Operative neurosurgery (Hagerstown, Md.)最新文献

{"title":"Anatomic Relationship Between the Greater Occipital Nerve and the Axis: Is It Possible to Safely Insert a Percutaneous C2 Screw Without Causing Occipital Neuralgia?","authors":"Anhelina Khadanovich, Michal Benes, Radek Kaiser, Jeremy Reynolds, Gerard Mawhinney, Jan Stulik, David Kachlik","doi":"10.1227/ons.0000000000001697","DOIUrl":"https://doi.org/10.1227/ons.0000000000001697","url":null,"abstract":"<p><strong>Background and objectives: </strong>Harms' technique is a widely used method for atlantoaxial stabilization. In recent years, minimally invasive surgery (MIS) using various robotic systems for percutaneous C1 to C2 screw insertion has started to be used. However, MIS raises concerns about the precision required to avoid injury to vascular and neural structures. The greater occipital nerve (GON) primarily arises from the C2 spinal root, located between the posterior arch of the C1 vertebra and the lamina of the C2 vertebra. The first bend of the GON could potentially overlay the lateral aspect of the C2 vertebra, specifically between the superior and inferior facets, ie, the interarticular part (IAP), making it susceptible to injury during C2 pedicle screw insertion causing the occipital neuralgia. That is why the aim of our study is to investigate the relationship of the GON to the axis and to assess the risk of its violation during C2 pedicle screw insertion.</p><p><strong>Methods: </strong>Eight cadaveric specimens, embalmed in classical formaldehyde solution, were dissected to describe the position of the GON in relation to the axis.</p><p><strong>Results: </strong>The apex of the first GON bend was localized 3.9 ± 2.2 mm from the lateral margin of the C2 IAP, 10.5 ± 2.7 mm caudal from the superior facet joint of the axis. The apex of the first bend was 3.5 ± 2.0 mm above the surface of the C2 IAP. The width of the C2 IAP was 14.2 ± 3.8 mm while the height was 15.9 ± 1.3 mm.</p><p><strong>Conclusion: </strong>The GON overlaid the cranial two-thirds of the IAP surface and can cross the entry point of the C2 screw. Therefore, we recommend using the most caudal entry point as possible, with steeper cranial angle controlled with navigation, to avoid the GON injury during MIS.</p>","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":"144556547","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":"Optimizing Endoscopic Approaches for Sphenoid Lateral Recess Cerebrospinal Fluid Leaks: Proposal of a New Algorithm.","authors":"Ravi Sankar Manogaran, Nidhin Das K, Amit Keshri, Awadesh Kumar Jaiswal, Arun Kumar Srivastava, Anant Mehrotra, Kuntal Kanti Das, Kamlesh Bhaisora, Prerna Angrish, Dheeneshwar Subramaniam, Sukriti Nehra, Reshma Raj, Sanjeev Kumar, Shrimoyee Roy, Nazrin Hameed, Kalyan Chidambaram, Mohd Aqib, Mohit Sinha, Ramandeep Singh Virk","doi":"10.1227/ons.0000000000001694","DOIUrl":"https://doi.org/10.1227/ons.0000000000001694","url":null,"abstract":"<p><strong>Background and objectives: </strong>Sphenoid lateral recess cerebrospinal fluid (CSF) leaks are a distinct subset of spontaneous CSF leaks, often linked to idiopathic intracranial hypertension. Despite their clinical significance, a structured management algorithm tailored for them is lacking. This work proposes a comprehensive algorithm for managing surgical interventions in sphenoid lateral recess CSF leaks, which is based on radiological classifications and anatomic parameters.</p><p><strong>Methods: </strong>This ambispective study, conducted from 2017 to 2024, integrated cadaveric dissections with clinical data from 33 patients presenting with sphenoid lateral recess CSF leaks. Cadaveric models were used to explore the feasibility of transcaruncular approach to lateral recess of sphenoid with respect to V 2 -Vidian distance (VVD). Spiral computed tomography scans with 1-mm slices provided a precise classification of defects. Radiological and intraoperative parameters were analyzed, including the VVD. Patient outcomes and surgical difficulty, scored using a Likert scale, were statistically evaluated.</p><p><strong>Results: </strong>The study classified defects into 4 types: Type I (0%), Type II (30.3%) with 12 cases, Type III (42.4%) with 14 cases, and Type IV (27.3%) with 7 cases. The mean VVD was 6.28 ± 1.9 mm, significantly influencing surgical difficulty. Modified transpterygoid and transpterygoid approaches were predominant for Types III and IV. Cases with VVD <4 mm had higher rates of Vidian nerve and sphenopalatine artery sacrifices ( P < .05). Surgical success was 100%, with no CSF recurrence. Complications included transient cheek paresthesia in 12% of patients, resolved on follow-up.</p><p><strong>Conclusion: </strong>Based on defect classification and anatomic parameters, the proposed algorithm optimizes the surgical management of sphenoid lateral recess CSF leaks. The study underscores the role of radiological evaluations in guiding approach selection and highlights the importance of preserving neurovascular structures to achieve improved outcomes.