Operative Neurosurgery最新文献

{"title":"Decreased Incidence of Radial Artery Vasospasm Using a Distal Transradial Approach in Diagnostic Cerebral Angiography: A Comparison of 200 Consecutive Cases.","authors":"Zachary S Hubbard, Conor M Cunningham, Rahim Abo Kasem, Mohammad-Mahdi Sowlat, Ahmed Muthana, Julio Isidor, Guilherme Porto, Kimberly Kicielinski, Sami Al Kasab, Jonathan Lena, Alejandro M Spiotta","doi":"10.1227/ons.0000000000001381","DOIUrl":"10.1227/ons.0000000000001381","url":null,"abstract":"<p><strong>Background and objectives: </strong>Radial artery vasospasm is a common complication of radial artery catheterization. During the implementation of distal transradial approach (dTRA), we observed a decreased incidence of radial artery vasospasm on radial artery angiography following access that was not well detailed in the literature. The purpose of this study was to characterize the phenomenon of radial artery vasospasm in the context of different radial artery access points for diagnostic cerebral angiography.</p><p><strong>Methods: </strong>We retrospectively reviewed consecutive patients undergoing diagnostic cerebral angiography from September 2023 to March 2024. Hundred conventional transradial approach (cTRA) and 100 dTRA diagnostic cerebral angiograms were performed. Following sheath insertion, all angiographic runs were reviewed, and a classification scheme was used to detail radial artery vasospasm occurrence.</p><p><strong>Results: </strong>Radial artery vasospasm was lower in the dTRA approach compared with the cTRA approach ( P = .019). A change in radial artery diameter was noted in 47 (47%) patients in the cTRA group vs 28 (28%) patients in the dTRA group. Radial artery diameter distal to the sheath was smaller in the cTRA group (2.30 ± 0.41) compared with the dTRA group (2.42 ± 0.48) ( P = .021). Patients with Grade II/III spasm were younger (58 years vs 62 years; P = .029) and had a higher percentage of females (77.3% vs 62.4%; P = .030). Grade II/III spasm patients had a higher percentage of the cTRA approach compared with the dTRA approach (62.7% vs 42.4%; P = .008). These procedures were significantly longer with Grade II/III procedure time of 18:00 minutes vs 15.59 minutes in the Grade I group. Number of vessels catheterized was not significantly different between groups ( P = .262).</p><p><strong>Conclusion: </strong>dTRA for diagnostic cerebral angiography is associated with a lower incidence of radial artery vasospasm compared with cTRA. Operators seeking to obviate radial artery vasospasm may consider using the dTRA approach for diagnostic cerebral angiography.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"883-890"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480669","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":"A Multivariate Approach to Quantifying Risk Factors Impacting Stereotactic Robotic-Guided Stereoelectroencephalography.","authors":"Ryan R Song, Akshay Sharma, Nehaw Sarmey, Stephen Harasimchuk, Juan Bulacio, Richard Rammo, William Bingaman, Demitre Serletis","doi":"10.1227/ons.0000000000001383","DOIUrl":"10.1227/ons.0000000000001383","url":null,"abstract":"<p><strong>Background and objectives: </strong>Stereoelectroencephalography (SEEG) is an important method for invasive monitoring to establish surgical candidacy in approximately half of refractory epilepsy patients. Identifying factors affecting lead placement can mitigate potential surgical risks. This study applies multivariate analyses to identify perioperative factors affecting stereotactic electrode placement.</p><p><strong>Methods: </strong>We collected registration and accuracy data for consecutive patients undergoing SEEG implantation between May 2022 and November 2023. Stereotactic robotic guidance, using intraoperative imaging and a novel frame-based fiducial, was used for planning and SEEG implantation. Entry-point (EE), target-point (TE), and angular errors were measured, and statistical univariate and multivariate linear regression analyses were performed.</p><p><strong>Results: </strong>Twenty-seven refractory epilepsy patients (aged 15-57 years) undergoing SEEG were reviewed. Sixteen patients had unilateral implantation (10 left-sided, 6 right-sided); 11 patients underwent bilateral implantation. The mean number of electrodes per patient was 18 (SD = 3) with an average registration mean error of 0.768 mm (SD = 0.108). Overall, 486 electrodes were reviewed. Univariate analysis showed significant correlations of lead error with skull thickness (EE: P = .003; TE: P = .012); entry angle (EE: P < .001; TE: P < .001; angular error: P = .030); lead length (TE: P = .020); and order of electrode implantation (EE: P = .003; TE: P = .001). Three multiple linear regression models were used. All models featured predictors of implantation region (157 temporal, 241 frontal, 79 parietal, 9 occipital); skull thickness (mean = 5.80 mm, SD = 2.97 mm); order (range: 1-23); and entry angle in degrees (mean = 75.47, SD = 11.66). EE and TE error models additionally incorporated lead length (mean = 44.08 mm, SD = 13.90 mm) as a predictor. Implantation region and entry angle were significant predictors of error ( P ≤ .05).