Operative Neurosurgery最新文献

{"title":"Validation of Härtel Surface Anatomical Landmarks for Locating the Foramen Ovale: A Computed Tomography Scan Analysis and Revised Technique Description.","authors":"Tomás Saavedra Azcona, Miguel Villaescusa, Florencia Casto, Pablo Paolinelli, Sophia E Dover, Pedro L Plou, Carlos A Ciraolo, Pablo M Ajler","doi":"10.1227/ons.0000000000001489","DOIUrl":"https://doi.org/10.1227/ons.0000000000001489","url":null,"abstract":"<p><strong>Background and objectives: </strong>Härtel triangle provides surface landmarks for locating the foramen ovale (FO) when performing trigeminal nerve percutaneous procedures. Although widely adopted in clinical practice, there is no report that these landmarks have ever been formally validated through modern imaging techniques. Here we aim to validate Härtel anatomical landmarks using computed tomography scans and propose technical considerations for percutaneous trigeminal procedures.</p><p><strong>Methods: </strong>Retrospective analysis of 198 FO from 99 adult head computed tomography scans. Measurements included distances from FO to external auditory canal (EAC), FO to midline, eye's midpupillary (MP) line to midline, and eye's inner canthus (IC) line to midline. Statistical analysis was performed, and results were compared with Härtel description.</p><p><strong>Results: </strong>The mean distance from EAC to FO was 23.26 mm (SD: 3.00 mm). Distance from midline to FO was 25.43 mm overall (SD: 1.87 mm). Distance from midline to MP line was measured at 31.96 mm (SD: 1.89 mm). The mean distance from midline to IC line was 14.68 mm (SD: 1.73 mm).</p><p><strong>Conclusion: </strong>Härtel landmarks can be adjusted for greater accuracy when performing percutaneous trigeminal nerve procedures. The FO is located closer to the EAC and more medially situated than previously assumed. Revised technique suggests aiming the needle trajectory approximately 2 to 2.5 cm anterior to the tragus and targeting a point between the IC and MP lines rather than directly along the MP line. Excessive medial and posterior needle displacement should be avoided to prevent inadvertent vascular injury. These adjustments could enhance procedural accuracy and safety, improving patient outcomes.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958840","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":"External Auditory Canal Transillumination-Guided Middle Fossa Approaches: An Anatomical Feasibility Study.","authors":"Mustafa Şahin, Abuzer Güngör, Yücel Doğruel, Sabino Luzzi, Adem Yilmaz, Uğur Türe","doi":"10.1227/ons.0000000000001492","DOIUrl":"https://doi.org/10.1227/ons.0000000000001492","url":null,"abstract":"<p><strong>Background and objectives: </strong>The middle fossa approaches are tremendously versatile for treating small vestibular schwannomas, selected petroclival meningiomas, midbasilar trunk aneurysms, and lesions of the petrous bone. Our aim was to localize the internal acoustic canal and safely drill the petrous apex with these approaches. This study demonstrates a new method to locate the internal acoustic canal during surgery in the middle fossa.</p><p><strong>Methods: </strong>The microsurgical anatomy of the middle fossa floor was studied in 11 formalin-fixed and silicone-injected cadaveric heads. Extradural dissection of the skull base was completed from the posterior to the anterior side. A zero-degree rigid endoscope was inserted perpendicularly into the external auditory canal. The light beam was first directed through the tympanic membrane, avoiding injury to the tympanic membrane. The room lights were dimmed to provide a clearer view of the transilluminated bony area. Drilling was performed with transillumination guidance.</p><p><strong>Results: </strong>The transilluminated area included the tympanic and mastoid tegmen up to the arcuate eminence. The nonilluminated area was bounded posteriorly by the arcuate eminence, laterally by the greater superficial petrosal nerve, and posteromedially by the petrous ridge. In all specimens, drilling the transition line between the Kawase triangle and the transilluminated area unroofed the internal auditory canal (IAC). No transillumination of the carotid canal was seen after anterior petrosectomy in any of the specimens. The entire contents of the IAC were preserved in both anterior petrosectomy and unroofing of the IAC.