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Electromagnetic Navigation Improves Accuracy and Reduces Complications of Ventriculoperitoneal Shunts in Patients with Idiopathic Normal Pressure Hydrocephalus: A Single-Center Clinical Experience 电磁导航提高特发性正常压力脑积水患者脑室腹腔分流术的准确性并减少并发症:单中心临床经验。
IF 1.9 4区 医学
World neurosurgery Pub Date : 2025-02-01 DOI: 10.1016/j.wneu.2024.11.011
Xudong Ma , Xuehai Fan , Wenqinyi Yang , Jiahe Guo , Ziwei Zhou , Dong Wang , Yimeng Wu , Ningnannan Zhang , Guozhi Song , Yan Xing , Xiuyun Liu , Kai Yu , Huijie Yu
{"title":"Electromagnetic Navigation Improves Accuracy and Reduces Complications of Ventriculoperitoneal Shunts in Patients with Idiopathic Normal Pressure Hydrocephalus: A Single-Center Clinical Experience","authors":"Xudong Ma ,&nbsp;Xuehai Fan ,&nbsp;Wenqinyi Yang ,&nbsp;Jiahe Guo ,&nbsp;Ziwei Zhou ,&nbsp;Dong Wang ,&nbsp;Yimeng Wu ,&nbsp;Ningnannan Zhang ,&nbsp;Guozhi Song ,&nbsp;Yan Xing ,&nbsp;Xiuyun Liu ,&nbsp;Kai Yu ,&nbsp;Huijie Yu","doi":"10.1016/j.wneu.2024.11.011","DOIUrl":"10.1016/j.wneu.2024.11.011","url":null,"abstract":"<div><h3>Background</h3><div>Ventriculoperitoneal (VP) shunt surgery is the primary treatment for patients with idiopathic normal pressure hydrocephalus (iNPH). This study compared the outcomes of VP shunt placement using electromagnetic (EM) navigation versus standard methods in patients with iNPH, focusing on catheter accuracy and postoperative complication rates.</div></div><div><h3>Methods</h3><div>This retrospective study included 31 patients with iNPH who underwent standard shunt placement using anatomical landmarks and 50 patients who underwent EM-guided shunt placement. Parameters assessed included shunt placement grade, catheter tip position, catheter angle, puncture attempts, operative duration, postoperative infection rates, intraparenchymal hemorrhage rates, and shunt malfunction rates. Patients had follow-ups at 3, 6, 12, and 24 months after surgery or until shunt failure.</div></div><div><h3>Results</h3><div>In the EM-guided group, a higher percentage of grade 1 shunt placements (92% vs. 71%, <em>P</em> = 0.03) and fewer grade 3 placements (2% vs. 13%, <em>P</em> = 0.068) were observed. The catheter tip position at the foramen of Monro was significantly more accurate (<em>P</em> &lt; 0.001), with smaller lateral catheter deviation angles in both coronal (19.69° vs. 24.2°, <em>P</em> &lt; 0.0001) and sagittal (21.75° vs. 39.3°, <em>P</em> &lt; 0.01) sections. The EM-guided group had fewer puncture attempts, shorter operative durations, lower incidence of intraparenchymal hemorrhage (<em>P</em> &lt; 0.01), and fewer shunt malfunctions over the 2-year follow-up period (2% vs. 26%, <em>P</em> = 0.0003).</div></div><div><h3>Conclusions</h3><div>The use of EM navigation in VP shunt placement for patients with iNPH improves catheter placement accuracy, reduces postoperative complications and shunt malfunction rates, and provides precise and individualized surgical treatment.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"194 ","pages":"Article 123428"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Endoscopic Occipital Transtentorial Approach for Dorsal Midbrain Cavernous Malformation: Technical Notes With Illustrative Case 背侧中脑海绵状畸形的内窥镜枕骨经支架入路:技术说明与病例举例。
IF 1.9 4区 医学
World neurosurgery Pub Date : 2025-02-01 DOI: 10.1016/j.wneu.2024.11.043
Shuang Liu, Chongjing Sun, Pin Chen, Hantao Yang, Tao Xie, Jinlong Huang, Qiang Xie, Fan Hu, Xiaobiao Zhang