</p>","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":"144556553","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":"Letter: Intradural Pituitary Hemitransposition: Technical Note and Case Series Illustration.","authors":"José Luis León Palacios, Felipe Ernesto Terpin Ayvar, Alvaro Joan Goyzueta Hanco, Yolanda Cristina Balta Anchi","doi":"10.1227/ons.0000000000001690","DOIUrl":"https://doi.org/10.1227/ons.0000000000001690","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":"144556552","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":"Using Quality Function Deployment to Design an Image-Guided, Multibiopsy Tool for Neurosurgical Applications.","authors":"Kaytlin Andrews, Hunter Dejean, Cameron MacLeod, Kate Prieditis, Heidi-Lynn Ploeg, James Purzner, Teresa Purzner","doi":"10.1227/ons.0000000000001696","DOIUrl":"https://doi.org/10.1227/ons.0000000000001696","url":null,"abstract":"<p><strong>Background and objectives: </strong>The ability to molecularly characterize spatially heterogeneous tumors, such as primary brain tumors, depends on the efficient and consistent collection of spatially defined tissue samples free of cross-contamination. Currently available neurosurgical tools, designed for clinical use rather than modern molecular characterization, limit our view of heterogeneous processes to snapshots of single regions. This study introduces a novel biopsy device that enables the precise, reproducible, and spatially registered collection of tissue across a tumor and surgical cavity, paving the way for advancements in personalized tumor characterization and treatment.</p><p><strong>Methods: </strong>Prototypes were developed using a Quality Function Deployment framework to prioritize user requirements and technical needs. Iterative modeling and 3D printing produced prototypes that underwent proof-of-concept and phantom testing. Final validation involved comparative testing of the novel biopsy tool and Yasargil tumor-grasping forceps by 6 neurosurgeons and 6 students. Clinical feasibility was assessed through the collection of 10 intraoperative tissue samples using each device.</p><p><strong>Results: </strong>The lead design, which met all Quality Function Deployment requirements, consists of an optically tracked capsule that attaches to a Frazier suction. When suction is applied, a piston is pulled up and the sample is securely contained. After releasing the suction, manual depression ejects the tissue. In comparative testing, the capsule method reduced variability in sample weight and collection time compared with the Yasargil forceps. It also demonstrated greater ease of use, enabling students to achieve results comparable with experienced surgeons. Clinical testing revealed no differences in sample variability, tissue preservation, or instrument failure.</p><p><strong>Conclusion: </strong>This optically tracked navigated biopsy tool offers a low-cost, efficient, easily used, and consistent method for brain biopsy collection. The novel device is well suited for precision medicine and translational research needs.</p>","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":"144556556","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":"Development of a Fiducial System for Registration of Stereotactic Head Frames: Process and Outcomes.","authors":"Farhan Khan, Nathan A Shlobin, W Elorm Yevudza, Brett E Youngerman, Guy M McKhann, Neil A Feldstein","doi":"10.1227/ons.0000000000001692","DOIUrl":"https://doi.org/10.1227/ons.0000000000001692","url":null,"abstract":"<p><strong>Background and objectives: </strong>It is critical to have fast and accurate intraoperative navigation coregistration between neuroimaging studies and the patient's cranial anatomy for functional neurosurgery procedures. Scalp-based laser or skull fiducial-based coregistration approaches have notable limitations. We have overcome these challenges by developing and manufacturing novel, noninvasive metal fiducial markers that attach directly to stereotactic head frames. We describe our development of fiducials, delineate our operative technique, and compare initial outcomes in targeting stereoelectroencephalography cases using fiducials for registration vs historical controls using a standard laser-based approach.</p><p><strong>Methods: </strong>A system of 6 aluminum fiducial markers (\"Felducials,\" named after one of the senior authors) that are hollowed out on the apex to match the robotic registration pointer probe of the ROSA robot were developed for the Cosman-Roberts-Wells® stereotactic frame and adapted to the Leksell Vantage™ frame. The operative approach involved placement of the stereotactic head frame, acquisition of intraoperative computed tomography, merging of preoperative MRI with intraoperative computed tomography, and navigation of the registration probe to each fiducial site. Root mean square coregistration accuracy and registration time were compared between patients who underwent registration with fiducials and laser.