Top Seven of Seven Series – 2024
With 2024 winding down, we will be counting down the top seven episodes of Seven Series from the past year. Keep scrolling as we revisit the most popular videos in the series. As always, thank you for watching along, and we look forward to another great year of Seven Series in 2025!
#7: STA-M4 Bypass for Moyamoya Disease
From Dr. Lawton: Most of what we do in neurosurgery is deconstructive—taking things down and removing them. Bypass surgery is constructive—building something beneficial that did not previously exist. That’s why these moyamoya patients are among my favorite. Some tips to keep in mind when performing bypass surgery:
- Handle the intima carefully
- Use a continuous suture technique for speed and rhythm
- Maximize the microscope zoom
- Don’t over-snug the suture line
#6: Trapping and Resection of a Mycotic M4 MCA Aneurysm with STA-MCA Bypass
From Dr. Lawton: Learn the “double fish-mouth” technique for end-to-end reanastomosis of an artery, in this case the temporal artery and M4 middle cerebral artery. It increases anastomotic area and decreases resistance for improved flow; suture lines are linearized and don’t require much vessel manipulation.
#5: Superficial Temporal Artery to Middle Cerebral Artery Bypass for Moyamoya Disease
From Dr. Lawton: Sewing a bypass is almost a battle against one’s own physiology and the limitations of equipment. Even with the microscope’s magnification and light dialed to their max, eyes strain to define transparent tissues. Muscles tighten with the pressure of ischemia time and precision of micromovement, but hands fight to stay fluid and calm and drive the needle delicately through its spiral.
#4: Anterior Interhemispheric Contralateral Transcallosal Approach for Resection of a Caudate Basal Ganglia Cavernous Malformation
From Dr. Lawton: Cavernomas in the basal ganglia are surrounded by critical structures and so deep that surgery may seem impossible, but points of access on an ependymal surface make them accessible, like this one in and under caudate head. Contralaterality gives cross-court exposure to reach the lateral-most part.
#3: Pterional Craniotomy for Clip Reconstruction of a Dolichoectatic Middle Cerebral Artery Aneurysm
From Dr. Lawton: Sometimes I pause to marvel at the beauty of the subarachnoid landscape, with its bright colors, unusual anatomy, and varied pathology sparkling under the intense light of the operating microscope. It’s like peering into a forbidden otherworld, like a deep sea dive or moon landing.
#2: Supratentorial-Infraoccipital Approach for Resection of a Medial Temporal Cavernous Malformation
From Dr. Lawton: It’s a fine line between removing every last bit of a thalamic cavernous malformation and causing harm to adjacent internal capsule. Achieving these two resection goals is a delicate balance, and recurrences are a part of the struggle to get it right.
#1: Pterional Craniotomy for Occlusion of a Basal Temporal Arteriovenous Fistula
From Dr. Lawton: Sometimes we need to think beyond the textbooks and taxonomies. This temporal arteriovenous fistula was so unusual—not dural, not parenchymal, but something in between—that it was misdiagnosed and mistreated for years. Multiple middle cerebral artery feeding arteries coalesced to join a varix on the middle fossa floor, but were easily interrupted. Happy Labor Day Weekend!