Journal of Craniovertebral Junction and Spine最新文献

{"title":"Intraoperative occipital to C2 angle and external acoustic meatus-to-axis angular measurements for optimizing alignment during posterior fossa decompression and occipitocervical fusion for complex Chiari malformation","authors":"Rachael K. Han, John K. Chae, Andrew L. A. Garton, Amanda Cruz, Rodrigo Navarro-Ramirez, Ibrahim Hussain, Roger Härtl, Jeffrey P Greenfield","doi":"10.4103/jcvjs.jcvjs_59_23","DOIUrl":"https://doi.org/10.4103/jcvjs.jcvjs_59_23","url":null,"abstract":"Background: Excess flexion or extension during occipitocervical fusion (OCF) can lead to postoperative complications, such as dysphagia, respiratory problems, line of sight issues, and neck pain, but posterior fossa decompression (PFD) and OCF require different positions that require intraoperative manipulation. Objective: The objective of this study was to describe quantitative fluoroscopic morphometrics in Chiari malformation (CM) patients with symptoms of craniocervical instability (CCI) and demonstrate the intraoperative application of these measurements to achieve neutral craniocervical alignment while leveraging a single axis of motion with the Mayfield head clamp locking mechanism. Methods: A retrospective cohort study of patients with CM 1 and 1.5 and features of CCI who underwent PFD and OCF at a single-center institution from March 2015 to October 2020 was performed. Patient demographics, preoperative presentation, radiographic morphometrics, operative details, complications, and clinical outcomes were analyzed. Results: A total of 39 patients met the inclusion criteria, of which 37 patients (94.9%) did not require additional revision surgery after PFD and OCF. In this nonrevision cohort, preoperative to postoperative occipital to C2 angle (O-C2a) (13.5° ± 10.4° vs. 17.5° ± 10.1°, P = 0.047) and narrowest oropharyngeal airway space (nPAS) (10.9 ± 3.4 mm vs. 13.1 ± 4.8 mm, P = 0.007) increased significantly. These measurements were decreased in the two patients who required revision surgery due to postoperative dysphagia (mean difference – 16.6°° in O C2a and 12.8°° in occipital and external acoustic meatus to axis angle). Based on these results, these fluoroscopic morphometrics are intraoperatively assessed, utilizing a locking Mayfield head clamp repositioning maneuver to optimize craniocervical alignment prior to rod placement from the occipital plate to cervical screws. Conclusion: Establishing a preoperative baseline of reliable fluoroscopic morphometrics can guide surgeons intraoperatively in appropriate patient realignment during combined PFD and OCF, and may prevent postoperative complications.","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"293 1","pages":"365 - 372"},"PeriodicalIF":1.1,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139327910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical management of spinal schwannomas arising from the first and second cervical roots: Results of a cumulative case series","authors":"F. Corrivetti, Raffaelino Roperto, R. Sufianov, G. Cacciotti, Arslan Musin, Albert Sufianov, L. Mastronardi","doi":"10.4103/jcvjs.jcvjs_75_23","DOIUrl":"https://doi.org/10.4103/jcvjs.jcvjs_75_23","url":null,"abstract":"Objective: Schwannomas of the first and second nerve roots are rare neurosurgical entities, harboring specific surgical features that make surgical resection particularly challenging and deserve specifics dissertations. This study is a retrospectively analysis of 14 patients operated in two different neurosurgical centers: the San Filippo Neri Hospital of Rome and the Federal Centre of Neurosurgery of Tjumen. Materials and Methods: In the last 6 years, 14 patients underwent neurosurgical resection of high cervical (C1–C2) schwannomas, in two different neurosurgical centers. Patients data regarding clinical presentation, radiological findings, and surgical results were retrospectively analyzed. Results: The mean age was 50 years (range 13–74), the follow-up mean duration was 30 ± 8.5 (range 24–72 months), and there was no significant differences among different tumor locations (intradural, extradural, and dumbbell). Surgical results were excellent: gross total resection was achieved in all cases and there were no intraoperative complications or postoperative mortality. All patients presented postoperative clinical improvement except one who remained stable. Karnofsky performance status, at the last follow-up, confirmed a global clinical improvement. No vertebral artery (VA) injury neither spinal instability occurred; nerve root sacrifice was reported in one case. Conclusions: Neurosurgical treatment of C1–C2 schwannomas is associated with good outcomes in terms of extent of resection and neurological function. In particular, dumbbell shape and VA involvement do not represent limitations to achieve complete tumor resection and good clinical outcome. In conclusion, microsurgery represents the treatment of choice for C1–C2 schwannomas.","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"99 