Operative neurosurgery (Hagerstown, Md.)最新文献

{"title":"Pump Versus Syringe: Aspiration Thrombectomy Direct Pressure Comparisons in a Comprehensive Benchtop 3-Dimensional-Printed Circle of Willis Model.","authors":"Holly Berns, Kimberly Han, Felipe Ramirez-Velandia, Kailey L Lewis, Sophia E Robertson, Wyatt E Clark, Jesse C Wells, Mohammed K Alnajrani, Christopher Rapoport, Steven Schwartz, Kana'i Hakes, Justin H Granstein, Christopher S Ogilvy, Timothy A Becker, Michael Young","doi":"10.1227/ons.0000000000001653","DOIUrl":"https://doi.org/10.1227/ons.0000000000001653","url":null,"abstract":"<p><strong>Background and objectives: </strong>Experiments have shown that 60-cc syringes generate stronger vacuum forces than mechanical pumps. However, few studies have measured catheter tip suction pressure during thrombus engagement. Therefore, this study aimed to compare aspiration forces and pressure drops, generated by mechanical pumps and 60-cc syringes connected to various catheters when aspirating synthetic clots in a 3-dimensional-printed model.</p><p><strong>Methods: </strong>The system includes a programmable pulsatile pump, a 3-dimensional-printed tissue-matched circle of Willis model, radiopaque synthetic blood clots positioned in the left internal carotid artery terminus, and pressure recording at 500 ± 10% mL/min and 120/80 ± 10 mm Hg. Each catheter underwent 3 soft and hard clot removal trials using a 60-cc syringe and an aspiration pump. Aspiration source pressure was recorded before, during, and after aspiration. The evaluated variables included engagement pressure change (∆Pengagement), aspiration pressure drops (∆Paspiration), and pressure efficiency (PE), defined as the percentage of peak pressure maintained during aspiration.</p><p><strong>Results: </strong>Aspirating soft clots with syringes showed low engagement pressure drops (∆Pengagement) (0-14 mm Hg), high PE at 93%-99% of Pp, and minimal aspiration pressure drops (∆Paspiration) (6F catheters: 4-8 mm Hg, 8F catheters: 19 mm Hg). Conversely, using a pump generated moderate ∆Pengagement (6F: 16-51 mm Hg, 8F: 122 mm Hg), lower PE (69%-93% of Pp), and greater ∆Paspiration (6F: 143-151 mm Hg, 8F: 270 mm Hg). For hard clots, syringes exhibited minimal ∆Pengagement and ∆Paspiration (4-13 mm Hg and 3-12 mm Hg, respectively), whereas pumps showed moderate ∆Pengagement (2-34 mm Hg) and large ∆Paspiration (6F: 82-162 mm Hg, 8F: 280 mm Hg).</p><p><strong>Conclusion: </strong>Syringe aspiration generates higher vacuum pressures and smaller pressure drops than aspiration pumps, likely because of vacuum tubing resistance in aspiration pumps. This effect is particularly evident with hard clots and larger inner diameter catheters.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268460","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":"Transitional Care Program for Spine Surgery: Impact on Length of Stay for Extended Recovery Unit Patients.","authors":"Rishab Ramapriyan, Gabriel Brito, Tarun Ramesh, Kathleen A Hill, Jakob V E Gerstl, Christopher S Hong, Timothy R Smith","doi":"10.1227/ons.0000000000001650","DOIUrl":"https://doi.org/10.1227/ons.0000000000001650","url":null,"abstract":"<p><strong>Background and objectives: </strong>This study evaluates the effectiveness of a transitional care program (TCP) implemented for spinal neurosurgery patients, focusing on the reduction of length of stay (LOS).</p><p><strong>Methods: </strong>We conducted a retrospective analysis of patients treated by 5 primary surgeons at our institution from January 2023 to December 2023. The analysis included 2 distinct parts: a multivariable ordinary least squares regression to determine factors affecting LOS for all spine surgery patients and a subset analysis using multivariable logistic regression to identify factors contributing to extended LOS in extended recovery unit (ERU)-admitted patients.</p><p><strong>Results: </strong>The study encompassed 986 patients, highlighting a significant reduction in LOS for those with planned ERU stays. Key findings from the ordinary least squares regression revealed factors such as chronic obstructive pulmonary disorder history and postoperative complications significantly increased LOS, whereas planned ERU admission decreased LOS. The logistic regression focused on ERU patients indicated that chronic obstructive pulmonary disorder markedly increased the odds of an extended LOS. However, receiving an educational visit from a TCP nurse significantly decreased the likelihood of extended LOS, underlining the importance of in-hospital education. In addition, complex surgeries indicated by the number of levels fused showed a correlation with prolonged LOS.