Operative neurosurgery (Hagerstown, Md.)最新文献

{"title":"Endoscopic Super Extended Endonasal Approach: Transplanum Transtubercullum With Pituitary Hemitransposition and Tailored Transclival Approach for the Resection of a Giant Craniopharyngioma: 2-Dimensional Operative Video.","authors":"Diego Méndez-Rosito, Jesus Abraham Ibarra-Ramos, Isai García-López, Cristian Alberto Pérez-Carrillo, Eli Hernandez-Chávez, Sheila Maria Del Mar Borrayo-Dorado, Ivan Alejandro Méndez-Guerrero, Farina Arreguín-González, Nadin J Abdala-Vargas","doi":"10.1227/ons.0000000000001630","DOIUrl":"https://doi.org/10.1227/ons.0000000000001630","url":null,"abstract":"","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144113329","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: Clinical and Radiographic Outcomes of Atlantoaxial or Occipitocervical Fixation and Fusion in Patients With Cervical Myelopathy due to Idiopathic Retro-Odontoid Pseudotumor.","authors":"Xin Zhou, Huasheng Jiang","doi":"10.1227/ons.0000000000001637","DOIUrl":"10.1227/ons.0000000000001637","url":null,"abstract":"","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":"167-168"},"PeriodicalIF":0.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112123","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":"Update and Evaluation of a Preoperative Scoring System to Predict Long-Term Outcomes After Microvascular Decompression in Trigeminal Neuralgia.","authors":"Margaret Tugend, Colby T Joncas, Yue-Fang Chang, Yanis Jaoui, Raymond F Sekula","doi":"10.1227/ons.0000000000001599","DOIUrl":"https://doi.org/10.1227/ons.0000000000001599","url":null,"abstract":"<p><strong>Background and objectives: </strong>Scoring systems attempting to predict long-term pain relief after microvascular decompression (MVD) for trigeminal neuralgia (TN) have been published previously. We compare the Panczykowski scoring system and a new scoring system, developed in response to published criticisms of previous scoring systems, in a larger cohort with longer term follow-up.</p><p><strong>Methods: </strong>In this retrospective cohort study, records from 410 patients undergoing MVD for TN were reviewed. Pain freedom after MVD was recorded, and Panczykowski scores (scoring system A) were calculated. Univariate logistic regression models were used to determine the relationship between clinical characteristics and pain freedom at follow-up. The predictive value of a tentative new scoring system was examined (scoring system B) and compared with scoring system A.</p><p><strong>Results: </strong>At a mean follow-up of 63 months, 282 patients (68.8%) were pain free without medications. Univariable analysis showed that age >45 years(χ2 = 6.26, df = 1, P = .012), TN type (χ2 = 53.16, df = 1, P < .0001), response to carbamazepine (χ2 = 6.65, df = 1, P = .010), and neurovascular compression (χ2 = 25.93, df = 1, P < .0001) all significantly predicted postoperative pain freedom without medication. Using scoring system A, a patient with a preoperative score of 3, 4, or 5 was, respectively, 2.05 (P = .114), 5.76 (95% CI 2.46-13.50, P < .0001), and 10.52 (95% CI 4.66-23.79, P < .0001) times more likely to attain long-term pain freedom without medication than a patient with a score of 0 or 1. Using scoring system B, a patient with a score of 3 or 4 was, respectively, 3.59 (95% CI 1.42-9.08, P = .007) and 8.68 (95% CI 3.42-22.05, P < .0001) times more likely to attain long-term pain freedom without medication than a patient with a score of 0 or 1.</p><p><strong>Conclusion: </strong>In a larger cohort of patients with longer term follow-up, both scoring systems A and B reliably predict long-term pain freedom after MVD for TN in this patient population and may be beneficial in selecting patients most likely to benefit from surgery.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144113173","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":"Quantitative MRI Tractography of White Matter Tracts After Tumor Craniotomy Surgery: Comparative Analysis Between Tubular Retractor and Open Craniotomy Surgery.","authors":"Cynthia Alms, Chikezie I Eseonu","doi":"10.1227/ons.0000000000001622","DOIUrl":"https://doi.org/10.1227/ons.0000000000001622","url":null,"abstract":"<p><strong>Background and objectives: </strong>Tubular retraction has been a technique used to minimize the extent of cerebral retraction injury; however, only qualitative imaging assessments exist in the literature comparing this technique with open craniotomies using spatula retraction. This study uses quantitative MRI tractography to analyze the extent of cerebral retraction injury using tubular retraction (TR) compared with open craniotomies (OC).