Operative Neurosurgery最新文献

{"title":"Have We Made Advancements in Optimizing Surgical Outcomes and Enhancing Recovery for Patients With High-Risk Adult Spinal Deformity Over Time?","authors":"Peter G Passias, Lara Passfall, Peter S Tretiakov, Ankita Das, Oluwatobi O Onafowokan, Justin S Smith, Virginie Lafage, Renaud Lafage, Breton Line, Jeffrey Gum, Khaled M Kebaish, Khoi D Than, Gregory Mundis, Richard Hostin, Munish Gupta, Robert K Eastlack, Dean Chou, Alexa Forman, Bassel Diebo, Alan H Daniels, Themistocles Protopsaltis, D Kojo Hamilton, Alex Soroceanu, Raymarla Pinteric, Praveen Mummaneni, Han Jo Kim, Neel Anand, Christopher P Ames, Robert Hart, Douglas Burton, Frank J Schwab, Christopher Shaffrey, Eric O Klineberg, Shay Bess","doi":"10.1227/ons.0000000000001420","DOIUrl":"10.1227/ons.0000000000001420","url":null,"abstract":"<p><strong>Background and objectives: </strong>The spectrum of patients requiring adult spinal deformity (ASD) surgery is highly variable in baseline (BL) risk such as age, frailty, and deformity severity. Although improvements have been realized in ASD surgery over the past decade, it is unknown whether these carry over to high-risk patients. We aim to determine temporal differences in outcomes at 2 years after ASD surgery in patients stratified by BL risk.</p><p><strong>Methods: </strong>Patients ≥18 years with complete pre- (BL) and 2-year (2Y) postoperative data from 2009 to 2018 were categorized as having undergone surgery from 2009 to 2013 [early] or from 2014 to 2018 [late]. High-risk [HR] patients met ≥2 of the criteria: (1) ++ BL pelvic incidence and lumbar lordosis or SVA by Scoliosis Research Society (SRS)-Schwab criteria, (2) elderly [≥70 years], (3) severe BL frailty, (4) high Charlson comorbidity index, (5) undergoing 3-column osteotomy, and (6) fusion of >12 levels, or >7 levels for elderly patients. Demographics, clinical outcomes, radiographic alignment targets, and complication rates were assessed by time period for high-risk patients.</p><p><strong>Results: </strong>Of the 725 patients included, 52% (n = 377) were identified as HR. 47% (n = 338) had surgery pre-2014 [early], and 53% (n = 387) underwent surgery in 2014 or later [late]. There was a higher proportion of HR patients in Late group (56% vs 48%). Analysis by early/late status showed no significant differences in achieving improved radiographic alignment by SRS-Schwab, age-adjusted alignment goals, or global alignment and proportion proportionality by 2Y (all P > .05). Late/HR patients had significantly less poor clinical outcomes per SRS and Oswestry Disability Index (both P < .01). Late/HR patients had fewer complications (63% vs 74%, P = .025), reoperations (17% vs 30%, P = .002), and surgical infections (0.9% vs 4.3%, P = .031). Late/HR patients had lower rates of early proximal junctional kyphosis (10% vs 17%, P = .041) and proximal junctional failure (11% vs 22%, P = .003).</p><p><strong>Conclusion: </strong>Despite operating on more high-risk patients between 2014 and 2018, surgeons effectively reduced rates of complications, mechanical failures, and reoperations, while simultaneously improving health-related quality of life.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"617-626"},"PeriodicalIF":1.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142734738","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: Transcavernous Approach Through Eyebrow Incision for Radiation-Induced Medial Temporal Lobe Cavernoma: 2 Dimensional Operative Video.","authors":"Nasser M F El-Ghandour","doi":"10.1227/ons.0000000000001415","DOIUrl":"10.1227/ons.0000000000001415","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"738-739"},"PeriodicalIF":1.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142523618","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":"Transcavernous Approach Through Eyebrow Incision for Radiation-Induced Medial Temporal Lobe Cavernoma: 2-Dimensional Operative Video.","authors":"Eva M Wu, Meredith C Costello, Ahmed Abdelsalam, Jacques J Morcos","doi":"10.1227/ons.0000000000001354","DOIUrl":"10.1227/ons.0000000000001354","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"737"},"PeriodicalIF":1.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300831","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: Bilateral High-Riding Persistent First Cervical Intersegmental Arteries in a Case of Klippel-Feil Syndrome: The Technique of Vertebral Artery Mobilization for C1-C2 Reduction and Fusion for Atlantoaxial Dislocation and Basilar Invagination: 2-Dimensional Operative Video.","authors":"Atul Goel","doi":"10.1227/ons.0000000000001365","DOIUrl":"10.1227/ons.0000000000001365","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"728-729"},"PeriodicalIF":1.