</p><p><strong>Conclusion: </strong>In this anatomical study, transillumination of the external auditory canal proved to be feasible, accurate, and safe in guiding the middle fossa approaches. The ease of implementation and cost-effectiveness of the technique may suggest a possible application in operative scenarios.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958827","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":"Trochlear Nerve Decompression by Endoscopic Suboccipital Supracerebellar Infratentorial Approach: A Technical Note: 2-Dimensional Operative Video.","authors":"Joshua Vignolles-Jeong, Guilherme Finger, Mark Damante, Matthieu D Weber, Kyle C Wu, Daniel M Prevedello","doi":"10.1227/ons.0000000000001494","DOIUrl":"https://doi.org/10.1227/ons.0000000000001494","url":null,"abstract":"<p><strong>Background and importance: </strong>Superior oblique myokymia (SOM) is a rare, acquired aberration of the innervation of the superior oblique, resulting in episodic monocular contraction of the superior oblique muscle characterized by intermittent rotatory eye movement causing diplopia and oscillopsia. Several treatment modalities have been described to treat SOM, including medication and surgical interventions. There is a paucity of reports describing microvascular decompression (MVD) of the trochlear nerve near the root entry zone for the treatment of a neurovascular conflict. The authors describe a case report of a patient who presented with SOM by a supracerebellar infratentorial approach using microscopic and endoscopic visualization.</p><p><strong>Clinical presentation: </strong>A 40-year-old woman presented with an 8-month history of rhythmic contractions of her right orbit with worsening double vision and occasional balance issues. Neuro-ophthalmological evaluation which revealed a right-sided SOM. MRI evaluation demonstrated a potential vascular compression by the superior cerebellar artery near the origin of the trochlear nerve. She underwent MVD by a supracerebellar infratentorial approach using microscopic and endoscopic visualization. The patient experienced resolution of her SOM in the immediate postoperative period and a Trochlear nerve palsy that resolved within 6 months.</p><p><strong>Conclusion: </strong>The endoscopic supracerebellar infratentorial approach for MVD of the trochlear nerve is a safe and efficacious approach that provides superior visualization of the trochlear nerve at its origin and in the setting of SOM. This approach shows outcomes comparable with those used in previously described cases.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958838","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 Situ M2 Bypass for Treatment of Fusiform Middle Cerebral Artery Bifurcation Aneurysm: Technical Case Instruction and Operative Video.","authors":"Rashad Jabarkheel, Najib Muhammad, Rachel Blue, Sonia Ajmera, Pierce Davis, Alex Vaz, Visish M Srinivasan, Jan-Karl Burkhardt","doi":"10.1227/ons.0000000000001486","DOIUrl":"https://doi.org/10.1227/ons.0000000000001486","url":null,"abstract":"<p><strong>Background and importance: </strong>Fusiform middle cerebral artery (MCA) bifurcation aneurysms can be challenging to treat with standard endovascular or microsurgical techniques. The in situ side-to-side bypass technique represents an elegant revascularization option for these aneurysms when trapping becomes necessary.</p><p><strong>Clinical presentation: </strong>A man in his 50s presented for evaluation of an incidentally found fusiform, 10 mm, right MCA bifurcation aneurysm with involvement of both the inferior and superior M2 trunks. Plan was initially made for a right pterional craniotomy for trapping of the aneurysm with exclusion of the inferior M2 trunk, preservation of the superior M2 trunk, with superficial temporal artery bypass to the inferior M2 trunk. Intraoperatively, after arachnoid dissection, it became clear that the distal superior and inferior M2 branches would lie in close approximation without tension, thus superficial temporal artery-M2 bypass was deferred, and instead in situ side-to-side M2 bypass was performed. Here in our operative video, we highlight the critical steps of in situ side-to-side M2 bypass technique.</p><p><strong>Conclusion: </strong>We present a technical case instruction and operative video highlighting the in situ side-to-side bypass technique for treatment of a large fusiform MCA bifurcation aneurysm.