</p><p><strong>Methods: </strong>This study performed a retrospective analysis of a cohort of 20 patients who underwent cranial tumor surgery for deep-seated brain tumors. Ten patients who underwent surgery with TR were case-control matched with 10 patients who underwent an OC with spatula retraction. Quantitative metrics evaluating white matter tract integrity (fractional anisotropy (FA), geodesic anisotropy (GA), mean diffusivity, radial diffusivity, axial diffusivity, and tract volume), extent of resection, and neurological outcome were compared between the groups.</p><p><strong>Results: </strong>Twenty patients underwent cranial surgery for deep-seated brain lesions. Preoperative neurological and tumor characteristics were comparable between the 2 cohorts. Postoperative extent of resection was found to be 90.4% in the TR group and 94.8% in the OC group (P = .395). Significant improvement was seen in the change in Karnofsky Performance Score from preoperative to postoperative status in the TR group, an 11-point increase, compared with the OC group, no change in score (P = .035). Quantitative metrics evaluating overall axonal status (FA) and compression (GA) showed significant signs of improvement in the TR group, with an FA of 0.322 vs 0.029 in the OC group (P = .011). GA was found to increase in the TR group (0.441) and decrease in the OC group (0.411, P = .0.012). Diffusivity metrics, evaluating axonal integrity were comparable between the 2 groups.</p><p><strong>Conclusion: </strong>Tubular retraction surgery provides a viable surgical option for deep-seated tumors that provides comparable extent of resection outcomes while mitigating the effects of some components of retraction injury.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112804","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: Omentomyelopexy for the Treatment of a Persistent Lumbar Pseudomeningocele: A Case Report With Technical Note.","authors":"Brahim Kammoun, Mehdi Borni, Ghassen Souissi, Fatma Kolsi, Basma Souissi, Hela Ben Jemaa, Mohamed Zaher Boudawara","doi":"10.1227/ons.0000000000001612","DOIUrl":"10.1227/ons.0000000000001612","url":null,"abstract":"","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":"163"},"PeriodicalIF":0.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112134","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: Cervicothoracic Deformity in the Setting of Adhesive Arachnoiditis: An Operative Video Article.","authors":"Ranbir Ahluwalia, Harsh Jain, Scott L Zuckerman","doi":"10.1227/ons.0000000000001504","DOIUrl":"https://doi.org/10.1227/ons.0000000000001504","url":null,"abstract":"","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":"29 1","pages":"158-159"},"PeriodicalIF":0.0,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304371","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":"Timing Matters: A Comprehensive Meta-Analysis on the Optimal Period for Cranioplasty After Severe Traumatic Brain Injury.","authors":"Lucca B Palavani, Márcio Yuri Ferreira, Raphael Camerotte, Lucas Pari Mitre, Lucas Piason, Filipi Fim Andreão, Anna Luiza Pereira, Ruy Monteiro, Robson Luis Oliveira de Amorim, Raphael Bertani, Wellingson Paiva","doi":"10.1227/ons.0000000000001404","DOIUrl":"10.1227/ons.0000000000001404","url":null,"abstract":"<p><strong>Background and objectives: </strong>Craniectomy is a commonly performed procedure in severe traumatic brain injury (TBI) to control intracranial hypertension and reduce mortality. The optimal timing for cranioplasty after craniectomy remains a topic of debate. The aim of this study was to investigate the ideal timing for cranioplasty after severe TBI, focusing on complications associated with temporal aspects and materials used in cranioplasty.</p><p><strong>Methods: </strong>Multiple databases, including PubMed, Embase, Cochrane, and Web of Science, were searched for studies reporting on the subject. Inclusion criteria involved randomized and observational studies comparing early and late cranioplasty procedures. Quality assessment was performed using the Methodological Index for Non-Randomized Studies scale. Results were pooled in a single-arm meta-analysis and presented as mean and 95% confidence interval.