</p><p><strong>Conclusion: </strong>Our study identified 2 primary predictors of SEEG lead error, region of implantation and entry angle, with nonsignificant contributions from lead length or order of electrode placement. Future considerations for SEEG may consider varying regional approaches and angles for more optimal accuracy in lead placement.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"824-831"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332306","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":"Vertebral Column Subluxation in Neurofibromatosis Type 1-Associated Dystrophic Scoliosis: A Report of Two Cases and Narrative Review.","authors":"Yosef Dastagirzada, Sean Neifert, David B Kurland, Nora C Kim, Tania Panicucci-Roma, Anthony Frempong-Boadu, Darryl Lau","doi":"10.1227/ons.0000000000001373","DOIUrl":"10.1227/ons.0000000000001373","url":null,"abstract":"<p><strong>Background and objective: </strong>Neurofibromatosis-1 (NF1) dystrophic scoliosis is a challenging disease to manage surgically, with multiplanar curves progressing rapidly and unpredictably. Conservative management with bracing is often unsuccessful, and many patients necessitate instrumented fusion to halt progression of their curves. In rare cases, patients can present with spontaneous vertebral subluxation, significantly complicating the surgical management of this already complex disease process. The objective here was to describe 2 cases of vertebral subluxation in NF1-associated dystrophic scoliosis along with their surgical corrections and clinical courses.</p><p><strong>Methods: </strong>A retrospective review of 2 cases at the authors' institution was performed to describe their preoperative symptom complexes, surgical corrections, and postoperative courses. A narrative review of the literature surrounding NF1-associated dystrophic scoliosis and subluxation is also presented.</p><p><strong>Results: </strong>Two cases of vertebral subluxation at T4-5 and C7-T1 are presented. Both patients had significant dystrophic features throughout their spines, and halo-gravity traction was unsuccessful in 1 patient and led to vertebral and subclavian artery injuries in the other. One patient underwent an uncomplicated deformity correction with partial vertebral column resection to facilitate his deformity correction. The other patient, after her vascular injuries, ultimately suffered a spinal cord injury after a fall and underwent emergent instrumentation, decompression, and partial vertebral column resection at the site of subluxation, with improvement in her neurological function afterward.</p><p><strong>Conclusion: </strong>Dystrophic scoliosis in NF1 remains a difficult disease to treat, and deformity correction in patients with subluxation is particularly complex. These cases here highlight the unpredictability and possible complications of halo-gravity traction, need for good fixation to facilitate subluxation reduction, high chance of hardware complications and proximal or distal failure, and importance of cooperative management of these patients in conjunction with other surgical services.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"762-771"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985697","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: A Staged Approach for Surgical Management of Basilar Invagination.","authors":"Jitin Bajaj","doi":"10.1227/ons.0000000000001543","DOIUrl":"10.1227/ons.0000000000001543","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"906"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574683","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":"Ventral Thoracic Cerebrospinal Fluid Leak Repair in Spontaneous Intracranial Hypotension Complicated by Superficial Siderosis: 2-Dimensional Operative Video.","authors":"Ryan M Naylor, Eugene S Bah, Giorgos Michalopoulos, Jeremy K Cutsforth-Gregory, Ajay A Madhavan, Jeremy L Fogelson","doi":"10.1227/ons.0000000000001372","DOIUrl":"10.1227/ons.0000000000001372","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"893-894"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332319","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":"Spinal