Operative Neurosurgery最新文献

{"title":"Modified Posterior Petrosal Approach for Microsurgical Resection of a Retrochiasmatic Craniopharyngioma: 2-Dimensional Operative Video.","authors":"Guilherme H W Ceccato, João O P Bzuneck, Larissa S Cardoso, Denys A Q Alcocer, Matheus S Flor, João V R Bubicz, Gustavo A R Passos, Paulo A S Kadri, Luis A B Borba","doi":"10.1227/ons.0000000000001603","DOIUrl":"https://doi.org/10.1227/ons.0000000000001603","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994859","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":"Suboccipital Craniectomy and C1-C2 Laminectomies for Resection of Calcified Intradural-Extramedullary Meningioma With Arterial Encasement of PICA: 2-Dimensional Operative Video.","authors":"Kara A Parikh, Alexandra H Kramer, Emal Lesha, Nickalus R Khan","doi":"10.1227/ons.0000000000001587","DOIUrl":"https://doi.org/10.1227/ons.0000000000001587","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999918","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":"Transorbital Transsylvian Selective Amygdalohippocampectomy: A Feasibility Anatomic Investigation.","authors":"Tingting Jiang, Roberto Manfrellotti, Roberto Tafuto, Pedro Roldan, Arianna Fava, Paolo di Russo, Beatriz Villa, Matteo de Notaris, Vincenzo Esposito, Alberto Prats-Galino, Alberto Di Somma, Joaquim Enseñat","doi":"10.1227/ons.0000000000001600","DOIUrl":"https://doi.org/10.1227/ons.0000000000001600","url":null,"abstract":"<p><strong>Background and objectives: </strong>Several surgical techniques have been developed to treat mesial temporal lobe epilepsy, the most common form of drug-resistant epilepsy. Although surgical treatment for mesial temporal lobe epilepsy has proven to be highly effective in controlling seizures and improving patients' quality of life, it carries potential risk to critical neurovascular structures, which can result in significant complications. With the advent of endoscopic techniques, the transorbital route has emerged as a potential alternative for mesial temporal lobe surgery. This study aims to assess the feasibility, potential advantages, and disadvantages of the transorbital transsylvian selective amygdalohippocampectomy (TTSA) and to provide a step-by-step anatomic description of this approach.</p><p><strong>Methods: </strong>A TTSA was performed on three injected cadaveric specimens (six sides). Computer tomography and MRI scans were performed before and after each dissection to demonstrate the extent of amygdalohippocampectomy. Neuronavigation was used to identify the optimal trajectory and the position of intra-axial structures, including the amygdala and hippocampus. For each side, a TTSA was performed and all the anatomic landmarks verified from the standard transcranial perspective through a frontotemporal craniotomy.</p><p><strong>Results: </strong>The dissection procedure was organized into four sequential steps: (1) the extradural approach, (2) identification and opening of the sylvian fissure, (3) identification and removal of the amygdala, and (4) identification and removal of the hippocampus and parahippocampal gyrus. The intradural steps were performed in accordance with the technique described by Yasargil. Furthermore, a unique and educational comparison between the transorbital anatomic view and the related standard transcranial perspective was provided.</p><p><strong>Conclusion: </strong>The described technique represents an innovative and feasible approach for amygdalohippocampectomy, achieving comparable surgical resection with traditional open surgery in cadaveric specimens, with potential advantages for neurological and neuropsychological outcomes. However, clinical series and further studies are imperative to validate these findings.