Operative Neurosurgery最新文献

{"title":"Spinal Anesthesia for Multilevel Awake Minimally Invasive Transforaminal Lumbar Interbody Fusion: Single-Center Experience.","authors":"Juan P Navarro-Garcia de Llano, Macarena Fuentes-Fernandez Cueto, Andrew P Roberts, Jesus E Sanchez-Garavito, Siddharth Shah, Gaetano De Biase, Harshvandan Iyer, Ogechuku Ariwodo, Loizos Michaelides, Jennifer S Patterson, Kate E White, Elird Bojaxhi, Rodrigo Navarro-Ramirez, Ian A Buchanan, Alfredo Quinones-Hinojosa, Kingsley O Abode-Iyamah","doi":"10.1227/ons.0000000000001380","DOIUrl":"https://doi.org/10.1227/ons.0000000000001380","url":null,"abstract":"<p><strong>Background and objectives: </strong>Awake minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) generates minimal surrounding tissue damage and has been shown to be a safe, time-effective, and cost-reductive technique in single-level procedures. The purpose of this study was to advocate for the utilization of multilevel MIS-TLIF even in challenging cases as it has demonstrated positive outcomes.</p><p><strong>Methods: </strong>Chart review was conducted for consecutive patients undergoing awake multilevel MIS-TLIF from 2020 to 2023. Various demographic, preoperative, and postoperative variables were collected and descriptively analyzed.</p><p><strong>Results: </strong>Sixteen patients underwent multilevel awake MIS-TLIF at our institution during the specified period. Among them, 87.5% underwent a two-level procedure and 12.5% a three-level procedure. The median age ± IQR was 69.5 ± 11 years, with a slight male predominance (56.25%). Common comorbidities included hypertension (56.25%), obesity (37.5%), sleep apnea (25%), and type 2 diabetes (18.75%). The American Society of Anesthesiologists risk was 2 in 43.75% of patients and 3 in 56.25%. All patients presented pain, and 12.5% showed motor deficit. Intraoperative data showed a median of 196 minutes in the operating room where 156 ± 27.75 minutes corresponded to actual procedure time. The median estimated blood loss was 50 ± 70 cc. In the immediate postoperative period, 1 patient had nausea and emesis, and 1 reported fatigue. The median pain score during this period was 4.6 ± 2.03. Pain control medications were required for various patients, with methocarbamol (50%), hydromorphone (37.5%), and oxycodone (25%) being the most commonly prescribed in the postanesthesia care unit. No patient had new neurological deficits after the surgical intervention. The median length of stay was 2 days ±1.25. All patients were discharged with no complications.</p><p><strong>Conclusion: </strong>Multilevel awake MIS-TLIF emerges as a safe and effective technique for complex cases, enhancing patient quality of life with minimal blood loss and postoperative pain.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332316","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 Standardized Approach to MRI-Guided Stereotactic Laser Corpus Callosotomy: Technical Description and Pediatric Case Series.","authors":"Timothy J Kaufmann, Vance T Lehman, Jamie J Van Gompel, Lily C Wong-Kisiel, Kai J Miller","doi":"10.1227/ons.0000000000001361","DOIUrl":"https://doi.org/10.1227/ons.0000000000001361","url":null,"abstract":"<p><strong>Background and objectives: </strong>Corpus callosotomy is an effective procedure approach for treating medication-resistant drop seizures, which pose a significant challenge in patients with epilepsy. Laser interstitial thermal therapy offers an alternative to open surgery for performing corpus callosotomy that may limit approach-related comorbidities. Practices vary regarding the number of laser filaments used and staging; outcome data for pediatric patients remain relatively limited.</p><p><strong>Methods: </strong>We illustrate a set of 4 standardized trajectories for performing MRI-guided stereotactic laser corpus callosotomy (SLCC). For this retrospective cohort study in a pediatric neurosurgery practice, the medical records and imaging were reviewed for 10 consecutive patients who had medication-refractory drop seizures and underwent SLCC. Data collected and analyzed included patient and epilepsy characteristics, procedural details, surgical approaches, and clinical follow-up results.</p><p><strong>Results: </strong>Over 2 years, complete, single-stage SLCC was performed in 8 patients, and posterior completion SLCC was performed in 2 patients who had previously had open anterior corpus callosotomy. Four laser fibers were used in four-eighth complete SLCC, and 3 fibers were used in four-eighth complete SLCC. Seven of 10 patients were discharged from the hospital on postoperative day 1, with only 1 requiring a maximum stay of 6 days. Five of 9 evaluable patients reported no drop seizures at the last clinical follow-up. In the other 4 patients, 1 experienced them only rarely, another experienced less than 25% preoperative frequency, and the remaining 2 had less than a 50% improvement. In addition, improvement in other seizure types exceeded 50% in 8 of 9 patients. Notably, no perioperative or postoperative complications were observed, nor were there any sustained neurological deficits reported.