Operative Neurosurgery最新文献

{"title":"Ultrasound-Assisted Transclival Resection of Clival Chordoma With Intradural Extension: A 3-Dimensional Operative Video.","authors":"Guilherme Mansur, Moataz D Abouammo, Rodrigo Gehrke, Chandrima Biswas, Ricardo L Carrau, Daniel M Prevedello","doi":"10.1227/ons.0000000000001454","DOIUrl":"10.1227/ons.0000000000001454","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"589-590"},"PeriodicalIF":1.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069693","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":"Acute Venous Outflow Obstruction After Coil Embolization of Giant Cavernous Carotid Aneurysm: 2-Dimensional Operative Video.","authors":"Andrew M Falzon, Ahmed Abdelghafar, Roshawn Jamasi, Timo Krings","doi":"10.1227/ons.0000000000001513","DOIUrl":"10.1227/ons.0000000000001513","url":null,"abstract":"<p><strong>Background and importance: </strong>Endovascular treatment of giant carotid cavernous aneurysms (GCCAs) may be associated with complications including rapid intrasaccular thrombosis, embolic ischemic stroke, and caroticocavernous fistula.</p><p><strong>Clinical presentation: </strong>A female in her 6th decade presented with a chronic, right partial abducens nerve palsy. Magnetic resononance angiography demonstrated a 25-mm right GCCA causing mass effect on the right cavernous sinus. Coil embolization of the aneurysm and parent vessel was performed after passing a balloon test occlusion. Final angiography demonstrated complete embolization of the aneurysm, however, absent ipsilateral cavernous sinus drainage, which was present previously. Intraprocedurally, the patient had ipsilateral proptosis and chemosis. Once extubated, urgent ophthalmology review documented preserved and symmetrical visual acuity with both pupils reactive to light. Intraocular pressure was 19-mm and 11-mm Hg in the right and left eye, respectively. The right eye had -2 abduction with otherwise intact extraocular movements. Acute management included a total of 16-mg IV dexamethasone on day 1, followed by a course of oral steroids and prophylactic low molecular weight heparin. Postprocedure computed tomography of the head demonstrated periorbital soft tissue edema and dilatation of the right superior ophthalmic vein, which peaked at 6 hours postprocedure. The patients' ocular findings and visual disturbances subsided within 36 hours postprocedure. The chronic partial abducens nerve palsy remained.</p><p><strong>Conclusion: </strong>Acute proptosis, chemosis, and visual disturbances may occur from mass effect on the cavernous sinus with venous outflow obstruction after GCCA embolization. This is thought to be secondary to increased mass effect from intrasaccular thrombosis and the large coil mass.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"584-587"},"PeriodicalIF":1.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469903","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":"Dual-Lesion Magnetic Resonance-Guided Focused Ultrasound Thalamotomy of the Ventralis Intermedius Nucleus and Ventralis Oralis Anterior and Posterior Nuclei for the Treatment of Tremor-Dominant Parkinson's Disease: Outcomes in 6 Treated Cases.","authors":"Nathan J Pertsch, Kazuki Sakakura, Julia Mueller, Dustin Kim, Lucinda Chiu, Jesus Roberto Varela, Jacob Mazza, Shama Patel, John Pearce, Sepehr Sani","doi":"10.1227/ons.0000000000001520","DOIUrl":"10.1227/ons.0000000000001520","url":null,"abstract":"<p><strong>Background and objectives: </strong>The ventralis intermedius nucleus of the thalamus (Vim) is the preferred target in magnetic resonance-guided focused ultrasound (MRgFUS) for tremor-dominant Parkinson's disease (TdPD), but some patients with TdPD have persistent tremor after Vim thalamotomy. Basal ganglia outflow through the ventralis oralis anterior and posterior (Voa/p) may be responsible. We present 6 cases with dual Vim and Voa/p MRgFUS thalamotomies for TdPD resistant to Vim treatment.</p><p><strong>Methods: </strong>Six patients with TdPD underwent Vim MRgFUS thalamotomy with persistent intraprocedural tremors (resting 5 patients and/or action tremors 1 patient), who then underwent Voa/p thalamotomy during the same procedure. Demographic and treatment information was collected. Tremor was evaluated using the Clinical Rating Scale for Tremor (CRST)-A and CRST-B.</p><p><strong>Results: </strong>Six patients were included in the study. The mean age was 71.5 years (SD = 2.7), 5 were male (83.3%), 4 had right-sided treatments (66.7%), and 1 had a repeat treatment (16.7%). The mean follow-up was 11 months (range 6-18 months). Mean Vim lesion coordinates from the posterior commissure were X = 13.9 mm, Y = 7.5 mm, and Z = 2 mm. Voa/p were targeted by moving approximately 3 to 5 mm anterior and 3 mm medial to the initial Vim lesion. Mean Voa/p lesion coordinates were X = 11.7 mm, Y = 11.3 mm, and Z = 2.3 mm. Five patients with resting tremor had improved postural/action tremor after Vim thalamotomy (mean CRST-B 8.8 improved to 0.4) but unsatisfactory control of resting tremor. After Voa/p thalamotomy, resting tremor improved in all 5 patients (mean CRST-A hand score 3.6 improved to 0.0). For the patient without resting tremor, postural/action tremor improved after Voa/p thalamotomy (CRST 3 improved to 1). All improvements were sustained at last follow-up except for 1 patient, who regressed to preoperative postural/action and resting tremor by 6 months. At last follow-up, 2 patients reported speech (33.3%) and 3 patients reported balance/gait (50%) changes.