Operative Neurosurgery最新文献

{"title":"Extradural and Intradural Anterior Clinoidectomy: Technical Nuances and Video Illustration.","authors":"Gurkirat Kohli, Tarek El Ahmadieh, Vera Vigo, Maximiliano A Nuñez, Muhammet Enes Gurses, Aaron A Cohen-Gadol, Juan C Fernandez-Miranda","doi":"10.1227/ons.0000000000001530","DOIUrl":"https://doi.org/10.1227/ons.0000000000001530","url":null,"abstract":"<p><p>An anterior clinoidectomy is an important skull-base technique to have in the armamentarium when managing pathology of the paraclinoid region. Drilling the anterior clinoid (AC) provides access to the clinoidal internal carotid artery and early decompression of the optic nerve. This technique is essential in the management of central skull base tumors and aneurysms, especially from the opticocarotid region. The intricate neurovascular anatomy associated with the AC can be difficult to master. There are 2 main techniques for drilling the AC, intradural and extradural, although hybrid techniques have been described. The goal of this article was to provide an up-to-date technical report on performing an anterior clinoidectomy supplemented by high-quality original dissections and a 4K 2-dimensional video as a resource for trainees and junior neurosurgeons.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674816","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":"Stereotactic Radiosurgery and Surgical Resection for Jugular Foramen Schwannomas: A Retrospective Comparative Study of Outcomes.","authors":"Amirhossein Akhavan-Sigari, David J Park, Ahed H Kattaa, Yusuke S Hori, Amit R L Persad, Deyaaldeen AbuReesh, Fred C Lam, Sara C Emrich, Louisa Ustrzynski, Armine Tayag, Steven D Chang","doi":"10.1227/ons.0000000000001534","DOIUrl":"https://doi.org/10.1227/ons.0000000000001534","url":null,"abstract":"<p><strong>Background and objectives: </strong>Jugular foramen schwannomas (JFS) are rare benign tumors arising from lower cranial nerves. In this study, we aim to compare the outcomes of surgical resection (SR) and stereotactic radiosurgery (SRS) in the treatment of JFS.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 31 patients with JFS who underwent SRS (13 patients [41.9%]) or surgical resection (18 patients [58.1%]) as their primary management modality over a two-decade period. Outcomes included progression-free survival, post-treatment adverse events based on Common Terminology Criteria for Adverse Events, symptom improvement, overall survival, and the necessity for secondary interventions. Local tumor control was also evaluated in all patients who received SRS.</p><p><strong>Results: </strong>Significant differences were observed in baseline characteristics between the SRS and SR groups, including median age (58 vs 48 years, P = .001), largest tumor diameter (32.0 vs 47.5 mm, P = .02), and total tumor volume (6.50 vs 20.5 mm3, P = .01). There were no significant differences in sex or lesion morphology (dumbbell vs nondumbbell shaped). After adjusting for baseline characteristics, no significant differences were noted in progression-free survival (90.9 vs 86.2%), overall survival (92.3 vs 100%), symptom improvement (61.5 vs 55.5%), or median Common Terminology Criteria for Adverse Events grade (1 in both groups) between the SRS and SR groups, respectively. SRS patients had significantly lower odds of requiring secondary treatment procedures after their primary intervention as compared with those who underwent SR (odds ratio = 0.02, 95% CI: 0.001-0.88, P-value = .04). Local tumor control in all SRS patients (19 patients) was 93.7% and 79.1% at six-month and five-year time points, respectively.</p><p><strong>Conclusion: </strong>SRS and SR demonstrate comparable effectiveness in treating JFS. However, SRS may be a more favorable option because of a reduced need for secondary interventions. Future controlled prospective studies are needed to draw more definitive conclusions.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674799","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":"Estimation of Intracranial Pressure in Patients with Traumatic Brain Injury by Optic Nerve Sheath Diameter Ultrasonography.","authors":"Mohamed Ali Youssef ElBheery, Abdelmaksod Mohammed Mousa, Mohamed Amr Eltayab, AbdElRhman Enayet","doi":"10.1227/ons.0000000000001549","DOIUrl":"https://doi.org/10.1227/ons.0000000000001549","url":null,"abstract":"<p><strong>Background and objectives: </strong>Intracranial pressure (ICP) is the cornerstone for physiological neuromonitoring after traumatic brain injuries (TBIs). Optic nerve sheath diameter (ONSD) ultrasonography serves as a noninvasive alternative for the gold standard invasive ICP monitoring devices. We aimed to evaluate the use of ultrasound ONSD as a tool for early detection and follow-up of increasing ICP in TBI in a low socioeconomic developing country where invasive devices are not always available.</p><p><strong>Methods: </strong>A prospective observational study was conducted on 50 polytrauma patients with TBI, who were older than 18 years with and Glasgow Coma Scale above 5, and a computed tomography (CT) brain in trauma survey showing signs of increasing ICP. All patients were recruited from the emergency department and intensive care unit at Cairo and October 6 University hospitals from January to May 2022. Clinical assessment, CT brain, and ONSD ultrasonography were performed on admission, after 12 hours, and after 48 hours. ONSD 5.0 mm was correlated with raised ICP in this study.