Operative Neurosurgery最新文献

{"title":"Cadaveric Feasibility of Robotic-Assisted Radial Artery-Internal Carotid Artery-Middle Cerebral Artery Anastomosis for Neurovascular Surgery.","authors":"Jun Muto, Hirofumi Nakatomi, Yuichi Hirose","doi":"10.1227/ons.0000000000001375","DOIUrl":"https://doi.org/10.1227/ons.0000000000001375","url":null,"abstract":"<p><strong>Background and objectives: </strong>To the best of our knowledge, this is the first reported cadaveric feasibility study of leader-follower type robotic-assisted middle cerebral artery (MCA)-radial artery-internal carotid artery anastomosis in the neurovascular surgery field using the da Vinci Xi system (da Vinci Surgical System; Intuitive Surgical, Inc.). Vascular suturing is a necessary skill in neurosurgery; however, the learning curve for deep and high-flow bypasses is severely low. Thus, robot-assisted surgery has been introduced. Here, we describe the surgical workflow adaptations of vascular anastomosis using the da Vinci system to assess the feasibility of robot-assisted anastomoses of the radial and middle cerebral arteries.</p><p><strong>Methods: </strong>Two fresh cadaver heads were studied using the da Vinci Xi Surgical System with 0° and 30° stereoscopic endoscopes to visualize the neuroanatomy.</p><p><strong>Results: </strong>The da Vinci Xi Surgical System was used throughout the anastomosis of the MCA and intracarotid artery. The optic nerve, optic chiasm, carotid artery, and oculomotor nerve were visualized using standard microdissection techniques. The Sylvian fissure was exposed from the proximal Sylvian membrane to the distal MCA. Using black diamond microforceps and Potts scissors, suturing was achieved on the radial artery-middle cerebral artery using 8-0 Prolene and on the radial artery-internal carotid artery using 7-0 Prolene.</p><p><strong>Conclusion: </strong>A bypass of the MCA-radial artery-internal carotid artery can be achieved using the da Vinci Xi Surgical System in cadaver models. This system provides experts and less experienced neurosurgeons with stable bypass techniques for both superficial and deep-seated arteries. However, further studies are needed to evaluate the safety and benefits of the da Vinci Xi Surgical System for bypass procedures.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142309139","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":"Distal Basilar Artery Aneurysm Clipping by an Anterior Temporal Transcavernous Approach: 2-Dimensional Operative Video.","authors":"Pedro Plou, Nakao Ota, Nuno Cubas Farinha, Pablo Ajler, Maria Peris-Celda, Kosumo Noda, Rokuya Tanikawa","doi":"10.1227/ons.0000000000001370","DOIUrl":"https://doi.org/10.1227/ons.0000000000001370","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300812","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":"Surgical Anatomy of the Supraretinacular Fat Pad: Sensory Innervation and Preservation in Open Carpal Tunnel Release.","authors":"Ildefonso Muñoz Romero, Robbert G E Notenboom, Martijn J A Malessy","doi":"10.1227/ons.0000000000001367","DOIUrl":"https://doi.org/10.1227/ons.0000000000001367","url":null,"abstract":"<p><strong>Background and objectives: </strong>Postoperative pain may occur following open carpal tunnel release (OCTR). Various causes have been postulated. During OCTR, adipose tissue located between the palmar aponeurosis and the flexor retinaculum is exposed. It is unknown whether damage to this pad of supraretinacular fat (SRF) might contribute to postoperative palmar pain or tenderness. We studied the sensory innervation of the SRF exposed in OCTR to assess whether SRF damage could potentially generate pain.</p><p><strong>Methods: </strong>A microanatomic dissection of the innervation and vascular supply of the SRF was performed in 25 embalmed human cadaveric upper limbs. Eight fat pads were removed en bloc for histological evaluation. Three-dimensional reconstructions were made based on immunohistochemically stained sections using computer-assisted microscopy.</p><p><strong>Results: </strong>The SRF is the radial continuation of the hypothenar fat pad that covers the neurovascular bundle in the Guyon canal. The fat pad is richly innervated and contains Pacinian corpuscles. The sensory innervation originates exclusively from the ulnar nerve (palmar branch) and its vascular supply from the ulnar artery. The integrity of the SRF can be preserved by detaching it from the flexor retinaculum in a radial to ulnar fashion.</p><p><strong>Conclusion: </strong>The SRF, which is exposed during OCTR, is richly innervated by sensory fibers from the ulnar nerve. It is the radialmost extension of the hypothenar fat pad. In view of its rich innervation, damage to the SRF during OCTR might generate postoperative pain. Preserving its integrity during OCTR is technically possible and even simplifies the procedure. Clinical trials are needed to corroborate whether preservation of the SRF during OCTR indeed makes a clinical difference in postoperative pain generation.