Operative Neurosurgery最新文献

{"title":"Effective Use of a Minimally Invasive Lighted Tubular Retractor System for Resection of a Ruptured Aneurysm in a Patient with Moyamoya Disease: 2-Dimensional Operative Video.","authors":"David R Hallan, Francis Jareczek, Ephraim W Church","doi":"10.1227/ons.0000000000001627","DOIUrl":"https://doi.org/10.1227/ons.0000000000001627","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":"144039467","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":"Endovascular Treatment of a Ruptured Complex Sigmoid Sinus Dural Arteriovenous Fistula Via Direct Puncture Technique: 2-Dimensional Operative Video.","authors":"Ehsan Dowlati, Jeffrey M Breton, Kyriakos Papadimitriou, Jeffrey C Mai, Daniel R Felbaum, Rocco A Armonda, Ai-Hsi Liu, Samir Sur","doi":"10.1227/ons.0000000000001626","DOIUrl":"https://doi.org/10.1227/ons.0000000000001626","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":"144058077","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":"Trends in Thalamic Stereoelectroencephalography Utilization During Phase II Monitoring in North America: A Survey.","authors":"Ahmad Alhourani, Philip B Ostrov, Jason M Schwalb, Andrew I Yang, Adriana E Palade, Edward F Chang, Joseph S Neimat","doi":"10.1227/ons.0000000000001614","DOIUrl":"https://doi.org/10.1227/ons.0000000000001614","url":null,"abstract":"<p><strong>Background and objectives: </strong>Thalamic neuromodulation is widely used in epilepsy surgery. However, thalamic sampling in invasive monitoring is not consistently used. We aimed to quantify current trends in thalamic stereoelectroencephalography (SEEG) utilization.</p><p><strong>Methods: </strong>We performed a survey of epilepsy neurosurgeons and neurologists to gauge their attitudes and experience with thalamic SEEG. We contacted all members of the American Society for Stereotactic and Functional Neurosurgery and American Epilepsy Society organizations using a mailing list.</p><p><strong>Results: </strong>We received 40 responses from centers using SEEG, including 31 neurosurgeons and 9 epileptologists. Among these respondents, 65% (26/40) included thalamic targets in their SEEG plans. The most common clinical rationales were to define the seizure network (22/26, 84.6%) or the high probability of targeted structure being a neuromodulation target (22/26, 84.6%). Over half of the respondents who used thalamic SEEG (15/26, 57.6%) endorsed that the findings informed target selection and feasibility of thalamic neuromodulation. The most commonly implanted thalamic targets included centromedian (23/26) and anterior nucleus of the thalamus (ANT) (22/26), followed by pulvinar (19/26).</p><p><strong>Conclusion: </strong>Thalamic SEEG is a diagnostic tool that is being increasingly used across epilepsy centers. This may be an important tool to support the paradigm shifts occurring in the surgical management of epilepsy.</p>","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":"144039775","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 Resection of a Recurrent Neurenteric Cyst Through an Anterior Cervical Approach: 2-Dimensional Operative Video.","authors":"Wanru Duan, Yue-Qi Du, Zan Chen","doi":"10.1227/ons.0000000000001615","DOIUrl":"https://doi.org/10.1227/ons.0000000000001615","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":"144040523","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":"Skull Base Anatomy Presented in 360° Photogrammetry 3-Dimensional Models.","authors":"Francesco Carbone, Daniele Armocida, Toma Spiriev, Michael Wolf-Vollenbröker, Martin Trandzhiev, Matteo de Notaris, Jan F Cornelius","doi":"10.1227/ons.0000000000001601","DOIUrl":"https://doi.org/10.1227/ons.0000000000001601","url":null,"abstract":"<p><strong>Background and objectives: </strong>Realistic 3-dimensional (3D) anatomical models may enhance three-dimensional comprehension of the complex anatomy of the skull base. Such models may be generated by photogrammetry, a technical algorithm for photorealistic surface scanning. This study presents a 360° visualization of key neuroanatomical landmarks of the central skull base.