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958834","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 Comparison of Decompression Size and Craniectomy Speed of Reverse Question Mark Versus Retroauricular Incisions for Decompressive Hemicraniectomy: A Cadaver Study.","authors":"Matthew K McIntyre, Miner Ross, Jamila Godil, Christina Gerges, Erin A Yamamoto, Dominic Siler, Josiah Orina, James Wright","doi":"10.1227/ons.0000000000001485","DOIUrl":"https://doi.org/10.1227/ons.0000000000001485","url":null,"abstract":"<p><strong>Background and objectives: </strong>Decompressive hemicraniectomy is a common emergent surgery for patients with stroke, hemorrhage, or trauma. The typical incision is a reverse question mark (RQM); however, a retroauricular (RA) incision has been proposed as an alternative. The widespread adoption ofthe RA incision has been slowed by lack of familiarity and concerns over decompression efficacy. Our goal is to compare the RA vs RQM incisions regarding decompression safety and to examine skill acquisition among resident neurosurgeons.</p><p><strong>Methods: </strong>Six cadaveric heads were randomized to first receive either RQM or RA decompressive hemicraniectomy, which was followed by use of the other incision on the contralateral side. Primary endpoints were decompression circumference and time to bone flap removal. Resident neurosurgeon (postgraduate year 3 through 7) confidence and operative times were compared.</p><p><strong>Results: </strong>All craniectomies yielded decompression diameters >13 cm (RQM: 13.5-15.5 cm; RA: 13.0-16.5 cm) and residual temporal bone heights <1.5 cm (RQM: 0.5-1.3 cm; RA: 0.5-1.5 cm). There were no differences between the RA and RQM groups in decompression circumference (P = .6605), residual temporal bone height (P = .7121), or time from incision until bone flap removal (P = .8452). There was a nonsignificant trend toward a shorter incision length with RA (RQM: 37.7 ± 0.7 cm vs RA: 35.1 ± 0.9; P = .0729). Regardless of which incision was performed first, operative time significantly improved from the first craniectomy to the second (-174.6 seconds, P = .0186). Surgeon confidence improved more with the RA incision, and there was a linear association with experience and time to bone flap removal in the RQM (P = .04) but not the RA (P = .95) groups.</p><p><strong>Conclusion: </strong>The RA incision may provide adequate operative exposure without significant changes in operative time. Cadaveric labs improve skill acquisition and should be considered during implementation of novel surgical approaches into practice.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933618","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":"Mini Pterional Craniotomy for Clip Ligation of a Large Middle Cerebral Artery Bifurcation Aneurysm by Picket-Fence Technique: 2-Dimensional Operative Video.","authors":"Kristine Ravina, Ritika Peddamallu, Fraz Zia, Benjamin Yim","doi":"10.1227/ons.0000000000001487","DOIUrl":"https://doi.org/10.1227/ons.0000000000001487","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932977","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":"Refining Stereotaxic Deep Brain Stimulation Surgery Procedures for Parkinson Disease in Pursuit of Zero Pneumocephalus: 2-Dimensional Operative Video.","authors":"Ran Wang, Kaiyu Liu, Feng Yu, Liemei Guo, Junfeng Ma, Yi Chai, Xiaohua Zhang, Hongyu Zhou","doi":"10.1227/ons.0000000000001460","DOIUrl":"https://doi.org/10.1227/ons.0000000000001460","url":null,"abstract":"<p><strong>Background and objectives: </strong>Deep brain stimulation (DBS) is a well-established intervention for alleviating both motor and nonmotor symptoms of Parkinson disease. However, a common complication of stereotaxic DBS surgery is pneumocephalus, which can compromise electrode accuracy, complicate postoperative assessments, and negatively affect the long-term outcomes of DBS surgery. This report proposes a comprehensive and robust set of recommendations aimed at optimizing DBS surgical protocols to achieve zero pneumocephalus outcomes.</p><p><strong>Methods: </strong>A retrospective analysis was undertaken on 138 patients with Parkinson disease who underwent simultaneous bilateral stereotaxic DBS targeting either the subthalamic nucleus or the globus pallidus internus at a single institution. The study compared the pneumocephalus volume and postsurgical electrode tip displacement between the original surgical technique and a refined procedure that incorporated modified supine position, dural puncture, and liquid sealing.