Operative Neurosurgery最新文献

{"title":"Comparative Analysis of Efficacy and Safety of Frame-Based, Frameless, and Robot-Assisted Stereotactic Brain Biopsies: A Systematic Review and Meta-Analysis.","authors":"Neslihan Nisa Gecici, N U Farrukh Hameed, Ahmed Habib, Hansen Deng, L Dade Lunsford, Pascal O Zinn","doi":"10.1227/ons.0000000000001408","DOIUrl":"10.1227/ons.0000000000001408","url":null,"abstract":"<p><strong>Background and objectives: </strong>For 50 years, frame-based stereotactic brain biopsy has been the \"gold standard\" for its high diagnostic yield and safety, especially for complex or deep-seated lesions. Over the past decade, frameless and robotic alternatives have emerged. This report evaluates and compares the outcomes, diagnostic yield, and safety of these methods.</p><p><strong>Methods: </strong>Major databases were screened for studies reporting data on diagnostic yield, postoperative hemorrhage, neurological deficits, and mortality after frame-based, robot-assisted or neuronavigation-assisted frameless biopsies. Meta-analysis with random-effect modeling was performed to compare diagnostic yield, operative duration, length of stay, complications, and mortality.</p><p><strong>Results: </strong>A total of 92 studies were included with 9801 patients in the frame-based group, 2665 in the robot-assisted group, and 1862 in the frameless group. Pooled diagnostic yield rates were 97% (96%-98%, I 2 = 49%) in robot-assisted, 95% (94%-96%, I 2 = 74%) in frame-based, and 94% (91%-96%, I 2 = 55%) frameless groups with a statistically significant difference ( P < .01, I 2 = 71%). The mean total operative duration including anesthesia, system setup, patient registration, trajectory planning, and skin incision to closure was significantly shorter in the robot-assisted group (76.6 vs 132.7 vs 97.3 minutes, P < .01). The duration from skin incision to closure was comparable between the groups (robot-assisted: 37.8 mins, frame-based: 42.6 minutes, frameless: 58.2 minutes; P = .23). Pooled rates of symptomatic hemorrhage (0.005% vs 0.009% vs 0.007, P = .71, I 2 = 34%), asymptomatic hemorrhage (4% vs 3% vs 3%, P = .64, I 2 = 93%), transient neurological deficit (3% vs 2% vs 2%, P = .5, I 2 = 72%), permanent neurological deficit (0.001% vs 0.001% vs 0.0002, P = .78, I 2 = 47%), and mortality (0% vs 0.001% vs 0.006%, P < .01, I 2 = 10%) were similar between groups. Deaths were mainly due to postprocedural hemorrhage (robotic: 46%, frame-based: 48%, frameless: 72%).</p><p><strong>Conclusion: </strong>Robot-assisted biopsy is not inferior in diagnostic yield and safety to the gold standard frame-based and neuronavigation-assisted frameless biopsy methods.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"749-761"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588173","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":"Cadaveric Feasibility of Robotic-Assisted Radial Artery-Internal Carotid Artery-Middle Cerebral Artery Anastomosis for Neurovascular Surgery.","authors":"Jun Muto, Hirofumi Nakatomi, Yuichi Hirose","doi":"10.1227/ons.0000000000001375","DOIUrl":"10.1227/ons.0000000000001375","url":null,"abstract":"<p><strong>Background and objectives: </strong>To the best of our knowledge, this is the first reported cadaveric feasibility study of leader-follower type robotic-assisted middle cerebral artery (MCA)-radial artery-internal carotid artery anastomosis in the neurovascular surgery field using the da Vinci Xi system (da Vinci Surgical System; Intuitive Surgical, Inc.). Vascular suturing is a necessary skill in neurosurgery; however, the learning curve for deep and high-flow bypasses is severely low. Thus, robot-assisted surgery has been introduced. Here, we describe the surgical workflow adaptations of vascular anastomosis using the da Vinci system to assess the feasibility of robot-assisted anastomoses of the radial and middle cerebral arteries.</p><p><strong>Methods: </strong>Two fresh cadaver heads were studied using the da Vinci Xi Surgical System with 0° and 30° stereoscopic endoscopes to visualize the neuroanatomy.</p><p><strong>Results: </strong>The da Vinci Xi Surgical System was used throughout the anastomosis of the MCA and intracarotid artery. The optic nerve, optic chiasm, carotid artery, and oculomotor nerve were visualized using standard microdissection techniques. The Sylvian fissure was exposed from the proximal Sylvian membrane to the distal MCA. Using black diamond microforceps and Potts scissors, suturing was achieved on the radial artery-middle cerebral artery using 8-0 Prolene and on the radial artery-internal carotid artery using 7-0 Prolene.