Acta neurochirurgica. Supplement最新文献

{"title":"New Trend in Craniovertebral Junction Surgical Strategy: Technical Note for the Treatment of Hangman's Fractures Through a Minimally Invasive Approach.","authors":"Silvana Tumbiolo, Maria Cristina Lombardo, Simona Porcaro, Alessandro Adorno, Giuseppe La Fata, Costanzo Tiziana, Lara Brunasso, Saverio Paolini, Massimiliano Visocchi, Domenico Gerardo Iacopino, Rosario Maugeri","doi":"10.1007/978-3-031-36084-8_44","DOIUrl":"10.1007/978-3-031-36084-8_44","url":null,"abstract":"<p><strong>Introduction: </strong>The reduction, stabilization, and maintenance of alignment are the main goals in the surgical treatment of unstable hangman's fractures. The choice of the surgical strategy remains poorly standardized; anterior and/or posterior fusion could be performed; and none of the available clinical studies in the literature have shown significant differences in outcomes or complication rates. Vertebral anatomy, age, comorbidities, patient factors, and surgical experience may guide the treatment choice.</p><p><strong>Methods: </strong>We present a case of a polytraumatized young woman with an unstable hangman's fracture type II, according to Levine-Edwards classification. We treated the fracture by using a plate with four holes to fix C2-C3 without discectomy and body fusion.</p><p><strong>Results: </strong>We performed a small incision, such as those used for the fixation of odontoid screws, where the working angle allowed us to easily and quickly position the plate by using a minimally invasive approach.</p><p><strong>Conclusion: </strong>The stabilization alone, without discectomy and body fusion with the cage, in the same way favored the natural healing of the bone fracture. In our opinion, in some select cases, fixation of C2-C3 alone through a minimally invasive approach allows for bone healing with fewer risks and an easier surgery.</p>","PeriodicalId":6913,"journal":{"name":"Acta neurochirurgica. Supplement","volume":"135 ","pages":"283-289"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139048082","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":"Spinal Dural Arteriovenous Fistulas: A Retrospective Analysis of Prognostic Factors and Long-Term Clinical Outcomes in the Light of the Recent Diagnostic and Technical Refinements.","authors":"Carmelo Lucio Sturiale, Anna Maria Auricchio, Iacopo Valente, Rosario Maugeri, Alessandro Pedicelli, Massimiliano Visocchi, Alessio Albanese","doi":"10.1007/978-3-031-36084-8_35","DOIUrl":"10.1007/978-3-031-36084-8_35","url":null,"abstract":"<p><p>Spinal dural arteriovenous fistulas (dAVFs) are abnormal connections between the meningeal branches of segmental arteries and a radiculomedullary veins that result in a progressive myelopathy thanks to perimedullary coronal venous plexus congestion. Usually, dAVFs show nonspecific symptoms, thus leading to late clinical suspicion and a difficult MRI diagnosis.Several authors have tried to identify prognostic factors before treatment, but published studies results are often inconsistent and sometimes contradictory.In this study, we reviewed our recent experience of 30 dAVF patients where we collected all demographic, clinical and angioarchitectural features as well as radiological and treatment-related characteristics. The thoracic spine was the most common location, constituting 53.3% of cases, followed by the lumbar roots, comprising 30%. About 83% of patients showed motor deficits, urinary disturbances were present in 70%, and bowel symptoms in 50%.We treated 86.7% of patients with microsurgery and 13.3% with endovascular occlusion with a mean interval between clinical onset and intervention of 10.8 ± 14.2 months.A significant clinical improvement was observed at follow-up in 80% of patients, with a significant reduction in mean G-score, U-score and F-score at a mean follow-up of 105.89 ± 191.9 months.However, none among the principal demographic, clinical and radiological characteristics showed significant prognostic value to the clinical improvement observed at follow-up.</p>","PeriodicalId":6913,"journal":{"name":"Acta neurochirurgica. Supplement","volume":"135 ","pages":"223-230"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139048101","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":"The Funnel: From the Skull Base to the Sacrum. New Trends and Technologies in Anaesthesia for the Adult Patient.","authors":"F Tosi, R Festa, Massimiliano Visocchi, R Garra","doi":"10.1007/978-3-031-36084-8_8","DOIUrl":"10.1007/978-3-031-36084-8_8","url":null,"abstract":"<p><p>The management of children affected by neurosurgical pathologies is multidisciplinary and should be set on several fronts.The potential need for massive blood components transfusions, the prolonged anaesthesia in paediatric age that may be often complicated by various forms of syndrome-related problems, and airway management are often encountered.The problems may be divided schematically into three large groups: preoperative, intraoperative and postoperative problems.The aim of this work is to optimize and make paediatric neurosurgery safe by highlighting the most important aspects in the various perioperative phases.