</p><p><strong>Conclusion: </strong>Complete SLCC can be safely and effectively performed in pediatric patients. It is comparable in effectiveness with open surgery but has lower complication rates and shorter hospitalization.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332307","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 \"Onion-Peeling\" Technique for Resection of Shamblin Grade III Succinate Dehydrogenase Carotid Body Paraganglioma: 2-Dimensional Operative Video.","authors":"Arevik Abramyan, Evgenii Belykh, Priyank Khandelwal, Rachel Kaye, Richard Chan Woo Park, James K Liu","doi":"10.1227/ons.0000000000001360","DOIUrl":"https://doi.org/10.1227/ons.0000000000001360","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332312","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 Clipping of a Type B Ophthalmic Artery Aneurysm Through a Cranio-Orbital Approach With Extradural Clinoidectomy: 2-Dimensional Operative Video.","authors":"John E Dugan, Sean M Himel, Kara A Parikh, Adam S Arthur, Nickalus R Khan","doi":"10.1227/ons.0000000000001386","DOIUrl":"https://doi.org/10.1227/ons.0000000000001386","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332313","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":"Brain Stiffness Correlates With Pathological Tissue in Patients With Drug-Resistant Epilepsy Due to Rasmussen Encephalitis and Focal Cortical Dysplasia.","authors":"Tristan Brunette-Clément, Julia W Chang, Geoffrey C Owens, Aristides Hadjinicolaou, Alexander G Weil, Aria Fallah","doi":"10.1227/ons.0000000000001387","DOIUrl":"https://doi.org/10.1227/ons.0000000000001387","url":null,"abstract":"<p><strong>Background and objectives: </strong>Complete resection of epileptogenic zone is the single most important determinant of favorable seizure outcomes in resective surgery. However, identifying and resecting this zone is challenging in patients harboring diffuse; MRI-occult malformations of cortical development, such as focal cortical dysplasia; or acquired pathology, such as Rasmussen encephalitis. Intraoperative adjuncts that can aid in identifying the lesion and/or epileptogenic zone can optimize the extent of resection and seizure outcome. We sought to study a novel intraoperative tool, brain tonometer, to measure brain stiffness and correlate with histopathological and radiological findings.</p><p><strong>Methods: </strong>Brain stiffness was measured at various presumed normal and abnormal areas of the cortex during surgery in 2 patients with drug-resistant epilepsy. These results were correlated with preoperative and intraoperative neuroimaging and histopathology.</p><p><strong>Results: </strong>We found brain stiffness correlated well with the degree of inflammation and cortical disorganization.</p><p><strong>Conclusion: </strong>Brain tonometry may help to intraoperatively identify inflammatory brain tissue along with structural and histopathological abnormalities. In select cases, this could potentially allow more tailored resections of the underlying lesion, to ensure complete removal of the epileptogenic lesion and improve the probability of achieving seizure freedom, while sparing normal brain leading to better functional outcomes.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332308","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":"Neurosurgical Residency Training at Veterans Affairs Medical Centers, the Resident Perspective.","authors":"Alexander G Yearley, Marcelle Altshuler, Ruchit V Patel, Jacob R Rachlin, Michael A Mooney","doi":"10.1227/ons.0000000000001390","DOIUrl":"https://doi.org/10.1227/ons.0000000000001390","url":null,"abstract":"<p><strong>Background and objective: </strong>Department of Veteran's Affairs (VA) Medical Centers play a crucial role in training neurosurgery residents. Although previous studies have examined the impact of VA rotations from the attending perspective, the resident experience remains unexplored. We present a national survey of neurosurgery residents to assess their perceptions of VA rotations, focusing on operative experience, call burden, longitudinal patient care experiences, and overall strengths and limitations.</p><p><strong>Methods: </strong>A 33-question survey was distributed by email to all neurosurgery residents who had previously completed a VA rotation within the past 7 years.