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Page 1 of 3: Images of some aneurysm, arteriovenous malformation, brain tumour, brain bypass, and cranial reconstructive surgeries carried out by Dr Khurana at The Canberra Hospital -
Note: Images shown on pages 1-3 of this section (see Link at the bottom of the page) have been reproduced with the enthusiastic support and written informed consent of Dr Khurana's neurosurgery patients.
On page 1 (this page): Brain aneurysm surgery, primary brain tumour surgery, brain vascular malformation surgery, operating room set-up and technologies including neuronavigation, 3-D imaging, ultrasonic flowmetry and MR spectroscopy
On page 2: Skull base meningioma; brain bypass for symptomatic carotid occlusion; neuronavigation during tumour surgery
On page 3: Microvascular decompression (MVD) for trigeminal neuralgia; trans-septal, trans-sphenoidal resection (TSR) of pituitary adenoma; interhemispheric or transcortical resection of a colloid cyst; titanium and "bone cement" cranioplasty for skull reconstruction
Left: 3D computerised tomographic angiogram (CTA) of an anterior communicating artery aneurysm prior to its successful clipping. Center: Intraoperative photograph of an aneurym being clipped. Right: Contrast-enhanced magnetic resonance imaging (MRI) showing multicentric glioblastoma multiforme (GBM; highest grade astrocytoma) involving the motor cortex and premotor area prior to volumetric resection.
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Left: Neurosurgical theatre at The Canberra Hospital (TCH) during arteriovenous malformation (AVM) resection. An array of titanium microclips are seen in the foreground. Right: One of our Toshiba Aquilion rapid CT scanners used for neurosurgical 2D-multiplanar and 3D imaging.
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Left: Dr Khurana carries out the first intraoperative quantitative Doppler ultrasonography for neurosurgery in Australia & New Zealand during arteriovenous malformation and aneurysm surgeries at The Canberra Hospital. The technology developed by Transonic Systems Inc. allows for measurement of blood flow through vessels of interest or vessels at risk, before and after surgical intervention, enhancing the safety and efficacy of neurovascular surgery. Right above and below: 3D CT angiogram (CTA) of a ruptured posterior inferior cerebellar artery (PICA) aneurysm and a ruptured posterior communicating (Pcom) artery aneurysm, respectively, prior to successful clipping. The advanced imaging software platform availabe at The Canberra Hospital allows the images to be manipulated in 3D, enabling a neurovascular surgeon to rehearse the surgical approach prior to actual surgery (virtual neurovascular surgery).
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Left: CT scan of a patient who presented with life-threatening "brain herniation" from a large extradural abscess and empyema from fulminant frontal sinusitis. The patient underwent complete evacuation of this large collection of pus, followed by successful surgical reconstruction of her anterior base of skull, and made a complete clinical recovery. Right: Dr Khurana operating on life-threatening conditions such as aneurysms, arteriovenous malformations (AVMs) and complicated brain tumours at The Canberra Hospital. The operating microscope is seen in the background, while the Medtronic Stealth Station ("GPS navigation for the brain") is seen in the foreground.
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Left: Sagittal 2D CT angiogram of a life-threatening twice-ruptured dural arteriovenous fistula (DAVF) of the torcula herophili, immediately prior to the successful disconnection of the fistula (intraoperative disconnection of this DAVF using titanium microclips is shown in the centre panel). The patient made an excellent recovery. Right: Medtronic intraoperative stereotactic display ("GPS for the brain") using the Leica operating microscope's sophisticated "heads-up cross-hair" display during neurosurgery. This feature allows the surgeon to accurately navigate through the brain to the surgical target. |
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Left: MRI T1 contrast study showing large pituitary tumour displacing the nerves for vision (optic chiasm). The tumour was completely resected through a transnasal transphenoidal approach without disturbing the visual and pituitary hormonal functions of the patient. Centre: Dr Khurana using the Medtronic stereotactic "wand" probe to accurately map out a brain tumour well before any skin incision is made. Right: A low grade glioma (astrocytoma) of the dominant supplementary motor area (SMA) in a young patient with seizures. The tumour was completely removed via stereotactic MRI-guided neurosurgery without any neurological deficit. |
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Left: CT "scout" image following surgical disconnection of the torcula dural ateriovenous fistula (shown earlier, above). Parallel microtitanium clips are seen, behind which is a titanium mesh used to aid in reconstruction of the skull bone at the conclusion of the operation. Centre: Enhanced T1 MRI showing a deep paravermian/brainstem region lung cancer metastasis which was completely resected with full resolution of the patient's preoperative (presenting) neurological symptoms. Right: T2 MRI showing a right frontal arteriovenous malformation prior to its complete resection by Dr Khurana at The Canberra Hospital. The patient was discharged from hospital neurologically intact on the third-postoperative day. |
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Left: MRI with contrast showing a giant, vascular meningioma invading the superior sagittal sinus (brain's equivalent of the jugular vein). Note the deep compressive nodule at the bottom margin of the tumour. The patient, a Jehovah's Witness, expressed an advance directive specifying no transfusion of any type of blood product. The tumour (Centre panel) was gross totally resected with meticulous attention to blood-conserving measures. The deep nodule noted on the preoperative imaging is now seen at the centre of this intraoperative image immediately above the words "Giant Tumour". This patient's tumour had partly invaded into and expanded the overlying skull bone (hyperostosis; evident at the very top of the above left image), so a titanium scaffold (above right-upper panel) plus methylmethacrylate bone cement (above right-lower panel) cranioplasty was carried out with optimal cosmetic and structural results. The patient made an excellent recovery. |
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