</p><p><strong>Conclusion: </strong>A bypass of the MCA-radial artery-internal carotid artery can be achieved using the da Vinci Xi Surgical System in cadaver models. This system provides experts and less experienced neurosurgeons with stable bypass techniques for both superficial and deep-seated arteries. However, further studies are needed to evaluate the safety and benefits of the da Vinci Xi Surgical System for bypass procedures.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"872-875"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142309139","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":"Treatment of Acute Iatrogenic Cerebrovascular Injury Using Flow Diverter Stents.","authors":"Eric A Grin, Svetlana Kvint, Eytan Raz, Maksim Shapiro, Vera Sharashidze, Jacob Baranoski, Charlotte Chung, Ayaz Khawaja, Donato Pacione, Chandra Sen, Caleb Rutledge, Howard A Riina, Peter K Nelson, Erez Nossek","doi":"10.1227/ons.0000000000001379","DOIUrl":"10.1227/ons.0000000000001379","url":null,"abstract":"<p><strong>Background and objectives: </strong>Iatrogenic cerebrovascular injury can cause intracranial hemorrhage and pseudoaneurysm formation, putting patients at high risk for postoperative bleeding. No consensus for management exists. This study describes endovascular treatment of these acute injuries with flow diverter stents.</p><p><strong>Methods: </strong>Electronic medical records were retrospectively reviewed for injury type and etiology, timing of diagnosis, and endovascular management, including antiplatelet regimens, embolization results, and clinical outcome.</p><p><strong>Results: </strong>Six patients were included. Three suffered an injury to the internal carotid artery, 1 suffered an injury to the left anterior cerebral artery, 1 suffered an injury to the right posterior cerebral artery, and 1 suffered an injury to the basilar artery. Four of the 6 injuries occurred during attempted tumor resection, 1 occurred during cerebrospinal fluid leak repair, and 1 occurred during an ophthalmic artery aneurysm clipping. All injuries resulted in pseudoaneurysm formation. Four were immediately detected on angiography; 2 were initially negative on imaging. Five were treated with a pipeline embolization device, and 1 was treated with a Silk Vista Baby. Two were treated with 2 pipeline embolization devices telescopically overlapped across the pseudoaneurysm. All devices deployed successfully. No pseudoaneurysm recurrence or rebleeding occurred. No parent artery occlusion or stenosis was observed, and complete pseudoaneurysm occlusion was observed in 4 patients (in 2 patients, follow-up imaging could not be obtained).</p><p><strong>Conclusion: </strong>With proper antiplatelet regimens, flow diverter stents can be used safely to successfully treat complex acute iatrogenic injuries. Early repeat angiogram is needed when immediate postinjury imaging does not discover the point of vessel injury.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"808-816"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300832","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 Endonasal Internal Carotid Artery Transposition Technique in Tumor With Parasellar Extension: A Single-Center Experience.","authors":"Limin Xiao, Bowen Wu, Han Ding, Yulin He, Xiao Wu, Shenhao Xie, Bin Tang, Tao Hong","doi":"10.1227/ons.0000000000001193","DOIUrl":"10.1227/ons.0000000000001193","url":null,"abstract":"<p><strong>Background and objectives: </strong>Lateralization or mobilization of the internal carotid artery (ICA) during a midline approach is required to expose lesions behind or lateral to the ICA. However, there have been no published data regarding the surgical outcomes of the endoscopic endonasal internal carotid transposition technique (EEITT). This study aimed to analyze the relevant surgical anatomy around the ICA and propose a grading scheme of EEITT.</p><p><strong>Methods: </strong>A retrospective review of patients who underwent EEITT at a single institution was performed. Based on structures that limited the ICA and intraoperative findings, an anatomically surgical grading scheme of EEITT was proposed.