Operative Neurosurgery最新文献

{"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}

{"title":"Cyanoacrylate Adhesive With Titanium Plate Fixation for Deep Brain Stimulation Leads: A Case Series and Technical Note.","authors":"Pablo Ramon Fruett da Costa, Guilherme Oliveira de Paula, Helen Michaela de Oliveira, Ana Paula de Siqueira Silva, Gabriella Oliveira Caetano, Julie G Pilitsis, Eduardo Joaquim Lopes Alho, Paulo Roberto Franceschini, Tiago da Silva Freitas, Bernardo Assumpção de Monaco","doi":"10.1227/ons.0000000000001604","DOIUrl":"https://doi.org/10.1227/ons.0000000000001604","url":null,"abstract":"<p><strong>Background and objectives: </strong>Deep brain stimulation (DBS) is a highly effective therapeutic intervention for managing neurological disorders, including Parkinson disease. However, conventional lead fixation methods, such as covering devices, often lead to complications, including cranial deformities and electrode migration. The aim of our study was to present a novel technique that integrates n-butyl-2-cyanoacrylate adhesive with a titanium \"dog-bone\" plate for DBS lead fixation, to enhance both esthetic and functional outcomes.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 32 patients with medication-refractory Parkinson disease or parkinsonism who had previously undergone DBS surgery using this fixation technique. The method involved applying n-butyl-2-cyanoacrylate around the lead at the burr-hole site, followed by secondary stabilization with a titanium plate. Intraoperative imaging confirmed lead positioning, and patients were monitored for up to 21.6 months (±10.2) for migration, infection, and esthetic satisfaction.</p><p><strong>Results: </strong>All 32 patients showed successful lead fixation without cases of migration, displacement, or mechanical failure over the follow-up. No postoperative infections, seizures, or meningitis were reported, indicating a favorable safety profile. The method provided a smooth cranial contour, with high patient satisfaction, especially among those with alopecia or thin skin. In addition, the technique potentially reduced operative time because of the rapid polymerization of the adhesive, thereby minimizing risks associated with prolonged surgeries.</p><p><strong>Conclusion: </strong>The combination of n-butyl-2-cyanoacrylate and a titanium \"dog-bone\" plate for DBS lead fixation offers an effective, aesthetically superior, and cost-efficient alternative to conventional methods. The reduced complication rates and enhanced patient satisfaction suggest that this technique may represent a viable future standard for DBS procedures. Further multicenter studies are recommended to validate these findings.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049765","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":"Long-Term Outcomes of Surgical Clipping of Woven EndoBridge-Eligible Middle Cerebral Artery Bifurcation Aneurysms.","authors":"William H Hicks, Jeffrey I Traylor, Kelsey Schmitt, Haldo Trevino, Bradley S Guidry, Babu G Welch, Jonathan A White, Rafael De Oliveira Sillero","doi":"10.1227/ons.0000000000001589","DOIUrl":"https://doi.org/10.1227/ons.0000000000001589","url":null,"abstract":"<p><strong>Background and objectives: </strong>Endosaccular flow disruption with the Woven EndoBridge (WEB) embolization device emerged as an alternative treatment for wide-necked bifurcation aneurysms (WNBAs). Previous studies used pooled aneurysm locations to conclude the efficacy of the WEB device, failing to account for locational differences in outcomes, most notably at the middle cerebral artery (MCA). Thus, we analyzed characteristics and outcomes among a cohort of WEB-eligible MCA bifurcation aneurysms treated surgically.</p><p><strong>Methods: </strong>We retrospectively reviewed a prospectively maintained aneurysm database at UT Southwestern between 2002 and 2022. WEB-eligible aneurysms met the criteria of a dome-to-neck ratio ≥1, a neck diameter >4.0 mm or a dome-to-neck ratio of ≤2, and an aneurysm diameter of 3.0-11.0 mm. Both unruptured and ruptured aneurysms were included. The end points assessed were functional status changes (modified Rankin scale [mRS]), complication rates, aneurysm recurrence, residual, morbidity, and mortality.