Operative Neurosurgery最新文献

{"title":"Open Microsurgical Versus Endovascular Management of Unruptured and Ruptured Brain Aneurysms.","authors":"Jennifer E Kim, Risheng Xu, Christopher M Jackson, Justin M Caplan, L Fernando Gonzalez, Judy Huang, Rafael J Tamargo","doi":"10.1227/ons.0000000000001448","DOIUrl":"https://doi.org/10.1227/ons.0000000000001448","url":null,"abstract":"<p><p>Open microsurgical and endovascular techniques are the 2 primary strategies for treating intracranial aneurysms. Microsurgical clipping and adjuvant technical maneuvers are well-established techniques with a track record for high occlusion rates and durable repairs. Endovascular, endosaccular, and extrasaccular therapies are associated with lower peri-procedural morbidity but with generally higher rates of retreatment. We discuss key clinical and anatomic considerations in treatment decision-making and compare the risks and benefits of microsurgical vs endovascular treatment within each context.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endonasal Endoscopic Extraction of an Intraorbital Foreign Body: 2-Dimensional Operative Video.","authors":"Soumen Kanjilal, Awadhesh Kumar Jaiswal, Ravi Sankar Manogaran, Ashutosh Kumar, Pawan Kumar Verma, Kuntal Kanti Das, Anant Mehrotra","doi":"10.1227/ons.0000000000001473","DOIUrl":"https://doi.org/10.1227/ons.0000000000001473","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multicenter Randomized Controlled Clinical Trial to Compare the Safety and Performance of Two Bone Flap Fixation Systems.","authors":"Álvaro Gómez de la Riva, Marta Rico, Matjaz Voršič, Valentin Rokavec, Carlos Asencio-Cortés, Fernando Muñoz-Hernández","doi":"10.1227/ons.0000000000001461","DOIUrl":"https://doi.org/10.1227/ons.0000000000001461","url":null,"abstract":"<p><strong>Background and objectives: </strong>Polymeric clamp-like devices present potential advantages regarding plates and screws to close craniotomies; however, no clinical research has provided enough evidence to compare them. This randomized controlled trial compares the clinical safety and performance of clamp-like devices with the standard of care for craniotomy closure: titanium plates and screws (P&S).</p><p><strong>Methods: </strong>A prospective, double-arm, multicenter randomized controlled trial was performed at 3 sites, recruiting 60 patients undergoing neurosurgical interventions requiring craniotomy. Patients were randomly allocated to 2 groups depending on the bone flap fixation system to be used: plates and screws (any brand) and clamp-like devices (Cranial LOOP, NEOS Surgery S.L.). The primary end point of the study (bone flap alignment) was assessed 6 months after surgery through neuroimaging. Secondary end points included adverse events and device deficiency assessment, closure method usability assessed by the surgeon, and patient-reported device-related inconveniences.</p><p><strong>Results: </strong>It was necessary to use a median of 3 Cranial LOOP and 4 plates and 8 screws to close craniotomies. All patients from both groups had equally good bone flap alignment. Most implantations were reported as easy or very easy for both groups, and surgeons were generally satisfied or very satisfied with both treatments. No related adverse events have been reported for any of the treatment groups. Two patients reported discomfort or protuberances caused by P&S; no inconveniences were reported for Cranial LOOP.</p><p><strong>Conclusion: </strong>Cranial LOOP performance is equal to P&S for fixation of the cranial bone flap. In addition, it presents some advantages, such as the use of a lower number of devices, potentially making this system more affordable, and the lack of discomfort previously linked with the use of P&S.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of Current Evidence in the Endovascular Treatment of Intracranial Aneurysms: A Systematic Review and Proposal for a Reporting Guideline to Enhance Reproducibility and Comparability of Surgical and Clinical Outcomes.","authors":"Marcio Yuri Ferreira, Sávio Batista, Raphael Camerotte, Marina Vilardo, Bernardo Vieira Nogueira, Anthony Hong, Ana B Santos, Ahmet Günkan, Jhon E Bocanegra-Becerra, Filipe Virgilio Ribeiro, Vinicius Perdigão, Leonardo Januário Campos Cardoso, Raphael Bertani, Christian Ferreira, David J Langer, Yafell Serulle","doi":"10.1227/ons.0000000000001440","DOIUrl":"https://doi.org/10.1227/ons.0000000000001440","url":null,"abstract":"<p><strong>Background and objectives: </strong>Endovascular therapy (EVT) has recently become the most widely used treatment method for intracranial aneurysms (IAs). However, the literature on this topic is heterogeneous, with studies assessing and reporting surgical and clinical outcomes in different ways, lacking standardization. We aimed to evaluate the quality of these studies and propose a reporting guideline focusing on essential elements to ensure reproducibility and comparability.