</p><p><strong>Results: </strong>Responses were received from 77 residents, representing 36 out of 40 neurosurgical residency programs with an active VA rotation. Most residents (79.2%) found their VA rotations adequate in length, having spent a median of 5 months at the VA. Residents completed an average of 11.7 (SD 7.2) cases per month while at the VA, including 8.9 (SD 5.5) spine, 1.7 (SD 2.0) cranial, and 1.4 (SD 1.6) peripheral nerve cases. Many residents reported completing a greater proportion of spine and peripheral nerve cases at the VA compared with their primary clinical sites. Across all postgraduate years, residents felt that the VA offered increased operative autonomy (79.0% agreement) at the expense of total operative volume (98.7% agreement) and complexity (81.9% agreement). Importantly, 94.8% of residents participated in longitudinal patient care experiences, and 59.7% followed all patients longitudinally.</p><p><strong>Conclusion: </strong>The resident experience at the VA varies, presenting both strengths and limitations. Addressing these factors could enhance the overall effectiveness of VA rotations in neurosurgical training programs in the future.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332314","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":"Repair of a Delayed, Atypical, Post-Traumatic Ventrolateral Dural Defect of the Cervicothoracic Spine: 2-Dimensional Operative Video.","authors":"Thomas Tyler Patterson, Michael Gaub, Grant W Mallory, Cristian Gragnaniello","doi":"10.1227/ons.0000000000001359","DOIUrl":"https://doi.org/10.1227/ons.0000000000001359","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300829","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 Resection of a Left Eloquent Arteriovenous Malformation Presenting With Papilledema: 3-Dimensional Operative Video.","authors":"Spyridon K Karadimas, Cybele C Woon, Timo Krings, Sunil A Sheth, Jacques J Morcos","doi":"10.1227/ons.0000000000001389","DOIUrl":"https://doi.org/10.1227/ons.0000000000001389","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300825","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 Resection of a Tectal Plate Arteriovenous Malformation: 2-Dimensional Operative Video.","authors":"Abhidha Shah, Ravikiran Vutha, Atul Goel","doi":"10.1227/ons.0000000000001378","DOIUrl":"https://doi.org/10.1227/ons.0000000000001378","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300826","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 Acute Iatrogenic Cerebrovascular Injury Using Flow Diverter Stents.","authors":"Eric A Grin, Svetlana Kvint, Eytan Raz, Maksim Shapiro, Vera Sharashidze, Jacob Baranoski, Charlotte Chung, Ayaz Khawaja, Donato Pacione, Chandra Sen, Caleb Rutledge, Howard A Riina, Peter K Nelson, Erez Nossek","doi":"10.1227/ons.0000000000001379","DOIUrl":"https://doi.org/10.1227/ons.0000000000001379","url":null,"abstract":"<p><strong>Background and objectives: </strong>Iatrogenic cerebrovascular injury can cause intracranial hemorrhage and pseudoaneurysm formation, putting patients at high risk for postoperative bleeding. No consensus for management exists. This study describes endovascular treatment of these acute injuries with flow diverter stents.</p><p><strong>Methods: </strong>Electronic medical records were retrospectively reviewed for injury type and etiology, timing of diagnosis, and endovascular management, including antiplatelet regimens, embolization results, and clinical outcome.</p><p><strong>Results: </strong>Six patients were included. Three suffered an injury to the internal carotid artery, 1 suffered an injury to the left anterior cerebral artery, 1 suffered an injury to the right posterior cerebral artery, and 1 suffered an injury to the basilar artery. Four of the 6 injuries occurred during attempted tumor resection, 1 occurred during cerebrospinal fluid leak repair, and 1 occurred during an ophthalmic artery aneurysm clipping. All injuries resulted in pseudoaneurysm formation. Four were immediately detected on angiography; 2 were initially negative on imaging. Five were treated with a pipeline embolization device, and 1 was treated with a Silk Vista Baby. Two were treated with 2 pipeline embolization devices telescopically overlapped across the pseudoaneurysm. All devices deployed successfully. No pseudoaneurysm recurrence or rebleeding occurred. No parent artery occlusion or stenosis was observed, and complete pseudoaneurysm occlusion was observed in 4 patients (in 2 patients, follow-up imaging could not be obtained).</p><p><strong>Conclusion: </strong>With proper antiplatelet regimens, flow diverter stents can be used safely to successfully treat complex acute iatrogenic injuries. Early repeat angiogram is needed when immediate postinjury imaging does not discover the point of vessel injury.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300832","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}