{"title":"Endoscopic Occipital Transtentorial Approach for Dorsal Midbrain Cavernous Malformation: Technical Notes With Illustrative Case","authors":"Shuang Liu,&nbsp;Chongjing Sun,&nbsp;Pin Chen,&nbsp;Hantao Yang,&nbsp;Tao Xie,&nbsp;Jinlong Huang,&nbsp;Qiang Xie,&nbsp;Fan Hu,&nbsp;Xiaobiao Zhang","doi":"10.1016/j.wneu.2024.11.043","DOIUrl":"10.1016/j.wneu.2024.11.043","url":null,"abstract":"<div><h3>Background</h3><div>The dorsal midbrain, an anatomically intricate region, presents significant challenges for traditional surgical interventions due to the heightened risk of vascular and neurological injury, and the necessity of brain tissue retraction.</div></div><div><h3>Methods</h3><div>This study retrospectively reviewed the case of a 29-year-old male diagnosed with a cavernous malformation located in the dorsal aspect of the left midbrain. The patient underwent resection via the endoscopic occipital transtentorial approach (EOTA) in July 2024. Comprehensive records were analyzed, including preoperative magnetic resonance imaging and computed tomography imaging, detailed surgical notes, and postoperative outcomes.</div></div><div><h3>Results</h3><div>The patient initially presented with headaches and diplopia. Imaging revealed a 17 × 13 mm tumor in the dorsal aspect of the left midbrain, associated with obstructive hydrocephalus. The 2.5-hour EOTA surgery resulted in complete resection of the tumor, with the resolution of headache symptoms and improvement of diplopia. No new complications were reported postoperatively. The patient was discharged 7 days postsurgery without the need for intensive care unit admission. Pathological examination confirmed the diagnosis of a cavernous malformation. Additionally, the EOTA facilitated a concurrent endoscopic third ventriculostomy, and no evidence of hydrocephalus was observed during the 3-month follow-up period.</div></div><div><h3>Conclusions</h3><div>The EOTA constitutes a significant advancement in neurosurgical techniques for the resection of dorsal midbrain tumors, enhancing surgical precision and safety. This approach contributes to improved patient outcomes and a reduction in complication rates. Further studies are warranted to validate these findings and to establish standardized protocols for the application of EOTA in midbrain tumor resection.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"194 ","pages":"Article 123460"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Cerebrospinal Fluid Prognostic Index in Ventriculoperitoneal Shunt Infection 脑室腹腔分流术感染的 CSF 预后指数
IF 1.9 4区 医学
World neurosurgery Pub Date : 2025-02-01 DOI: 10.1016/j.wneu.2024.11.088
Abdurrahman Arpa, Pinar Aydin Ozturk
{"title":"Cerebrospinal Fluid Prognostic Index in Ventriculoperitoneal Shunt Infection","authors":"Abdurrahman Arpa,&nbsp;Pinar Aydin Ozturk","doi":"10.1016/j.wneu.2024.11.088","DOIUrl":"10.1016/j.wneu.2024.11.088","url":null,"abstract":"<div><h3>Background</h3><div>Considering the consequences of shunt infection, the importance of early diagnosis and effective treatment becomes clear. However, there is no clear parameter to predict the management of shunt infection. Since we thought that an index including cerebrospinal fluid (CSF) leukocyte, glucose, and protein levels may affect treatment guidance, we aimed to investigate its effect on prognosis using the index we defined as CSF prognostic index.</div></div><div><h3>Methods</h3><div>Ventriculoperitoneal shunt infection patients' age, gender, etiology of hydrocephalus, serum glucose, leukocytes, white blood cell, C-reactive protein, CSF leukocyte, glucose, and leukoglycemic index (LGI) at admission were included. A new index was defined to include leukocyte, glucose, and protein values in CSF and investigate their effect on prognosis. CSF prognostic index = CSF leukocyte × CSF protein/CSF glucose.</div></div><div><h3>Results</h3><div>The study included 46 patients aged less than 18 years with shunt infection. There was no correlation among serum glucose, C-reactive protein, leukocytes, monocytes, lymphocytes, platelets, serum LGI, CSF LGI, and treatment duration. A positive correlation was found between CSF prognostic index and treatment duration, which was statistically significant (<em>P</em> = 0.011).