Operative Neurosurgery最新文献

{"title":"Feasibility of Robotic Transorbital Surgery.","authors":"Min Ho Lee, Limin Xiao, Juan C Fernandez-Miranda","doi":"10.1227/ons.0000000000001321","DOIUrl":"https://doi.org/10.1227/ons.0000000000001321","url":null,"abstract":"<p><strong>Background and objectives: </strong>The transorbital approach (TOA) facilitates access to pathologies lateral to the optic nerve, a region that is difficult to access with an endonasal approach. In this study, we sought to investigate the feasibility of robotic-assisted surgery in lateral TOA.</p><p><strong>Methods: </strong>Six colored-silicon-injected human postmortem heads were prepared for dissection. The DaVinci Xi model was used with a 0-degree camera, 8 mm in diameter. A black diamond microforceps with an 8-mm diameter and 10-mm jaw length was used. The entry point of V1 (superior orbital fissure), V3 (foramen ovale), and posterior root of the trigeminal ganglion were chosen as the surgical targets. The length from the entry opening to each target point was measured. The angles formed between pairs of target points were measured to obtain the horizontal angle (root of the trigeminal ganglion-entry-V1) and the vertical angle (root of the trigeminal ganglion-entry-V3).</p><p><strong>Results: </strong>Dissection was performed on 12 sides (6 specimens). The median distance from the entry point was 55 mm (range 50-58 mm) to the entry point of V1 (superior orbital fissure), 65 mm (range 57-70 mm) to the entry point of V3 (foramen ovale), and 76 mm (range 70-87 mm) to the root of the trigeminal ganglion. Meanwhile, the median of surgical angle between the entry point and the target was 19.1° (range 11.8-30.4°) on the horizontal angle and 16.5° (range 6.2-21.6°) on the vertical angle.</p><p><strong>Conclusion: </strong>This study found that application of lateral TOA in robotic-assisted surgery is premature because of the large size of the tool. However, although the entrance in lateral TOA is narrow, the internal surgical space is wide; this offers potential for design of appropriate surgical tools to allow increase tool usage.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114763","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":"Posterior Release, Reduction, and Intra-Articular Fusion for Irreducible Type III Atlantoaxial Rotary Fixation.","authors":"Ji Wu, Yang Li, Wenxiang Chu, Fei Chen, Zhenji Xu, Yiyang Ding, Bin Ni, Xuhua Lu, Qunfeng Guo","doi":"10.1227/ons.0000000000001347","DOIUrl":"https://doi.org/10.1227/ons.0000000000001347","url":null,"abstract":"<p><strong>Background and objectives: </strong>For irreducible atlantoaxial rotary fixation (AARF), anterior or posterior release was often needed before posterior reduction and fusion. Anterior atlantoaxial joint release has potential complications such as retropharyngeal abscess, persistent hoarseness, and infection. This study aims to assess the efficacy of posterior release, reduction, and intra-articular fusion without resecting the C2 nerve root on irreducible type III AARF.</p><p><strong>Methods: </strong>The data of 9 pediatric patients diagnosed with AARF who underwent posterior atlantoaxial release, reduction, and intra-articular fusion without resecting the C2 nerve root were retrospectively reviewed. Japanese Orthopaedic Association scores and Visual Analog Scale for Neck Pain were used to assess outcomes. The preoperative and follow-up assessments of atlantodens interval (ADI) were documented to evaluate the reduction of atlantoaxial joint. The patient demographics, surgery time, blood loss, bone fusion time, follow-up period, and surgery-related complications were meticulously documented.</p><p><strong>Results: </strong>The mean follow-up duration was 35.1 ± 11.5 months. Complete reduction was achieved in 8 patients, while one patient did not achieve complete reduction. The ADI decreased significantly from 8.7 ± 2.2 mm before surgery to 2.1 ± 1.3 mm at the final follow-up. All patients demonstrated successful bone fusion, with an average fusion period of 3.7 ± 1.3 months. The Visual Analog Scale for Neck Pain at the final follow-up exhibited a significant decrease compared with preoperative values (P < .05), while no significant difference was observed in Japanese Orthopaedic Association scores. There were no complications related to surgery.</p><p><strong>Conclusion: </strong>Posterior atlantoaxial release, reduction, and intra-articular fusion with a C2 nerve root preservation technique is effective in the treatment of irreducible type III AARF.