</p><p><strong>Conclusion: </strong>Patients with TdPD with tremor refractory to Vim MRgFUS thalamotomy may benefit from a secondary lesion in Voa/p although incidence of adverse effects may be increased.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"484-494"},"PeriodicalIF":1.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558816","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":"Intracranial-Intracranial Revascularization of the Anterior Cerebral Artery Using a Superficial Temporal Artery Interposition Graft for the Treatment of Symptomatic Atherosclerotic Anterior Cerebral Artery Stenosis: A 2-Dimensional Operative Video.","authors":"Gahn Duangprasert, Nakao Ota, Yasuaki Okada, Nuno Cubas Farinha, Kohei Yoshikawa, Keita Toh, Kosumo Noda, Rokuya Tanikawa","doi":"10.1227/ons.0000000000001455","DOIUrl":"10.1227/ons.0000000000001455","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"591-592"},"PeriodicalIF":1.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069627","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":"10.1227/ons.0000000000001472","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"602-603"},"PeriodicalIF":1.4,"publicationDate":"2025-10-01","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":"Transpetrosal Fissure Approach to the Middle Cerebellar Peduncle and Dorsolateral Pons: 2-Dimensional Surgical Video.","authors":"Maged T Ghoche, Herika Karla Negri Brito, Abhijith R Bathini, Evelyn L Turcotte, Devi P Patra, H Hunt Batjer, Bernard R Bendok","doi":"10.1227/ons.0000000000001475","DOIUrl":"10.1227/ons.0000000000001475","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"594-595"},"PeriodicalIF":1.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774870","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":"Trigeminal Malignant Melanotic Nerve Sheath Tumor: 3-Dimensional Operative Video.","authors":"Ludovico Agostini, Jonathan Rychen, Vera Vigo, Vladimir A Ljubimov, Juan C Fernandez-Miranda","doi":"10.1227/ons.0000000000001449","DOIUrl":"10.1227/ons.0000000000001449","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"588"},"PeriodicalIF":1.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048493","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 With and Without Lateral Rim Osteotomy: Anatomical Reappraisal and Clinical Experience to the Orbit and Middle Cranial Fossa.","authors":"Fabio Torregrossa, Cesare Zoia, Daniele Bongetta, Megan M J Bauman, Amedeo Piazza, Miguel Saez-Alegre, Alessandro De Bonis, Luciano Leonel, Stephen Graepel, Giovanni Grasso, Maria Peris-Celda","doi":"10.1227/ons.0000000000001532","DOIUrl":"10.1227/ons.0000000000001532","url":null,"abstract":"<p><strong>Background and objectives: </strong>The lateral transorbital approach (LTOA) has gained increased recognition, but there is still a paucity of data on its effectiveness and advantages compared with the LTOA with lateral orbitotomy, herein denoted as the lateral orbital wall approach (LOWA). The aim of this study was to provide an anatomical reappraisal and the authors' clinical experience to compare the 2 approaches to the orbit and middle cranial fossa (MCF).</p><p><strong>Methods: </strong>Eight latex-injected cadaveric specimens were used to perform LTOA and LOWA. The operative depth of each approach to key anatomical landmarks was measured. Fifty high-resolution computed tomography studies were reviewed to calculate the operative angles. We reviewed 40 consecutive cases treated with LTOA and LOWA at our institution.</p><p><strong>Results: </strong>Compared with the LTOA, the LOWA provided shorter operative depths to the optic foramen ( P < .05), foramen ovale ( P < .05), and to the junction eyeball-cranial nerve II ( P = .13). It also offered better access to the anterior aspect of the orbit with less orbital content retraction. The LTOA and LOWA provided different operative angles to key anatomical landmarks in the orbit and MCF ( P < .05). In our chart review, 31 patients underwent the LTOA, whereas 9 underwent the LOWA to treat orbital and MCF lesions. Patients undergoing LOWA experienced postoperative complications related to periorbital nerves, such as frontalis palsy (n = 1) and supraorbital neuralgia (n = 1). Patients undergoing LTOA were more prone to complications associated with intraorbital manipulation (n = 4), including diplopia and ptosis.</p><p><strong>Conclusion: </strong>Our data suggest that the LTOA can be an effective surgical strategy for addressing orbital apex and MCF lesions. Although the LOWA provides access to the aforementioned areas, it may be more suitable for anterior orbital lesions that require direct access with wider entry exposure and extensive orbital content manipulation.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"543-554"},"PeriodicalIF":1.