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028835","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":"Neurovascular Pathology in Intracranial Mucormycosis: Treatment by Cranial Bypass and Literature Review.","authors":"Eric A Grin, Maksim Shapiro, Eytan Raz, Vera Sharashidze, Charlotte Chung, Caleb Rutledge, Jacob Baranoski, Howard A Riina, Donato Pacione, Erez Nossek","doi":"10.1227/ons.0000000000001594","DOIUrl":"https://doi.org/10.1227/ons.0000000000001594","url":null,"abstract":"<p><strong>Background and importance: </strong>Rhino-orbital cerebral mucormycosis (ROCM) is an aggressive fungal infection involving the paranasal sinuses, orbit, and intracranial cavity, with a propensity for vascular invasion. This can lead to complications such as internal carotid artery (ICA) thrombosis and occlusion, presenting major neurosurgical challenges. Although surgical debridement and antifungal therapy are the mainstays of treatment, cases with significant neurovascular involvement require specialized intervention. We report a case of ROCM with severe flow-limiting ICA stenosis treated by direct extracranial-intracranial bypass.</p><p><strong>Clinical presentation: </strong>tA 65-year-old man with diabetes presented with progressive left-sided blindness and facial numbness. Imaging revealed a left orbital mass extending into the paranasal sinuses and intracranially. Empiric antifungal therapy was started. Pathology confirmed Rhizopus species. Despite extensive surgical debridement and antifungal therapy, the patient developed progressive severe cavernous ICA stenosis, leading to watershed territory strokes. To restore cerebral perfusion, protect from distal emboli, and prepare for potential aggressive debridement, a flow-replacing direct (superficial temporal artery-middle cerebral artery (M2)) bypass was performed, and the supraclinoid carotid was trapped. Intraoperative angiography confirmed robust flow through the bypass. The patient was discharged on antifungal therapy and aspirin. At 6-month follow-up, the patient was neurologically intact with an modified Rankin Scale score of 1. Computed tomography angiography and transcranioplasty Doppler ultrasonography confirmed good flow through the bypass.</p><p><strong>Conclusion: </strong>In addition to antifungal therapy and surgical debridement, superficial temporal artery-middle cerebral artery bypass can be a lifesaving intervention in the management of ROCM with severe cerebrovascular compromise. This case highlights the critical role of cranial bypass in preserving cerebral perfusion in patients with flow-limiting ROCM-associated ICA invasion.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026914","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":"Cervical 3-4 Hemilaminectomies for Resection of a Ventrolateral Cavernous Malformation: 2-Dimensional Operative Video.","authors":"Kenneth James, Samantha Walker, Gagandeep Japra, Martin Rutkowski","doi":"10.1227/ons.0000000000001588","DOIUrl":"https://doi.org/10.1227/ons.0000000000001588","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055555","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":"Commentary: Fluorescence-Guided Cord Transection for Supramaximal Resection of Spinal High-Grade Glioma: 2-Dimensional Operative Video.","authors":"Nasser M F El-Ghandour","doi":"10.1227/ons.0000000000001585","DOIUrl":"https://doi.org/10.1227/ons.0000000000001585","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053095","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":"Endoscopically Assisted Release Surgery for Idiopathic Spinal Cord Herniation: Technical Case Instruction.","authors":"Takashi Yagi, Toru Tateoka, Hideyuki Yoshioka, Masakazu Ogiwara, Hiroyuki Kinouchi","doi":"10.1227/ons.0000000000001584","DOIUrl":"https://doi.org/10.1227/ons.0000000000001584","url":null,"abstract":"<p><strong>Background and importance: </strong>Idiopathic spinal cord herniation through a defect in the ventral dura mater is rare and typically results in progressive myelopathy. Various surgical procedures to release the tethered spinal cord can prevent the progression of myelopathy; however, the optimal procedure has not yet been established. We describe techniques using endoscopic assistance to minimize spinal cord manipulation.</p><p><strong>Clinical presentation: </strong>A 60-year-old woman presented with Brown-Séquard syndrome. Magnetic resonance imaging demonstrated ventral displacement of the spinal cord at T3-4. Right T2, T3, T4, and T5 hemilaminectomies and T4 pediculectomy were performed. After paramedian durotomy and transection of the dentate ligament, we identified a defect in the inner layer of the dura mater ventrally and found the spinal cord incarcerated in a pocket between the inner and outer layers. The spinal cord was adherent to the dura at the caudal end of the defect. The defect was extended caudally on the right under microscopic observation. On the left, which could not be visualized under the microscope, the adhesions were dissected under endoscopic guidance. After complete spinal cord untethering, the defect was closed using collagen matrix. The patient's motor weakness fully recovered, and she was walking independently at the time of discharge.