Operative neurosurgery (Hagerstown, Md.)最新文献

{"title":"External Ventricular Drain Placement Using Active Augmented Reality Guidance: A Proof of Concept of a Clinically Integrable System.","authors":"Jesse A M van Doormaal, Tim Fick, Jene W Meulstee, Tessa M Kos, Maarten Bot, Patrick O'Donnell, Bachtiar Burhani, Pierre A J T Robe, Eelco W Hoving, Tristan P C van Doormaal","doi":"10.1227/ons.0000000000001681","DOIUrl":"https://doi.org/10.1227/ons.0000000000001681","url":null,"abstract":"<p><strong>Background and objectives: </strong>Suboptimal placement occurs in 26% of external ventricular drain (EVD) procedures performed using traditional freehand methods. We developed a low-cost augmented reality stereotactic navigation system aimed at improving accuracy and safety of the procedure, which is readily compatible with existing Picture Archiving and Communication Systems and automated image segmentation algorithms.</p><p><strong>Methods: </strong>The system integrates cloud storage, image segmentation, trajectory planning, point-based image-to-patient registration, and real-time 3-dimensional guidance superimposed over the surgical field. As a proof of concept, 15 neurosurgeons, neurosurgical residents, and physician assistants used anatomical landmark-based registration to conduct 29 EVD placements on anatomical phantoms with small ventricles within a simulated surgical environment. From postoperative computed tomography, placement accuracy was assessed using the Kakarla grading scale, along with the distance to target and angular deviation.</p><p><strong>Results: </strong>Twenty EVDs (69.0%; 95% CI, 52.1%-85.8%) were graded as optimal Kakarla 1 placements, 4 (13.8%; 95% CI, 1.2%-26.3%) as suboptimal Kakarla 2 placements, and 5 (17.2%; 95% CI, 3.5%-31.0%) as suboptimal Kakarla 3 placements. The mean distance to target was 9.49 mm (SD, 4.64 mm), and the mean angular deviation was 9.20° (SD, 6.35°). The mean workflow time was 22 minutes 45 seconds (SD, 11 minutes 38 seconds), and the system demonstrated a fiducial registration error of 4.00 mm (SD, 1.16 mm). Challenges related to human-computer interaction were identified, suggesting further refinement is needed to optimize usability.</p><p><strong>Conclusion: </strong>While the accuracy, user interface, and procedural time of the system require further refinement for clinical implementation, this proof of concept demonstrates the clinical and technical feasibility of an end-to-end 3-dimensional augmented reality system with the potential to enhance the safety and accuracy of EVD placements.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602813","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":"Interhemispheric Transcallosal Transchoroidal Resection of a Third Ventricular Ganglioglioma: 2-Dimensional Operative Video.","authors":"David R Peters, L Erin Miller, Scott D Wait","doi":"10.1227/ons.0000000000001713","DOIUrl":"https://doi.org/10.1227/ons.0000000000001713","url":null,"abstract":"","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602815","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":"Endovascular Treatment of a Fenestrated Basilar Artery Aneurysm: 2-Dimensional Operative Video.","authors":"Hector R Martínez, Rogelio E Flores-Salcido, Jose A Moran-Guerrero, Luis E Perez-Martinez, Marcos Vinicius Sangrador-Deitos, J Antonio Infante Cantú, Jose A Figueroa-Sanchez","doi":"10.1227/ons.0000000000001719","DOIUrl":"https://doi.org/10.1227/ons.0000000000001719","url":null,"abstract":"","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602812","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":"Fluorescein-Guided Removal of Thoracic Spinal Solitary Fibrous Tumor: 2-Dimensional Operative Video.","authors":"Tariq Sabbah, Ettore Carpineta, Silvia Michelini, Francesco Calvosa, Luana Licata, Luciano Mastronardi","doi":"10.1227/ons.0000000000001700","DOIUrl":"https://doi.org/10.1227/ons.0000000000001700","url":null,"abstract":"","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602814","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":"Mononostril Endoscopic Endonasal Chopstick Technique for Low Petroclival Meningioma With Sphenoidal Sinus Cranialization and Rostral Mucosal Closure.","authors":"Luca Ferlendis, Nobuyuki Watanabe, Arianna Fava, Tingting Jiang, Thibault Passeri, Sebastien Froelich","doi":"10.1227/ons.0000000000001695","DOIUrl":"https://doi.org/10.1227/ons.0000000000001695","url":null,"abstract":"<p><strong>Background and importance: </strong>Lower petroclival meningiomas (PCMs) and jugular tubercle meningiomas are among the most challenging tumors in neurosurgery, with the optimal approach still debated. Traditional posterior and lateral open approaches are still commonly employed but are invasive and carry significant risks due to brain retraction and neurovascular manipulation. The extended endonasal transclival approach has emerged as a less invasive alternative for midline lesions, offering direct access with early tumor devascularization and reduced manipulation of critical structures. However, limitations include lateral tumor extension, challenging skull base reconstruction, and nasal morbidity, especially when using a nasoseptal flap, which may negatively affect quality of life. To minimize both intracranial and nasal morbidities, we propose a right mononostril contralateral endonasal approach using the chopstick technique with angled scopes and instruments, combined with sphenoid sinus cranialization and rostral mucosal suturing for reconstruction.