</p><p><strong>Methods: </strong>After Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, we searched Medline, Embase, Cochrane Library, and Web of Science databases. Eligible studies were observational or randomized, reported clinical and/or surgical outcomes of EVTs for IAs, included over 200 patients, and were published in English between January 1, 2022, and January 1, 2024. Studies were assessed focusing on key domains: (1) reporting on the baseline characteristics of the patient sample, (2) assessment and reporting on imaging methods and aneurysm characteristics, (3) reporting on pivotal concepts definitions, (4) reporting on operator(s) and staff characteristics, (5) reporting on anesthetic protocol, (6) reporting on antiaggregant and anticoagulation therapy, (7) reporting on surgical details, (8) assessing and reporting clinical and surgical outcomes, and (9) reporting retreatment details.</p><p><strong>Results: </strong>Thirty-nine studies comprising 79 604 patients were included. Our assessment revealed substantial gaps in the literature on EVTs for IAs, including deficiencies across all domains. An EndoIAs Reporting Guideline was developed, consisting of 74 items distributed across 10 domains, focusing on key surgical and clinical outcomes.</p><p><strong>Conclusion: </strong>Substantial deficiencies were identified in data collection and outcomes reporting in the available literature on EVT for IAs, thereby impeding comparability and reproducibility and hindering the building of cumulative evidence. The aim of the proposed EndoIAs Reporting Guideline was to address these fundamental aspects and has the potential to enhance the reproducibility and comparability of future studies, thereby fostering the building of cumulative and reliable evidence of EVT for IAs.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three-Step Anterior Skull Base Reconstruction Technique for Invasive Aspergillosis: 2-Dimensional Operative Video.","authors":"Nobuyasu Kato, Kenta Nakase, Takayuki Ishikawa, Yuichiro Isozawa, Tomiyuki Miyake, Yosuke Sakai, Hayato Yokoyama, Tetsuya Tsukada, Yusuke Sakamoto, Yoshio Araki, Tetsuya Nagatani, Yukio Seki","doi":"10.1227/ons.0000000000001472","DOIUrl":"https://doi.org/10.1227/ons.0000000000001472","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Rochester Model for Spinal CSF Leak Repair Simulation and Scoring.","authors":"Muhammad I Jalal, Gabrielle Santangelo, Joshua Samodal, Sandra Catanzaro, Taylor Furst, Rohin Singh, Herman Li, Sameer Jain, Aman Singh, Varun Puvanesarajah, Andrew Wensel, David A Paul, Jonathan J Stone","doi":"10.1227/ons.0000000000001458","DOIUrl":"https://doi.org/10.1227/ons.0000000000001458","url":null,"abstract":"<p><strong>Background and objective: </strong>Iatrogenic spinal durotomies occur at a rate of 1% to 17%. Surgical simulation for durotomy repair is needed to provide affordable, accessible, and validated practice. This study sought to design and validate a simple 3-dimensional printed model for spinal cerebrospinal fluid (CSF) leak repair and to introduce the Rochester original objective structured assessment of technical skills (OSATS) CSF leak (ROCL) repair criteria for assessment.</p><p><strong>Methods: </strong>A spinal model was designed to mimic a lumbar laminectomy with the L3-5 lamina removed and 3-dimensional printed using Vero polymers. The model was paired with a porcine collagen \"dura\" that was pressurized using IV saline and overlayed with gel-molded fascial, muscle, and skin layers with an opening. Participants were provided a training model with a 1.5-cm midline durotomy, surgical microinstrument set, microscope, and 6-0 prolene suture. The 25-point ROCL repair criteria were adapted from the original OSATS principles to assess proficiency in surgical repair by 2 blinded neurosurgeons not participating in the trials. Postsimulation survey data regarding model realism were collected.