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Page 2 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: 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 (this page): 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
Skull base meningioma (above collage): This patient was found to have an extensive meningioma surrounding or displacing several critical cranial nerves and blood vessels at the base of her skull. Upper-left panel: MRI shows part of the tumour (red circle). Note the close proximity of the tumour to the upper brainstem (bst) and surrounding anterior and middle cerebral arteries (light blue arrows). Upper-centre panel: MRI shows part of the tumour (Tu) and the immediately adjacent and gradually encased nerves for vision (optic apparatus; yellow arrow heads) and internal carotid arteries (indicated by the white lines on either side of midline). Upper-right panel: Intraoperative image shows the tumour (Tu) being exposed. Note the immediately adjacent optic nerve (yellow arrow head) which was bowed by the tumour. Lower-left panel is an intraoperative photograph that shows the tumour being removed by a special device known as an ultrasonic aspirator (CUSA). The tip of this device is only a few millimetres in size. Lower-centre panel is a postoperative MRI scan showing complete removal of the tumour without any neurological complication. The tumour was previously located in the area encompassed by the red dotted circle. The brainstem (bst) lies immediately behind this region. The major arteries of this region (white in this panel) are all preserved. Lower-right panel is another postoperative MRI scan showing that the previously compressed and displaced optic apparatus (yellow arrow heads) now lies preserved and free of any tumour. The pituitary gland and its stalk (green arrow head) are intact and functioning normally postoperatively. The patient was back at work not long after surgery.
Brain bypass (above collage): The above four images are from a recent complex and successful brain bypass procedure carried out at The Canberra Hospital by Drs Khurana, Hardman and Duke and their respective neurosurgery, vascular surgery, and anaesthesia teams. For further information regarding the concept and procedure of brain bypass, and for an explanation of the above images, please visit the brain bypass page of our partner educational Site:
Neuronavigation (collage above, and poster below): Neuronavigation technology is like GPS navigation for the brain. It is an essential technology in neurosurgery, enhancing the safety and accuracy of the surgery while minimising the area of the surgical incision and craniotomy. Sophisticated hardware and software, in conjunction with a detailed preoperative MRI or CAT scan, allow the surgeon to build a multiplanar picture of the patient's brain and track the position of the surgical instruments as the surgery is being carried out. Top left image: Brain tumour. Top right image: The position of the surgeon's instrument or the "tip of the navigation probe" is located at the centre of the green cross-hairs in images that simultaneously project the patient's brain tumour (white region in these images) in multiple planes during the surgery. Bottom image: Dr Khurana looks at the position of the surgical instruments either on the screen or projected as "heads-up" images into the eyepiece(s) of his operating microscope. In the poster below: Dr Khurana's awake brain surgery team operate on a patient with the assistance of Medtronic's Stealth Treon Neuronavigation system (left side of poster below). The Canberra Hospital will soon acquire an intraoperative MRI to make this surgical environment truly "cutting-edge".
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