Operative Neurosurgery最新文献

{"title":"Exoscopic Repair of Orbital Meningoencephalocele Causing Pulsatile Proptosis: A 2-Dimensional Operative Video.","authors":"Khizar R Nandoliya, Nishanth S Sadagopan, Constantine L Karras, Liza M Cohen, Stephen T Magill","doi":"10.1227/ons.0000000000001470","DOIUrl":"10.1227/ons.0000000000001470","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"600-601"},"PeriodicalIF":1.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840377","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":"Burr Hole Hemispherotomy: Case Series.","authors":"Michael E Baumgartner, Kathleen Galligan, Tracy M Flanders, Alexander M Tucker, Peter J Madsen, Benjamin C Kennedy","doi":"10.1227/ons.0000000000001527","DOIUrl":"10.1227/ons.0000000000001527","url":null,"abstract":"<p><strong>Background and objectives: </strong>Hemispherotomy represents definitive treatment for drug-resistant epilepsy with unilateral hemispheric onset. Traditional approaches involve a large incision and open craniotomy, with associated risks of blood loss, infection, poor wound healing, pain, cosmetic concerns, and long hospital stays. The authors describe a minimally invasive hemispherotomy technique through a single burr hole overlying the Sylvian fissure. A case series of the first cohort of patients to undergo this procedure is detailed to provide an initial evaluation of the safety and efficacy of this approach.</p><p><strong>Methods: </strong>A retrospective analysis was performed on the first 7 patients to have undergone burr hole hemispherotomy at the Children's Hospital of Philadelphia. Data on demographics, hospital stay, complications, completeness of disconnection, and postoperative seizure control were collected.</p><p><strong>Results: </strong>Hemispherotomy was performed through a 15 to 18 mm burr hole on 7 patients-4 with epilepsy due to perinatal stroke, 1 with hemispheric malformation including schizencephaly, and 2 with a history of traumatic brain injury. Patient ages ranged from 18 months to 21 years at surgery. Complete hemispheric disconnection was achieved in all cases. Estimated blood loss was minimal (mean 25.7 cc, median 20, range 20-50) with no perioperative blood transfusions, intraoperative complications, or deaths. One patient returned to the operating room for closure of a wound dehiscence secondary to a fall. Opioid usage was minimal, with an average total postoperative opioid usage through postoperative day 5 of 468.9 morphine µg/kg equivalents (median 372.6 µg/kg, range 0.0-1751.7 µg/kg). One patient experienced a delayed ipsilateral basal ganglia hemorrhage with self-limited symptoms. All patients experienced substantial reduction in seizure burden, with 71% (5/7) achieving Engel Class IA outcome. No patients developed hydrocephalus or shunt malfunction.</p><p><strong>Conclusion: </strong>The burr hole hemispherotomy approach consistently achieved complete hemispheric disconnection and represents a viable surgical approach. Preliminary results suggest a favorable risk profile.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"507-516"},"PeriodicalIF":1.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558781","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":"Use of Preoperative Spinal Angiography in Severe Spinal Deformity Patients Who Require Thoracic 3 Column Osteotomy: A Case Series and Review of the Literature.","authors":"Sean N Neifert, W Caleb Rutledge, Anthony Frempong-Boadu, Darryl Lau","doi":"10.1227/ons.0000000000001506","DOIUrl":"10.1227/ons.0000000000001506","url":null,"abstract":"<p><strong>Background and objectives: </strong>Three-column osteotomy (3CO) offers substantial spinal deformity correction. Thoracic neurovascular bundle sacrifice is often required, and anterior spinal artery (ASA) perfusion can be compromised. Spinal angiography allows localization of variable ASA vascular contribution. This study's objective was to describe a series of patients who underwent preoperative spinal angiography and discuss the impact on surgical planning and execution of thoracic 3CO for deformity correction.</p><p><strong>Methods: </strong>Patients who underwent preoperative spinal angiograms and thoracic 3CO for deformity correction were reviewed. Preoperative, angiographic, and postoperative information was recorded. A literature review on preoperative spinal angiography in deformity surgery was performed.</p><p><strong>Results: </strong>Eight patients were identified: single-level pedicle subtraction osteotomies (1), single-level vertebral column resections (2), and multilevel vertebral column resections (5). The average age was 40.0 years, and 75.0% were female. Thoracic scoliosis ranged from 0 to 105° preoperatively and 0 to 45.1° postoperatively. Thoracic kyphosis ranged from 29° to 120° preoperatively and 20.6° to 54.9° postoperatively. Twelve ASA supply vessels were identified bilaterally in 6 patients. Four patients had nontraditional ASA supply at T4 (1), T6 (1), and L2 (2), and 4 had multiple ASA feeders. Based on angiographic results, osteotomy site was changed (1), and neurovascular bundles were spared (2), a 37.5% rate of surgical plan alteration. There were no permanent neuromonitoring changes or postoperative neurologic deficits. No articles reported on using spinal angiography specifically for deformity surgery.