</p><p><strong>Conclusion: </strong>Our findings underscore the significance of targeted educational interventions and preoperative planning in achieving these outcomes. Future efforts should aim to further refine the TCP and explore digital innovations for patient engagement and education.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268463","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":"M3-M3 Bypass and Microsurgical Resection of Giant Previously Coiled Middle Cerebral Artery Aneurysm: 2-Dimensional Operative Video.","authors":"Kara A Parikh, Alexandra H Kramer, Mustafa Motiwala, Daniel A Hoit, Adam S Arthur, Nickalus R Khan","doi":"10.1227/ons.0000000000001665","DOIUrl":"https://doi.org/10.1227/ons.0000000000001665","url":null,"abstract":"","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268459","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":"Combined Dorsal and Ventral Rhizotomy for Spasticity and Dystonia in a Pediatric Patient With Nonambulatory Cerebral Palsy: 2-Dimensional Operative Video.","authors":"Benjamin R Johnston, Carolina Lopes, Weston T Northam","doi":"10.1227/ons.0000000000001671","DOIUrl":"https://doi.org/10.1227/ons.0000000000001671","url":null,"abstract":"","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268458","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":"Suprasellar Versus Third Ventricular Cysts: Anatomic and Surgical Considerations.","authors":"Roy Chebel, Joyce Koueik, Vivek Sivan, Michael Peek, Anas Abou Merhi, Bermans J Iskandar","doi":"10.1227/ons.0000000000001658","DOIUrl":"https://doi.org/10.1227/ons.0000000000001658","url":null,"abstract":"<p><strong>Background and importance: </strong>Intracranial arachnoid cysts are benign cerebrospinal fluid-filled sacs that occur in 2.6% of children and 1.4% of adults. Suprasellar arachnoid cysts (SACs) represent between 9% and 21% of pediatric arachnoid cysts. These are often confused with the less common third ventricular cysts (3VCs). Both can grow and cause obstructive hydrocephalus, requiring urgent treatment. The aim of surgical treatment was to re-establish cerebrospinal fluid circulation. In this article, we describe and contrast the imaging characteristics of SAC and 3VC, and show stepwise endoscopic surgical approaches for each.</p><p><strong>Clinical presentation: </strong>We show examples of patients with SAC and 3VC who presented with symptoms of obstructive hydrocephalus and who underwent endoscopic intraventricular resection of the cysts leading to long-term resolution of the hydrocephalus and symptoms. Magnetic resonance imaging of the anatomic differences and video demonstrations of the surgical approaches reveal important features that distinguish between the 2 cysts.</p><p><strong>Conclusion: </strong>Safe endoscopic treatment of SAC and 3VC requires a thorough understanding of how each distorts the anatomy of the third ventricle and suprasellar cistern, and a stepwise surgical approach based on this anatomy.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268461","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 Transdural Closure of a Ventral Spinal Cerebrospinal Fluid Leak in Spontaneous Intracranial Hypotension: 2-Dimensional Operative Video.","authors":"Levin Häni, Christopher Marvin Jesse, Tomas Dobrocky, Eike Immo Piechowiak, Ralph Thomas Schär, Andreas Raabe","doi":"10.1227/ons.0000000000001657","DOIUrl":"https://doi.org/10.1227/ons.0000000000001657","url":null,"abstract":"","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259921","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 Transorbital Extended Middle Fossa Approach: A Potential Addition to the Lateral Skull Base Surgical Armamentarium-Anatomic Feasibility Study.","authors":"Juan C Yanez-Siller, Raywat Noiphithak, Kris S Moe, Ricardo L Carrau, Daniel M Prevedello, Tingting Jiang, Francesco Corrivetti, Edoardo Porto, Alfonso Scarpa, Matteo De Notaris","doi":"10.1227/ons.0000000000001641","DOIUrl":"https://doi.org/10.1227/ons.0000000000001641","url":null,"abstract":"<p><strong>Background and objectives: </strong>Various