</p><p><strong>Results: </strong>ONSD ranged from 4.6 to 7.1 mm with mean ± SD of 5.93 ± 0.55 on admission. On the second follow-up, the range regressed to 4.5 to 6.0 mm with mean ± SD of 4.8 ± 0.48, suggesting a decrease in the measurements of ONSD after receiving treatment either medical or surgical. The correlation between the measurement of ONSD and the CT findings indicating raised or decreased ICP was found in 94%, 82%, and 90% of patients on admission, first follow-up, and second follow-up, respectively. The specificity of ONSD measurement was 100% on admission and second follow-up, and its accuracy was 94% and 90 % for both occasions, respectively.</p><p><strong>Conclusion: </strong>Bedside ONSD measurements are highly correlated with CT brain findings and dynamic changes in ICP in response to head trauma management protocols. Hence, ultrasonic ONSD can replace invasive monitoring in following the ICP of patients with TBI.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674811","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 Far-Lateral Approach and Its Variants: Technical Nuances and Video Illustration.","authors":"Gurkirat Kohli, Minwoo Song, Tarek Y El Ahmadieh, Vera Vigo, Muhammet Enes Gurses, Aaron A Cohen-Gadol, Juan C Fernandez-Miranda","doi":"10.1227/ons.0000000000001550","DOIUrl":"https://doi.org/10.1227/ons.0000000000001550","url":null,"abstract":"<p><p>Far-lateral craniotomy is a versatile skull base approach that combines a suboccipital craniotomy with a C1 hemilaminectomy. The approach was initially described to manage vascular pathologies of the vertebrobasilar junction; however, the corridor provided by this approach can be applied to various pathologies in the ventral and ventrolateral craniovertebral region. Safe and successful execution of the approach requires an extensive understanding of the anatomy and technique. In this article, we discuss the advantages and disadvantages of the approach, as well as important technical nuances and common pitfalls. The goal of this article is to provide an up-to-date technical report of this approach supplemented by original high-quality dissections and a 4K 2-dimensional video as an educational resource for trainees and junior neurosurgeons.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674804","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":"Resection of a Cervical Spine Hemangioblastoma in Von Hippel-Lindau Disease: 2-Dimensional Operative Video.","authors":"Joseph Yunga Tigre, Nathaniel B Dusseau, Neel Sonik, Bhavjeet S Sanghera, Adham M Khalafallah, S Shelby Burks, Allan D Levi","doi":"10.1227/ons.0000000000001545","DOIUrl":"https://doi.org/10.1227/ons.0000000000001545","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674820","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: Minipterional Approach for Cavernous Sinus Hemangioma: 2-Dimensional Operative Video.","authors":"Atul Goel","doi":"10.1227/ons.0000000000001548","DOIUrl":"https://doi.org/10.1227/ons.0000000000001548","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659630","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: Minipretemporal Approach for Cavernous Sinus Hemangioma: 2-Dimensional Operative Video.","authors":"Rafael Martinez-Perez, Jorge Mura","doi":"10.1227/ons.0000000000001547","DOIUrl":"https://doi.org/10.1227/ons.0000000000001547","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659629","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":"Clinical Validation of Intraoperative Ultrasound-Based Automated Rigid Image Fusion to Update Neuronavigation Using Preoperative MRI.","authors":"Aliasgar V Moiyadi, Prakash Shetty, Vikas Singh, Chandrima Biswas, Lakshay Raheja, Amitkumar J Choudhari, Miguel Araque Caballero, Susanne Hager, Patrick Hiepe","doi":"10.1227/ons.0000000000001519","DOIUrl":"https://doi.org/10.1227/ons.0000000000001519","url":null,"abstract":"<p><strong>Background and objectives: </strong>MRI-based neuronavigation may suffer from inaccuracies that can be compensated by navigated 3D intraoperative ultrasound (iUS) and applying MRI-iUS rigid image fusion (RIF). In this work, such an automated application is evaluated.</p><p><strong>Methods: </strong>Twenty-five adult patients with gliomas were enrolled and underwent resection using navigated iUS. Intraoperative evaluation and postoperative quantification [ie, measurement of the target registration error (TRE)] were conducted to assess the accuracy of registration-based fusion and automated RIF at various stages of surgery [before dura opening (BDO), after dura opening (ADO), after partial resection (APR), after completion of resection (ACR)]. Linear mixed models were used to assess and analyze TRE and the effect of patient- and tumor-related factors on the performance of the RIF. Furthermore, the TRE was measured after applying different prealignments.