Operative neurosurgery (Hagerstown, Md.)最新文献

{"title":"Endoscopic Far-Lateral Supracerebellar Infratentorial Approach for Petroclival Region Meningioma: Surgical Technique and Clinical Experience.","authors":"Tao Xie,&nbsp;Yushe Wang,&nbsp;Xiaobiao Zhang,&nbsp;Naiyuan Shao,&nbsp;Weicheng Lu,&nbsp;Qiaoqiao Yang,&nbsp;Chenghui Qu,&nbsp;Chen Li,&nbsp;Tengfei Liu,&nbsp;Shuang Liu,&nbsp;Wei Zhu","doi":"10.1227/ons.0000000000000126","DOIUrl":"https://doi.org/10.1227/ons.0000000000000126","url":null,"abstract":"<p><strong>Background: </strong>The management of petroclival region meningioma remains the ultimate achievement in neurosurgery, because of the formidable technical challenges involved.</p><p><strong>Objective: </strong>To describe the technique and feasibility of the purely endoscopic far-lateral supracerebellar infratentorial approach (EF-SCITA) for the treatment of petroclival region meningiomas.</p><p><strong>Methods: </strong>We reviewed the clinical data of 10 consecutive cases of petroclival region meningiomas treated with the EF-SCITA from August 2018 to August 2020. The clinical outcomes were analyzed. The patient was placed in the lateral position, and then, a \"C\" shaped incision and craniotomy with exposed sigmoid and transverse sinuses were performed. With the endoscopic holder, endoscopic procedures were performed using standard 2-hand microsurgical techniques. Whether the tentorium or Meckel cave was handled depended on the tumor extension.</p><p><strong>Results: </strong>The mean diameter was 45 × 25 mm. Dizziness and headache were the main symptoms. All 10 patients achieved gross total or subtotal resection (Petroclival Meningioma Grade I-III) with good neurological outcomes. The EF-SCITA provides satisfactory, direct exposure to the petroclival region. Cranial nerve deficits are the main postoperative complications. Two patients had a trochlear nerve injury, 3 patients had transient facial paralysis, and 2 patients had oculomotor paralysis (1 total and 1 incomplete), but both of them recovered during the follow-up period. One patient experienced an ipsilateral superior cerebellar artery infarction, and another patient had transient hemiparesis.</p><p><strong>Conclusion: </strong>The EF-SCITA is effective for most petroclival region meningiomas, except for the cavernous sinus type. This approach simplifies craniotomy procedures, omits burdensome petrosectomy, and avoids crossing posterior neurovascular structures.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":"290-297"},"PeriodicalIF":2.3,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40312686","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":"Intracranial-Intracranial Bypass for Aneurysms: Quantitative Intraoperative Assessment of Flow Preservation.","authors":"Matthew J Koch,&nbsp;Christopher J Stapleton,&nbsp;Fady T Charbel,&nbsp;Jonathan Russin,&nbsp;Sepideh Amin-Hanjani","doi":"10.1227/ons.0000000000000136","DOIUrl":"https://doi.org/10.1227/ons.0000000000000136","url":null,"abstract":"<p><strong>Background: </strong>Intraoperative flow measurement has proven utility in extracranial-intracranial bypass, particularly in assessing the adequacy of donors by measurement of cut flow. The nature of intracranial-intracranial (IC-IC) bypass precludes cut flow measurement, but quantitative intraoperative flow measurements may evaluate augment assessment of the bypass.</p><p><strong>Objective: </strong>To retrospectively evaluate flow measurements performed in IC-IC bypass to determine the adequacy of the constructs in preserving flow.</p><p><strong>Methods: </strong>With institutional review board approval, we performed a retrospective review of our bypass database from 2001 to 2021 for aneurysms treated with IC-IC bypass and with intraoperative flow measurements. Patients' preoperative characteristics, bypass indications, prebypass and postbypass intraoperative flow measurements, and patient outcomes were recorded.