 View of the Surgeon in ENS
4.11.3.3 Summary Remarks on ENS Anatomy (Graph 4.68)
4.11.3.4 General Remarks on Variety of Lesions
4.11.4 Cases (Graph 4.70, 4.71 and 4.72)
4.11.5 Summary and Final Reflections
4.11.5.1 Indication
4.11.6 Final Reflections on ENS (2005) (s. Chap. 3)
4.12 Final Summary on Ultrasound as Key-Technique in MIN (Graph 4.74)
Suggested Reading
5: Key Techniques of MIN: Neuroendoscopy
5.1 Introduction: The Story
5.2 Surgical Endoscopic Anatomy for Neurosurgery
5.3 The Ventricular System
5.3.1 Foramen Monroi and Lateral Ventricles
5.3.2 Foramen Monroi (FM)
5.3.3 Lateral Ventricle (LV)
5.3.4 Third Ventricle (TV)
5.4 Posterior Third Ventricle, Aqueduct and Fourth Ventricle
5.5 Subarachnoidal Space
5.5.1 Retro-Clival Cisterns
5.5.2 Caudal Basal Cisterns, Foramen Magnum
5.6 Approach-Canal
5.7 Subarachnoidal Space, Basal and Hemispheral
5.8 Supra-Orbital Key-Hole
5.9 CPA Exoscopic Surgical Anatomy
5.10 Endoscopic Anatomy of Latero-Basal Key-Holes to the Posterior Fossa
5.10.1 Introduction
5.10.2 Results
5.10.3 Topology of Endoscopic Views
5.10.4 Discussion
5.10.5 Conclusion
5.11 Per-nasal Endoscopic Anatomy
5.11.1 Technique and Video-Chain
5.11.2 Adjustment of the Endoscope
5.11.3 Application-Fields of Neuro-Endoscopy
5.12 Clinical Cases
Suggested Reading
6: Scientific Conditions for MIN
6.1 The Limits of Clinical Trials Within the MIN-Key Concept
6.2 Missconception of “EBM”
6.2.1 The Hippocratic Imperative
6.3 The MIN-Key Concept Between K. Popper and Th. Kuhn
6.4 Misconception of “Image Guided Therapy” in Neurosurgery
6.5 System Medicine and Big Data Medicine
6.6 The AI-Systems
6.7 The Role of Philosophy in MIN
6.8 The Meaning of Beauty and Aesthetics of the Brain in MIN
Suggested Reading
