Acta neurochirurgica. Supplement最新文献

{"title":"Postoperative Intratumoral or Peritumoral Hematomas After Vestibular Schwannoma Resection.","authors":"Tetsuya Goto,&nbsp;Toshihiro Ogiwara,&nbsp;Kohei Kanaya,&nbsp;Ridzky Firmansyah Hardian,&nbsp;Yoshiki Hanaoka,&nbsp;Yu Fujii,&nbsp;Shunsuke Ichinose,&nbsp;Kazuhiro Hongo","doi":"10.1007/978-3-030-12887-6_7","DOIUrl":"https://doi.org/10.1007/978-3-030-12887-6_7","url":null,"abstract":"<p><strong>Background: </strong>Surgical removal of a vestibular schwannoma is a complex and challenging procedure, which may be complicated by development of postoperative hematomas, particularly after incomplete resection of the tumor.</p><p><strong>Objective: </strong>To investigate the occurrence of postoperative intra- or peritumoral hematomas after surgery for a vestibular schwannoma.</p><p><strong>Methods: </strong>This retrospective study evaluated 49 patients (age range 17-78 years) with a vestibular schwannoma, who were treated surgically via the lateral suboccipital approach between 2011 and 2016. The tumors ranged in size from 0 mm (in a case of an intracanalicular lesion) to 56 mm. In 30 cases (61%), total or near-total resection was accomplished, and in 19 cases (39%), subtotal or partial resection was done. On the basis of their bleeding tendency during tumor removal, the patients were divided into a \"less-bleeding\" (38 cases; 78%) and a \"more-bleeding\" (11 cases; 22%) subgroups.</p><p><strong>Results: </strong>A maximal vestibular schwannoma diameter >30 mm, patient age >60 years, and more bleeding during tumor removal were significantly associated with incomplete (subtotal or partial) resection. In six cases (12%), serial computed tomography after surgery demonstrated a postoperative hematoma, which was caused by insufficient irrigation of the surgical field (in two cases) or resulted from peritumoral hemorrhage (in two cases), intratumoral hemorrhage (in one case), or both intra- and peritumoral hemorrhage (in one case). The latter patient required urgent reoperation. In all cases, postoperative hematomas occurred after incomplete (subtotal or partial) resection of a vestibular schwannoma, and their development was significantly associated with more bleeding during tumor removal.</p><p><strong>Conclusion: </strong>For avoidance of postoperative hematomas, careful hemostasis is required after completion of vestibular schwannoma removal, especially in cases with incomplete resection and an excessive bleeding tendency of the tumor tissue.</p>","PeriodicalId":6913,"journal":{"name":"Acta neurochirurgica. Supplement","volume":"130 ","pages":"47-52"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9953595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Different Approaches in Skull Base Surgery Carry Risks for Different Types of Complications.","authors":"Joao Paulo Almeida,&nbsp;Miguel Marigil-Sanchez,&nbsp;Claire Karekezi,&nbsp;Ian Witterick,&nbsp;Fred Gentili","doi":"10.1007/978-3-030-12887-6_2","DOIUrl":"https://doi.org/10.1007/978-3-030-12887-6_2","url":null,"abstract":"<p><p>Complications are not uncommon in the complex field of skull base surgery. The intrinsic relationship of lesions in this region to important neurovascular structures, dura mater, and bone may lead to significant morbidity and mortality. The evolution of endoscopic endonasal surgery has had a significant impact on this field as a less invasive option for treatment of selected lesions, but major morbidity may still occur; moreover, endoscopic approaches have been associated with higher rates of some specific complications, such as cerebrospinal fluid leaks. Based on a presented case report, the authors discuss the management of various complications associated with different approaches for resection of skull base malignancies, including epidural and intradural pneumocephalus, subdural hematoma, and subdural empyema. Important lessons learned by the senior author throughout more than 30 years of his skull base surgery practice are highlighted. The inherent risk of complications in skull base surgery emphasizes the importance of their avoidance, prevention, and learning from one's unfavorable experience so as not to repeat them.