</p><p><strong>Results: </strong>Of 346 bypasses, 21 cases using 22 IC-IC bypasses were included. The median age was 55 years; 13 of 21 cases were ruptured aneurysms. Aneurysms involved posterior inferior cerebellar artery (n = 7), middle cerebral artery (n = 6), distal anterior cerebral artery (n = 5), and anterior communicating artery (n = 3). Six bypasses were end-to-side (ETS), 10 were side-to-side (STS), and 6 were excisional with reanastomosis (end-to-end, ETE). Intraoperatively, 21 of the bypasses were patent; the postbypass/prebypass flow index averaged 1.15 (±0.32): ETE (n = 6) 1.22 ± 0.34 and ETS/STS bypasses (n = 15) 1.11 ± 0.32. All intraoperatively patent bypasses were patent on postoperative angiography. One occluded on delayed angiography without clinical sequelae.</p><p><strong>Conclusion: </strong>Despite advances in endovascular therapy, IC-IC bypass remains essential to the treatment of large and fusiform aneurysms. We demonstrate quantitatively that IC-IC donors provide adequate direct (ETE) and redistributed (STS ETS) flow to the recipient territory. Flow measurement provides valuable information regarding the patency and adequacy of IC-IC bypass for flow preservation.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":"337-342"},"PeriodicalIF":2.3,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40313254","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":"Commentary: Robotic Nerve Sheath Tumor Resection With Intraoperative Neuromonitoring: Case Series and Systematic Review.","authors":"Katherine E Wagner,&nbsp;Ghani Haider,&nbsp;Anand Veeravagu","doi":"10.1227/ons.0000000000000164","DOIUrl":"https://doi.org/10.1227/ons.0000000000000164","url":null,"abstract":"","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":"e227-e228"},"PeriodicalIF":2.3,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40313943","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 Anatomy of the Middle Communicating Artery and Guidelines for Predicting the Feasibility of M2-M2 End-to-End Reimplantation.","authors":"Irakliy Abramov,&nbsp;Evgenii Belykh,&nbsp;Thanapong Loymak,&nbsp;Visish M Srinivasan,&nbsp;Mohamed A Labib,&nbsp;Mark C Preul,&nbsp;Michael T Lawton","doi":"10.1227/ons.0000000000000133","DOIUrl":"https://doi.org/10.1227/ons.0000000000000133","url":null,"abstract":"<p><strong>Background: </strong>M2-M2 end-to-end reimplantation that creates a middle communicating artery has recently been proposed as a reconstruction technique to treat complex aneurysms of the middle cerebral artery that are not amenable to clipping.</p><p><strong>Objective: </strong>To examine the surgical anatomy, define anatomic variables, and explore the feasibility of this bypass.</p><p><strong>Methods: </strong>Sixteen cadaver heads were prepared for bypass simulation. After the middle cerebral artery bifurcation was approached, the proximal insular (M2) segments and perforators were explored. To define the maximal distance between the M2 segments that allows the bypass to be performed, the M2 segments were mobilized and reimplanted in an end-to-end fashion.</p><p><strong>Results: </strong>Successful reimplantation was performed in all specimens. The mean maximal distance between the M2 segments to create the proposed reimplantation was 9.1 ± 3.2 mm. The mean vessel displacement was significantly greater for the superior (6.0 ± 2.3 mm) M2 segment than for the inferior (3.2 ± 1.4 mm) M2 segment (P < .001).</p><p><strong>Conclusion: </strong>In this cadaveric study, the stumps of the M2 segments located at a distance of ≤9.1 mm could be approximated to create a feasible M2-M2 end-to-end anastomosis. Intraoperative inspection of the M2 segments and their perforators could allow further assessment of the feasibility of the procedure before final revascularization decisions are made.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":"328-336"},"PeriodicalIF":2.3,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40312221","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":"Commentary: The Results of Interfacetal Fusion Using Local Bone Combined With an Atlantoaxial Instrumentation.","authors":"Barry Cheaney,&nbsp;Khoi D Than","doi":"10.1227/ons.0000000000000171","DOIUrl":"https://doi.org/10.1227/ons.0000000000000171","url":null,"abstract":"","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":"e187-e188"},"PeriodicalIF":2.3,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40313942","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":"The Results of Interfacetal Fusion Using Local Bone Combined With an Atlantoaxial Instrumentation.","authors":"Younggyu Oh,&nbsp;Byung-Jou Lee,&nbsp;Subum Lee,&nbsp;Sang Ryong Jeon,&nbsp;Sung Woo Roh,&nbsp;Jin Hoon Park","doi":"10.1227/ons.0000000000000124","DOIUrl":"https://doi.org/10.1227/ons.0000000000000124","url":null,"abstract":"<p><strong>Background: </strong>Many studies have described different C1-2 fusion techniques that have evolved over time. We introduced an easy and effective C1-2 fusion technique using local bone chips combined with atlantoaxial instrumentation.