</p><p><strong>Results: </strong>With the implementation of the refined procedure, the volume of pneumocephalus significantly decreased from 14.40 ± 17.00 to 0.32 ± 1.02 mL, with 92.9% of patients showing no visible pneumocephalus or intracranial air less than 1 mL. In addition, the refined procedure was associated with less electrode tip displacement in the postoperative stage.</p><p><strong>Conclusion: </strong>The refined procedure effectively minimized the average pneumocephalus volume to approximately 0, and bilateral DBS electrodes exhibited enhanced stability during the postoperative stage.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933316","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":"Giant Brainstem Cavernoma in Children: Microsurgical Strategies and Neuroanatomical Implications: 2-Dimensional Operative Video.","authors":"Érico Samuel Gomes Galvão da Trindade, Talita Helena Martins Sarti, Luis Ángel Canache Jiménez, Erica Antunes Effgen, Mariano Teyssandier, Francisco Jose Luis de Sousa, Bruna Lisboa do Vale, Feres Chaddad-Neto","doi":"10.1227/ons.0000000000001490","DOIUrl":"https://doi.org/10.1227/ons.0000000000001490","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932530","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":"Intracranial Hypotension Mechanism and Implant Retention Procedure for Patients With Titanium Mesh Exposure.","authors":"Rui-Zhe Zheng, Zeng-Xin Qi, Li-Jian Lang, Wen-Tao Huang, Jia-Yu Chen, Tong-Ming Zhu, Xue-Hai Wu","doi":"10.1227/ons.0000000000001405","DOIUrl":"https://doi.org/10.1227/ons.0000000000001405","url":null,"abstract":"<p><strong>Background and objectives: </strong>The study aimed to investigate the potential pathogenesis and present an implant retention procedure for patients with titanium mesh exposure after cranioplasty.</p><p><strong>Methods: </strong>The clinical data were obtained from 26 consecutive cases with titanium mesh exposure who underwent surgical treatment between 2018 and 2023. These patients' medical records, scalp photographs, operative notes, and outcomes were retrospectively analyzed. In addition, a literature search was conducted for articles describing treatment strategies for titanium mesh exposure published within the past 10 years.</p><p><strong>Results: </strong>A total of 26 patients (15 males; mean age [±SD] 52.3 ± 15.0 years) underwent surgical treatment for titanium mesh exposure. Among the subset of patients with a history of ventriculoperitoneal shunt implantation (n = 10), low-pressure hydrocephalus was observed in 90% of cases. The pathogenesis of titanium mesh exposure can be categorized into 4 stages: ischemic stage, depletion stage, defect stage, and infection stage, with a median onset time of 392 days (range from 40 to 5114 days). Based on this, we introduce a novel technique of using a pedicled galea aponeurotica-periosteal flap in titanium mesh retention surgery for treating various types of skin defects. Consequently, 15 patients (57.8%) underwent this procedure and exhibited favorable wound healing over a follow-up period averaging at 640.4 ± 397.2 days (range 117-1573 days).</p><p><strong>Conclusion: </strong>Implant removal surgery is not the optimal choice for patients presenting with titanium mesh exposure after cranioplasty. The 4 stages of skin defect outlined in this study offer clinical guidance for managing cases of titanium mesh exposure, while highlighting intracranial hypotension as an underappreciated pathogenic factor. A pedicle galea aponeurotica-periosteal flap represents a valuable and versatile alternative for retaining the existing titanium mesh, as it ensures adequate blood supply and withstands pressure gradients.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932815","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 Treatment of a Recurrent Tentorial Dural Arteriovenous Fistula After Endovascular Embolization With Skeletonization of the Dural Venous Sinuses: 2-Dimensional Operative Video.","authors":"Sean M Himel, Taylor Orr, John E Dugan, Mustafa Motiwala, Adam Arthur, Nickalus R Khan","doi":"10.1227/ons.0000000000001496","DOIUrl":"https://doi.org/10.1227/ons.0000000000001496","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932780","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}