</p><p><strong>Conclusion: </strong>Spinal angiography is low risk and provides critical information regarding ASA supply to potentially mitigate ischemic risk during neurovascular bundle takedown during thoracic 3CO. Further case series are warranted to evaluate the benefits in larger populations, but its clinical applications appear practical.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"526-535"},"PeriodicalIF":1.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061494","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: External Auditory Canal Transillumination-Guided Middle Fossa Approaches: An Anatomical Feasibility Study.","authors":"Abdulrahman Albakr, Mohammadmahdi Sabahi, Badih Adada, Hamid Borghei-Razavi","doi":"10.1227/ons.0000000000001542","DOIUrl":"10.1227/ons.0000000000001542","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"542"},"PeriodicalIF":1.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574679","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":"Repair of a Delayed, Atypical, Post-Traumatic Ventrolateral Dural Defect of the Cervicothoracic Spine: 2-Dimensional Operative Video.","authors":"Thomas Tyler Patterson, Michael Gaub, Grant W Mallory, Cristian Gragnaniello","doi":"10.1227/ons.0000000000001359","DOIUrl":"10.1227/ons.0000000000001359","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"902-903"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300829","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 Endoscopic Endonasal Approach for Giant Pediatric Craniopharyngiomas: Technical Note and Case Series.","authors":"YouYuan Bao, LaiSheng Pan, Jun Fu, Xiao Wu, ShenHao Xie, Bin Tang, Tao Hong","doi":"10.1227/ons.0000000000001191","DOIUrl":"10.1227/ons.0000000000001191","url":null,"abstract":"<p><strong>Background and objectives: </strong>Giant pediatric craniopharyngiomas are rare tumors whose clinical and surgical management is extremely challenging. A variety of open transcranial approaches has been used to resect these lesions. Although there has been an increasing acceptance of the endoscopic endonasal approach (EEA) for the resection of pediatric craniopharyngiomas in recent years, many surgeons continue to recommend against the use of the EEA for giant pediatric craniopharyngiomas. This study aimed to evaluate the feasibility of extended EEA for giant craniopharyngiomas in the pediatric population.</p><p><strong>Methods: </strong>All consecutive pediatric patients with giant craniopharyngiomas (diameter >4 cm) who underwent endoscopic endonasal surgery at our institution were retrospectively reviewed. Data on demographic information, preoperative assessment, imaging features, surgical results, complications, and recurrences were recorded and analyzed.</p><p><strong>Results: </strong>A total of 16 pediatric patients with an average age of 12 years were identified. The mean maximum diameter and volume of the tumors were 4.35 cm and 24.1 cm 3 , respectively. Gross total resection was achieved in 13 patients (81.3%) and subtotal resection in 3 patients (18.7%). Postoperatively, partial or complete anterior pituitary insufficiency occurred in 100% of patients, and 62.5% developed new-onset diabetes insipidus. Visual function improved in 9 patients (56.3%) and remained stable in 7 patients (43.7%). Postoperative cerebrospinal fluid leakage occurred in 2 patients and was successfully repaired through the EEA. During a mean follow-up of 44.3 months, 18.8% of patients had a >9% increase in body mass index, and 93.8% of patients successfully returned to school or work. Two patients (12.5%) suffered a recurrence. Disease control was achieved in 16 patients (100%) at final follow-up.</p><p><strong>Conclusion: </strong>The extended EEA allows adequate access to this challenging tumor and enables complete resection and visual improvement with a reasonable approach-related complication rate.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"779-787"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141072232","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":"Trilayered Decompression of the Middle Cranial Fossa for Cavernous Sinus Meningiomas: 2-Dimensional Operative Video.","authors":"Alejandro Bugarini, Rafael Martinez-Perez","doi":"10.1227/ons.0000000000001358","DOIUrl":"10.1227/ons.0000000000001358","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"901"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332318","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":"Interpretation and Strategy to Resolve Neuromonitoring Changes Associated With Brain Sag.","authors":"Mitali Bose, Matthew Toczylowski, Xiaopeng Guo, David D Liu, Thomas Epplin-Zapf, W Bryan Wilent, Wenya Linda Bi","doi":"10.1227/ons.0000000000001430","DOIUrl":"10.1227/ons.0000000000001430","url":null,"abstract":"<p><strong>Background and objectives: </strong>Intraoperative neuromonitoring (IONM) aides in safe maximal resection of brain tumors in eloquent areas. During the resection of large or deep-seated tumors, shifts in the peri-resectional parenchyma and cortical surface relative to cranial electrodes, or brain sag, can cause false-positive loss of sensorimotor signals. We describe patterns of electrophysiological changes associated with brain sag and a facile technique to rapidly resolve these changes intraoperatively by saline infusion.