</p><p><strong>Results: </strong>Six residents and 4 attendings participated. Median operative time in minutes was 13 minutes among residents and 7 minutes among attendings. Moreover, the ROCL score was a median of 19/25 for attendings and 15/25 for residents. The suture angle was statistically more consistent among senior residents and attendings compared with junior residents. Participants agreed that the model was realistic (median 4/5), useful for improving the operative technique (median 5/5), and would increase comfort in spinal CSF leak repair procedures (median 5/5). Each reusable model had a cost of $19.99 if printed with polylactic acid and each replacement dura cost <3¢.</p><p><strong>Conclusion: </strong>This study presents an affordable, realistic, and educational spinal CSF leak repair model and introduces ROCL for assessment.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Purely Endoscopic Subtemporal Keyhole Approach for Trigeminal Schwannomas: Surgical Techniques and Early Results.","authors":"Tsuyoshi Sasaki, Hiroki Morisako, Manish Beniwal, Shohei Ikeda, Atsufumi Nagahama, Masaki Ikegami, Kenji Ohata, Takeo Goto","doi":"10.1227/ons.0000000000001465","DOIUrl":"https://doi.org/10.1227/ons.0000000000001465","url":null,"abstract":"<p><strong>Background and objectives: </strong>In the past, microscopic transcranial approach was the mainstay of treatment of trigeminal schwannomas. In recent years, several endoscopic procedures have been reported for trigeminal schwannomas. For trigeminal schwannomas arising around the Meckel cave, we introduced a fully endoscopic procedure with a small temporal craniotomy in June 2020 and have performed radical tumor removal as in the conventional approach. This article describes the details of the purely endoscopic subtemporal keyhole approach (PESKA) surgical procedure and reports the initial surgical results.</p><p><strong>Methods: </strong>Between June 2020 and November 2023, 8 cases of trigeminal schwannoma were treated with PESKA. The mean tumor diameter was 33.1 mm. The surgical procedure for PESKA consists of a 7-cm linear skin incision made upward from the anterior to the auricle on the side of the lesion, followed by a 4-cm temporal craniotomy and then endoscopic manipulation. The intradural part of the middle cranial fossa is observed, and the Meckel cave is identified and opened. The tumor is removed with preserving most normal trigeminal nerve fibers. The site of the lesion, the extent of resection, complications, operative time, Karnofsky Performance Status, and intraoperative blood loss were evaluated.</p><p><strong>Results: </strong>All 8 patients underwent gross total resection. Only one patient had new temporal edema on the side of the lesion, which was asymptomatic. The mean operative time was 4 hours and 21 minutes.</p><p><strong>Conclusion: </strong>We report on PESKA, a fully endoscopic procedure with a small temporal craniotomy for a trigeminal schwannoma arising around the Meckel cave. The use of an endoscope allowed for a wide field of view, even in a narrow operative field, reducing brain traction and allowing radical resection of the tumor while preserving normal trigeminal nerve fibers. This method may represent an effective surgical alternative for trigeminal schwannomas.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Direct Aspiration Versus Combined Technique for Anterior Distal, Medium Vessel Occlusions Stroke: The JET Distal Vessel Occlusion Study.","authors":"Vitanio Palmisano, Luigi Simonetti, Nicola Marotti, Lorenzo Reverberi, Alessio Comai, Maria Porzia Ganimede, Simone Comelli, Francesco Taglialatela, Andrea Zini, Matteo Paolucci, Massimo Sponza, Chiara Ciardi, Luca Verganti, Stefano Vallone, Tommaso Gorgatti, Enrica Franchini, Antonio Marrazzo, Andrea Paladini, Giuseppina Della Malva, Michele Barone, Alessandra Briatico Vangosa, Carmine Di Stasi, Nicola Burdi, Vittorio Semeraro","doi":"10.1227/ons.0000000000001411","DOIUrl":"https://doi.org/10.1227/ons.0000000000001411","url":null,"abstract":"<p><strong>Background and objectives: </strong>The optimal mechanical thrombectomy technique for distal, medium vessel occlusion (DMVO) stroke remains unknown. We aimed to compare the safety and efficacy of 2 thrombectomy first-line approaches, direct aspiration (DA), and combined technique (CT) in patients with DMVOs.