</p>","PeriodicalId":6913,"journal":{"name":"Acta neurochirurgica. Supplement","volume":"130 ","pages":"13-18"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10325445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atlantoaxial Anterior Transarticular Screw Fixation: Indications and Surgical Technique.","authors":"Filippo Maria Polli, Alessandro Rapisarda, Sokol Trungu, Stefano Forcato, Nicola Montano, Francesco Signorelli, Massimiliano Visocchi, Alessandro Olivi","doi":"10.1007/978-3-031-36084-8_42","DOIUrl":"10.1007/978-3-031-36084-8_42","url":null,"abstract":"<p><p>Posterior atlantoaxial screw fixation is a widely adopted therapeutic option for C1-C2 instability secondary to fractures or dislocation, degenerative diseases, or tumors at this level. Anterior transarticular screw fixation (ATSF) is an effective alternative to the posterior approaches, presenting several advantages despite being scarcely known and rarely chosen.In this chapter, we describe the ATSF step by step, illustrating its variations reported in literature, and we critically analyze the several advantages and contraindications of this technique. Moreover, we provide a list of tips and tricks on the surgical procedure, including critical operating room settings-the result of more than 10 years of experience in the field by a senior author.ATSF is a valid strategy for the treatment of different diseases occurring at the level of the atlantoaxial complex that needs consideration. Given the significant learning curve of this strategy, some hints may be essential to begin introducing this technique in the personal armamentarium of a spine surgeon so that they can perform ATSF safely and effectively.</p>","PeriodicalId":6913,"journal":{"name":"Acta neurochirurgica. Supplement","volume":"135 ","pages":"273-277"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139048003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chiari Malformation Type 1 and Syringomyelia: Why Do Patients Claim for International Guidelines? Commentary on the 2021 Chiari and Syringomyelia Consensus Document.","authors":"Luca Massimi, Ignazio Gaspare Vetrano, Paola Peretta, Luisa Chiapparini, Veronica Saletti, Palma Ciaramitaro, Massimiliano Visocchi, Laura Grazia Valentini","doi":"10.1007/978-3-031-36084-8_23","DOIUrl":"10.1007/978-3-031-36084-8_23","url":null,"abstract":"<p><p>The diagnosis of Chiari malformation type 1 (CM1) and Syringomyelia (Syr) has become increasingly common during the past few years. Contemporarily, the body of literature on these topics is growing, although randomized controlled studies on significant case series to drive guidelines are missing in the pediatric and adult populations. As a result of the different opinions about surgical indications and techniques raised by CM1-Syr, an increasing number of well-informed but disoriented patients is emerging. To bridge this gap, an International Consensus Conference on CM1-Syr held in Milan in November 2019 aimed to find a consensus among international experts, to suggest some recommendations that, in the near future, could lead to guidelines. Here, we comment on the most relevant recommendations about the definition, diagnosis, surgical management, failures and re-intervention, and outcome. We also focus on some \"wrong\" indications or techniques that, although widely disapproved by the experts, and negatively experienced by many patients, are still largely in use.</p>","PeriodicalId":6913,"journal":{"name":"Acta neurochirurgica. Supplement","volume":"135 ","pages":"139-145"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139048006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation Between Cervical Spine Sagittal Alignment and Clinical Outcome After Standalone Intersomatic Titanium Cage CeSPACE for Cervical Anterior Discectomy and Fusion in Cervical Degenerative Disk Diseases.","authors":"R Zaccaria, F Cacciola, G Caruso, S Ferri, M Caffo, A Curcio, I Ghetti, A Germanò","doi":"10.1007/978-3-031-36084-8_55","DOIUrl":"10.1007/978-3-031-36084-8_55","url":null,"abstract":"<p><p>The aim of this study was to determine the relationship between cervical spine sagittal alignment and clinical outcomes after using a standalone intersomatic titanium cage CeSPACE for anterior cervical discectomy and arthrodesis. We present our clinical experience in a group of 180 patients with a mean follow-up for at least 2 years. Patients were evaluated by clinical and radiological assessment preoperatively, immediately after surgery and at regular follow-up. There were 97 male and 83 female patients (average age: 56.6 years) who were preoperatively affected by cervical radiculomyelopathy that was due to spondylosis or cervical disk herniation and who underwent surgical treatment. All patients underwent an anterior discectomy and interbody fusion through the positioning of one or more levels of the CeSPACE device. Compared with the preoperative scores, improvement was seen in postoperative visual analog scale (VAS) scores and Neck Disability Index (NDI) values. The standalone intersomatic titanium cage CeSPACE for anterior cervical discectomy and arthrodesis improved radiculomyelopathy and increased the probability of cervical kyphotic alignment. However, cervical sagittal alignment after surgery was not significantly associated with clinical outcomes in terms of postoperative improvement in VAS scores and NDI values. Similarly, the change in cervical sagittal alignment was not related to visual analog scale scores or Neck Disability Index values.