</p><p><strong>Clinical presentation: </strong>A 33-year-old man presented with progressive headaches. Neuroimaging revealed a 29 × 39-mm PCM centered in the lower petroclival junction. Preoperative embolization was followed by tumor resection using a right mononostril endoscopic endonasal approach. Closure involved cranialization of the sphenoid sinus with rostral mucosa suturing. Postoperatively, lumbar punctures for cerebrospinal fluid depletion were conducted. No cerebrospinal fluid leakage or new neurological deficits were observed.</p><p><strong>Conclusion: </strong>The mononostril endoscopic endonasal chopstick technique provides direct access to the petroclival region, enabling total resection of selected low-lying PCMs or jugular tubercle meningiomas. This minimally invasive technique, combined with rostral mucosal closure, may reduce surgical morbidity and improve postoperative quality of life.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602816","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":"Anatomic Feature and Preventive Strategy of Anterior Spinal Artery Occlusion in Endovascular Internal Trapping of Vertebral Artery Dissecting Aneurysms Distal to the Bifurcation of the Posterior Inferior Cerebellar Artery.","authors":"Koji Hashimoto, Hideyuki Yoshioka, Takuma Wakai, Toru Tateoka, Norito Fukuda, Ryo Horiuchi, Shin Nakano, Yuichiro Naito, Masahiro Shimizu, Hiroyuki Kinouchi","doi":"10.1227/ons.0000000000001707","DOIUrl":"https://doi.org/10.1227/ons.0000000000001707","url":null,"abstract":"<p><strong>Background and objectives: </strong>In endovascular internal trapping for intracranial vertebral artery dissecting aneurysms (VADAs) distal to the posterior inferior cerebellar artery bifurcation, anterior spinal artery (ASA) occlusion is a serious complication although it is relatively infrequent because of the presence of collateral blood vessels. In this article, we investigated the correlation between vascular anatomy and ischemic complications of the ASA.</p><p><strong>Methods: </strong>We retrospectively evaluated 21 patients with ruptured PICA-distal type VADA treated by internal trapping at our affiliated institutions from 2008 to 2022. The parent arteries were embolized from the dilated segment to the normal vessel, with careful preservation of the perforating arteries and the ASA. Primary end points included ASA origin anatomy, ASA occlusion incidence, and ischemic complications in the medullary and spinal cord regions.</p><p><strong>Results: </strong>The ASA originated from bilateral vertebral arteries (VAs), the contralateral VA, and the ipsilateral VA, in 7, 11, and 3 cases, respectively. Postoperative ASA occlusion was observed in 3 cases. In 2 of these cases, ischemic complications did not occur because of the presence of collateral flow from the ASA originating from the contralateral side. However, the third patient developed medullary cervical infarction because of occlusion of the ipsilateral ASA 5 hours after the treatment although the ASA had been preserved during intervention. In these 3 patients, the distance between the ASA and the distal coil end was shorter than that in nonobstructed cases. In addition, lateral medullary syndrome occurred in 1 case.</p><p><strong>Conclusion: </strong>Cases of distal VADA with unilateral ipsilateral bifurcation of the ASA and proximity of the dissection site to the ASA origin carry the risk of severe medullary cervical infarction despite intraoperative preservation of the ASA. In such cases, strict postoperative management including antithrombotic therapy or alternative treatment modalities such as direct surgical VA trapping by clips should be considered.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577616","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":"Catalogue and Evolution of Minimally Invasive Approaches for Adult Intracranial Pathology From 2011 to 2023.","authors":"Max Yang, Ishan Shah, Alex Renn, Vivek Satish, Gage A Guerra, David Gomez, David J Cote, Stephanie Cheok, Racheal Peterson, Tyler Cardinal, Robert G Briggs, Jonathan Sisti, Gabriel Zada","doi":"10.1227/ons.0000000000001682","DOIUrl":"https://doi.org/10.1227/ons.0000000000001682","url":null,"abstract":"<p><strong>Background and objectives: </strong>Minimally invasive surgery (MIS) presents an attractive alternative to conventional open cranial approaches because it limits tissue exposure, promotes wound healing, and enhances patient satisfaction. This study aimed to describe our experience with selection and use of prospectively catalogued MIS cranial approaches to treat a variety of pathologies, highlighting clinical outcomes and trends over time.</p><p><strong>Methods: </strong>We used a prospectively maintained database of patients undergoing cranial surgery by the senior author at our institution between 2011 and 2023. Cases were classified as open or MIS at the time of surgery. We defined MIS as inclusive of any endoscopic, endoscopic-assisted keyhole, or port-based approach, including channel-based neuro-endoscopy, endoscopic-assisted craniotomy, and exoscopic port-based approaches. The details of each approach, the pathological target, and major postoperative complications were recorded and analyzed.