Novel Use of Robotically Harvested Internal Thoracic Artery in High-Flow Cerebral Bypass.

Mesenchymal tumors of the head and neck can lead to tumor-induced osteopeni, necessitating a biochemical cure to alleviate associated symptoms. We present a case of a 40-year-old man who presented with diffuse pain and wheelchair dependency secondary to a skull base mesenchymal tumor producing tumor-induced osteopeni. The tumor involved the cavernous sinus, infratemporal fossa, and middle cranial fossa. The patient failed the balloon occlusion test. Additionally, the patient consented to the procedure. Cerebral revascularization was performed using a robotically harvested internal thoracic artery because of the patient's short radial arteries and history of chronic superficial and deep vein thrombosis. After the common carotid artery-internal thoracic artery-M2 bypass, the patient underwent endovascular embolization of the external carotid artery feeders and occlusion of the cavernous external carotid artery. Several days later, the patient underwent a gross total resection via endoscopic assisted microsurgery. The residual biochemical disease was then addressed via supplemental radiosurgery. The patient's clinical outcome was favorable, with regained ambulatory function and resolution of initial symptoms. Unfortunately, he developed left optic neuropathy due to the embolization of the external carotid artery feeders.

Microsurgical Resection of Spinal Arteriovenous Malformation with Clipping of Anterior Spinal Artery Aneurysm.

Spinal cord arteriovenous malformations (AVMs) are rare and usually present in younger patients. We present the case of a 76-year-old woman with a 2-year history of unsteady gait. She presented to us with sudden-onset thoracic pain, numbness, and weakness in both legs. She was found to have urinary retention, dissociative pain loss in the left leg, and weakness involving the right leg. Magnetic resonance imaging demonstrated an intramedullary spinal AVM with subarachnoid hemorrhage and cord edema. The spinal angiogram detailed the architecture of the AVM and revealed a flow-related aneurysm in the anterior spinal artery. The patient underwent T8-T11 laminoplasty with a T10 transpedicular approach to allow for ventral exposure of the cord. Initially, a microsurgical clipping of the aneurysm was performed, followed by a pial resection of the AVM. Postoperatively, the patient recovered her bladder control and motor function. She is now able to walk with a walker due to impaired proprioception. Videos 1-4 detail the key steps and techniques for safe clipping and resection.