Operative Neurosurgery最新文献

{"title":"Robotic-Assisted Obturator Nerve Repair: A Technical Report.","authors":"Arjun Syal, Sima Vazquez, Akiva P Novetsky, Jared Pisapia","doi":"10.1227/ons.0000000000001315","DOIUrl":"10.1227/ons.0000000000001315","url":null,"abstract":"<p><strong>Background and importance: </strong>Untreated obturator nerve injury may result in weakness in thigh adduction, decreased medial thigh sensation, and groin pain. A neurosurgeon may be consulted intraoperatively for repair. Although there are reports of obturator nerve injury and repair in the gynecologic surgery literature, there are few reports detailing the specific steps of nerve repair after partial transection and the underlying principles of nerve coaptation, especially in the robotic-assisted setting.</p><p><strong>Clinical presentation: </strong>A partial transection of the right obturator nerve was noted in a patient undergoing total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and lymph node dissection using the da Vinci robot. Sutures were placed in the epineurium of the cut nerves to realign the fascicles. A porcine wrap was placed around the coaptation site and covered with fibrin glue. The right lower extremity was passively ranged to ensure no tension was present across the repair site. The patient had loss of right leg adduction after surgery, but she recovered full motor function 5 months after surgery with no numbness or pain.</p><p><strong>Conclusion: </strong>The current report describes a repair strategy for partial-thickness obturator nerve injury in the setting of a laparoscopic surgery. Working in a multidisciplinary fashion, the tenets of nerve repair may be applied to robotic-assisted cases of obturator nerve injury, resulting in neurologic recovery.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"571-573"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142005830","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 Petrosectomy, Trans-Zygomatic Approach, and Facial Nerve Decompression for Resection of a Giant Aneurysmal Bone Cyst in a 5-Year-Old Patient: 2-Dimensional Operative Video.","authors":"Aymen Kabir, Maximiliano Alberto Nunez, Jeffrey Sharon, Ivan El-Sayed, Ezequiel Goldschmidt","doi":"10.1227/ons.0000000000001324","DOIUrl":"10.1227/ons.0000000000001324","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"591"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142005869","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":"Impact of Previous Surgery and/or Radiation Therapy on Endoscopic Reconstruction Outcomes.","authors":"Rita Snyder, Franco Rubino, Scott Seaman, Matei Banu, Shirley Y Su, Ehab Y Hanna, Franco DeMonte, Shaan M Raza","doi":"10.1227/ons.0000000000001318","DOIUrl":"10.1227/ons.0000000000001318","url":null,"abstract":"<p><strong>Background and objectives: </strong>The impact of prior local therapies, including radiation and surgery, on reconstruction outcomes after endonasal surgery is currently not well known. Reconstruction nuances in the preoperative setting merit further evaluation to avoid potential postoperative complications that can hinder overall tumor management and negatively impact patient outcome. We sought to determine whether prior treatments increase risk of reconstruction-related postoperative morbidity and to evaluate the effectiveness of our current treatment paradigm for skull base reconstruction.</p><p><strong>Methods: </strong>A retrospective review of all endonasal surgeries for tumor resection between March 2000 and March 2022 was performed. Patients were grouped based on treatment history. Patient demographics, operative, and postoperative reconstruction-related morbidity data were collected, including cerebrospinal fluid leak, sinonasal morbidity, and infectious complications. Variables significantly associated with postoperative complications in the univariate analysis were included in the multivariate Cox proportional hazards regression model. Complication-free survival curves were generated, and the log-rank test evaluated the relationship between complication-free survival and the different clinical, surgical, and treatment parameters. All statistical analyses were performed with SPSS 26 (IBM Corp) and Graph Pad 9.0 (GraphPad Software).</p><p><strong>Results: </strong>A total of 418 patients were included. 291 patients had no prior treatments, 49 patients had previously received radiation, and 78 patients had prior surgeries. Of the 49 patients who had prior radiation, 27% underwent reconstruction with tunneled pericranial flaps vs 16% of treatment-naïve patients. On multivariate analysis, prior treatment was not significantly associated with reconstruction-related complications. Negative smoking history, no leak or small intraoperative leak, and use of vascularized flap in reconstruction were protective factors.</p><p><strong>Conclusion: </strong>In patients undergoing endonasal surgery, prior radiation and/or surgery does not appear to significantly increase the risk of immediate or delayed reconstruction complications using our current reconstructive management plan, which incorporates an upfront regional flap for high-risk cases.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"496-505"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057289","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":"Modified Peri-Insular Hemispherotomy in Pediatric Epilepsy: A Non-Middle Cerebral Artery Sparing Approach: 2-Dimensional Operative Video.","authors":"Santiago E Cicutti, Guido P Gromadzyn, Javier F Cuello, Facundo Villamil, Marcelo Bartuluchi","doi":"10.1227/ons.0000000000001327","DOIUrl":"10.1227/ons.0000000000001327","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"592-593"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057290","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: Establishing Competency Assessment Standards for Graduating Neurosurgery, Plastic Surgery, and Orthopedic Surgery Residents in Peripheral Nerve Surgery.","authors":"Ken Porche, Robert J Spinner","doi":"10.1227/ons.0000000000001553","DOIUrl":"https://doi.org/10.1227/ons.0000000000001553","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765860","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":"Ventral Thoracic Cord Herniation Repair: 2-Dimensional