</p><p><strong>Methods: </strong>We reviewed cases operated on by the senior author and identified cases where brain sag was noted intraoperatively. Preoperative and postoperative imaging, operative details, and IONM electrophysiological traces were analyzed to surmise generalizable patterns.</p><p><strong>Results: </strong>We observe stepwise decreases in somatosensory-evoked potentials and transcranial motor-evoked potentials that occur with removal of a large intraparenchymal mass or after significant loss of cerebrospinal fluid. The pattern of upper extremity or lower extremity signal change depends on the location of the lesion and the positioning of the head, depending on which regions of the motor or somatosensory cortices are most affected by brain sag. Recovery of the somatosensory-evoked potentials and transcranial motor-evoked potentials during saline infusion into the resection cavity or ventricle, which reconstitutes the cortical topography, suggests that the IONM signal change was artifactual, rather than reflecting true physiological injury. We present 6 illustrative cases that highlight distinct patterns of electrophysiological change associated with brain sag and the extent of signal restoration.</p><p><strong>Conclusion: </strong>Brain sag is commonly encountered during the resection of large or deep-seated tumors. Improved understanding of the spatiotemporal electrophysiological signatures of brain sag and application of the saline infusion technique to reverse false-positive drops in neuromonitoring signals improves the utility of IONM and enhances safe resection.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":"28 6","pages":"841-854"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12068778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082000","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}

{"title":"Letter: Interpretation and Strategy to Resolve Neuromonitoring Changes Associated With Brain Sag.","authors":"Nishanth Sampath, Gomathi Sivakumar, Vishwaraj Ratha, Suresh Bapu","doi":"10.1227/ons.0000000000001565","DOIUrl":"10.1227/ons.0000000000001565","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"909-910"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765863","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":"Posterior Reduction and Temporary Fixation Through Intermuscular Approach for Odontoid Fracture.","authors":"Zhenji Xu, Ji Wu, Haibin Wang, Changhong Chen, Bangke Zhang, Xuhua Lu, Bin Ni, Fei Chen, Qunfeng Guo","doi":"10.1227/ons.0000000000001399","DOIUrl":"10.1227/ons.0000000000001399","url":null,"abstract":"<p><strong>Background and objective: </strong>Posterior reduction and temporary fixation (PRTF) through open approach can effectively avoid the loss of C1-C2 motion caused by posterior atlantoaxial fusion in the treatment of odontoid fracture. PRTF through intermuscular approach can preserve the integrity of the paravertebral muscle. However, its contribution to the preservation of C1-C2 rotation remains unassessed in the context of fresh odontoid fractures.</p><p><strong>Methods: </strong>The data of 31 patients with odontoid fractures who underwent PRTF through intermuscular approach were retrospectively reviewed. Operation time, intraoperative blood loss, the time of ambulation and surgery-related complications were recorded. After fracture healing, the instrumentation was removed. The Japanese Orthopedic Association score, Visual Analog Scale score for neck pain, and patient satisfaction were recorded. The range of motion in rotation of C1-C2 was calculated 1 month after removing the instrumentation.</p><p><strong>Results: </strong>Fracture healing was observed in all patients, and the instrumentation was removed. After removing the instrumentation, the range of motion of C1-C2 in rotation was returned to 35.6° ± 4.8°. Patient satisfaction was improved ( P < .05). There was no significant difference in Japanese Orthopedic Association scores and Visual Analog Scale score for neck pain between 2 values before and after removing the instrumentation ( P > .05). No osteoarthritis was observed at the C1-C2 lateral mass joints. There were no perioperative complications.</p><p><strong>Conclusion: </strong>PRTF through intermuscular approach can be used as a salvage treatment of an odontoid fracture with an intact transverse ligament in cases of failure of, or contraindication to, anterior screw fixation. This minimally invasive technique can effectively preserve the rotational function of the atlantoaxial complex.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"772-778"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512927","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}