1","pages":"426 - 432"},"PeriodicalIF":1.1,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139328082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of magnetic resonance imaging and 18-fluorodeoxyglucose positron emission tomography-computed tomography in identifying pain generators in patients with chronic low back pain","authors":"Deepak Nandkishore Sharma, V. Yerramneni, Madhur K. Srivastava, Thirumal Yerragunta, Sasank Akurati","doi":"10.4103/jcvjs.jcvjs_88_23","DOIUrl":"https://doi.org/10.4103/jcvjs.jcvjs_88_23","url":null,"abstract":"Objective: Low back pain (LBP) is a major cause of pain and disability. Identification of the pathology accurately or the pain generators is sometimes difficult with the conventional modalities such as magnetic resonance imaging (MRI), computed tomography (CT), or X-ray. Nuclear medicine investigations such as single-photon emission CT (SPECT/CT) or 18-fluorodeoxyglucose positron emission tomography-CT (18-FDG PET-CT) have emerged as an adjuvant tool in these cases. In this study, we evaluated and analyzed the role of 18-FDG PET-CT in identifying active pain generators and the outcomes of interventions based on that compared to MRI. Methodology: This study included all patients who fell under inclusion criteria presented with chronic LBP with or without radiculopathy. History and clinical examination were done as well as Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores were calculated. All the patients underwent MRI lumbosacral spine with sacroiliac (SI) joint and 18-FDG PET-CT whole spine. Patients in whom PET-CT was positive and active pain generator was identified were managed for the specific level or pain generator responsible by appropriate modalities, i.e. surgery, interfacetal injections, transforaminal epidural injections, and SI joint injections. Patients in whom PET-CT was negative were managed according to the pain generator identified on the basis of MRI and clinical correlation. Patients were told to follow-up after 1 week and 1 month, and subsequent improvement was evaluated on the basis of VAS after 1 week and 1 month and ODI score after 1 month. Results: A total of 20 patients were included in the study, with a mean age of 41.9 ± 13.53 years. Twelve patients had multiple level pathology without the indication of significant pain generator and eight patients' symptoms did not correlate with the MRI findings. 18-FDG PET-CT was done in all patients. 10% (2/20) patients were identified with active pain generators on PET-CT which were not identified on MRI. Eleven out of twenty patients underwent intervention in the form of surgery or pain injections. The mean VAS and ODI score in the patients intervened on the basis of 18-FDG PET-CT improved by 70.59% and 50%, respectively, whereas in patients who underwent intervention on the basis of MRI had improvement in mean VAS and ODI score by 58.57% and 30.81%, respectively after 1 month. Conclusion: Inflammation and associated degenerative process in the spine is a continuous process and affects multiple levels and might not be easily picked up on MRI or other conventional modalities. Thus, 18-FDG PET-CT is useful in identifying these active inflammatory processes and thereby helping in the localization of active pain generators. Treating these active pain generators has a better outcome in patients after intervention in terms of better pain relief and quality of life and also reduces the levels being treated.","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"12 1","pages":"381 - 387"},"PeriodicalIF":1.1,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139331244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcervical, retropharyngeal odontoidectomy - Anatomical considerations.","authors":"Salim M Yakdan, Jacob K Greenberg, Ajit A Krishnaney, Thomas E Mroz, Alexander Spiessberger","doi":"10.4103/jcvjs.jcvjs_112_23","DOIUrl":"10.4103/jcvjs.jcvjs_112_23","url":null,"abstract":"<p><strong>Context: </strong>Anterior craniocervical junction lesions have always been a challenge for neurosurgeons. Presenting with lower cranial nerve dysfunction and symptoms of brainstem compression, decompression is often required. While posterior approaches offer indirect ventral brainstem decompression, direct decompression via odontoidectomy is necessary when they fail. The transoral and endoscopic endonasal approaches have been explored but come with their own limitations and risks. A novel retropharyngeal approach to the cervical spine has shown promising results with reduced complications.</p><p><strong>Aims: </strong>This study aims to explore the feasibility and potential advantages of the anterior retropharyngeal approach for accessing the odontoid process.