</p><p><strong>Methods: </strong>One formaldehyde-fixed head specimen with polymer-injected vessels underwent extensive exocranial and endocranial dissections on the right side after a sagittal cut. Initially, the dissection of the orbital region, cavernous sinus, and paranasal sinuses identified cranial nerves II, III, IV, and VI; their branches; extraocular muscles; and major vessels. Subsequently, the 5 terminal branches of the VII were exposed, along with cranial nerves IX, X, XI, and XII. A retrolabyrinthine approach and neck dissection revealed the entire course of cranial nerve VII, sigmoid sinus, the jugular bulb, and the intracranial and extracranial segments of nerves IX, X, XI, and XII. In addition, the infratemporal fossa, pterygopalatine fossa, and middle ear structures were presented. Finally, the vertebral artery segments (v2-v4) and the internal carotid artery, including the petrosal and cavernous segments, were dissected and documented. The specimen was 3D scanned by photogrammetry 3D, refined with 3D modeling software, and uploaded to virtual reality and web visualization.</p><p><strong>Results: </strong>Seven photorealistic models were created and virtual reality videos demonstrating the relevant anatomy in an immersive environment. The courses of intracranial nerves and the associated vascular and soft tissue anatomy were systematically captured from both intracranial and exocranial viewpoints, creating an accurate 360° virtual depiction of the pertinent anatomy.</p><p><strong>Conclusion: </strong>The 3D 360° photogrammetric models developed in this study may allow a better understanding of essential intracranial and extracranial structures of the skull base. These models facilitate customizable views and represent a valuable, freely accessible resource that complements traditional dissections, photographic atlases, and conventional 3D models.</p>","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":"144018872","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":"Simulation of a Remote Robotic Endovascular Thrombectomy.","authors":"João Victor Sanders, Marion Oliver, Demetrius Lopes","doi":"10.1227/ons.0000000000001625","DOIUrl":"https://doi.org/10.1227/ons.0000000000001625","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":"144026260","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":"Percutaneous Endoscopic Debridement and Drainage as a First-Line Diagnosis and Management Intervention for Spondylodiscitis: A Novel Treatment Algorithm.","authors":"Nischal Acharya, Gabrielle Hovis, Ashish Ramesh, Alvin Chan, Charles H Li, Shruti Gohil, Michael Oh","doi":"10.1227/ons.0000000000001606","DOIUrl":"https://doi.org/10.1227/ons.0000000000001606","url":null,"abstract":"<p><strong>Background and objectives: </strong>Spondylodiscitis (SD) is an infection of the intervertebral disk. In the nonseptic, MRI-positive patient without focal deficits, current guidelines recommend computed tomography-guided biopsy (CTGB) for pathogen identification. Yet, pathogen positivity from CTGB is low (37%). Percutaneous endoscopic debridement and drainage (PEDD) may improve pathogen identification and reduce pain. We aimed to evaluate the utility of PEDD as the first-line intervention for the diagnosis and management of SD.</p><p><strong>Methods: </strong>Demographic characteristics, perioperative outcomes, intraoperative data, and microbiological data were collected through retrospective chart review from 9 consecutive adult patients with suspected SD managed with PEDD between 2021 and 2024. Patients were followed postoperatively until no longer seen in clinic. Paired t -tests were used to compare Visual Analog Pain Scale and morphine milligram equivalents change after intervention.</p><p><strong>Results: </strong>The mean age was 56.4 years (SD: 10.0) with 7 male patients (77.8%). The mean follow-up was 7.1 months (SD: 9.6). On presentation, back pain was reported in 100% and lower extremity weakness and paresthesia in 33.3%; 77.8% of patients were treated with antibiotics preoperatively. The mean operative duration was 87.7 minutes (SD: 21.2). The mean estimated blood loss was 16.9 mL (SD: 20.7). The mean length of stay was 9.6 days (SD: 9.9). There were no intraoperative or postoperative complications associated with PEDD. Successful pathogen identification was achieved in 88.9%. The mean time to pathogen identification was 5.5 days (SD: 5.2). All patients had postoperative pain relief. There was a significant reduction in Visual Analog Pain Score postoperatively from 9.2 to 3.2 ( P < .001). This pain reduction was also associated with a significant reduction in morphine milligram equivalents from 32.7 to 29.5 ( P < .001).