</p><p><strong>Results: </strong>In our pilot comparison study, 32 patients underwent coregistration with our fiducials and 21 with standard ROSA laser-based methodology. Root mean square error was significantly lower in the fiducial group (0.38 ± 0.15) relative to the laser group (0.46 ± 0.12) ( P = .012). Registration time was also significantly lower in the fiducial group (6.28 ± 3.70 minutes) compared with the laser group (17.81 ± 8.99 minutes) ( P < .001).</p><p><strong>Conclusion: </strong>Our novel noninvasive aluminum fiducial system (\"Felducials\") is compatible with common stereotactic head frame systems and readily adaptable to other stereotactic systems as they are developed. Registration of the ROSA ONE® Brain system using Felducials provided superior accuracy and registration time in comparison with the standard laser approach.</p>","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":"144556548","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":"Letter: Extradural and Intradural Anterior Clinoidectomy: Technical Nuances and Video Illustration.","authors":"Giuseppe Mariniello, Sergio Corvino, Oreste de Divitiis","doi":"10.1227/ons.0000000000001688","DOIUrl":"https://doi.org/10.1227/ons.0000000000001688","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":"144556551","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":"Intraoperative Malfunction of Neuroendoscopic Biopsy Forceps: A Case Report With Technical Note.","authors":"Kayla Byrne, Jacob Mazza, Melissa A LoPresti, Jonathan Scoville, Michael DeCuypere, Sandi Lam","doi":"10.1227/ons.0000000000001703","DOIUrl":"10.1227/ons.0000000000001703","url":null,"abstract":"<p><strong>Background and importance: </strong>Pineal region tumors often present with symptoms of hydrocephalus, due to obstruction of cerebrospinal fluid outflow at the cerebral aqueduct. A commonly used option for neurosurgical management involves endoscopic third ventriculostomy with concurrent biopsy of the pineal lesion for both diagnostic and management purposes. This can be performed with 1 or 2 trajectories of a rigid endoscope or through a single burr hole with a flexible neuroendoscope. This case is presents an example of real-time considerations.</p><p><strong>Clinical presentation: </strong>This is a case of a 16-year-old adolescent boy who presented with a pineal region mass causing obstructive hydrocephalus. He underwent flexible neuroendoscopic third ventriculostomy and biopsy. Intraoperatively, the biopsy forceps malfunctioned in a constitutively open position within the endoscope. Several steps were taken to troubleshoot and eventually remove the malfunctioned equipment without injury. This experience shows that such equipment malfunction can occur and demonstrates an approach to intraoperative problem-solving in flexible neuroendoscopy.</p><p><strong>Conclusion: </strong>Intraoperative device malfunction is known occurrence for which every surgeon must be prepared. This case highlights an approach to work through such a scenario of instrument failure and the limitations of the equipment. Understanding of the tools at hand, intended use, and suitable alternatives or lack thereof can mitigate the risk of device malfunction affecting patient outcomes.</p>","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":"144556550","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":"Single-Session Middle Meningeal Artery Embolization With Concomitant Evacuation Surgery for Chronic Subdural Hematomas: A Multicenter Assessment of Feasibility, Safety, and Efficacy.","authors":"Santiago Gomez-Paz, Kent Richter, Maggie McGrath, Jeffrey M Breton, Samuel H Wakelin, Immaculate Christie, Kory B D Pasko, Ahmed Aljuboori, Philipp Hendrix, Gregory M Weiner, Ben Slee, Edward A M Duckworth, Jan-Karl Burkhardt, Visish M Srinivasan, Brian T Jankowitz, Thomas Snyder, Michael R Levitt, Rocco Armonda, Daniel R Felbaum, William J Ares, Mohamed M Salem, Ramesh Grandhi","doi":"10.1227/ons.0000000000001686","DOIUrl":"https://doi.org/10.1227/ons.0000000000001686","url":null,"abstract":"<p><strong>Background and objectives: </strong>Middle meningeal artery embolization (MMAE) is a safe and efficacious adjunct to surgical evacuation for symptomatic chronic subdural hematoma (cSDH). We evaluated the concomitant performance of MMAE with surgical evacuation in a single anesthetic session rather than a staged approach.