Day 2 :
Keynote Forum
Michael Friebe
Otto-von-Guericke-University,Germany
Keynote: Conceptual idea for brain tumour treatment through intra-arterial pathways
Time : 09:00-09:20
Biography:
Prof. Michael Friebe, PhD, has been involved in diagnostic imaging and image guided therapeutic products and services, asrnfounder / innovator / CEO investor, and scientist. Dr. Friebe currently is a Board Member of two startup R&D companies, as wellrnas investment partner of a medical technology startup-fund. He is an affiliated professor with the chair for Computer AidedrnMedical Procedures (CAMP) at TU München, and full professor of Image Guided Therapies at the Otto-von-Guericke-Universityrnin Magdeburg, Germany. He is listed inventor of more than 60 patent applications and the author of numerous papers
Abstract:
There are many invasive (removal of the tumour tissuernthrough skull based access) and non-invasive medicalrntreatment strategies (mainly radiation therapy). Very oftenrnalso a combination of both.rnWe have created a new device, that would allow usingrnthe vascular structure as a possible pathway for treatingrnintracranial diseases. One option would be the placement ofrnradiation seeds directly into a brain tumour. The main issuesrnwith this catheter based approach are the defined puncture ofrnthe vessel, the prevention of liquid exchange (blood / brain),rnsealing of the vessel after the procedure, and the accuraternplacement and control of the procedure using externalrndiagnostic imaging.rnThe catheter based device (see figure), guided andrncontrolled by 3D X-ray (Artis Zeego, Siemens Healthcare,rnErlangen, Germany), is presented consisting of a one-sidedrntriple-hole balloon, a tube feeding this balloon and a secondrntube combined with a guide assistant for the puncture andrntreatment. 3D shaped X-ray markers allow accuraternplacement.rnThe presented pathway could be an alternative tumourrnaccess and particularly well suited for placements of smallrnradioactive seeds.
Keynote Forum
Dongwoo John chang
CIGNA, Hospital, USA
Keynote: THE SUBTEMPORAL APPROACH IN CRANIAL NEUROSURGERY: A ROAD LESS TRAVELED
Time : 09:00-02:30
Biography:
Dr.Dongwoo John chang
Abstract:
THE SUBTEMPORAL APPROACH IN CRANIAL NEUROSURGERY: A ROAD LESS TRAVELED rnINTRODUCTIONrnThe subtemporal approach was popularized by Dr. Charles Drake for the microneurosurgical clipping of aneurysms of the distal basilar artery. The competing approach for such problems was and still is the transsylvian approach to the interpeduncular region. Because an increasing proportion of cerebral aneurysms, particularly those of the basilar artery, are treated by endovascular methods, it is probable that the subtemporal approach is being used less and less in contemporary neurosurgical practice. However, the elegance of this approach lends itself to the neurosurgical treatment of not only vascular lesions, but also for the definitive microsurgical management of tumorous lesions that occur in the deep, central portions of the cranial cavity.rnMETHODSrnRetrospective review of the clinical practice database of a single cerebrovascular/skull base neurosurgeon revealed that the following lesions were treated with the subtemporal approach and its variations: basilar apex aneurysm (small to giant sizes clipped with standard techniques and with hypothermic circulatory standstill), superior cerebellar artery aneurysm, posterior cerebral artery aneurysm, tentorial meningioma, parahippocampal (and other subtemporal) metastatic tumor, large mesencephalic lymphoma, giant pontomesencephalic region pilocytic astrocytoma, and chordoma.rnRESULTSrnThe subtemporal approach can be subdivided into 3 subcategories: (1) anterior subtemporal, (2) mid-subtemporal, and (3) posterior subtemporal. Excellent microsurgical exposure was obtained in all cases approached with each of the 3 variations of the subtemporal approach. Definitive lesionectomy (whether it was aneurysm clipping, lesion biopsy, or tumoral removal) was accomplished in all cases. Technical nuances to avoid surgical complications are discussed in this presentation, ranging from (and including) bony exposure, lumbar drainage, location/method of tentorial incision, and management of cerebral veins to the optimal mechanical trajectories of brain retractors that facilitate final surgical exposure while minimizing iatrogenic brain injury. The specific surgical approach was tailored to the anatomic details of the treated lesion—based on vascular, bony, and lesional anatomy—to arrive at the most applicable surgical approach.rnCONCLUSIONSrnThe subtemporal approaches provide orthogonal anatomic routes that often result in a short, direct route to neurosurgical lesions that occur at the tentorial incisura and in the interpeduncular cistern. The subtemporal approaches are useful for lesions that may originate in different anatomic compartments but have lesional extensions into the traditional “central†cranial compartment (pontomesencephalic, clival, and tentorial incisural regions), for which the classical subtemporal approach has been historically useused. Finally, anatomic insights gained from the use of the subtemporal approaches are particularly useful in the microneurosurgery of the mesial temporal lobe region, and vice versa.rn
- Angiogenesis in Neuro Oncology