</p><p><strong>Objective: </strong>To identify the efficacy of interfacetal fusion using local bone combined with atlantoaxial instrumentation by assessment of clinical outcomes and fusion rate.</p><p><strong>Methods: </strong>We retrospectively reviewed the data from 25 patients who underwent atlantoaxial stabilization surgery using C1-2 pedicle screws and interfacetal bone fusion by a single surgeon between March 2012 and December 2019.</p><p><strong>Results: </strong>The demographics were 15 men and 10 women with a mean age of 57.6 years (range, 27-85 years) at the time of surgery. Three patients underwent surgery for myelopathy due to os odontoideum, 9 for C1-2 instability, 9 for trauma, 3 for rheumatoid arthritis, and 1 for bony spur, C1-2. At 3 months postsurgery, 3 and 21 patients showed 2-point and 1-point improvements in the Nurick grade, respectively. There was no difference in the Nurick score in 1 patient. Seven patients had a computed tomography scan at 1 year after surgery, which revealed a bridging trabecular bone. No movement was observed in the x-ray flexion/extension view at 1 year after surgery in all patients. In addition, no patients complained of postoperative occipital neuralgia.</p><p><strong>Conclusion: </strong>This study showed that interfacetal fusion with C1-2 pedicle screws using the free-hand technique was efficient and simple.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":"284-289"},"PeriodicalIF":2.3,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40312219","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":"Case Series in the Utility of Invasive Blood Pressure Monitoring in Microvascular Decompression.","authors":"Risheng Xu,&nbsp;Sumil K Nair,&nbsp;Josh Materi,&nbsp;Divyaansh Raj,&nbsp;Ravi Medikonda,&nbsp;Pavan P Shah,&nbsp;Nivedha V Kannapadi,&nbsp;Andrew Wang,&nbsp;David Mintz,&nbsp;Allan Gottschalk,&nbsp;Laurie J Antonik,&nbsp;Judy Huang,&nbsp;Chetan Bettegowda,&nbsp;Michael Lim","doi":"10.1227/ons.0000000000000130","DOIUrl":"https://doi.org/10.1227/ons.0000000000000130","url":null,"abstract":"<p><strong>Background: </strong>The utility of arterial lines in microvascular decompression (MVD) is not well described.</p><p><strong>Objective: </strong>To examine the safety and costs of arterial lines compared with noninvasive blood pressure (NIBP) monitoring in MVDs.</p><p><strong>Methods: </strong>We retrospectively reviewed patients undergoing MVD from 2012 to 2020. Patients were grouped by procedure date from 2012 to 2014 and 2015 to 2020, reflecting our institution's decreasing trend in arterial line placement around 2014 to 2015. Patient features, intraoperative characteristics, and postoperative complications were collected for all cases. Statistical differences were evaluated using chi-squared analyses and t-tests.</p><p><strong>Results: </strong>Eight hundred fifty-eight patients underwent MVDs, with 204 between 2012 and 2014 and 654 between 2015 and 2020. Over time, the frequency of arterial line placement decreased from 64.2% to 30.1%, P < .001. Arterial lines involved 11 additional minutes of preincision time, P < .001. Patients with arterial lines required both increased doses and costs of vasoactive medications intraoperatively. Patients receiving arterial lines demonstrated no significant differences in complications compared with patients with NIBP monitoring. On average, patients with arterial lines incurred $802 increased costs per case compared with NIBP monitoring.