</p><p><strong>Methods and surgical technique: </strong>To investigate the anatomical aspects of the anterior retropharyngeal approach, a paramedian skin incision was performed below the submandibular gland on two cadaveric specimens. The subcutaneous tissue followed by the platysma is dissected, and the superficial fascial layer is opened. The plane between the vascular sheath laterally and the pharyngeal structures medially is entered below the branching point of the facial vein and internal jugular vein. After reaching the prevertebral plane, further dissection cranially is done in a blunt fashion below the superior pharyngeal nerve and artery. Various anatomical aspects were highlighted during this approach.</p><p><strong>Results: </strong>The anterior, submandibular retropharyngeal approach to the cervical spine was performed successfully on two cadavers highlighting relevant anatomical structures, including the carotid artery and the glossopharyngeal, hypoglossal, and vagus nerves. This approach offered wide exposure, avoidance of oropharyngeal contamination, and potential benefit in repairing cerebrospinal fluid fistulas.</p><p><strong>Conclusions: </strong>For accessing the craniocervical junction, the anterior retropharyngeal approach is a viable technique that offers many advantages. However, when employing this approach, surgeons must have adequate anatomical knowledge and technical proficiency to ensure better outcomes. Further studies are needed to enhance our anatomical variations understanding and reduce intraoperative risks.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"14 4","pages":"393-398"},"PeriodicalIF":1.1,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10805156/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139547553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-time ultrasound guidance in the endoscopic endonasal resection of a retro-odontoid pannus: Technical note and case illustration","authors":"Matthieu D Weber, Guilherme Finger, Vikas Munjal, Kyle C Wu, Basit A. Jawad, Asad S. Akhter, Vikram B. Chakravarthy, R. Carrau, D. Prevedello","doi":"10.4103/jcvjs.jcvjs_117_23","DOIUrl":"https://doi.org/10.4103/jcvjs.jcvjs_117_23","url":null,"abstract":"Background and Objectives: Odontoidectomy is a surgical procedure indicated in the setting of various pathologies, with the main goal of decompressing the ventral brain stem and spinal cord as a result of irreducible compression at the craniovertebral junction. The endoscopic endonasal approach has been increasingly used as an alternative to the transoral approach as it provides a straightforward, panoramic, and direct approach to the odontoid process. In addition, intraoperative ultrasound (US) guidance is a technique that can optimize safety and surgical outcomes in this context. It is used as an adjunct to neuronavigation and provides intraoperative confirmation of decompression of craniovertebral junction structures in real time. The authors aim to present the use and safe application of real-time intraoperative US guidance during endonasal endoscopic resection of a retro-odontoid pannus. Methods: A retrospective chart review of a single case was performed and presented herein as a case report and narrated operative video. Results: A minimally invasive US transducer was used intraoperatively to guide the resection of a retro-odontoid pannus and confirm spinal cord decompression in real time. Postoperative examination of the patient revealed immediate neurological improvement. Conclusions: Intraoperative ultrasonography is a well described and useful modality in neurosurgery. However, the use of intraoperative US guidance during endonasal endoscopic approaches to the craniovertebral junction has not been previously described. As demonstrated in this technical note, the authors show that this imaging modality can be added to the ever-evolving armamentarium of neurosurgeons to safely guide the decompression of neural structures within the craniocervical junction with good surgical outcomes.","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"7 1","pages":"433 - 437"},"PeriodicalIF":1.1,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139327911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic versus microscopic discectomy for pathologies of lumbar spine: A nationwide cross-sectional study from a lower-middle-income country","authors":"Bhavya Pahwa, Anish Tayal, Dhiman Chowdhury, G. Umana, Bipin Chaurasia","doi":"10.4103/jcvjs.jcvjs_39_23","DOIUrl":"https://doi.org/10.4103/jcvjs.jcvjs_39_23","url":null,"abstract":"Objective: We conducted a cross-sectional study to assess the preference of spine surgeons between MD for microdiscectomy and endoscopic discectomy (ED) surgery for the management of lumbar pathologies in a lower-middle-income country (LMIC). Methodology: An online survey assessing the preference of spine surgeons for various lumbar pathologies was developed and disseminated in “Neurosurgery Cocktail” a social media platform. Statistical analyses were performed using SPSS software with a level of significance <0.05. Results: We received responses from 160 spine surgeons having a median experience of 6.75 years (range 0–42 years) after residency. Most of the spine surgeons preferred MD over ED, preference being homogeneous across all lumbar pathologies. In ED, the