</p><p><strong>Results: </strong>One hundred two patients met radiographic inclusion criteria as WEB-eligible WNBA who underwent microsurgical clipping. Eighty-five (83.3%) aneurysms were unruptured. Patients with ruptured aneurysms presented with a worse mRS and experienced more significant improvements in functional status at the final follow-up. Regardless of rupture status, outcomes with open surgery were excellent, with a 99% treatment success rate, 4.9% morbidity rate, and 0% mortality rate. Among unruptured MCA WNBAs, functional outcomes showed a final mRS ≤2 in 94.1% of patients and an improved or stable functional status in 91.8%. Microsurgical treatment of unruptured MCA WNBA carried a 5.9% thromboembolic complication rate.</p><p><strong>Conclusion: </strong>Outcomes of WEB-eligible MCA WNBAs are comparable with the high success rates in large, heterogeneous series of MCA aneurysms and superior to those in WEB cohorts. Functional outcomes remain excellent regardless of treatment strategy; however, surgical treatment may offer higher complete occlusion rates, lower retreatment rates, and lower complication rates than endovascular treatment with WEB.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026494","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":"Innovative Technique of Anchoring the Upper End of the Cervical Plate With C1 Anterior Arch Screw for Upper Cervical Tumors.","authors":"Pankaj Kumar Singh, Ramesh Sharanappa Doddamani, Sivaraman Kumarasamy, Deepak Agarwal, Poodipedi Sarat Chandra, Shashank Sharad Kale","doi":"10.1227/ons.0000000000001591","DOIUrl":"https://doi.org/10.1227/ons.0000000000001591","url":null,"abstract":"<p><strong>Background and objectives: </strong>Upper cervical spine bony tumors pose a challenge to surgeons because of their extensiveness and proximity to vital structures. Reconstruction following resection is necessary to prevent instability. Our objective is to describe a technical note on the C1 anterior arch screw with mesh cage reconstruction for anchoring the upper end of the cervical plate after resection of the upper cervical tumor.</p><p><strong>Methods: </strong>A retrospective review of patients with primary bony tumors of the upper cervical spine after surgical resection between 2018 and 2022 was included in the study. Imaging workup included computed tomography, MRI, and computed tomography angiogram.</p><p><strong>Results: </strong>A total of 4 patients with primary bony tumors of the upper cervical spine underwent C1 anterior screw fixation with mesh cage reconstruction. The mean age was 33.8 ± 14.3 years. Tumor extent was C2-C4 in 2 patients (50%) and C2 in 2 patients (50%). Three patients had a spinal instability neoplastic score of >12 and were deemed unstable preoperatively, mandating the stabilization procedure. All patients underwent surgical resection: gross total resection (1, 25%), near-total excision (1, 25%), and tumor decompression (2, 50%). Surgery was staged in 3 patients (75%) because of the extensiveness of the tumor and massive blood loss. There was no perioperative mortality. The mean postoperative Nurick grading score was 1.5 ± 1.3 (range 0-3). All patients were ambulatory and showed neurological improvement postoperatively with a mean follow-up of 37.5 ± 21.9 months and evidence of fusion on the latest imaging.</p><p><strong>Conclusion: </strong>Radical resection of tumors involving the upper cervical spine requiring C2 corpectomy is challenging. En bloc resection is not always feasible. Neurosurgeons can consider using the anterior arch as an anchor point. The use of neuronavigation facilitates the precise placement of the C1 arch screws.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057167","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":"Macrovascular Decompression of the Optic Nerve: Technical Case Instruction: 2-Dimensional Operative Video.","authors":"Shravan Atluri, Ethan Cline, Anthony Guidotti, John Na, Mario Zanaty, Ondrej Choutka","doi":"10.1227/ons.0000000000001607","DOIUrl":"https://doi.org/10.1227/ons.0000000000001607","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005903","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: A Midline-Sparing Minimally Invasive Approach for Resection of a C2 Dumbbell Schwannoma: 2-Dimensional Surgical Video.","authors":"Harsh Jain, Alan R Tang, Scott L Zuckerman","doi":"10.1227/ons.0000000000001613","DOIUrl":"https://doi.org/10.1227/ons.0000000000001613","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055562","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}