</p><p><strong>Conclusion: </strong>NIBP monitoring in MVDs provides neurologically and hemodynamically safe outcomes compared with invasive blood pressure monitoring. For patients without significant cardiopulmonary risk factors, NIBP monitoring may be a cost-effective alternative in MVDs.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":"262-268"},"PeriodicalIF":2.3,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40312685","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":"Commentary: Resection of a Vestibular Schwannoma Using the Retrosigmoid Approach in a Patient With a High Jugular Bulb: 2-Dimensional Operative Video.","authors":"Zhifeng Shi,&nbsp;Hailiang Tang","doi":"10.1227/ons.0000000000000175","DOIUrl":"https://doi.org/10.1227/ons.0000000000000175","url":null,"abstract":"Using the Retrosigmoid Approach in a Patient With a High Jugular Bulb: 2-Dimensional Operative Video Jugular bulb, located in the jugular fossa, is a spherical enlargement at the junction of the sigmoid sinus and internal jugular vein. Under normal circumstances, there are some variations in its height and position.1,2 High jugular bulb is diagnosed when it is above the level of inferior margin of cochlear base, and the incidence is approximately 6% to 63%. High jugular bulb is easily misdiagnosed as glomus jugular tumor,3 exhibiting bone invasion in highresolution computed tomography scan of the skull base. Generally, high jugular bulb is a congenital vascular variation, which may increase the difficulty when performing operations using the translabyrinthine approach.4-6 It is showed that high jugular bulb sometimes may influence the ear structures and cause dizziness and tinnitus in patients, which usually demands no surgical management.7,8 The existence of high jugular bulb may carry the risk of bleeding during cerebellopontine angle (CPA) tumor surgery using the retrosigmoid approach and increase the difficulty in the exposure of CPA tumor.9-11 In the literature, Rauch et al12 reported a case in which bleeding resulted from injury to high jugular bulb during surgical exposure of the internal auditory canal (IAC) through the suboccipital route and discussed their lessons in dealing with high jugular bulb under such kind of situations. Gupta et al13 described a safety area (between the high jugular bulb and the internal acoustic meatus) available for drilling the meatus. Akaishi et al14 in the surgery of CPA meningioma by the suboccipital retrosigmoid approach introduced that after tumor resection, the uneven surface of the bone under the tumor base was also removed using a diamond drill, and the high jugular bulb became visible through the thinned bone and not harassed. However, these above cases are different from the surgery presented in this video.15 The authors here showed us a very difficult case of vestibular schwannoma using the retrosigmoid approach with a high jugular bulb. They safely exposed the jugular bulb overlying the IAC using a highspeed drill and made proper displacement of jugular bulb by using a cottonoid patty, bone wax, and rubber sheet. After that, the authors would have sufficient space to remove the tumor inside the IAC.","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":"e229-e230"},"PeriodicalIF":2.3,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40313247","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: Traumatic and Spontaneous Vertebral Artery Dissections: An Analysis of a Tertiary-Center 310 Patient Cohort.","authors":"Robert J Trager,&nbsp;Alyssa M Troutner","doi":"10.1227/ons.0000000000000160","DOIUrl":"https://doi.org/10.1227/ons.0000000000000160","url":null,"abstract":"","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":"e233-e234"},"PeriodicalIF":2.3,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40312215","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":"Management of an L5-S1 Far Lateral Disk Herniation: 2-Dimensional Operative Video.","authors":"S Harrison Farber,&nbsp;Luis M Tumialán","doi":"10.1227/ONS.0000000000000097","DOIUrl":"https://doi.org/10.1227/ONS.0000000000000097","url":null,"abstract":"","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":"e171"},"PeriodicalIF":2.3,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39793226","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}