</div></div><div><h3>Conclusions</h3><div>The CSF prognostic index is an index that can be easily evaluated with CSF findings at the time of presentation and can predict both the duration of treatment and the need for intrathecal treatment. Considering the use of broader spectrum antibiotherapies initially in patients with a high CSF prognostic index will avoid possible complications, provide less psychosocial impact on the patient and his/her relatives, and reduce the cost of treatment.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"194 ","pages":"Article 123505"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Navigated Osteosynthesis for Unstable Atlas Fractures: Technical Note and Case Series 不稳定寰椎骨折的导航植骨术:技术说明和病例系列。
IF 1.9 4区 医学
World neurosurgery Pub Date : 2025-02-01 DOI: 10.1016/j.wneu.2024.11.107
John D. Arena , Yohannes Ghenbot , Samuel B. Tomlinson , Connor A. Wathen , Andrea L.C. Schneider , H. Isaac Chen , Zarina S. Ali , James M. Schuster , Dmitriy Petrov
{"title":"Navigated Osteosynthesis for Unstable Atlas Fractures: Technical Note and Case Series","authors":"John D. Arena ,&nbsp;Yohannes Ghenbot ,&nbsp;Samuel B. Tomlinson ,&nbsp;Connor A. Wathen ,&nbsp;Andrea L.C. Schneider ,&nbsp;H. Isaac Chen ,&nbsp;Zarina S. Ali ,&nbsp;James M. Schuster ,&nbsp;Dmitriy Petrov","doi":"10.1016/j.wneu.2024.11.107","DOIUrl":"10.1016/j.wneu.2024.11.107","url":null,"abstract":"<div><h3>Objective</h3><div>Fractures of the atlas are typically considered stable or unstable based on the integrity of the transverse ligament. Whereas stable Jefferson burst fractures can be treated nonoperatively, unstable fractures with disruption of the transverse ligament often require surgical intervention. Atlas osteosynthesis has been proposed as a motion-preserving alternative to atlantoaxial fusion. Intraoperative navigation may facilitate safe placement of C1 instrumentation.</div></div><div><h3>Methods</h3><div>Cases of patients with unstable atlas fractures treated with navigated osteosynthesis at a single level I trauma center were identified and retrospectively reviewed. Clinical presentation, surgical management, and postoperative outcomes were assessed.</div></div><div><h3>Results</h3><div>Eight patients underwent navigated posterior atlas osteosynthesis for unstable C1 fractures between December 2015 and January 2024. All patients demonstrated injury to the transverse ligament (Dickman type I [<em>n</em> = 1] and type II [<em>n</em> = 7]). Patients were followed with serial radiographs showing preserved alignment, with no significant change in postoperative atlantodental interval at the most recent follow-up (+0.2 ± 0.87 mm [mean change ± standard deviation]; <em>P</em> = 0.53). Six patients obtained follow-up computed tomography, all of which demonstrated evidence of osseous union across fractures without hardware complication. No patients developed postoperative instability requiring fusion.</div></div><div><h3>Conclusions</h3><div>Atlas osteosynthesis is an attractive motion-preserving approach to the treatment of unstable atlas fractures, avoiding the morbidity of atlantoaxial fusion. Classically reserved for Jefferson fractures with Dickman type II transverse ligament injury, atlas osteosynthesis may also be a viable option for type I transverse ligament injuries. Intraoperative navigation can be particularly useful for screw placement in the setting of traumatically distorted anatomy with lateral mass displacement.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"194 ","pages":"Article 123524"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142751860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Enhancing the Technical Pearls for L5–S1 Anterior Lumbar Interbody Fusion in Patients with Body Mass Index More Than 30: Clinical and Radiographic Outcomes at 1-Year Follow-Up 在体重指数大于30的患者中增强L5-S1前路腰椎体间融合的技术指标:1年随访的临床和影像学结果