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114764","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":"Ruptured Perinidal Aneurysm Clipping and Spinal Arteriovenous Malformation Resection: 2-Dimensional Operative Video.","authors":"Otavio F De Toledo, Manuel F Granja, Gustavo Maldonado Cortez, Salvador F Gutierrez-Aguirre, Amin Aghaebrahim, Eric Sauvageau, Ricardo A Hanel","doi":"10.1227/ons.0000000000001345","DOIUrl":"https://doi.org/10.1227/ons.0000000000001345","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114765","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":"https://doi.org/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":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-08-29","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":"Transoral Approach for Ruptured Anterior Spinal Artery Aneurysm at the Cervicomedullary Junction: 2-Dimensional Operative Video.","authors":"Tatiana Abou-Mrad, Morteza Sadeh, Laura Stone McGuire, Ashleigh Weyh, Nicholas Callahan, Gursant Singh Atwal","doi":"10.1227/ons.0000000000001353","DOIUrl":"https://doi.org/10.1227/ons.0000000000001353","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114767","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":"Bilateral Optic Canal Decompression and Skull Base Resection During Transbasal Approach for Total Excision of Tuberculum Meningioma: 2-Dimensional Operative Video.","authors":"Jeremy Kam, Mendel Castle-Kirszbaum, Michael Rizzuto, David Chi Hau Tan, Serge Makarenko, Peter Gooderham, Ryojo Akagami","doi":"10.1227/ons.0000000000001343","DOIUrl":"https://doi.org/10.1227/ons.0000000000001343","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142074542","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 of Anterior Communicating Artery Aneurysm Compressing the Optic Chiasm Causing Visual Field Deficits: 2-Dimensional Operative Video.","authors":"Guilherme J Agnoletto, Farshad Nassiri, Vance Mortimer, William T Couldwell","doi":"10.1227/ons.0000000000001342","DOIUrl":"https://doi.org/10.1227/ons.0000000000001342","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142074543","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":"Open Versus Endoscopic Approach for Thoracic Disk Herniations: Equivalent Short-Term Outcomes With Significantly Different Costs.","authors":"Campbell Liles, Hani Chanbour, Omar Zakieh, Keyan Peterson, Robert J Dambrino, Iyan Younus, Soren Jonzzon, Richard A Berkman, Julian G Lugo-Pico, Amir M Abtahi, Byron F Stephens, Scott L Zuckerman, Raymond J Gardocki","doi":"10.1227/ons.0000000000001325","DOIUrl":"https://doi.org/10.1227/ons.0000000000001325","url":null,"abstract":"<p><strong>Background and objectives: </strong>Open thoracic diskectomy often requires significant bone resection and fusion, whereas an endoscopic thoracic diskectomy offers a less invasive alternative. Therefore, we sought to compare one-level open vs endoscopic thoracic diskectomy regarding (1) perioperative outcomes, (2) neurological recovery, and (3) total cost.</p><p><strong>Methods: </strong>A single-center, retrospective, cohort study using prospectively collected data of patients undergoing one-level thoracic diskectomy was undertaken from 2018 to 2023. The primary exposure variable was open vs endoscopic. The primary outcome was perioperative outcomes and neurological recovery. Secondary outcomes were total cost of care. Multivariable regression analysis controlled for age, body mass index, sex, symptom onset, disk characteristics, operative time, and length of stay.</p><p><strong>Results: </strong>Of 29 patients undergoing thoracic diskectomy, 17 were open and 12 were endoscopic. Preoperative demographics, symptoms, and radiographic findings were comparable between the cohorts. Perioperatively, open surgery had significantly higher mean length of stay (4.9 ± 1.5 vs 0.0 ± 0.0 days, P < .001), median (IQR) longer operative time (342.8 [68.4] vs 141.5 [36] minutes, P < .001), and more blood loss (350 [390] vs 6.5 [20] mL; P < .001). 16 (94%) open patients required fusion vs 0 endoscopic (P < .001). Postoperative opioid use (P = .119), readmission (P = .665), reoperation (P = .553), and rate of neurological improvement (P > .999) were similar between the 2 groups. Financially, open surgical median costs were 7x higher than endoscopic ($59 792 [$16 118] vs $8128 [$1848]; P < .001), driven by length of stay (β = $2261/night, P < .001), open surgery (β = $24 106, P < .001), and number of pedicle screws (β = $1829/screw, P = .002) on multivariable analysis. On sensitivity analysis, open surgery was never cost-efficient against endoscopic surgery and excess endoscopic revision rates of 86% above open revision rates were required for break-even costs between the surgical approaches.</p><p><strong>Conclusion: </strong>Endoscopic thoracic diskectomy was associated with decreased length of stay, operative time, blood loss, and total cost compared with the open approach, with similar neurological outcomes. These findings may help patients and surgeons seek endoscopic approach as a less morbid and less costly alternative.