</p><p><strong>Results: </strong>Forty-two patients (mean age 45.6 years, 57.1% female patients) were included. Of them, 29 cases (69.0%) were Knosp grade 4 pituitary adenoma, 6 cases (14.3%) were chordoma, 6 cases (14.3%) were meningioma, and a single case (2.4%) was meningeal IgG4-related disease. The EEITT was categorized into Grades 1, 2 and 3, which was used in 24 (57.1%), 12 (28.6%), and 6 (14.3%) cases, respectively. The most common symptom was visual disturbance (45.2%). The gross total resection rate in Grade 1 (79.2%) and Grade 2 (83.3%) was much higher than that in Grade 3 (66.6%). The overall rate of visual function improvement, preoperative cranial nerve (CN) palsy improvement, and postoperative hormonal remission was 89.4%, 85.7%, and 88.9%, respectively. The rate for the following morbidities was cerebrospinal fluid leakage, 2.4%; permanent diabetes insipidus, 4.8%; new transient CN palsy, 9.5%; permanent CN palsy, 4.7%; panhypopituitarism, 7.1%; and ICA injury, 2.4%.</p><p><strong>Conclusion: </strong>The EEITT is technically feasible and could be graded according to the extent of disconnection of limiting structures. For complex tumor with parasellar extensions, the distinction into Grades 1, 2, and 3 will be of benefit to clinicians in predicting risks, avoiding complications, and generating tailored individualized surgical strategies.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"796-807"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141089332","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":"Comparative Assessment of Thermal Damage Induced by Bipolar Forceps in a Bovine Liver.","authors":"Neslihan Çavuşoğlu, Abuzer Güngör, Muhammed Emin Aksu, Erhan Emel, Berk Burak Berker, Yücel Doğruel, Uğur Türe","doi":"10.1227/ons.0000000000001385","DOIUrl":"10.1227/ons.0000000000001385","url":null,"abstract":"<p><strong>Background and objectives: </strong>Bipolar electrocautery systems in neurosurgical procedures may induce thermal damage to adjacent tissues, especially neural tissues. Therefore, it is crucial to control thermal spread from the tips of bipolar forceps into adjacent tissues. The goal of this study was to compare the thermal damage induced in unintended adjacent tissues during coagulation with 6 different bipolar forceps.</p><p><strong>Methods: </strong>Fresh ex vivo bovine liver tissues were coagulated with 6 different bipolar forceps: Aesculap® nonstick, Atlas Choice™, ISOCOOL®, SilverGlide®, Spetzler™-Malis®, and VersaTru® (45 trials per bipolar forceps). For all forceps, coagulation was performed with a power setting of 35 Malis units, 1-mm tip spacing, and 3-second activation time. Tissue samples were evaluated for the extent of thermal damage (30 trials per bipolar forceps). Tissue temperatures were measured with thermocouples placed in the tissues (15 trials per bipolar forceps). The area and maximum depth of thermal damage were measured manually with image analysis software.</p><p><strong>Results: </strong>The injury area induced by ISOCOOL® and Atlas Choice™ bipolar forceps was significantly less than that of the Aesculap® nonstick ( P < .001), SilverGlide® ( P < .001), Spetzler™-Malis® ( P < .001), and VersaTru® ( P < .001). The areas of thermal injury caused by the ISOCOOL® and Atlas Choice™ forceps were not statistically significantly different from each other ( P = .08). Lesions from the ISOCOOL® and Atlas Choice™ forceps showed significantly less depth of injury than the Aesculap® nonstick ( P = .001), SilverGlide® ( P < .001), Spetzler™-Malis® ( P < .001), and VersaTru® ( P < .001). There was no statistically significant difference in the depth of thermal injury between the ISOCOOL® and Atlas Choice™ forceps ( P = 1.0).</p><p><strong>Conclusion: </strong>Bipolar forceps that effectively limit excessive thermal dissipation reduce the risk of unintended injury to adjacent or peripheral tissues. In an ex vivo bovine liver model, coagulation tests with ISOCOOL® and Atlas Choice™ bipolar forceps resulted in less depth and lower mean injury areas compared with other forceps.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"832-840"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142523619","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":"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":"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":"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":1.4,"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":"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}