interlaminar approach was preferred more frequently than the transforaminal approach. The most commonly chosen contraindication for the interlaminar approach and transforaminal approach was ≥ 3 levels lumbar disc herniation (LDH) (n = 117, 73.1%) and calcified LDH (n = 102, 63.8%), respectively. There was no significant association between the type of approach preferred (MD vs. ED; and interlaminar vs. translaminar endoscopic approach) with the type of workplace and the level of experience. Conclusion: Spine surgeons were inclined toward MD over ED, due to various reasons, such as a steep learning curve, lack of training opportunities, and upfront expenses. There is a pressing need for the upliftment of ED in LMICs which requires global action.","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"9 1","pages":"373 - 380"},"PeriodicalIF":1.1,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139330319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is the quality of reporting in randomized controlled trials in spinal conditions","authors":"Andreas K. Demetriades, J. Tiefenbach, Jay J. Park, Mohammed Ma'arij Anwar, Sara Manzoor Raza","doi":"10.4103/jcvjs.jcvjs_121_23","DOIUrl":"https://doi.org/10.4103/jcvjs.jcvjs_121_23","url":null,"abstract":"Purpose: Substandard quality across published randomized controlled trials (RCTs) is a major concern. Imperfect reporting has the potential to distort the evidence landscape and waste valuable health-care resources. In this study, we aim to assess the current quality of reporting in the field of spine using a modified version of the Consolidated Standards of Reporting Trials (CONSORT) checklist. Materials and Methods: A list of published RCTs in the field of spine disease from January 1, 2013, to December 31, 2020, was built. Two reviewers scored the published RCTs against a modified CONSORT checklist. The mean adjusted CONSORT scores for each study, reporting category, and checklist item were calculated. Results: The mean and median scores across all of the RCTs were 0.72 and 0.74 out of 1.00, respectively. The spectrum of scores was wide, ranging from 0.45 to 0.94. The reporting categories with the lowest score included randomization, blinding, and abstract. The items which were most under-reported included allocation sequence generation, type of randomization used, full trial protocol details, and abstract methodology. The inter-rater reliability between our reviewers was substantial (κ = 0.7, κ = 0.71). Conclusion: Our findings correlate with only a moderate level of compliance to the CONSORT criteria on the quality of reporting for RCTs in spinal conditions. This is in line with previous reports on compliance, both within and outside the field of spinal conditions. Further continued and sustained efforts are still required to enhance the quality and consistency of RCT reporting, ultimately reducing health-care resource wastage and improving patient safety.","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"1 1","pages":"404 - 411"},"PeriodicalIF":1.1,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139326140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"”Only fixation” in cases with failed decompression for lumbar canal stenosis – Analysis of outcome in 14 cases","authors":"Atul Goel, Apurva Prasad, A. Shah, Shradha Maheshwari, Ravikiran Vutha","doi":"10.4103/jcvjs.jcvjs_151_23","DOIUrl":"https://doi.org/10.4103/jcvjs.jcvjs_151_23","url":null,"abstract":"Aim: The rationale of “only fixation” of affected spinal segments without any form of bone or soft-tissue decompression in cases with failed decompressive laminectomy for lumbar canal stenosis is discussed on the basis of an experience with 14 cases. Materials and Methods: During the period between 2010 and 2022, 14 patients who symptomatically worsened or did not improve following a long-segment “wide” decompressive laminectomy for multisegmental lumbar canal stenosis were identified. All patients were treated by segmental spinal stabilization aimed at arthrodesis by facetal distraction by Goel's facetal spacers (6 cases) or Camille's transarticular facetal fixation (8 cases). No bone, soft tissue, or disc resection was done for spinal or neural canal “decompression.” Oswestry Disability Index and Visual Analog Scale were used to clinically assess the patients before and after the surgery and at follow-up. In addition, video recordings of patient's self-assessment of clinical outcome were used to monitor the outcome. Results: During the average period of follow-up of 71 months (range 6 months to 16 years), all patients recovered in majority of their major symptoms, the recovery was observed in the immediate postoperative period. During the period of follow-up, none of the patients complained of recurrent symptoms or needed any additional surgery. There was firm stabilization and evidences of bone fusion of the treated spinal segments in all patients. There were no infections or implant failure. No patient worsened after treatment. Conclusions: Instability of the spinal