</p><p><strong>Conclusion: </strong>We demonstrate that PEDD is a safe and effective procedure for the management of SD. PEDD may improve pathogen identification compared with CTGB while simultaneously reducing pain and opioid requirements. These data suggest that PEDD may be considered as a first-line intervention for SD. Further prospective studies are required to inform guidelines.</p>","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":"144042751","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":"Addressing Temporal Muscle Atrophy and Enhancing Cranioplasty Outcome: A Technical Note.","authors":"Victoria Dembour, Salvatore Chibbaro, Charles-Henry Mallereau, Mario Ganau, Biagio Roberto Carangelo, Franco Moruzzi, Alessandro Zalaffi, Giorgio Spatola, Julien Todeschi","doi":"10.1227/ons.0000000000001623","DOIUrl":"https://doi.org/10.1227/ons.0000000000001623","url":null,"abstract":"<p><strong>Background and objectives: </strong>Decompressive craniectomy (DC) is a critical surgical intervention for reducing elevated intracranial pressure. However, subsequent cranioplasty (CP) can be complicated by adhesions between anatomic layers, particularly the temporalis muscle (TM), dura mater, and brain surface. A dual-layer dural substitute during DC can help prevent these adhesions, improving CP outcomes.</p><p><strong>Methods: </strong>In this three-year prospective multicenter study, 59 patients underwent DC followed by CP. A dual-layer dural substitute was placed between the TM and dura mater (and sometimes the subcutaneous layer) during DC. Outcomes evaluated included adhesion formation, ease of dissection during CP, and overall functional results.</p><p><strong>Results: </strong>No infections or wound complications were reported. The dual-layer technique significantly reduced adhesions in the muscle-cutaneous flap layers, facilitating TM elevation during CP. This resulted in minimal fibrotic adhesions, no change in TM thickness postoperatively, significantly shorter operative times, negligible blood loss, and a 0% rate of postoperative CP-related epilepsy.</p><p><strong>Conclusion: </strong>Using a dual-layer dural substitute during DC effectively prevents adhesion formation, reducing wound healing complications. This technique improves subsequent CP success by facilitating TM elevation, preserving its function, and protecting underlying brain structures. It also shortens surgical time, minimizes blood loss, reduces hospital stays, and lowers postoperative epilepsy rates.</p>","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":"144062322","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 Implantation of Spinal Cord Stimulators: Technical Note and Comparison With Standard Techniques.","authors":"Ahmad M S Ali, Mohamed Elmolla, Vishwas Vijayendra, Feras Sharouf, Rafal Szylak, Ali G Yörükoglu, Jibril O Farah, Narendra K Rath, Deepti Bhargava","doi":"10.1227/ons.0000000000001610","DOIUrl":"https://doi.org/10.1227/ons.0000000000001610","url":null,"abstract":"<p><strong>Background and objectives: </strong>Spinal cord stimulation (SCS) is an effective neuromodulatory tool for various chronic pain conditions. Traditionally, the SCS procedure involved an open approach with laminotomy for paddle implants. The minimally invasive percutaneous lead placement has largely replaced open paddles. However, percutaneous leads are prone to migration and may be unfeasible in patients with preexisting epidural scarring, necessitating open paddle placement. An endoscopic approach to the spine would offer reduced morbidity with the stimulation benefits and security of open paddle. We therefore aimed to develop this technique.