</p><p><strong>Conclusion: </strong>Endoscopic assistance for release of thoracic spinal cord herniation is useful for minimizing intraoperative spinal cord manipulation.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049069","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":"Endoscopic Right-Sided Transforaminal T8-T9 Microdiskectomy: 2-Dimensional Operative Video.","authors":"Noah Willett, Chibuikem A Ikwuegbuenyi, Abdullah Okar, Alan Hernández-Hernández, Galal Elsayed, Osama N Kashlan","doi":"10.1227/ons.0000000000001597","DOIUrl":"https://doi.org/10.1227/ons.0000000000001597","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021426","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":"Applicability of a Dexterity-Enhancing Handheld Robot for 360° Endoscopic Skull Base Approaches: An Exploratory Cadaver Study.","authors":"Joachim Starup-Hansen, Dan Zimelewicz Oberman, John G Hanrahan, Emmanouil Dimitrakakis, Hani J Marcus, Joao Paulo Almeida","doi":"10.1227/ons.0000000000001582","DOIUrl":"https://doi.org/10.1227/ons.0000000000001582","url":null,"abstract":"<p><strong>Background and objectives: </strong>Endoscopic skull base surgery aims to reduce surgical morbidity by minimizing tissue manipulation and exposure. However, the anatomic constraints posed by the narrow surgical corridors and constrained operative workspace present technical challenges due to reduced dexterity. This study evaluates the applicability of a novel dexterity-enhancing handheld robot for endoscopic skull base approaches.</p><p><strong>Methods: </strong>The robotic system is comprised of interchangeable articulated end-effectors coupled to a handheld controller. Two attending skull base neurosurgeons and 2 neurosurgery residents performed 8 skull base approaches on cadaveric specimens, spanning anterior, anterolateral, lateral, posterolateral, and posterior approaches. Conventional instruments were used to expose anatomic landmarks, followed by intraoperative tasks using the handheld robot. Participants were interviewed during the procedures to assess the robot's feasibility (ability to safely reach and perform its objective of manipulating tissue at the operative site) and usefulness (ability to perform desired objectives well).</p><p><strong>Results: </strong>The handheld robotic system was tested across 8 endoscopic skull base approaches, achieving feasibility in all cases. Superior workspace reach compared with standard instruments was demonstrated in 6 of 8 approaches. Tissue manipulation was satisfactory in all approaches. All surgeons reported that the current or a future device prototype could be useful across all 8 approaches. The most frequently cited advantage was the expanded dextrous workspace reach provided by the articulated end-effectors, particularly in approaches with long working channels, such as the endonasal approach. However, the robot encountered difficulties in transcranial approaches (trans-sylvian and subtemporal) due to the lack of shorter, curved shafts, which impaired visualization.</p><p><strong>Conclusion: </strong>The handheld robotic system demonstrated applicability across various endoscopic skull base approaches, offering increased dextrous workspace and effective tissue manipulation capabilities. Overall, this study supports the potential of handheld robots in endoscopic skull base surgery while highlighting the need for iterative development to optimize instrument design and functionality.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009115","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":"Letter: Commentary: Cervicothoracic Deformity in the Setting of Adhesive Arachnoiditis: An Operative Video Article.","authors":"Mohamad G Bakhaidar, Ataollah Shahbandi, Saman Shabani","doi":"10.1227/ons.0000000000001611","DOIUrl":"https://doi.org/10.1227/ons.0000000000001611","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049768","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}