Anesthesia for Multilevel Awake Minimally Invasive Transforaminal Lumbar Interbody Fusion: Single-Center Experience.","authors":"Juan P Navarro-Garcia de Llano, Macarena Fuentes-Fernandez Cueto, Andrew P Roberts, Jesus E Sanchez-Garavito, Siddharth Shah, Gaetano De Biase, Harshvandan Iyer, Ogechuku Ariwodo, Loizos Michaelides, Jennifer S Patterson, Kate E White, Elird Bojaxhi, Rodrigo Navarro-Ramirez, Ian A Buchanan, Alfredo Quinones-Hinojosa, Kingsley O Abode-Iyamah","doi":"10.1227/ons.0000000000001380","DOIUrl":"10.1227/ons.0000000000001380","url":null,"abstract":"<p><strong>Background and objectives: </strong>Awake minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) generates minimal surrounding tissue damage and has been shown to be a safe, time-effective, and cost-reductive technique in single-level procedures. The purpose of this study was to advocate for the utilization of multilevel MIS-TLIF even in challenging cases as it has demonstrated positive outcomes.</p><p><strong>Methods: </strong>Chart review was conducted for consecutive patients undergoing awake multilevel MIS-TLIF from 2020 to 2023. Various demographic, preoperative, and postoperative variables were collected and descriptively analyzed.</p><p><strong>Results: </strong>Sixteen patients underwent multilevel awake MIS-TLIF at our institution during the specified period. Among them, 87.5% underwent a two-level procedure and 12.5% a three-level procedure. The median age ± IQR was 69.5 ± 11 years, with a slight male predominance (56.25%). Common comorbidities included hypertension (56.25%), obesity (37.5%), sleep apnea (25%), and type 2 diabetes (18.75%). The American Society of Anesthesiologists risk was 2 in 43.75% of patients and 3 in 56.25%. All patients presented pain, and 12.5% showed motor deficit. Intraoperative data showed a median of 196 minutes in the operating room where 156 ± 27.75 minutes corresponded to actual procedure time. The median estimated blood loss was 50 ± 70 cc. In the immediate postoperative period, 1 patient had nausea and emesis, and 1 reported fatigue. The median pain score during this period was 4.6 ± 2.03. Pain control medications were required for various patients, with methocarbamol (50%), hydromorphone (37.5%), and oxycodone (25%) being the most commonly prescribed in the postanesthesia care unit. No patient had new neurological deficits after the surgical intervention. The median length of stay was 2 days ±1.25. All patients were discharged with no complications.</p><p><strong>Conclusion: </strong>Multilevel awake MIS-TLIF emerges as a safe and effective technique for complex cases, enhancing patient quality of life with minimal blood loss and postoperative pain.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"855-861"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332316","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":"Resection of a Dorsal Arachnoid Web of the Cervical Spine: 2-Dimensional Operative Video.","authors":"Arjun R Adapa, Anthony J Tang, Andrew K Chan","doi":"10.1227/ons.0000000000001374","DOIUrl":"10.1227/ons.0000000000001374","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"904-905"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332315","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 Approach Through a Transpalpebral Incision for Resection of a Meningioma Involving the Lateral Anterior Clinoid Process: 2-Dimensional Operative Video.","authors":"Camille Milton, Emal Lesha, Andrew H Miller, Taylor Orr, Brian Fowler, L Madison Michael","doi":"10.1227/ons.0000000000001395","DOIUrl":"https://doi.org/10.1227/ons.0000000000001395","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":"28 6","pages":"895-896"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082068","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":"10.1227/ons.0000000000001376","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"899"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","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":"Maximizing the Carotid-Oculomotor Triangle and Oculomotor-Trochlear Corridor for Microsurgical Clipping of a Large Wide-Neck Low-Lying Basilar Apex Aneurysm: 2-Dimensional Operative Video.","authors":"Diego Mendez-Rosito, Cristian Alberto Pérez-Carrillo, Jaime Jecsan Serrano-Verduzco, Iván Alejandro Méndez-Guerrero, Gustavo Melo-Guzmán, James K Liu, Jesús Abraham Ibarra-Ramos, Nadin J Abdala-Vargas","doi":"10.1227/ons.0000000000001336","DOIUrl":"10.1227/ons.0000000000001336","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"891-892"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332311","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}