</p><p><strong>Methods: </strong>An endoscopic method for SCS paddle implantation was developed initially in a cadaveric laboratory. We tested an anterograde and retrograde method of implantation. The retrograde method of implantation was chosen and subsequently used in 5 patients. A retrospective review of electronic medical records was subsequently undertaken to compare these endoscopic cases with consecutive concurrent open and percutaneous cases.</p><p><strong>Results: </strong>The retrograde method of implantation was chosen because of reduced bony and soft tissue dissection required. In addition, more secure implantation was possible with this approach. We describe the endoscopic technique in detail. Five endoscopic cases were compared with 20 percutaneous and 13 open cases. Postoperative analgesia requirements for the endoscopic and percutaneous cases were similar, and both were significantly lower than for open cases (P < .001). Operative time was expectantly longer for endoscopic cases. Same-day programming was possible with endoscopic cases, and with modified anesthetic and programming protocols, same-day discharge was possible for our last endoscopic case. With 6-month follow-up, we did not have any wound-related problems or hardware migration in these cases.</p><p><strong>Conclusion: </strong>Our findings indicate that endoscopic SCS implantation is a safe and feasible option that combines key advantages of both open and percutaneous standard approaches for SCS implantation.</p>","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":"144026490","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":"Rare and Easily Misdiagnosed Intracranial and Craniocervical Junction Dural Arteriovenous Fistulas With Spinal Perimedullary Drainage.","authors":"Zihao Song, Xin Su, Yuxiang Fan, Chengbin Yang, Tianqi Tu, Huishen Pang, Huiwei Liu, Jinhui Yu, Ming Ye, Peng Zhang, Yongjie Ma, Hongqi Zhang","doi":"10.1227/ons.0000000000001619","DOIUrl":"https://doi.org/10.1227/ons.0000000000001619","url":null,"abstract":"<p><strong>Background and objectives: </strong>Intracranial and craniocervical junction dural arteriovenous fistulas (DAVFs) with spinal perimedullary drainage are rare, and large cohort studies are lacking. The aim of this study was to describe clinical characteristics and angioarchitecture of these DAVFs, share our treatment experience, and identify risk factors associated with subarachnoid hemorrhage and poor outcomes.</p><p><strong>Methods: </strong>A total of 158 consecutive patients treated at our neurosurgical center were retrospectively reviewed. The patients were grouped according to lesion location, and their baseline clinical characteristics, angioarchitecture, treatment strategies, and outcomes were summarized.</p><p><strong>Results: </strong>The patients' mean age was 53.4 years. Most patients were male with 141 patients (89.2%). The most common clinical manifestation was nonhemorrhagic neurological deficits (71.5%), followed by subarachnoid hemorrhage (28.5%). Microsurgery was the most common treatment strategy applied for 112 patients (70.9%), 34 patients (21.5%) were treated with interventional embolization only, and 12 (7.6%) received both interventional embolization and microsurgery. At the last follow-up, there were 122 patients (77.2%) with favorable outcomes (modified Rankin Scale <3). Clinical manifestation of numbness (odds ratio [OR] 4.098, 95% CI 1.491-11.263, P = .006), clinical manifestation of urinary dysfunction (OR 3.991, 95% CI 1.378-11.558, P = .011), and pretreatment modified Rankin Scale ≥3 (OR 19.523, 95% CI 5.066-75.242, P < .001) were significantly associated with poor outcomes.</p><p><strong>Conclusion: </strong>Intracranial and craniocervical junction DAVFs with spinal perimedullary drainage are indeed rare. Specific sign on magnetic resonance imaging is beneficial for accurate diagnosis. The choice between microsurgery or interventional embolization is primarily based on lesion location and angioarchitecture. Early diagnosis, prevention of misdiagnosis, and appropriate treatment are crucial for improved outcomes.</p>","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":"144043068","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}