Operative Neurosurgery最新文献

{"title":"Accuracy of Boltless Frame-Based Stereo-Electroencephalography Electrode Implantation.","authors":"Yuya Fujita, Hui Ming Khoo, Yuki Kimoto, Takuto Emura, Takamitsu Iwata, Takahiro Matsuhashi, Shimpei Miura, Takufumi Yanagisawa, Koichi Hosomi, Naoki Tani, Satoru Oshino, Masayuki Hirata, Haruhiko Kishima","doi":"10.1227/ons.0000000000001209","DOIUrl":"10.1227/ons.0000000000001209","url":null,"abstract":"<p><strong>Background and objectives: </strong>Boltless implantation of stereo-electroencephalography electrode is a useful alternative especially when anchor bolt is not available such as in country with limited resources or is less appropriate such as placement in patients with thin skull or at the occiput area, despite some drawbacks including potential dislodgement. While the accuracy of implantation using anchor bolt is well-studied, data on boltless implantation remain scarce. This study aimed to reveal the accuracy, permissible error for actual placement of electrodes within the grey matter, and delayed electrode dislodgement in boltless implantation.</p><p><strong>Methods: </strong>A total of 120 electrodes were implanted in 15 patients using a Leksell Stereotactic G Frame with each electrode fixed on the scalp using sutures. Target point error was defined as the Euclidean distance between the planned target and the electrode tip on immediate postimplantation computed tomography. Similarly, delayed dislodgement was defined as the Euclidean distance between the electrode tips on immediate postimplantation computed tomography and delayed MRI. The factors affecting accuracy were evaluated using multiple linear regression. The permissible error was defined as the largest target point error that allows the maximum number of planned gray matter electrode contacts to be actually placed within the gray matter as intended.</p><p><strong>Results: </strong>The median (IQR) target point error was 2.6 (1.7-3.5) mm, and the permissible error was 3.2 mm. The delayed dislodgement, with a median (IQR) of 2.2 (1.4-3.3) mm, was dependent on temporal muscle penetration ( P = 5.0 × 10 -4 ), scalp thickness ( P < 5.1 × 10 -3 ), and insertion angle ( P = 3.4 × 10 -3 ).</p><p><strong>Conclusion: </strong>Boltless implantation of stereo-electroencephalography electrode offers an accuracy comparable to those using anchor bolt. During the planning of boltless implantation, target points should be placed within 3.2 mm from the gray-white matter junction and a possible delayed dislodgement of 2.2 mm should be considered.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"788-795"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141421808","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":"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":"817-823"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","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":"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":"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":"862-871"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12068757/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Reply: Interpretation and Strategy to Resolve Neuromonitoring Changes Associated With Brain Sag.","authors":"Wenya Linda Bi, Matthew Toczylowski, Xiaopeng Guo, Mitali Bose","doi":"10.1227/ons.0000000000001566","DOIUrl":"10.1227/ons.0000000000001566","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"911"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765862","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":"Transoral Approach for Ruptured Anterior Spinal Artery Aneurysm at the Cervicomedullary Junction: 2-Dimensional Operative Video.","authors":"Tatiana Abou-Mrad, Morteza Sadeh, Laura Stone McGuire, Ashleigh Weyh, Nicholas Callahan, Gursant Singh Atwal","doi":"10.1227/ons.0000000000001353","DOIUrl":"10.1227/ons.0000000000001353","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"900"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114767","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":"Neurosurgical Residency Training at Veterans Affairs Medical Centers, the Resident Perspective.","authors":"Alexander G Yearley, Marcelle Altshuler, Ruchit V Patel, Jacob R Rachlin, Michael A Mooney","doi":"10.1227/ons.0000000000001390","DOIUrl":"10.1227/ons.0000000000001390","url":null,"abstract":"<p><strong>Background and objective: </strong>Department of Veteran's Affairs (VA) Medical Centers play a crucial role in training neurosurgery residents. Although previous studies have examined the impact of VA rotations from the attending perspective, the resident experience remains unexplored. We present a national survey of neurosurgery residents to assess their perceptions of VA rotations, focusing on operative experience, call burden, longitudinal patient care experiences, and overall strengths and limitations.</p><p><strong>Methods: </strong>A 33-question survey was distributed by email to all neurosurgery residents who had previously completed a VA rotation within the past 7 years.