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574685","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":"Deep Brain Stimulation Electrode Deviations are Associated With Brain Stiffness Interfaces Measured by Magnetic Resonance Elastography.","authors":"Chengyuan Wu, Mahdi Alizadeh, Mary K Kramer, Matthew B Kroen, Robert Ziechmann, Feroze B Mohamed, Qianhong Wu, Curtis L Johnson","doi":"10.1227/ons.0000000000001523","DOIUrl":"10.1227/ons.0000000000001523","url":null,"abstract":"<p><strong>Background and objectives: </strong>The efficacy of deep brain stimulation (DBS) relies on accurate electrode placement. Unfortunately, electrode deviation poses a persistent problem, with most electrodes demonstrating some degree of bending. Although such bending does not always result in target deviation, an estimated 3% to 8% of patients still require revision surgery to address suboptimal electrode placement. DBS electrode deviation may occur at mechanical tissue interfaces, with denser internal capsule (IC) fibers being the most likely factor. Based on basic principles of physics, we hypothesized that the angle of a planned trajectory relative to tissue interfaces created by the IC induces deviation.</p><p><strong>Methods: </strong>Ten patients with Parkinson disease scheduled for DBS surgery underwent preoperative 3T magnetic resonance elastography (MRE) using synchronized external vibrations to measure brain tissue stiffness. The IC stiffness interface (ICSI) was defined as the transition between the corona radiata and IC on MRE. The rate of transition was calculated as the change in stiffness across the ICSI. Postoperative computed tomography was used to measure target deviation . The angle of approach was calculated as the angle between the planned trajectory and the normal vector to the ICSI. Pearson correlations and t -tests were performed to evaluate associations between the angle of approach and target deviation.</p><p><strong>Results: </strong>Twenty-one electrode trajectories were analyzed. The mean electrode deviation was 1.27 ± 0.63 mm. A significant correlation (r = 0.57, 95% CI [0.18, 0.80], P = .007) was found between angle of approach and target deviation, with larger angles associated with greater deviations. The rate of transition did not correlate with deviation ( P = .874).</p><p><strong>Conclusion: </strong>MRE effectively quantifies in vivo brain tissue stiffness in Parkinson disease. The angle between the planned trajectory and the ICSI correlates with target deviation, supporting the hypothesis that tissue mechanics influence electrode bending. MRE has potential to quantify the likelihood of DBS electrode deviation, which could reduce revision surgeries and enhance clinical outcomes.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"517-525"},"PeriodicalIF":1.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460752","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":"Management of Major Arterial Injuries: A Critical Complication of Endoscopic Endonasal Surgery.","authors":"Atakan Emengen, Eren Yilmaz, Aykut Gokbel, Ayse Uzuner, Ozgur Cakir, Ercument Ciftci, Bedrettin Ozsoy, Anil Ergen, Melih Caklili, Burak Cabuk, Ihsan Anik, Savas Ceylan","doi":"10.1227/ons.0000000000001507","DOIUrl":"10.1227/ons.0000000000001507","url":null,"abstract":"<p><strong>Background and objectives: </strong>Endoscopic endonasal surgery (EES) is the preferred approach for treating sellar and parasellar lesions due to its panoramic view and detailed anatomical definition. This study aims to review major arterial injuries during EES, a rare but critical complication associated with high mortality and morbidity rates.</p><p><strong>Methods: </strong>A retrospective analysis was conducted, including 15 patients from 5640 EES procedures performed between August 1997 and February 2024 at in our center/Department of Neurosurgery. The study focuses on perioperative and postoperative management strategies, highlighting the use of oxidized regenerated cellulose (Surgicel®)/gelatin-thrombin matrix (Floseal®) and multidisciplinary collaboration to achieve hemostasis.</p><p><strong>Results: </strong>The incidence of major arterial injury was 0.2%, with a mean patient age of 38.4 years and a female-to-male ratio of 10:5. The most common tumors were adenomas (n = 7) and chordomas (n = 5). The most commonly bleeding arteries in 6 patients each are the cavernous segment of the internal carotid artery and the paraclival carotid artery. Low-flow bleeding was observed in 10 of our patients, while high-flow bleeding was seen in 5 patients, 4 of whom were recurrent cases ( P < .05). In 3 patients with high-flow bleeding from segments of the carotid artery, digital subtraction angiography was performed for stent placement or coil embolization, while in 1 patient with high-flow bleeding, digital subtraction angiography was used for monitoring cerebral blood flow. One of our patients died of a myocardial infarction at the 14th month of follow-up and 1 of our patients developed left-hemiparesis.</p><p><strong>Conclusion: </strong>The study underscores the importance of preoperative planning, surgical expertise, and multidisciplinary teamwork in managing major arterial injuries during EES. The authors advocate for the development of standardized treatment algorithms to improve outcomes in these patients. The findings contribute to the limited literature on managing internal carotid artery injuries in EES, emphasizing the need for ongoing research and algorithm development.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"474-483"},"PeriodicalIF":1.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12507322/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}