Operative Video.","authors":"Tyler Cardinal, Aria Jamshidi, Long Di, Emade Jaman, Allan D Levi","doi":"10.1227/ons.0000000000001567","DOIUrl":"https://doi.org/10.1227/ons.0000000000001567","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765873","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 Left Precentral Gyrus Arteriovenous Malformation: 3-Dimensional Operative Video.","authors":"Spyridon K Karadimas, Jacques J Morcos","doi":"10.1227/ons.0000000000001288","DOIUrl":"10.1227/ons.0000000000001288","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"574"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141621774","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":"Minimally Destabilizing Corridor for Resection of Dumbbell Nerve Sheath Tumors: A Novel Surgical Technique.","authors":"Georgios A Maragkos, Kristina P Kurker, Jonathan Yun, Chun-Po Yen, Ashok R Asthagiri","doi":"10.1227/ons.0000000000001322","DOIUrl":"10.1227/ons.0000000000001322","url":null,"abstract":"<p><strong>Background and objectives: </strong>Current surgical strategies for dumbbell nerve sheath tumors (DNSTs) with cord compression have primarily involved wide spinal exposures with total laminectomy and unilateral facetectomy, often leading to spinal destabilization and requiring fusion, or staged procedures separately addressing the intraspinal and extraforaminal tumor components. This study highlights technical nuances of a novel approach for DNST resection to minimize spinal destabilization and avoid fusion while facilitating safe, single-stage complete resection.</p><p><strong>Methods: </strong>A retrospective chart review was conducted on patients undergoing DNST resection. Using unilateral subperiosteal dissection, hemilaminotomy and medial facetectomy procedures are performed. The extradural tumor component is resected, followed by internal decompression of the intradural tumor. A small horizontal incision at the origin of the nerve root sleeve releases the underlying dural stricture, facilitating delivery of the remaining intradural tumor and allowing section of the nerve root of origin. Ultrasonography confirms complete tumor resection and return of cord pulsation, and excludes intradural hemorrhagic complications. The dura is reconstructed using a dural substitute bolstered with fat graft and sealant.</p><p><strong>Results: </strong>Twelve consecutive patients undergoing this approach from 2014 to 2021 were included. Mean patient age was 53.5 years, and 58.3% were male. Nine tumors were cervical and 3 were lumbar. Five patients presented with myelopathy, 4 with radiculopathy, and 4 with axial pain. Two cases had transient intraoperative neuromonitoring signal changes. Eleven tumors were diagnosed as schwannomas and 1 as neurofibroma. All patients had complete resection of the intraspinal component; 2 had far distal extraforaminal residual. No patient has had recurrence, progression of residual, or signs of spinal instability during follow-up (median 28.5 months, range 6-66 months).</p><p><strong>Conclusion: </strong>This study highlights technical considerations for DNST resection, focusing the approach at the center of the tumor, with minimal bone removal and ligamentous disruption. Intraoperative ultrasound is instrumental in the safety of this approach.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":"28 4","pages":"511-518"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631039","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: 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":"https://doi.org/10.1227/ons.0000000000001566","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","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":"The Association of Area Deprivation Index and Spine Surgery Outcomes: A Systematic and Narrative Review.","authors":"Yifei Sun, Nicholas M B Laskay, Garrett W Thrash, Sasha Howell, James H Mooney, Jakub Godzik","doi":"10.1227/ons.0000000000001551","DOIUrl":"https://doi.org/10.1227/ons.0000000000001551","url":null,"abstract":"<p><strong>Background and objectives: </strong>With an aging population, the prevalence of spine pathology including degenerative spine disease continues to increase. These pathologies present a significant disease burden, often requiring long-term and expensive care. Recent literature has linked several socioeconomic determinants of health with outcomes after spine surgery. We sought to conduct a systematic review to determine the relationship between Area Deprivation Index (ADI), a measure of neighborhood-level socioeconomic status, and objective and patient-reported outcome (PRO) measures after spine surgery and to propose potential interventions.</p><p><strong>Methods: </strong>An Embase and Medline search was conducted from inception to April 1st, 2024, for relevant articles assessing ADI and spine surgery outcomes. The inclusion criteria were all North American observational studies available in English that reported on the association of ADI and adult cervical, lumbar, neoplastic, or deformity spine surgery outcomes.</p><p><strong>Results: </strong>Ten articles met the inclusion criteria resulting in a combined 56 925 patients who had undergone elective surgery for cervical, lumbar, spine metastases, and adult spine deformity pathologies. Two studies reported ADI to be associated with increased costs of care and postoperative lengths of stay after cervical spine surgery. Five studies found the association between high ADI with increased rates of respiratory failure, 90-day emergency room visits, longer lengths of stay, 90-day reoperation rates, and poor PROs after lumbar spine surgery. One study found an association with high ADI and increased 30-day and 90-day readmissions across all spine surgeries, and 1 study found no association between ADI and overall survival after surgery for spinal metastases.</p><p><strong>Conclusion: </strong>Across available literature, high ADI seems to be associated with higher rates of postoperative readmissions and worse PROs. Further studies are needed to better understand the mechanisms underlying the effects of ADI on spine surgery outcomes and identify possible interventions to optimize outcomes.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765869","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}