</p><p><strong>Results: </strong>Responses were received from 77 residents, representing 36 out of 40 neurosurgical residency programs with an active VA rotation. Most residents (79.2%) found their VA rotations adequate in length, having spent a median of 5 months at the VA. Residents completed an average of 11.7 (SD 7.2) cases per month while at the VA, including 8.9 (SD 5.5) spine, 1.7 (SD 2.0) cranial, and 1.4 (SD 1.6) peripheral nerve cases. Many residents reported completing a greater proportion of spine and peripheral nerve cases at the VA compared with their primary clinical sites. Across all postgraduate years, residents felt that the VA offered increased operative autonomy (79.0% agreement) at the expense of total operative volume (98.7% agreement) and complexity (81.9% agreement). Importantly, 94.8% of residents participated in longitudinal patient care experiences, and 59.7% followed all patients longitudinally.</p><p><strong>Conclusion: </strong>The resident experience at the VA varies, presenting both strengths and limitations. Addressing these factors could enhance the overall effectiveness of VA rotations in neurosurgical training programs in the future.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"876-882"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332314","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":"In Reply: A Staged Approach for Surgical Management of Basilar Invagination.","authors":"Steven Knafo","doi":"10.1227/ons.0000000000001544","DOIUrl":"10.1227/ons.0000000000001544","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"907-908"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574681","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":"Combined Microscopic-Endoscopic Retrosigmoid Approach for a Cerebellopontine Angle Epidermoid Cyst With Supratentorial Extension: Nuances for Maximizing Resection With Cranial Nerve Preservation: 2-Dimensional Operative Video.","authors":"Mehdi Khaleghi, Adnan Hussain Shahid, Asa Record Barnett, Danner Butler, Garrett Dyess, Ursula Hummel, Danielle N Chason, Jai Deep Thakur","doi":"10.1227/ons.0000000000001624","DOIUrl":"https://doi.org/10.1227/ons.0000000000001624","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081951","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":"Is Reoperation Within 6 Months of Adult Spinal Deformity Surgery Associated With Worse Outcomes?","authors":"Iyan Younus, Omar Zakieh, Hani Chanbour, Harsh Jain, Ranbir Ahluwalia, Campbell Liles, Amir M Abtahi, Byron F Stephens, Scott L Zuckerman","doi":"10.1227/ons.0000000000001578","DOIUrl":"https://doi.org/10.1227/ons.0000000000001578","url":null,"abstract":"<p><strong>Background and objectives: </strong>In a cohort of patients undergoing Adult Spinal Deformity (ASD) surgery, we sought to (1) report the rate of and reason for reoperation within 6 months of the index surgery and (2) determine the association between early reoperation and 2-year patient-reported outcome measures (PROMs).</p><p><strong>Methods: </strong>A single-institution, retrospective cohort study was performed for patients undergoing ASD surgery from 2009 to 2021. The primary outcomes included early reoperations within 6 months and reason for reoperation, including proximal junctional kyphosis/failure (PJK/F), distal junctional kyphosis, pseudarthrosis/rod fracture, and implant failure. Secondary outcomes included all mechanical complications requiring reoperation beyond 6 months and PROMs. Descriptive statistics and multivariable logistic regression were performed.</p><p><strong>Results: </strong>Of 238 patients undergoing ASD surgery, 19 (8%) underwent early reoperation within 6 months primarily for PJK/F (42%), distal junctional kyphosis (11%), implant failure (11%), and pseudarthrosis (11%). Early reoperation was significantly more likely in patients with 2+ comorbidities (63.2% vs 38.6%, P = .038) but did not predict future reoperation beyond 6 months (47.4% vs 58.0%; P = .159). At 2 years, patients with early reoperation had worse PROMs: higher Oswestry Disability Index (ODI) (53.9 vs 33.8, P = .001), Numeric Rating Scales for back pain (NRS-BP) (6.8 vs 4.7, P = .019), Numeric Rating Scales for leg pain (NRS-LP) (5.7 vs 2.8, P = .004) and lower EuroQoL Group questionnaire (EQ-5D) (0.50 vs 0.70, P = .003). There was less improvement in ODI (-16.6 vs -2.0, P = .025) and EQ-5D (0.0 vs 0.2, P = .038), with no significant change in NRS-BP (P = .051) and NRS-LP (P = .115). Early reoperation was linked to decreased odds of ODI improvement (OR 14.41, P = .028).</p><p><strong>Conclusion: </strong>Reoperation within 6 months after ASD surgery occurred in 8% of patients at mean 85.5 days, primarily because of PJK/F (42%). Early reoperations did not significantly increase the rate of subsequent reoperations beyond 6 months. Patients with early reoperation within 6 months had worse ODI, NRS-BP, and NRS-LP and less improvement in ODI and EQ-5D, but no difference in change for NRS-BP and NRS-LP. Early reoperation significantly decreased odds of ODI improvement.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081980","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 Fenestration of Midbrain Cyst: 2-Dimensional Operative Video.","authors":"Colin P Sperring, Evan F Joiner, Brett E Youngerman","doi":"10.1227/ons.0000000000001631","DOIUrl":"https://doi.org/10.1227/ons.0000000000001631","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026291","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}