</p><p><strong>Results: </strong>Within the 13-year inclusion period, 1371 MIS procedures were performed, comprising 54% of 2540 cranial neurosurgical operations. There was a marked increase in the proportion of MIS cases from 49.4% in the initial half to 58.4% in the final half of the timeline (P = .002). The majority of MIS cases were endoscopic endonasal approaches (n = 1068, 77.9%), including 742 (69.5%) direct and 326 (30.5%) extended approaches to treat skull base lesions. Endoscopic channel-based (n = 86, 6.3%) and keyhole approaches (n = 114, 8.3%) were used to access cortical and subcortical lesions. Hybrid microscopic/endoscopic, exoscopic/endoscopic, and blue-light endoscopic procedures increased substantially in the later years of the cohort. Complication rates changed from 12.3% to 10.7% for MIS and 11.9% to 14.2% for open cases when comparing initial with subsequent years.</p><p><strong>Conclusion: </strong>MIS approaches have become increasingly valuable tools in our surgical armamentarium over the past decade, as evidenced by the evolving proportion of MIS procedures performed over time. Reasonable complication profiles further contribute to the efficacy and safety of MIS cranial approaches.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577617","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":"Minimally Invasive, Tubular Approach for Ligation of Spinal Cerebrospinal Fluid-Venous Fistulas: A Single Surgeon, Consecutive Case Series.","authors":"Ryan Gensler, Stefan T Prvulovic, Alan Balu, Jason Lim, Jean-Paul Bryant, Gnel Pivazyan, Anousheh Sayah, Vinay Deshmukh","doi":"10.1227/ons.0000000000001701","DOIUrl":"https://doi.org/10.1227/ons.0000000000001701","url":null,"abstract":"<p><strong>Background and objectives: </strong>Spontaneous intracranial hypotension results from spinal cerebrospinal fluid (CSF) leaks, with Type III leaks, CSF-venous fistulas, being particularly challenging to diagnose and treat. Over approximately 2 years, 138 patients were diagnosed with spontaneous CSF leaks at our institution, with 57 requiring surgery with 31 of those surgical patients having Type III leaks. This study evaluates the safety, efficacy, and durability of a minimally invasive (MIS), tubular, nerve-sparing surgical technique for repairing Type III CSF leaks.</p><p><strong>Methods: </strong>We retrospectively reviewed 31 consecutive patients (mean age: 57.0 ± 15.0 years; 51.6% female; mean body mass index: 27.4 ± 6.3) diagnosed with Type III CSF leaks who underwent MIS surgical ligation from September 2022 to October 2024. Most leaks involved the thoracic spine (96.8%), with 35.5% of patients exhibiting multilevel leaks. Preoperative evaluation included MRI and myelography for precise leak localization. The surgical approach used a paramedian incision, tubular retractor placement, lateral facetectomy, and venous ligation without nerve sacrifice. Clinical outcomes included symptom resolution, headache severity (Visual Analog Scale scores), radiographic improvement measured by Bern scores, and postoperative complications.</p><p><strong>Results: </strong>Presenting symptoms included headaches (100%), dizziness (51.6%), nausea (38.7%), neck pain (32.3%), tinnitus (29.0%), and cognitive disturbances (29.0%). Postoperatively, 90.3% experienced complete headache resolution. Headache severity significantly decreased from a median preoperative Visual Analog Scale of 4.0 (IQR: 2.5) to 1.0 (IQR: 3.0) postoperatively (P < .01). Bern scores improved significantly from 6.3 ± 2.8 preoperatively to 3.0 ± 2.9 postoperatively (P < .001). The median follow-up was 5.87 months (IQR: 6.62). Complications were limited to 2 patients (6.4%): 1 transient high-pressure headache managed conservatively.</p><p><strong>Conclusion: </strong>MIS, tubular ligation of CSF-venous fistulas is a safe and effect management strategy with high efficacy rates and low incidence of complications.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577618","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":"Olfactory Carcinoma Invading Orbital Apex Treated by Combined Transnasal-Transorbital Resection with Extended Orbital Clearance and Anterior Cavernosectomy: 2-Dimensional Operative Video.","authors":"Iacopo Dallan, Simona Serioli, Matteo Barucco, Marco Ferrari, Lorena Di Girolami, Giacomo Fiacchini, Michele Caniglia, Francesco Acerbi","doi":"10.1227/ons.0000000000001685","DOIUrl":"https://doi.org/10.1227/ons.0000000000001685","url":null,"abstract":"","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577619","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":"In Reply: Extradural and Intradural Anterior Clinoidectomy: Technical Nuances and Video Illustration.","authors":"Gurkirat Kohli, Tarek Y El Ahmadieh, Vera Vigo, Muhammet Enes Gurses, Aaron A Cohen-Gadol, Juan C Fernandez-Miranda","doi":"10.1227/ons.0000000000001689","DOIUrl":"https://doi.org/10.1227/ons.0000000000001689","url":null,"abstract":"","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556549","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}