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300809","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":"Selective Apical Convex Rod Derotation: A Fast and Secure Technique for the Correction of Adolescent Idiopathic Scoliosis-A Case Series of 38 Patients.","authors":"Salim Şentürk, İdris Avci, Kemal Paksoy, Melih Kapdan, Onur Yaman","doi":"10.1227/ons.0000000000001348","DOIUrl":"10.1227/ons.0000000000001348","url":null,"abstract":"<p><strong>Background and objectives: </strong>We present a novel technique of selective apical convex rod derotation as an effective and safe maneuver for the correction of adolescent idiopathic scoliosis and give the clinical results of our patients. Adolescent idiopathic scoliosis is the three-dimensional deformity of the spine of more than 10° affecting children from 10 to 18 years. The gold standard for the correction of larger curves is posterior fusion. With the help of osteotomies, the spine becomes mobile and the ideal alignment can be achieved with correction maneuvers. Derotations from the concave side harvest numerous complications such as exacerbation of apical rotation, screw pullout, and implant failure.</p><p><strong>Methods: </strong>After the transpedicular screws are placed, a short titanium rod is put on the convex-side screws just covering the apex and the screw nuts are loosely tightened. The convex apical rod is held with 2 rod holders and derotation is applied to the rod and the convex spine is pulled toward the midline. After the desired correction is reached, a permanent rod is placed to the concave side and screw nuts are tightened.</p><p><strong>Results: </strong>A total of 38 patients have been included in this study. Preoperative median Cobb angle was 47.19°, postoperative Cobb angle was measured as 18.45°, and 1 year follow-up was 17.25°. Thoracic kyphosis values were 19.07°, 30.52°, and 33.05°, respectively. Lumbar lordosis were measured as 42.63°, 43°, and 45.75°, respectively.</p><p><strong>Conclusion: </strong>Selective apical convex rod derotation is an effective treatment of adolescent idiopathic scoliosis with minimal risk for screw pullout, pedicular bursting, or hypokyphosis. Correction results are similar to classic correction maneuvers.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"635-640"},"PeriodicalIF":1.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114766","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: Posterior Release, Reduction and Intra-Articular Fusion for Irreducible Type III Atlantoaxial Rotary Fixation.","authors":"M Burhan Janjua, Andrew Jea","doi":"10.1227/ons.0000000000001394","DOIUrl":"10.1227/ons.0000000000001394","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"634"},"PeriodicalIF":1.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512925","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":"Clipping, Aneurysmotomy, and Thrombectomy of an Enlarged Thrombosed Giant Posterior Cerebral Artery Aneurysm After Flow Diverter Treatment: 2-Dimensional Operative Video.","authors":"Daniele Piccolo, Sara Fabbro, Francesco Tuniz, Vladimir Gavrilovic, Miran Skrap, Marco Vindigni","doi":"10.1227/ons.0000000000001337","DOIUrl":"10.1227/ons.0000000000001337","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"723"},"PeriodicalIF":1.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142005868","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":"Surgical Anatomy of the Supraretinacular Fat Pad: Sensory Innervation and Preservation in Open Carpal Tunnel Release.","authors":"Ildefonso Muñoz Romero, Robbert G E Notenboom, Martijn J A Malessy","doi":"10.1227/ons.0000000000001367","DOIUrl":"10.1227/ons.0000000000001367","url":null,"abstract":"<p><strong>Background and objectives: </strong>Postoperative pain may occur following open carpal tunnel release (OCTR). Various causes have been postulated. During OCTR, adipose tissue located between the palmar aponeurosis and the flexor retinaculum is exposed. It is unknown whether damage to this pad of supraretinacular fat (SRF) might contribute to postoperative palmar pain or tenderness. We studied the sensory innervation of the SRF exposed in OCTR to assess whether SRF damage could potentially generate pain.</p><p><strong>Methods: </strong>A microanatomic dissection of the innervation and vascular supply of the SRF was performed in 25 embalmed human cadaveric upper limbs. Eight fat pads were removed en bloc for histological evaluation. Three-dimensional reconstructions were made based on immunohistochemically stained sections using computer-assisted microscopy.