approaches have been developed to treat diseases of the lateral skull base. The endoscopic transorbital approach has been recently used as stand-alone or as a complementary approach for selected pathologies of the anterior, middle, and posterior cranial base. However, its anatomy and applicability to structures of temporal bone (TB) at the lateral skull base have not been previously described. We propose the endoscopic transorbital approach as an alternative to access structures of the TB at the lateral skull base, a strategy introduced herein as the endoscopic transorbital extended middle cranial fossa approach (ETEMF). This study aims to evaluate its feasibility.</p><p><strong>Methods: </strong>ETEMF was carried out in 7 cadaveric heads (14 sides). The tegmen, internal acoustic canal, and petrous apex were unroofed and structures exposed. Anatomy relevant to ETEMF was examined.</p><p><strong>Results: </strong>Structures including the crista ovale, eustachian groove, tegmen, petrous internal carotid artery, cochlea, geniculate ganglion, the superior and lateral semicircular canals, internal acoustic canal, intracanalicular, labyrinthine, and tympanic portions of facial nerve were exposed. The crista ovale, foramen ovale, foramen spinosum, eustachian groove, greater superficial petrosal nerve, and arcuate eminence served as major landmarks during the dissection. Minimal retraction of the orbital globe and dura were required.</p><p><strong>Conclusion: </strong>Exposure of the TB anatomy at the lateral skull base is feasible through ETEMF. This is the first study to propose this application. Major structures within the TB are accessible through this approach. Additional studies are necessary to define its role in the surgical armamentarium.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251965","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":"A Novel Retrievable Drug Infusion Stent and Blood-Brain Barrier Portal for Antibody Therapies to the Spinal Cord.","authors":"Jordan F Stafford, Dahlia M Kenawy, Jan M Schwab, Foued Amari, Drayson Campbell, Bryan W Tillman","doi":"10.1227/ons.0000000000001640","DOIUrl":"https://doi.org/10.1227/ons.0000000000001640","url":null,"abstract":"<p><strong>Background and objectives: </strong>The blood-brain barrier (BBB) is prohibitive to intravascular drug delivery. We hypothesized that isolation of spinal cord perfusion would focus on a higher effective dose while minimizing systemic toxicity and that a histamine portal would increase BBB permeability and facilitate large molecule therapies to the spinal cord.</p><p><strong>Methods: </strong>A dumbbell-shaped, retrievable drug infusion stentgraft (RDIS) was constructed from nitinol and polytetrafluorethylene. A porcine model under anesthesia underwent percutaneous femoral insertion of the sheathed RDIS and deployment in the lower thoracic aorta by sheath withdrawal. Antiglial fibrillary acidic protein (GFAP) tracer antibody was instilled to the outer chamber for 30 minutes +/- 80 μg of histamine, followed by stent recovery by sheath advancement, staining of spinal cord with fluorescent secondary antibody, and measurement of mean fluorescence intensity.</p><p><strong>Results: </strong>Angiography confirmed center lumen distal perfusion while an integrated cannula allowed infusion to the isolated outer chamber and intercostals. Although 80 μg of histamine delivered intravenously decreased the mean arterial pressure by 22 mm Hg briefly but significantly (P = .002), histamine infused into the RDIS outer chamber did not exhibit hypotensive effect. Animals treated using RDIS + histamine + GFAP (n = 5) revealed increased mean fluorescence intensity (mean 1074 ± 199) compared with either RDIS + GFAP without histamine (n = 5; 792 ± 223, P < .002) or simple IV infusion of GFAP + histamine (n = 5; 748 ± 172, P < .001). Although the stent perfused only 2-3 sets of intercostals, positive staining was observed well into the adjacent upper thoracic and lumbar spinal cord.</p><p><strong>Conclusion: </strong>An RDIS achieves focal drug delivery of antibody to the spinal cord and is retrievable after use, whereas a histamine portal facilitates passage across the BBB. The RDIS may have future utility for vascular-based delivery of antibody therapeutics or other macromolecules focused to the spinal cord for oncological, spinal cord injury and neurodegenerative disease.