</p><p><strong>Methods: </strong>In this retrospective, multicenter cohort study, patients with cSDH who underwent MMAE and surgical evacuation during 1 anesthetic session from January 2020 through August 2024 were included. The primary endpoints were feasibility (technical success), safety (complication and mortality rates), and efficacy (radiographic improvement and modified Rankin Scale score ≤2).</p><p><strong>Results: </strong>Among 157 patients (median age 74 years), 66% had unilateral cSDH and 34% had bilateral disease. Technical success was achieved in 153 patients (97.4%), with no major intraprocedural failures. The overall complication rate was 10.8%, including intraprocedural complications (ie, vessel injuries, cardiac arrest) in 4 patients (2.5%) and periprocedural adverse events in 13 patients (8.3%), including seizures, hemorrhages, respiratory failure, ischemic events, infections, and recurrent hematomas. The overall mortality rate was 12.7% (6 [3.8%] early postoperative deaths, 13 [8.3%] late unrelated deaths). Radiographic improvement was observed in 91.7% of patients, with 63.1% achieving ≥50% reduction in hematoma thickness at last available follow-up. At median follow-up of 54 days, 99/118 (83.9%) patients achieved or maintained functional independence (modified Rankin Scale ≤2).</p><p><strong>Conclusion: </strong>Single-session MMAE with concomitant surgical evacuation proved feasible and safe. Radiographic and clinical outcomes were favorable, without higher complication rates compared with staged approaches. Future prospective studies should clarify the long-term benefits, assess the impact on resource use and cost-minimization, and determine ideal patient-selection criteria for this integrated treatment strategy.</p>","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":"144556554","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":"Supracerebellar Transtentorial Approach for Resection of a Basal Ganglia Thalamic Cavernous Malformation: 2-Dimensional Operative Video.","authors":"Christopher S Graffeo, Jacob F Baranoski, Michael T Lawton","doi":"10.1227/ons.0000000000001691","DOIUrl":"https://doi.org/10.1227/ons.0000000000001691","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":"144556555","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":"Safety Profile of Select Perioperative Lumbar Drain Use After Endoscopic Endonasal Surgery.","authors":"Danielle Wishart, Mehrdad Pahlevani, David J Cote, Joseph Hendrix, Racheal Peterson, Bozena B Wrobel, Jonathan Sisti, Robert G Briggs, Gabriel Zada","doi":"10.1227/ons.0000000000001656","DOIUrl":"https://doi.org/10.1227/ons.0000000000001656","url":null,"abstract":"<p><strong>Background and objectives: </strong>Lumbar drains (LD) may be selectively used in complex endoscopic endonasal surgery (EES) to promote cerebrospinal fluid (CSF) diversion and decrease CSF leak rates. Perioperative outcomes related to LD insertion have not been described in detail. We aimed to study safety profiles and complications associated with LD placement for EES.</p><p><strong>Methods: </strong>We retrospectively reviewed patients undergoing EES for anterior skull-base tumors from January 2014 to December 2023. Patients were stratified based on selected use or nonuse of a LD placed perioperatively. Drain-related complications and outcomes were determined for LD patients.</p><p><strong>Results: </strong>Of 690 patients, 141 (20.4%) underwent LD insertion at the time of EES. Most LD patients (81.6%) underwent an extended EES compared with 14.4% of non-LD patients. Common pathologies for LD patients included pituitary adenoma (27.7%), craniopharyngioma (21.3%), meningioma (9.9%), and chordoma (5.7%). Tumor invasion into parasellar regions, including the suprasellar, infrasellar, and cavernous sinus spaces, was common (97.4%). The median drain duration was 4 days (range: 0-18 days). The average amount of CSF diverted was 650 mL (SD = 318 mL). Rates of postoperative CSF leak and meningitis in this select high-risk group were 16.3% and 3.6%, respectively. There was no significant difference among the LD and non-LD group on rates of meningitis (P = .0530). Insertion-related complications included 2 patients (1.4%) with LDs who were not adequately draining CSF immediately postoperatively because of obstructions, 2 patients (1.4%) requiring multiple LD insertion attempts, and 1 patient (0.9%) experiencing CSF over-drainage, resulting in severe pneumocephalus and seizures without long-term neurological sequelae. There were no complications related to LD removal, including retained or broken catheters.</p><p><strong>Conclusion: </strong>Patients with high-flow intraoperative CSF leaks who underwent LD placement for EES tend to have larger, more invasive tumors often requiring extended approaches. Patients undergoing LD placement should be monitored closely for complications; however, LDs are generally well tolerated.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532859","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}