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300830","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":"Extended Retrosigmoid Craniotomy for Resection of a Ruptured Cerebellar Petrosal Arteriovenous Malformation: 2-Dimensional Operative Video.","authors":"Matthew Webb, Michael Gaub, Justin Mascitelli","doi":"10.1227/ons.0000000000001376","DOIUrl":"https://doi.org/10.1227/ons.0000000000001376","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300814","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":"Microsurgical Anatomy of the Common Tendinous Ring and Its Surgical Implications.","authors":"Ying Huang, Xu Wang, Zhi-Feng Tian, Li Cai, Xu-Ming Wang, Dan Tang, Jian Ren, Xiao-Hai Liu, Ge Chen, Peng Hu, Ming-Chu Li","doi":"10.1227/ons.0000000000001377","DOIUrl":"https://doi.org/10.1227/ons.0000000000001377","url":null,"abstract":"<p><strong>Background and objectives: </strong>The common tendinous ring (CTR), also known as the common annular tendon or annulus of Zinn, is a critical anatomic structure located at the convergence of the orbital apex, superior orbital fissure (SOF), optic canal, and the anterior aspect of the lateral sellar compartment. It plays a vital role in both neurosurgical and neuro-ophthalmological interventions. The aim of this study was to delineate the complex 3-dimensional (3D) topography of the CTR and explore its implications for surgical procedures.</p><p><strong>Methods: </strong>Ten formalin-fixed skull base specimens from adult Chinese cadavers were meticulously dissected to investigate the morphology of the CTR, focusing particularly on its relationship with the 4 extraocular rectus tendons, the optic strut, the SOF, and the optic canal. Additional skull base specimens were subjected to 3D surface scanning, computed tomography, and histopathological examinations to deepen our understanding of the CTR's structural complexities.</p><p><strong>Results: </strong>The CTR establishes a spatial, 3D tendinous assembly, encompassing 4 rectus tendons, 2 tendinous connections, and a singular common tendinous root. These components interlink to form a distinctive dual-ring configuration, featuring the optic foramen and the oculomotor foramen. The posterior part of the superior rectus tendon demarcates the common boundary between these 2 foramina. The oculomotor foramen itself serves as the central sector of the SOF. Precise incisions of the medial and lateral tendinous connections and fusions are essential for safely opening the CTR.</p><p><strong>Conclusion: </strong>The structural composition, interconnections, and dual-ring configuration of the CTR are crucial for precise and safe surgery of orbital apex and adjacent regions.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300824","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":"Middle Meningeal Artery Embolization for Chronic Subdural Hematoma Using N-Butyl Cyanoacrylate With a D5W Push Technique: A Multicentric North American Study of 269 Patients.","authors":"Ahmed Abdelsalam, Ian A Ramsay, Evan M Luther, Joshua D Burks, Eva M Wu, Michael A Silva, John W Thompson, Miguel Bandes, Hayes B Fountain, Tiffany Eatz, Sai Sanikommu, Adib A Abla, Mohamed M Salem, Jan-Karl Burkhardt, Visish M Srinivasan, Denise Brunozzi, Ali Alaraj, Gursant Atwal, Fawaz Al-Mufti, Christopher P Kellner, Ansaar T Rai, Robert M Starke","doi":"10.1227/ons.0000000000001369","DOIUrl":"https://doi.org/10.1227/ons.0000000000001369","url":null,"abstract":"<p><strong>Background and objectives: </strong>As the aging population increases, the incidence of chronic subdural hematomas (cSDHs) is expected to rise. Surgical evacuation, though effective, sees up to 30% recurrence. Middle meningeal artery (MMA) embolization, particularly with n-butyl cyanoacrylate (n-BCA) glue diluted in D5W for distal penetration, has shown promise in reducing recurrences. Limited reports have investigated the safety and technical feasibility of n-BCA as a primary liquid embolic agent using the D5W push technique in cSDH. This series is the largest in the literature investigating the outcomes of this technique in cSDH.</p><p><strong>Methods: </strong>A multicenter retrospective database analysis was conducted on consecutive patients who underwent MMA embolization using n-BCA embolisate. Data collected included patient demographics, procedural information, angiographic data, and periprocedural complications.</p><p><strong>Results: </strong>The study included 269 patients with a median age of 76 years. Nearly half of the patients had previous surgeries, and 93 underwent contralateral embolization for bilateral cSDH. Successful MMA embolization with effective distal penetration was achieved in all cases. The complication rate was 2.2%. Significant improvements were noted at a 60-day follow-up, with a median reduction in cSDH diameter of 40.6% (P < .001) and 53% of patients showing neurological improvement. No recurrent cSDH or need for retreatment was observed in patients who underwent follow-up.</p><p><strong>Conclusion: </strong>MMA embolization using n-BCA with the D5W push technique is safe and technically feasible. It can be used adjunctively or as an alternative to surgery in patients with cSDH, resulting in decreased recurrence, high technical success, improved distal penetration, and low complication rates.