IF 1.9 4区 医学
World neurosurgery Pub Date : 2025-02-01 DOI: 10.1016/j.wneu.2024.11.119
Juan P. Giraldo, Gabriella P. Williams, Martin P. Zomaya, Winward Choy, Jay D. Turner, Laura A. Snyder, Juan S. Uribe
{"title":"Enhancing the Technical Pearls for L5–S1 Anterior Lumbar Interbody Fusion in Patients with Body Mass Index More Than 30: Clinical and Radiographic Outcomes at 1-Year Follow-Up","authors":"Juan P. Giraldo,&nbsp;Gabriella P. Williams,&nbsp;Martin P. Zomaya,&nbsp;Winward Choy,&nbsp;Jay D. Turner,&nbsp;Laura A. Snyder,&nbsp;Juan S. Uribe","doi":"10.1016/j.wneu.2024.11.119","DOIUrl":"10.1016/j.wneu.2024.11.119","url":null,"abstract":"<div><h3>Background</h3><div>Performing anterior lumbar interbody fusion (ALIF) in patients with a body mass index (BMI) &gt;30 presents surgical challenges. To overcome those challenges, a modified procedure is described.</div></div><div><h3>Methods</h3><div>This study retrospectively reviewed patients with a BMI &gt;30 who underwent the modified L5–S1 ALIF procedure from August 2017 to September 2023. Patient demographic and operative characteristics were collected. Clinical and radiographic outcomes were analyzed before surgery and at 1-year follow-up. An analysis was performed comparing patients with a BMI &gt;30 who underwent the modified ALIF procedure versus the standard ALIF procedure.</div></div><div><h3>Results</h3><div>A total of 26 patients with BMI &gt;30 were evaluated. Thirteen received treatment with the modified ALIF technique, and 13 received treatment with the standard ALIF technique. Operative time was significantly shorter in the modified ALIF technique cohort (<em>P</em> = 0.006). Preoperative and postoperative radiographic findings indicated significant differences in anterior disc height (<em>P</em> &lt; 0.001), posterior disc height (<em>P</em> = 0.02), and L5–S1 segmental lordosis (<em>P</em> &lt; 0.001) in patients undergoing the modified ALIF technique. There were no intraoperative complications. Postoperative visual analog scale for back pain, visual analog scale for leg pain, and Oswestry Disability Index scores significantly improved after surgery (<em>P</em> &lt; 0.05) in both cohorts after 1 year. Complete interbody fusion was achieved according to computed tomography evaluation 1 year after surgery in more than 80% of cases.</div></div><div><h3>Conclusions</h3><div>ALIF surgery is a safe technique to address lumbar pathologies. This operative technique provides complimentary abdominal exposure data for access surgeons while performing ALIFs in patients with BMI &gt;30. This technique could reduce operative time in such patients.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"194 ","pages":"Article 123536"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Letter to the Editor Regarding “Global Trends of Mechanical Thrombectomy in Acute Ischemic Stroke over the Past Decade: A Scientometric Analysis Based on WOSCC and GBD Database” 关于“近十年来急性缺血性卒中机械取栓的全球趋势:基于WOSCC和GBD数据库的科学计量学分析”的致编辑信。
IF 1.9 4区 医学
World neurosurgery Pub Date : 2025-02-01 DOI: 10.1016/j.wneu.2024.123622
Saarang Patel, Kyle W. Scott, Visish M. Srinivasan
{"title":"Letter to the Editor Regarding “Global Trends of Mechanical Thrombectomy in Acute Ischemic Stroke over the Past Decade: A Scientometric Analysis Based on WOSCC and GBD Database”","authors":"Saarang Patel,&nbsp;Kyle W. Scott,&nbsp;Visish M. Srinivasan","doi":"10.1016/j.wneu.2024.123622","DOIUrl":"10.1016/j.wneu.2024.123622","url":null,"abstract":"","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"194 ","pages":"Article 123622"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Toward a Personalized Paradigm for Extracranial Pseudoaneurysm Treatment 颅内外假性动脉瘤治疗的个性化范例。
IF 1.9 4区 医学
World neurosurgery Pub Date : 2025-02-01 DOI: 10.1016/j.wneu.2024.11.071
Emmanuel O. Mensah, Jean Filo, Christopher S. Ogilvy