</p>","PeriodicalId":6913,"journal":{"name":"Acta neurochirurgica. Supplement","volume":"135 ","pages":"361-366"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139048032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Far Lateral Approach: \"Trans-tumor Approach\" on Huge Dumbbell-Shape Neurofibroma of Anterior Foramen Magnum Without Craniectomy-Anatomical Consideration and New Trend.","authors":"Ibrahim Dao, Abdoulaye Sanou, Haoua Alzouma, Frédéric Bako, Yves Hema, Sylvain Delwendé Zabsonré, Abel Kabré","doi":"10.1007/978-3-031-36084-8_21","DOIUrl":"10.1007/978-3-031-36084-8_21","url":null,"abstract":"<p><p>The foramen magnum approach is always challenging because of the relationships between vital neurovascular structures in this area. Several approaches have been described, among them, the far lateral approach remains a cornerstone for the resection of anterior or anterolateral processes of the foramen magnum. This approach displays two main steps: the first is cervical, whereas the second is cranial.We report the case of a 63 year-old woman admitted for a progressive quadriplegia with swallowing disorders revealing a process of the anterior and anterolateral part of the foramen magnum. A cervical step of a far lateral approach without opening the foramen magnum achieved a near total resection of the process via a trans-tumor corridor and confirmed a dumbbell shape neurofibroma. The postoperative period showed a resolution of swallowing disorders and a progressive improvement of muscular strength. At 8 months follow-up, she was asymptomatic and able to walk with a normal balance. The surgical technique and anatomical correlation of this trans-tumor approach are discussed.</p>","PeriodicalId":6913,"journal":{"name":"Acta neurochirurgica. Supplement","volume":"135 ","pages":"125-130"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139048057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Image-Guided Surgery in Complex Skull Base and Facial Fractures: Initial Experience on the Role of Intra-Operative Computer Tomography.","authors":"Francesco Certo, Roberto Altieri, Salvatore Crimi, Giorgio Gurrera, Giacomo Cammarata, Massimiliano Visocchi, Alberto Bianchi, Giuseppe M V Barbagallo","doi":"10.1007/978-3-031-36084-8_11","DOIUrl":"10.1007/978-3-031-36084-8_11","url":null,"abstract":"<p><p>Surgery of fractures involving the skull base and the facial skeleton often presents challenges that should be addressed to prevent secondary brain injuries (i.e., cerebro-spinal fluid leak), preserve visual functioning, and guarantee a good esthetic result. Complex craniofacial reconstruction can be aided by navigation and pre-operative planning. In recent years, computerized planning of surgical reconstruction drastically increased the safety and efficacy of surgery, but the impact of intraoperative high quality image devices such as an intraoperative computed tomography (CT) scan has not been investigated yet. This case-control study reports the institutional preliminary experience of using intraoperative CT scans in the surgical management of complex cranio-facial fractures. The results in terms of accuracy of bony reconstruction and neurological or surgical complications have been analyzed in 12 consecutive patients treated with (6 cases) or without (6 cases) i-CT. Comparative analysis demonstrated a greater accuracy of reconstruction in patients treated with the assistance of i-CT. Intraoperative CT is a useful tool with a promising role in a multidisciplinary surgical approach to complex cranio-facial surgery.</p>","PeriodicalId":6913,"journal":{"name":"Acta neurochirurgica. Supplement","volume":"135 ","pages":"61-67"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139048060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally Invasive Instrumentation of the Cervical Spine: Past, Present, and Future.","authors":"Sara Lener, Anto Abramovic, Anna Lang, Claudius Thomé, Sebastian Hartmann","doi":"10.1007/978-3-031-36084-8_38","DOIUrl":"10.1007/978-3-031-36084-8_38","url":null,"abstract":"<p><p>Posterior cervical instrumentation and fusion procedures are becoming more and more common with the aging population and rising numbers of multisegmental and revision procedures. The instrumentation of the cervical spine has so far been performed almost exclusively via open approaches. Over the past two decades, minimally invasive surgery (MIS) techniques have gained increasing popularity. To date, only a few attempts to instrument the cervical spine in a minimally invasive fashion have been reported. The following article, after a detailed review of the currently available literature, overviews MIS in dorsal cervical instrumentation and past, present and future techniques, and it discusses the current limitations. Nevertheless, and because of the multiple advantages of MIS instrumentation, a lot of work remains to be carried out to fully establish MIS procedures for posterior cervical instrumentation.