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210752","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":"Closing a Three-Column Osteotomy with a Construct-To-Construct Closure: Case Series and Technical Note With Intraoperative Pictures and Videos.","authors":"Harsh Jain, Ranbir Ahluwalia, Iyan Younus, Tyler Zeoli, Keyan Peterson, Zeeshan M Sardar, Scott L Zuckerman","doi":"10.1227/ons.0000000000001649","DOIUrl":"https://doi.org/10.1227/ons.0000000000001649","url":null,"abstract":"<p><strong>Background and objectives: </strong>When performing a 3-column osteotomy (3CO) in adult spinal deformity surgery, osteotomy closure carries major risk. The construct-to-construct closure technique has been previously described as a safe means to close a 3CO. We sought to provide an in-depth description of the construct-to-construct closure technique through a case series using illustrations and intraoperative pictures and videos for spine surgeons looking to incorporate this technique.</p><p><strong>Methods: </strong>A retrospective, single-surgeon case series was undertaken of 3COs using the construct-to-construct closure technique. A detailed description of the technique with corresponding illustrations was provided. For each case, a summary with key intraoperative pictures and videos was included. Descriptive statistics were performed.</p><p><strong>Results: </strong>Seven patients (mean age: 57.1 ± 10.2 years; 57% females) underwent a 3CO with mean follow-up of 12 months at the following levels: L4, T11, L3, T10, T10-12, T12, and L2. Construct-to-construct closure was used in all cases with a mean correction of 36.3° ± 5.8° (range 28°-47°). Neuromonitoring data were stable in 5 cases, but a significant decrease in data was seen during osteotomy closure in 2 cases. In the 2 cases where data were lost, the correction was quickly released in a controlled manner and the postoperative neurological examination was stable to improved. No cases of screw pullout, screw plowing, or subluxation occurred.</p><p><strong>Conclusion: </strong>The current case series provides an in-depth description of the construct-to-construct closure technique to close a 3CO and is accompanied by illustrations and intraoperative pictures and videos.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210753","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":"Simple Microvascular Decompression for Hemifacial Spasm Caused by Dolichoectatic Vertebral Artery.","authors":"Adel Azghadi, Marte van Keulen, Sepideh Amin-Hanjani","doi":"10.1227/ons.0000000000001655","DOIUrl":"https://doi.org/10.1227/ons.0000000000001655","url":null,"abstract":"<p><strong>Background and importance: </strong>Hemifacial spasm (HFS) secondary to a dolichoectatic vertebral artery (VA) is a rare but debilitating condition. Macrovascular displacement of the vessel away from the nerve using a Teflon sling is an effective, but not always feasible, method. Transection, relocation, and reanastomosis of the dolichoectatic VA has also been described but presents a significant surgical challenge and carries a higher risk profile. In this case report, we demonstrate that simple microvascular decompression by translocation of the compression point away from the root entry zone (REZ) is an effective measure in treating HFS in this setting.</p><p><strong>Clinical presentation: </strong>A 67-year-old patient presented with debilitating left-sided HFS secondary to a large torturous VA abutting the facial nerve root entry point at the brainstem. The patient underwent retrosigmoid craniotomy, and the dolichoectatic VA was able to be mobilized away from the REZ, although compression remained along the cisternal segment. Using Teflon pledgets, the compression point caused by the VA at the REZ was carefully padded, and despite residual compression in the more distal cisternal nerve segment, the patient experienced complete resolution of symptoms.</p><p><strong>Conclusion: </strong>HFS caused by a dolichoectatic vessel poses a challenge for complete surgical decompression. We demonstrate that decompression of the REZ alone represents a simple and effective solution, resulting in complete resolution of the symptoms without the need to resort to more complex and potentially riskier options.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210756","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}