</p><p><strong>Methods: </strong>We conducted a retrospective review of a prospectively collected multicenter database of patients with DMVOs (at or distal to M2 and A1), who underwent mechanical thrombectomy with JET D reperfusion catheters between January 2020 and December 2021. The primary end point was the rate of first-pass complete recanalization, defined as modified treatment in cerebral infarction (mTICI) 3. The hemorrhagic complications, the 90 days functional independence rate (modified Rankin Scale 0-2), and mortality were also evaluated.</p><p><strong>Results: </strong>A total of 171 consecutive patients were enrolled (95 in DA and 76 in CT cohort). The 2 groups had comparable demographics and baseline characteristics. The DA group had a higher rate of first-pass effect (40.0% vs 10.5%, P < .001), final mTICI 2b-3 (89.5% vs 71.1%, P = .003) and final mTICI 3 (58.9% vs 28.9%, P < .001), shorter groin to reperfusion time (65 ± 43 min vs 101 ± 60 min, P < .001), and higher rate of 90-day functional independence (63.7% vs 36.1%; P = .001) compared with the CT group. There were no significant differences in hemorrhagic complications between the 2 groups. The DA group showed a lower rate of 90-day mortality (9.9% vs 27.8%; P = .004).</p><p><strong>Conclusion: </strong>In patients with DMVOs, DA with a distal dedicated reperfusion catheter appears to demonstrate better safety and efficacy when compared with the CT using the same catheter.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sequential Hemodynamic Analysis of Ruptured Posterior Communicating Artery Aneurysms Treated With Coil Embolization and Delayed Flow Diversion.","authors":"Felipe Ramirez-Velandia, Vincenzo T R Loly, Alejandro Enriquez-Marulanda, Michael Young, Rafael T Tatit, Arthur Cintra, Carlos E Baccin, Max Shutran, Philipp Taussky, Christopher S Ogilvy","doi":"10.1227/ons.0000000000001421","DOIUrl":"https://doi.org/10.1227/ons.0000000000001421","url":null,"abstract":"<p><strong>Background and objectives: </strong>Computational fluid dynamics has advanced our knowledge of the pathogenesis of intracranial aneurysms and the dynamic changes observed after treatment. Herein, we analyze hemodynamic changes throughout the intervention stages for ruptured posterior communicating artery (PComA) aneurysms, treated with acute coiling and delayed flow diversion (FD).</p><p><strong>Methods: </strong>We performed a retrospective analysis of ruptured PComA aneurysms treated with the acute coiling and delayed FD strategy between June 2013 to November 2022, using 3-dimensional reconstructions of digital subtraction angiographies. Hemodynamic simulations using ANSYS® calculated aneurysmal and adjacent arteries' wall shear stress (WSS), aneurysmal low shear areas (LSA), and mean velocities in the distal arteries.</p><p><strong>Results: </strong>Six of the 22 patients were selected for computational fluid dynamics analysis, including 4 females and 2 males with a median age of 60 years. The average aneurysm volume was 984.12 mm3, with an average surface area of 386.11 mm2; LSA was 22.90%, and the average WSS was 3.39 Pa. The 2 largest aneurysms also had the highest LSA values. After coiling, there was a reduction in the aneurysmal volume (-78.42%) and the average surface area (-55.28%), and aneurysmal WSS increased to 6.10 Pa (+79.90%). WSS values for the middle cerebral artery (MCA) increased to 10.76 Pa, while anterior cerebral artery (ACA) increased to 7.51 Pa. Complete occlusion was achieved with delayed FD at a median follow-up of 19.7 months. After FD, average WSS increased to 14.94 Pa for the MCA (+70.64%) and to 10.82 Pa for the ACA (+30.10%). The mean MCA velocity increased to 43.04 cm/s (+36.85%), and 3 cases showed an increase in ACA velocities.</p><p><strong>Conclusion: </strong>LSA may have triggered rupture for the PComA aneurysms analyzed. After coiling, average WSS increased in the aneurysm wall and downstream vessels in the majority of cases analyzed. Delayed FD caused hemodynamic disturbances distal to deployment, reflected in the sequential increase in the WSS and velocities in both the ACA and MCA.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Reply: Navigated Intraoperative Ultrasound Offers Effective and Efficient Real-Time Analysis of Intracranial Tumor Resection and Brain Shift.","authors":"Timothy R West, Mercy H Mazurek, Brian V Nahed","doi":"10.1227/ons.0000000000001451","DOIUrl":"https://doi.org/10.1227/ons.0000000000001451","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}