segments is the primary issue in cases with lumbar canal stenosis and stabilization in the treatment.","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"37 1","pages":"330 - 335"},"PeriodicalIF":1.1,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139329086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atlas fractures with and without simultaneous dens fractures differ with respect to clinical, demographic, and management characteristics","authors":"M. Cloney, P. Texakalidis, Anastasios G Roumeliotis, N. Tecle, N. Dahdaleh","doi":"10.4103/jcvjs.jcvjs_126_23","DOIUrl":"https://doi.org/10.4103/jcvjs.jcvjs_126_23","url":null,"abstract":"Background: Patients with simultaneous fractures of the atlas and dens have traditionally been managed according to the dens fracture's morphology, but data supporting this practice are limited. Methods: We retrospectively examined all patients with traumatic atlas fractures at our institution between 2008 and 2016. We used multivariable regression and propensity score matching to compare the presentation, management, and outcomes of patients with isolated atlas fractures to patients with simultaneous atlas-dens fractures. Results: Ninety-nine patients were identified. Patients with isolated atlas fractures were younger (61 ± 22 vs. 77 ± 14, P = 0.0003), had lower median Charlson Comorbidity Index (3 vs. 5, P = 0.0005), had better presenting Nurick myelopathy scores (0 vs. 3, P < 0.0001), and had different mechanisms of injury (P = 0.0011). Multivariable regression showed that having a simultaneous atlas-dens fracture was independently associated with older age (odds ratio [OR] =1.59 [1.22, 2.07], P = 0.001), worse presenting myelopathy (OR = 3.10 [2.04, 4.16], P < 0.001), and selection for surgery (OR = 4.91 [1.10, 21.97], P = 0.037). Propensity score matching yielded balanced populations (Rubin's B = 23.3, Rubin's R = 1.96) and showed that the risk of atlas fracture nonunion was no different among isolated atlas fractures compared to simultaneous atlas-dens fractures (P = 0.304). Age was the only variable independently associated with atlas fracture nonunion (OR = 2.39 [1.15, 5.00], P = 0.020), having a simultaneous atlas-dens fracture was not significant (P = 0.2829). Conclusions: Among patients with atlas fractures, simultaneous fractures of the dens occur in older patients and confer an increased risk of myelopathy and requiring surgical stabilization. Controlling for confounders, the risk of atlas fracture nonunion is equivalent for isolated atlas fractures versus simultaneous atlas-dens fractures.","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"285 1","pages":"418 - 425"},"PeriodicalIF":1.1,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139328229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vertebral artery is an anatomical landmark in the posterior unilateral resection of cervical benign nerve sheath tumors with dumbbell extension of Eden type 2 or 3","authors":"Ryokichi Yagi, Masao Fukumura, Naoki Omura, R. Hiramatsu, Masahiro Kameda, N. Nonoguchi, M. Furuse, Shinji Kawabata, Toshihiro Takami, M. Wanibuchi","doi":"10.4103/jcvjs.jcvjs_84_23","DOIUrl":"https://doi.org/10.4103/jcvjs.jcvjs_84_23","url":null,"abstract":"Background: In the cervical nerve sheath tumor (NST) surgery with dumbbell extension of Eden type 2 or 3, selection of anterior, posterior, or combined approach remains controversial. Objectives: This technical note aimed to propose possible advantages of the posterior unilateral approach (PUA). Methods: Six patients who underwent the surgical treatment of cervical NSTs with dumbbell extension of Eden type 2 or 3 were included. The critical surgical steps included (1) complete separation of extradural and intradural procedures, (2) careful peeling of the neural membranes (epineurium and perineurium) from the tumor surface in the extradural procedure, (3) complete removal of the extradural tumor within the neural membranes, (4) intradural disconnection of tumor origin, and (5) intentional tumor removal up to the vertebral artery (VA), i.e., the VA line. Results: The tumor location of dumbbell extension was Eden types 2 and 3 in two and four patients. Gross total resection was achieved in two patients and intentional posterior removal of the tumor to the VA line was achieved in the remaining four patients. No vascular or neural injuries associated with surgical procedures occurred. Postoperative neurological assessment revealed no symptomatic aggravation in all patients. No secondary surgery was performed during the study period. Conclusion: PUA was safe and less invasive for functional recovery and tumor resection, if the anatomical relationship between the tumor and VA is clearly understood. The VA line is an important anatomical landmark to limit the extent of tumor resection.","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"16 1","pages":"388 - 392"},"PeriodicalIF":1.1,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139331405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}