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300827","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":"Cranio-Orbital Approach and Decompression of the Optic Nerves: A 2-Stage, 4-by-4-Step Approach to Improve Vision in Sellar and Parasellar Lesions.","authors":"Nebojsa Lasica,Kara A Parikh,Kenan I Arnautović","doi":"10.1227/ons.0000000000001344","DOIUrl":"https://doi.org/10.1227/ons.0000000000001344","url":null,"abstract":"BACKGROUND AND OBJECTIVESDespite advances in cranial base techniques, surgery of the sellar and parasellar regions remains challenging because of complex neurovascular relationships. Lesions within this region frequently present with progressive visual deterioration caused by distortion and compression of the optic chiasm and nerves. In addition to the direct mass effect from mechanical forces acting on the optic apparatus, these lesions alter blood supply and reduce vascular perfusion, prompting surgical treatment to remove the lesion, alleviate compression, and improve blood flow to the optic nerve. We sought to describe a 2-stage, 4-by-4-step approach, broken down and described as a \"four-by-four\" technique for optic apparatus decompression and a wide approach to different sellar and parasellar lesions.METHODSWe describe the operative nuances and key anatomic points in the microsurgical removal of sellar and parasellar lesions. The technique is illustrated with examples of different cases with pre- and follow-up MRI imaging and a brief overview of visual outcomes.RESULTSThe described technique has been demonstrated in various lesions in 5 patients. Patients presented with bilateral visual loss in 4 (80.0%) cases and with unilateral visual loss in 1 (20.0%) case. Improvement in visual function was noted in all cases, confirmed with visual acuity and visual field testing.DISCUSSIONThe transcranial approach (\"from above\") remains an important surgical option for patients with excellent exposure and visualization of the sellar and parasellar regions. It permits early access to the optic canal for careful microsurgical decompression and relaxation of the optic nerve to preserve and improve its microvascularization and ultimately vision.CONCLUSIONThe authors augmented the 2-stage, 4-by-4-step technique of decompression with elaborate illustrations of diverse sellar and parasellar lesions to demonstrate the versatility of this approach.","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":"39 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142267233","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 Combined Transnasal and Contralateral Transmaxillary Approach for Chondrosarcoma: 2-Dimensional Operative Video.","authors":"Simona Serioli, Riccardo Maria Brancaleone, Maria Grazia De Antoniis, Mario Rigante, Michele di Domenico, Valentina Masini, Alessandro Izzo, Pier Paolo Mattogno, Liverana Lauretti, Vincenzo Arena, Simona Gaudino, Jacopo Galli, Alessandro Olivi, Marco Maria Fontanella, Francesco Doglietto","doi":"10.1227/ons.0000000000001384","DOIUrl":"https://doi.org/10.1227/ons.0000000000001384","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300813","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":"Reappraisal of the Previously Described False Localizing Sign at C1-2 in Cases of Spontaneous Intracranial Hypotension.","authors":"Gianna Fote, Hania Shahin, Nolan J Brown, Joseph Falcone, Alexander Lopez, Edward C Kuan, Frank P K Hsu, Michael Y Oh, Ahmed Mohyeldin","doi":"10.1227/ons.0000000000001341","DOIUrl":"https://doi.org/10.1227/ons.0000000000001341","url":null,"abstract":"<p><strong>Background and objectives: </strong>We present an illustrative case of spontaneous intracranial hypotension (SIH) in the setting of a suspected C1-2 cerebrospinal fluid (CSF) leak that was successfully treated with muscle, collagen, and epidural blood patch. We examined the literature to identify similar cases reporting Cl-2 retrospinal fluid collections identified on imaging in the setting of SIH and quantified the success of targeted treatment to this area despite previous reports that caution about a \"C1-2 false localizing sign.\"</p><p><strong>Methods: </strong>A systematic search was performed identifying cases of SIH resulting from CSF leak with C1-2 fluid collection observed on imaging. PubMed, Google Scholar, and Web of Science were queried, and articles were screened for possible inclusion by 2 authors and supervised by the senior author.</p><p><strong>Results: </strong>In total, 28 studies were included with a total of 32 patients. The number of patients in each study with C1-2 fluid collections, number of patients with fluid collections at multiple levels, specific intervention used, and outcomes of each intervention were recorded, with a focus on whether treatment occurred at the levels exhibiting fluid signal.</p><p><strong>Conclusion: </strong>Although the C1-2 fluid signal in SIH has previously been described as a \"false localizing sign,\" our study indicates that treating this level as the source of CSF leak results in successful and durable outcomes. Most SIH cases with signal at C1-2 did not have a fluid signal at any other level and were treated successfully and most commonly through epidural blood patch at the C1-2 level. Symptom resolution was also reported after direct repair of C1-2 CSF leaks through primary closure, Gelfoam patch, and muscle fragment with fibrin. In patients with SIH, C1-2 fluid signal, and no other source of CSF leak identified on imaging, surgical intervention at the C1-2 level seemed to have a high success rate.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300828","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: Bilateral High-Riding Persistent First Cervical Intersegmental Arteries in a Case of Klippel-Feil Syndrome: The Technique of Vertebral Artery Mobilization for C1-C2 Reduction and Fusion for Atlantoaxial Dislocation and Basilar Invagination: 2-Dimensional Operative Video.","authors":"Atul Goel","doi":"10.1227/ons.0000000000001365","DOIUrl":"https://doi.org/10.1227/ons.0000000000001365","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300809","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}