</p>","PeriodicalId":6913,"journal":{"name":"Acta neurochirurgica. Supplement","volume":"135 ","pages":"247-251"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139048078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuronavigated Retropharyngeal Anterior Screw Fixation of the Odontoid for the Treatment of C2 Type II Fractures: Case Report.","authors":"S Ferri, F Cacciola, R Zaccaria, I Ghetti, A Curcio, Antonino Francesco Germanò","doi":"10.1007/978-3-031-36084-8_43","DOIUrl":"10.1007/978-3-031-36084-8_43","url":null,"abstract":"<p><p>Odontoid fractures, frequently observed in patients over the age of 70, often involve the base of the axis (Anderson-D'Alonzo type 2). For surgical treatment, posterior C1-C2 fixation is the traditional method, whose fusion rates range between 93 and 100%. However, morbidity and mortality rates are high. In addition, cervical motion, especially axial rotation, is postoperatively reduced. Nakanishi and Bohler introduced the anterior screw fixation approach for the surgical treatment of odontoid fracture type II. This procedure preserves the atlantoaxial complex motion, provides immediate stability and high fracture healing rates, and, most importantly, has a low incidence of complications with good fusion rates. The surgical strategy must take into account the patient's anatomy, the morphological characteristics of the fracture, the quality of the bone, and any concomitant injuries. In this chapter, we describe a C2 type II fracture treated via a neuronavigated anterior retropharyngeal approach.</p>","PeriodicalId":6913,"journal":{"name":"Acta neurochirurgica. Supplement","volume":"135 ","pages":"279-282"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139048081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nuance in Craniovertebral Junction Surgical Approach for Posterior C1-C2 Harms Stabilization: \"Window Transposition\" of the External Vertebral Venous Plexus for Bloodless C1 Lateral Mass Screw Insertion: Anatomical Aspects and Technical Notes.","authors":"Vito Fiorenza, Francesco Ascanio, Lara Brunasso, Benedetto Lo Duca, Anna Maria Fimognari, Luisa Grippi, Evier Andrea Giovannini, Rosario Maugeri, Domenico Gerardo Iacopino","doi":"10.1007/978-3-031-36084-8_47","DOIUrl":"10.1007/978-3-031-36084-8_47","url":null,"abstract":"<p><p>Atlas and axis instrumentation may be necessary in cases of several craniocervical junction pathologies. According to the Harms technique, C1-C2 polyaxial screws are inserted respectively in the C1 lateral masses and in C2 pedicles. C1 lateral mass screw insertion requires the careful subperiosteal dissection of the posterior elements of C1, the identification of the screw entry point by the downward distraction of C2 nerve root, and the cautious sparing of the overlying posterior external vertebral venous plexus (peVVP), whose bleeding, obstructing the surgical field, is sometimes barely controlled by hemostatic agents and swabbing. The authors describe in detail the anatomical aspects of an alternative surgical technique developed for the microsurgical transposition of the C1-C2 interposed external vertebral venous plexus in the case of Harms C1-C2 screw stabilization. The longitudinal median incision of the atlantoaxial membrane, followed by bilateral subperiosteal dissection and microsurgical section respectively at the inferior borders of the C1 laminae and at the superior borders of the C2 laminae, allows, as a \"window opening,\" the symmetrical mediolateral transposition of the peVVP. This procedure provides a faster and cleaner anatomical exposition of the posterior surface of the C1 lateral mass and the C2 isthmus, preventing troublesome intraoperative venous bleeding that hinders C1 lateral mass screw insertion.</p>","PeriodicalId":6913,"journal":{"name":"Acta neurochirurgica. Supplement","volume":"135 ","pages":"307-313"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139048084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}