{"title":"Toward a Personalized Paradigm for Extracranial Pseudoaneurysm Treatment","authors":"Emmanuel O. Mensah,&nbsp;Jean Filo,&nbsp;Christopher S. Ogilvy","doi":"10.1016/j.wneu.2024.11.071","DOIUrl":"10.1016/j.wneu.2024.11.071","url":null,"abstract":"","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"194 ","pages":"Article 123488"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Recurrent Internal Carotid Artery Dissection Due to Missed Diagnosis of Eagle Syndrome 因鹰氏综合征漏诊而复发性颈内动脉夹层。
IF 1.9 4区 医学
World neurosurgery Pub Date : 2025-02-01 DOI: 10.1016/j.wneu.2024.123581
Lukas Andereggen , Angelo Tortora
{"title":"Recurrent Internal Carotid Artery Dissection Due to Missed Diagnosis of Eagle Syndrome","authors":"Lukas Andereggen ,&nbsp;Angelo Tortora","doi":"10.1016/j.wneu.2024.123581","DOIUrl":"10.1016/j.wneu.2024.123581","url":null,"abstract":"<div><div>An unusual case of a patient with bilateral carotid artery dissection caused by compression from elongated styloid processes is presented. The diagnosis was overlooked 8 years earlier. Eagle syndrome, marked by an elongated styloid process, can result in cervical artery dissection, highlighting the significance of recognizing this correlation in recurrent cases, which occur more frequently than idiopathic internal carotid artery dissections.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"194 ","pages":"Article 123581"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Technical Feasibility and Safety of Transpedicular Thoracic Partial Corpectomy Using Biportal Endoscopic Technique: A Novel Approach for Separation Surgery in Spinal Metastatic Disease 经椎弓根胸椎体部分切除术的技术可行性和安全性:一种用于脊柱转移性疾病分离手术的新方法。
IF 1.9 4区 医学
World neurosurgery Pub Date : 2025-02-01 DOI: 10.1016/j.wneu.2024.123582
Yohannes Ghenbot , Joshua Golubovsky , Hasan S. Ahmad , John D. Arena , Gabrielle Santangelo , Connor Wathen , Rahwa Ghenbot , Mert Marcel Dagli , Daksh Chauhan , Emily Ling-Lin Pai , Jang W. Yoon
{"title":"Technical Feasibility and Safety of Transpedicular Thoracic Partial Corpectomy Using Biportal Endoscopic Technique: A Novel Approach for Separation Surgery in Spinal Metastatic Disease","authors":"Yohannes Ghenbot ,&nbsp;Joshua Golubovsky ,&nbsp;Hasan S. Ahmad ,&nbsp;John D. Arena ,&nbsp;Gabrielle Santangelo ,&nbsp;Connor Wathen ,&nbsp;Rahwa Ghenbot ,&nbsp;Mert Marcel Dagli ,&nbsp;Daksh Chauhan ,&nbsp;Emily Ling-Lin Pai ,&nbsp;Jang W. Yoon","doi":"10.1016/j.wneu.2024.123582","DOIUrl":"10.1016/j.wneu.2024.123582","url":null,"abstract":"<div><div>Bony metastases frequently involve the spinal column, most commonly the thoracic spine.<span><span><sup>1</sup></span></span> Surgical interventions in spinal metastatic disease are palliative and effective in providing diagnoses, reducing pain, and maintaining ambulatory function through neural element decompression and improving axial pain and posture through spinal column stabilization. Surgeons must weigh the benefits of surgery against fragility and limited life expectancy in patients with cancer.<span><span><sup>2</sup></span></span><sup>,</sup><span><span><sup>3</sup></span></span> Minimally invasive techniques such as tubular and endoscopic approaches modulate preoperative risk profiles by disrupting less tissue, which may hasten time for postoperative recovery and time to radiation and systemic therapy for disease control.<span><span><sup>4</sup></span></span><sup>,</sup><span><span><sup>5</sup></span></span> Advancements in surgical technique and technology have expanded endoscopic indications in spinal oncology. Indications have evolved from biopsy and hybrid open minimally invasive surgery approaches to fully endoscopic separation surgery and gross total resection of nonmetastatic tumors.