</p><p><strong>Results: </strong>Early cranioplasty was associated with a lower likelihood of subdural effusion (odds ratio [OR] 0.3735 [0.1643; 0.8490], P = .0187). However, no differences were detected for the presence of infection between both groups (OR 0.7460 [0.2065; 2.6945], P = .6548). Cranioplasties performed within or equal to 3 months from the TBI incident were associated with a reduced likelihood of minor complications (OR 0.4471 [0.2467; 0.8102], P = .0080). Paradoxically, this time frame exhibited an elevated risk of hydrocephalus (OR 3.2035 [1.4860; 6.9059], P = .0030), as well as total complications (OR 1.4190 [1.0453; 1.9262] P = .0248).</p><p><strong>Conclusion: </strong>This comprehensive review highlights the current lack of consensus on the optimal timing for cranioplasty after severe TBI. Early cranioplasty, within 35 days, showed a reduced risk of subdural effusion, but no disparity in the odds of infection was found. A reduced incidence of minor complications was observed in the earlier approach, however with an elevated risk for hydrocephalus and total complications. The association between timing and complications, including hydrocephalus, highlights the need for further research and standardization in this critical aspect of TBI management.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":"29 1","pages":"1-18"},"PeriodicalIF":0.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304370","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":"Neuroapraxia of Trigeminal Nerve Controlled by Neuromonitoring During Microvascular Decompression in Multiple Sclerosis Patients Affected by Drug-Resistant Trigeminal Neuralgia Recurrent After Previous Operations.","authors":"Nicola Montano, Renata Martinelli, Alessandro Izzo, Quintino Giorgio D'Alessandris, Benedetta Burattini, Manuela D'Ercole, Michele Di Domenico, Alessandro Olivi","doi":"10.1227/ons.0000000000001438","DOIUrl":"https://doi.org/10.1227/ons.0000000000001438","url":null,"abstract":"<p><strong>Background and importance: </strong>Trigeminal neuralgia (TN) can complicate the clinical course of multiple sclerosis (MS) and can be very difficult to treat. Usually, these patients experience multiple recurrences after surgical procedures with a poor overall outcome. To the best of our knowledge, we report the first 3 cases of drug-resistant MS-related TN recurrent after previous operations in which intraoperative neuromonitoring controlled neuroapraxia of trigeminal nerve was performed. We describe the surgical technique, report the clinical outcomes of patients, and review the pertinent literature.</p><p><strong>Clinical presentation: </strong>Neuroapraxia of trigeminal nerve was conducted using a standard straight Yasargil temporary titanium aneurysm clip on the main trunk of the trigeminal nerve. Trigeminal somatosensory evoked potentials and cortico-bulbar motor evoked potentials registered from trigeminal and facial nerves were recorded during the procedure. The trigeminal nerve clipping was conducted for a maximum of 30 seconds or less in the case of a decrease in neurophysiological responses. The preoperative Barrow Neurological Institute score was V, IV, and IV for the 3 patients, respectively. We obtained acute pain relief in all patients after the procedure. All patients had a Barrow Neurological Institute I at the latest follow-up (10, 10, and 9 months, respectively). No complications were reported postoperatively and at follow-up.</p><p><strong>Conclusion: </strong>Intraoperative neuromonitoring controlled neuroapraxia of trigeminal nerve with temporary titanium aneurysm clip application during microvascular decompression is a promising and safe procedure in MS patients with recurrent MS-related TN. Further studies with longer follow-up are needed to confirm our encouraging results.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":"29 2","pages":"295-300"},"PeriodicalIF":0.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144639602","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 Preliminary Assessment on Reproducibility of Triggered Electromyography During Selective Dorsal Rhizotomy.","authors":"Bo Xiao, Wenbin Jiang, Nobuhito Morota, Samuel R Browd, Shlomi Constantini, Rong Mei, Min Wei, Wang Junlu, Yunhai Song, Rui Wang, Qijia Zhan","doi":"10.1227/ons.0000000000001443","DOIUrl":"https://doi.org/10.1227/ons.0000000000001443","url":null,"abstract":"<p><strong>Background and objectives: </strong>Selective dorsal rhizotomy (SDR) reduces spasticity in children with spastic cerebral palsy (CP). Intraoperative neurophysiology, triggered electromyography (trigger-EMG) is crucial in guiding sensory rootlet selection, but its reproducibility during SDR surgery has not been fully investigated. The objective of this study was to evaluate the reproducibility of trigger-EMG during SDR performed in children with spastic CP.