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142074454","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 Invasive Anterolateral Cervical Cordotomy for Intractable Cancer Pain Using Microtubular Retractors: A Single Institution Case Series.","authors":"Gil Kimchi, Layton Lamsam, Brett Gu, Ehud Mendel, Ran Harel, Nachson Knoller, Zvi R Cohen, Lior Ungar, Zion Zibly","doi":"10.1227/ons.0000000000001326","DOIUrl":"https://doi.org/10.1227/ons.0000000000001326","url":null,"abstract":"<p><strong>Background and objectives: </strong>As advancements in cancer treatments have allowed patients with a high burden of disease to live longer, the number of patients who present with debilitating refractory pain has increased. Anterolateral cordotomy has long been used for the treatment of intractable unilateral cancer pain using either an imaging-guided percutaneous approach or an open surgical approach. In this report, we describe a novel minimally invasive modification to the open surgical approach. It combines the benefits of both approaches by providing direct visualization for lesioning without the collateral tissue damage of an open approach.</p><p><strong>Methods: </strong>This retrospective study evaluated medical records, operative reports, and imaging studies of patients who underwent a minimally invasive cordotomy at a single institute between 2018 and 2022. The surgical technique involved a microscope-assisted C2 hemilaminectomy using microtubular retractors followed by dural opening and anterolateral cordotomy under direct visualization and with intraoperative neurophysiological monitoring.</p><p><strong>Results: </strong>Eleven patients were included in the study. None were converted to an open approach, and no wound-related postoperative complications were observed. A clinically significant decrease in pain was observed after the procedure, and 10 of the 11 patients (91%) were ambulatory by the time of analysis.</p><p><strong>Conclusion: </strong>Compared with image-guided percutaneous cordotomy, anterolateral cervical cordotomy with microtubular retractors potentially improves the safety of the procedure through direct visualization while being less invasive than a conventional open approach. Our preliminary experience with this technique demonstrates the feasibility of the approach, as it was both safe and effective.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142074453","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":"Carotid Plexus Sympathetic Nerves as a Landmark for the Abducens Nerve Within the Cavernous Sinus During Endoscopic Endonasal Surgery: Cadaveric Anatomic Study and Surgical Consideration.","authors":"I-Sorn Phoominaonin, Andres Felipe Vargas Rosales, Garret W Choby, Eric W Wang, Georgios A Zenonos, Carl H Snyderman, Paul A Gardner","doi":"10.1227/ons.0000000000001334","DOIUrl":"https://doi.org/10.1227/ons.0000000000001334","url":null,"abstract":"<p><strong>Background and objectives: </strong>The abducens nerve (CN VI) is vulnerable to injury during endoscopic endonasal transcavernous surgery. In this study, the authors aimed to develop the surgical anatomic landmark and explore the relationship between the sympathetic nerves (SNs) around the internal carotid artery (ICA) and CN VI within the cavernous sinus (CS).</p><p><strong>Methods: </strong>The relationship and patterns between the SNs and CN VI were investigated in 15 cadaveric specimens. The intraoperative examples of anatomic landmark were presented.</p><p><strong>Results: </strong>There were SNs around the ICA running into the CN VI, classified into ascending SNs and accessory sympathetic branches. The ascending SNs were divided into 3 types: (1) Type I had a single ascending SN. There were 2 subtypes of Type I (Type IA [17/30, 56.7%] was defined as a single ascending branch that ran into the CN VI, and Type IB [4/30, 13.3%] was defined as a single ascending branch with a terminal bifurcation before merging into the CN VI or lateral CS wall), (2) Type II (7/30, 23.3%) was defined as 2 ascending branches that ran into the CN VI and the lateral CS wall, and (3) Type III (2/30, 6.7%) was defined as 3 ascending branches that ran into the CN VIs and the lateral wall of the CS. The accessory branches of the SNs were defined by sympathetic branches from the posterior genu or horizontal ICA and found in 6/30 sides (20%).</p><p><strong>Conclusion: </strong>The authors propose a classification of the relationship between paraclival ICA SNs and the CN VI within the CS, as approached during endoscopic endonasal surgery. The consistent relationship of the ascending SN and CN VI within the CS provides a reliable anatomic landmark during the endonasal approach to the CS.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057232","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}