</p><p><strong>Results: </strong>The SRF is the radial continuation of the hypothenar fat pad that covers the neurovascular bundle in the Guyon canal. The fat pad is richly innervated and contains Pacinian corpuscles. The sensory innervation originates exclusively from the ulnar nerve (palmar branch) and its vascular supply from the ulnar artery. The integrity of the SRF can be preserved by detaching it from the flexor retinaculum in a radial to ulnar fashion.</p><p><strong>Conclusion: </strong>The SRF, which is exposed during OCTR, is richly innervated by sensory fibers from the ulnar nerve. It is the radialmost extension of the hypothenar fat pad. In view of its rich innervation, damage to the SRF during OCTR might generate postoperative pain. Preserving its integrity during OCTR is technically possible and even simplifies the procedure. Clinical trials are needed to corroborate whether preservation of the SRF during OCTR indeed makes a clinical difference in postoperative pain generation.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"712-720"},"PeriodicalIF":1.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11981261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Somatosensory Mapping Using a Novel Sensory Discrimination Task: Technical Note.","authors":"Abraham Dada, Gray Umbach, Areti Majumdar, Jasleen Kaur, Sena Oten, Mitchel S Berger, David Brang, Shawn L Hervey-Jumper","doi":"10.1227/ons.0000000000001349","DOIUrl":"10.1227/ons.0000000000001349","url":null,"abstract":"<p><strong>Background and objectives: </strong>Although diffuse gliomas in the primary somatosensory cortex (S1) are often considered resectable, gliomas in the primary motor cortex require motor mapping to preserve motor function. Recent evidence indicates that some somatosensory cortex neurons may trigger motor responses, necessitating refined somatosensory mapping techniques.</p><p><strong>Methods: </strong>Using piezoelectric tactile stimulators on patients' faces and hands, we delivered 25 Hz vibrations and prompted patients to discriminate between dermatomes. Testing included areas contralateral to tumor-infiltrated and to non-tumor-infiltrated cortical regions. Sensory thresholds were determined by reducing stimulus intensity based on performance. Intraoperatively, electrocorticography electrode arrays were used to map sensory responses, and postoperative assessments evaluated sensory outcomes.</p><p><strong>Results: </strong>The high-grade glioma case involved a 61-year-old man with right-sided weakness and numbness with a left parietal mass on MRI. Preoperative testing showed that the average vibratory detection threshold of the hand contralateral to the suspected tumor site was significantly higher than that of the hand contralateral to healthy cortex ( P < .001). Intraoperative mapping confirmed the absence of functional involvement in cortical structures overlying the tumor. Postoperative imaging confirmed gross total resection, and sensory vibratory thresholds were normalized ( P = .51). The low-grade glioma case included a 54-year-old man with a left parietal nonenhancing mass on MRI. No baseline sensory impairments were found on preoperative testing. Intraoperative mapping identified motor and sensory cortices, guiding tumor resection while preserving motor function. Postoperative MRI confirmed near-total resection, but new sensory impairments were noted in the hand and face contralateral to the resection site ( P < .001). These deficits resolved by postoperative day 11, with no evidence of tumor progression on follow-up imaging.</p><p><strong>Conclusion: </strong>The sensory discrimination task provides a quantifiable method for assessing sensory changes and functional outcomes related to glioma. This technique enhances our understanding of how glioma infiltration remodels sensory systems and affects clinical outcomes in patients.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"667-676"},"PeriodicalIF":1.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156611","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: Feasibility of Endovascular Deep Brain Stimulation of Anterior Nucleus of the Thalamus for Refractory Epilepsy.","authors":"Ioannis Mavridis","doi":"10.1227/ons.0000000000001540","DOIUrl":"10.1227/ons.0000000000001540","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"744"},"PeriodicalIF":1.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574684","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}