<span><span>6</span></span>, <span><span>7</span></span>, <span><span>8</span></span>, <span><span>9</span></span>, <span><span>10</span></span> In the case presented in <span><span>Video 1</span></span>, we used a biportal endoscopic technique to separate an unstable T12 retropulsed burst fracture from the ventral thoracic spinal cord. The biportal endoscopic technique allowed use of standard instruments for partial corpectomy such as osteotomes, rongeurs, and drills assisted by endoscopic visualization. Minimally invasive surgery percutaneous instrumentation was performed to stabilize the spinal column. Postoperative imaging showed improved spinal alignment and adequate spinal canal decompression, which allowed the patient to be discharged on postoperative day 4 without wound complications and undergo stereotactic body radiation therapy. The patient consented to this procedure, and identifiable individuals consented to publication of their image.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"194 ","pages":"Article 123582"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Application of the Posterior Atlanto-Occipital Membrane Tension Release Technique for Surgical Exposure of the Horizontal Part of the Vertebral Artery's Third Segment: An Anatomical and Clinical Investigation 寰枕后膜张力释放技术在椎动脉第三段水平段手术暴露中的应用:解剖学和临床研究。
IF 1.9 4区 医学
World neurosurgery Pub Date : 2025-02-01 DOI: 10.1016/j.wneu.2024.123597
Jie Liu , Ge Huang , Jing Zhang , Tian-Kang Yi , Shen-Yu Li , Guang-Sheng Zhu , Xin-Hua Tian , Qing-Chun Mu , Zhong Liu
{"title":"The Application of the Posterior Atlanto-Occipital Membrane Tension Release Technique for Surgical Exposure of the Horizontal Part of the Vertebral Artery's Third Segment: An Anatomical and Clinical Investigation","authors":"Jie Liu ,&nbsp;Ge Huang ,&nbsp;Jing Zhang ,&nbsp;Tian-Kang Yi ,&nbsp;Shen-Yu Li ,&nbsp;Guang-Sheng Zhu ,&nbsp;Xin-Hua Tian ,&nbsp;Qing-Chun Mu ,&nbsp;Zhong Liu","doi":"10.1016/j.wneu.2024.123597","DOIUrl":"10.1016/j.wneu.2024.123597","url":null,"abstract":"<div><h3>Objective</h3><div>This study aims to elucidate the anatomical principles governing the surrounding venous structures (VS) of the horizontal part of the third segment of the vertebral artery (V3h) and develop a safe and bloodless surgical technique for exposing V3h.</div></div><div><h3>Methods</h3><div>This study used 10 formalin-infused cadaveric head specimens. The dissections were performed stepwise to simulate the far lateral approach process, exposing the V3h with a novel technique. Additionally, we applied this technique to 10 patients undergoing far or extreme lateral approaches.</div></div><div><h3>Results</h3><div>The VS surrounding V3h is divided into 3 components: the vertebral venous plexus, suboccipital cavernous sinus, and the anastomotic vein. The posterior atlanto-occipital membrane (PAOM), a resilient fascial layer in the craniovertebral junction, extends from the periosteum of the occipital squama to the posterior arch of the atlas. It adheres ventrally to the VS within the suboccipital triangle (SOT), forming a tent-like structure that maintains tension and ensures fullness of the VS around V3h. We discovered that by releasing tension in this membrane and reducing strain on this tent-like structure, the collapse of the venous sinus within the SOT can be achieved, resulting in reduced intraoperative bleeding and improved surgical efficiency. Additionally, we successfully managed 10 clinical cases employing the PAOM tension release technique in clinical cases, with no reported incidents of intraoperative vertebral artery injury.</div></div><div><h3>Conclusions</h3><div>The application of the PAOM tension release technique effectively collapses the tent-like structure within the SOT, significantly reducing bleeding during V3h exposure in craniovertebral junction.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"194 ","pages":"Article 123597"},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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