</p><p><strong>Results: </strong>In total, 79 MRI-iUS data sets derived from 24 patients and enriched with 600 anatomic landmark pairs were evaluated. Overall, RIF resulted in a significantly reduced mean TRE compared with registration-based fusion (from 4.7 mm to 3.5 mm, P < .002). This difference in TRE was dependent on the stage of surgery, being significant for BDO, ADO, and APR stages, but not ACR. It was independent of any tumor-related factors. Simulation tests showed that RIF can significantly improve TRE for a range of ±15 mm prealignment accuracy with highest effect for BDO and ADO.</p><p><strong>Conclusions: </strong>RIF using intraoperative navigated ultrasound improves registration accuracy for intra-axial tumor surgeries. It shows reliable results not only for preresection stages but also partially for later surgical stages.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651722","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":"Avoidance of Major Vascular Injury in Transcranial Brain Tumor Surgery Using Real-Time Doppler Navigation: Technical Note and Case Series.","authors":"R Justin Garling, Regin Jay Mallari, Davendran Kanesen, Byron Hontiveros, Walavan Sivakumar, Daniel F Kelly, Garni Barkhoudarian","doi":"10.1227/ons.0000000000001529","DOIUrl":"https://doi.org/10.1227/ons.0000000000001529","url":null,"abstract":"<p><strong>Background and objectives: </strong>In endoscopic endonasal surgery, the Doppler probe has proven useful for localizing the paraclival and cavernous internal carotid arteries (ICA) and avoiding ICA injury. Similarly, during transcranial brain tumor removal, the Doppler probe may help avoid major vascular injury, particularly for tumors encasing or adherent to Circle of Willis branches. In this study, we describe the technique, outcomes, and potential neurovascular benefits of real-time navigation using the Doppler probe during craniotomy for brain tumor removal.</p><p><strong>Methods: </strong>Patients from 2015 to 2022 who underwent craniotomy for brain tumor resection and the Doppler probe was used were retrospectively analyzed. Data collection included demographics, tumor pathology, incidence of major/minor vascular injury, MRI-confirmed stroke/infarction, and extent of tumor resection.</p><p><strong>Results: </strong>In total, 695 patients underwent 840 craniotomies for brain tumor resection; in 501 craniotomies (59.6%), the Doppler was used. One major vascular injury (0.2%) of a supraclinoid ICA was directly attributed to non-Doppler probe use immediately before vessel injury, leading to stroke and severe neurological decline. There were 7 strokes (1.4%) leading to permanent neurological deficit attributable to vasospasm or small vessel injury and 26 asymptomatic infarctions/strokes (5.2%) attributable to unrecognized vascular injury or spasm at the time of surgery.</p><p><strong>Conclusion: </strong>In this series of 501 craniotomies for brain tumor removal where the Doppler probe was used, the rate of direct large vessel injury was under 1%. Although our data show that smaller vessel injuries can still occur and may lead to permanent neurological deficits, routine Doppler probe use may help guide tumor dissection and aggressiveness of removal, avoiding inadvertent major arterial injury. Our experience suggests that it is most useful as tumor dissection progresses as the resulting brain shift makes stereotactic neuronavigation less reliable. We recommend routine Doppler probe use during transcranial brain tumor removal, particularly for tumors encasing or adherent to major arteries.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651694","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 Persistent Pyogenic Ventriculitis With Active Exchange of Cerebrospinal Fluid: A Report of 2 Cases.","authors":"Kevin Gilotra, Peter G Gerace, Racheed Mani, Yuehjien Gu, Catherine Sheng, Colleen Calandra, Reza Dashti","doi":"10.1227/ons.0000000000001538","DOIUrl":"https://doi.org/10.1227/ons.0000000000001538","url":null,"abstract":"<p><strong>Background and importance: </strong>Pyogenic ventriculitis is a rare, but fatal complication associated with community-acquired meningitis and invasive procedures. The blood-brain barrier poses a major challenge for systemic antibiotics to adequately treat infections confined to the ependyma of the ventricles.</p><p><strong>Clinical presentation: </strong>In this case report, we demonstrate 2 cases of pyogenic ventriculitis that responded to active cerebrospinal fluid (CSF) exchange where continuous irrigation with antibiotics allowed for adequate CSF distribution. The first case is an 83-year-old man who acquired ventriculitis secondary to epidural injections for pain. The second case is that of a 60-year-old woman who developed ventriculitis as a complication of external ventricular drainage placement for left thalamic intracerebral hemorrhage with intraventricular extension.</p><p><strong>Conclusion: </strong>Although both patients had a complex medical history, inpatient complications, and initially failed to respond to systemic antibiotic therapy, their infections were cleared rapidly on initiation of active CSF exchange. Larger scale studies will be needed to demonstrate efficacy of this novel technique.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651858","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}