</p><p><strong>Methods: </strong>A retrospective review was performed for cases where dorsal roots were stimulated twice 1 to 2 minutes apart during SDR using a specific protocol. With single-pulse stimulation of 0.2 ms width having a gradually increasing intensity from 0.01 mA until the EMG amplitude is >200 μV. Criteria were established to evaluate trigger-EMG reproducibility.</p><p><strong>Results: </strong>This study showed that the reproducibility of trigger-EMG was excellent, as the most responsive channels in the second stimulation trial were the same as those in the first one in 90.1% of the roots stimulated. In addition, the 3 most responsive channels were mostly the same between the first and second stimulation trials in 96.9% of the roots tested. Furthermore, when comparing the evoked EMG pattern since the beginning to the end point between the 2 stimulation trials in all 131 roots, the amplitudes of trigger-EMG in 3 most responsive channels were similar to each other, particularly the most responsive one. Amplitudes of each phase in each EMG evoked were also similar to each other.</p><p><strong>Conclusion: </strong>The excellent reproducibility of trigger-EMG, as demonstrated by its consistent activation of specific spinal motor circuits, provides a solid foundation for future research. Further investigation into the underlying electrophysiological mechanisms of this reproducibility could inform the development of more refined stimulation protocols and data analysis techniques. These advancements hold promise for enhancing the accuracy of dorsal root selection during SDR and ultimately improving clinical outcomes for patients with spastic CP.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":"29 2","pages":"255-262"},"PeriodicalIF":0.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144639601","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 and Cost-Effective Access to Deep-Seated Intracranial Lesions Using 19F Peel-Away Sheath Introducer and \"Dynamic\" Retraction: Technical Note and a Case Series.","authors":"Elizabeth Siomin, Michael McDermott, Andrea Castaldi, Vitaly Siomin","doi":"10.1227/ons.0000000000001403","DOIUrl":"10.1227/ons.0000000000001403","url":null,"abstract":"<p><strong>Background and objectives: </strong>Minimally invasive (MIS) techniques for resection of deep-seated brain lesions (DSL) have become widespread in the past 2 decades. Various devices for endoscopic and open microscopic procedures are now common in many institutions. Most setups use image-guided tubular brain retractors inserted along the paths sparing the eloquent cortical and subcortical structures. The cost of the commercially available retractors may be significant, making them unaffordable in the developing world and even in countries with well-developed economies. The authors introduce a novel, cost-effective technique involving the use of the 19F peel-away sheath introducer and subsequent \"dynamic\" retraction to remove DSL. The objective of this study was to evaluate the feasibility and safety of a new MIS technique in patients with various cerebral pathologies.</p><p><strong>Methods: </strong>We report on 13 patients who underwent transcortical resection of the DSL. Six patients (46%) had the diagnosis of glioblastoma (2 of which were recurrent). The remaining 7 patients had metastases (3 cases), cavernous malformation (2 cases), thalamic pilocytic astrocytoma, and colloid cyst of the third ventricle.</p><p><strong>Results: </strong>All 13 patients underwent aggressive resection of the brain lesions without any complications, except one 37-year old patient with large left basal ganglia glioblastoma experienced worsening of the contralateral hemiparesis and transient expressive aphasia, which improved the baseline over 4 weeks after surgery. Gross total resection was achieved in 11 of the 13 cases after the initial surgery.</p><p><strong>Conclusion: </strong>The described MIS technique appears safe, technically feasible, and cost-effective alternative to the commonly used tubular retraction systems. The use of \"dynamic\" retraction through narrow surgical tract may become a viable surgical option in patients with deep-seated lesions. It could serve as an affordable alternative to the commercially available systems, particularly in medical centers with limited resources.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":"29 1","pages":"118-124"},"PeriodicalIF":0.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12150987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304369","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}