![]() Anatomy, anatomy, anatomy, especially when were talking about the third ventricle, this is a view from above where we can see the two internal cerebral veins. So in order to obviate that we have designed some instruments that really bring light down to us, as you can see right here, by either utilizing a lighted suction or a lighted bipolar. And that can vary between three to six degrees, depending on how long your focal length is, which means that if you wanna have the best vision, which is straight down the visual axis, your light may be totally inadequate because it'll bounce off the side and this is particularly so as we work with very increasingly smaller corridors. One of the things that's really important is to recognize is that our visual axis and our light axis come in at different angles. And this is basically the way we sit at the operating room table. And with a foot pedal, you can obviously use the mouthpiece in an arc motion rather than just the X, Y axis. And the mouthpiece also always gives you the very best trajectory for your vision and for your light. There are many different ways to be in the comfort zone, for me to be sitting, having arm rests and wrist support, and then utilizing your foot pedals, like playing an organ, to move the microscope if necessary, always using a mouthpiece so that your hands are constantly available. In order to really do microsurgery as is required for this particularly difficult area, the surgeon needs to be comfortable. And that really requires everything that we know how to get to the deep portions of the brain. It's a pleasure to be talking about a kind of lesion that really requires everything that we have learned about the anatomy. Spetzler, thank you again for being such an immense contributor to this series and please go ahead. And that's an indication for really the difficulty of this location. ![]() And they're more approaches described to the third ventricle than any other place in the brain. And really one of the most difficult places to reach. He's gonna talk to us about the third ventricular tumors or lesions in the area, a place many of us refer to as the seat of the soul, if such a thing exists as the seat of the soul per se. He doesn't require any introduction, truly a role model for me and all of us. Robert Spetzler from Barrow Neurological Institute. QRS fragmentation arrhythmogenic right ventricular cardiomyopathy implantable cardioverter defibrillator sudden cardiac death ventricular arrhythmia.- Colleagues and friends, thank you for joining us for another session of this short OR. ![]() Therefore, large scale and prospective studies are needed to confirm those findings. The frQRS complex on standard 12-lead ECG predicts fatal and nonfatal arrhythmic events in patients with ARVC/D. Also, the number of ECG leads with frQRS complex was higher in patients with arrhythmic events (5.08 ± 2.5 vs 1.14 ± 1.7, P < 0.001, respectively). The frQRS was significantly associated with arrhythmic events (P < 0.001). The phenomenon of frQRS was defined as deflections at the beginning of the QRS complex, on top of the R-wave, or in the nadir of the S-wave similar to the definition in CAD in either one right precordial lead or in more than one lead including all standard ECG leads.ĭuring 38 ± 14 months follow-up period, 3 patients (3.8%) died suddenly, 36 patients (46.1%) experienced arrhythmic events (32 ventricular tachycardias and 4 ventricular fibrillation, 30 in the ICD group). ![]() Eleven patients with complete/incomplete right bundle branch block were excluded from the study. Baseline ECG evaluation revealed frQRS complex in 46 patients (59%). Seventy-eight patients (51 men, 65.4% mean age: 31.25 ± 11.5 years) with the diagnosis of ARVC/D according to 2010 modified Task Force Criteria were analyzed retrospectively. Therefore, we aimed to investigate the association of frQRS with arrhythmic events in patients with ARVC/D. However, there are little data regarding the prognostic role of frQRS in these patients. Fragmented QRS (frQRS) complex, with various morphology, has been recently described as a diagnostic criterion of arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D).
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