</p>","PeriodicalId":6913,"journal":{"name":"Acta neurochirurgica. Supplement","volume":"135 ","pages":"39-43"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139048108","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":"Tools and Modalities for Postural Ergonomics Research in Surgery and Neurosurgery.","authors":"Georgios Mavrovounis, Torstein R Meling, Jesus Lafuente, Konstantinos N Fountas, Andreas K Demetriades","doi":"10.1007/978-3-031-36084-8_4","DOIUrl":"10.1007/978-3-031-36084-8_4","url":null,"abstract":"<p><p>Work-related musculoskeletal disorders (WMSDs) are common amongst neurosurgeons and can affect a surgeon's ability to operate. Performing surgical ergonomics research is important to minimize the prevalence and effect of WMSDs on the surgeons. The aim of this review is to highlight some of the most important objective and subjective tools available for surgical ergonomics research. Subjective tools can be divided into three categories: (1) questionnaires (either validated or non-validated) filled out by the participants, (2) survey assessments/standardized scoring systems filled out by the researchers, and (3) video analysis. Subjective tools have the drawbacks of recall bias and intra-rater and inter-rater variability. Some of the most important objective tools available are surface electromyography, force plate/pressure sensors analysis, inertial measurement units (IMUs) and kinematics data capturing using reflective markers. Although these modalities do not have the drawbacks that hinder the use of subjective tools, using most of them in the real-life operating theatre, with the exception of IMUs, is challenging. Conducting surgical ergonomics research is important to optimize the performance of neurosurgeons. The advancements towards wearable, wireless technologies will make it easier for surgeons to perform ergonomics research in the operating room.</p>","PeriodicalId":6913,"journal":{"name":"Acta neurochirurgica. Supplement","volume":"135 ","pages":"15-20"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139048114","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":"Radiotherapy-Induced Neurocognitive Dysfunction in Brain Tumor Survivors: Burden and Rehabilitation.","authors":"Rakesh Jalali,&nbsp;Priyamvada Maitre","doi":"10.1007/978-3-030-12887-6_24","DOIUrl":"https://doi.org/10.1007/978-3-030-12887-6_24","url":null,"abstract":"<p><p>Radiotherapy-induced neurocognitive dysfunction after cranial irradiation has an incidence of 40-100%. It may affect both children and adults, and represents a significant burden not only on ill individuals and their caregivers but also on the health care system and society in general. Multiple patient-, tumor-, and treatment-related factors may contribute to development of this complication, but its pathophysiological mechanisms are still not understood clearly. It is hoped that introduction of more advanced techniques for conformal irradiation, optimized dosimetry, and specific prophylactic measures will decrease the risk of neurocognitive decline in brain tumor survivors in the future.</p>","PeriodicalId":6913,"journal":{"name":"Acta neurochirurgica. Supplement","volume":"130 ","pages":"197-206"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9953866","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":"Wrong-Level Spine Surgery: Introduction of a Protocol for Avoidance of This Complication.","authors":"James Paul Agolia,&nbsp;Ekkehard M Kasper","doi":"10.1007/978-3-030-12887-6_21","DOIUrl":"https://doi.org/10.1007/978-3-030-12887-6_21","url":null,"abstract":"<p><p>Wrong-level spine surgery, in which an operation is performed at a vertebral level different from the intended one, is a rare but serious complication with wide-ranging medical and legal effects. Although many protocols have been developed to prevent such a serious unfavorable event, the problem has not yet been eliminated. Research into the effectiveness of strategies to prevent wrong-level spine surgery is lacking. Herein, we describe a case of 44-year-old woman presented with neck pain and bilateral upper extremity weakness and numbness. Magnetic resonance imaging showed C5/6 and C6/7 disc herniations with spinal cord compression. The patient underwent anterior cervical discectomy and fusion; however, at the conclusion of the surgery, intraoperative radiographs showed that it was accomplished at C4/5 and C5/6-one level above the intended level. On the basis of this case and similar ones, a new protocol was developed that included implementation of a Spine Level Safety Checklist to document the reference point, the landmark, and the level of exposure that is marked on the intraoperative radiograph. Since implementation of this protocol, the incidence of wrong-level spine surgery at the senior author's institution has decreased from 4/7000 to 0/11,200. Adoption of this protocol by other centers is thus recommended to reduce the incidence of such complication.</p>","PeriodicalId":6913,"journal":{"name":"Acta neurochirurgica. Supplement","volume":"130 ","pages":"179-184"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10007391","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":"Preventing Medicolegal Problems in Neurosurgical Practice: Do's and Don'ts.","authors":"Lalit Kapoor","doi":"10.1007/978-3-030-12887-6_27","DOIUrl":"https://doi.org/10.1007/978-3-030-12887-6_27","url":null,"abstract":"<p><p>There is a sea change in the scenario of medical practice, manifested in a serious trust deficit between patients and doctors and an exponential rise in malpractice litigation. This has given boost to the practice of defensive medicine by doctors. Neurosurgery is considered to be a high-risk branch of surgery in terms of potential for medicolegal issues. It is inevitable that as a response to these changes, we should identify the potential problem areas and adopt measures to deal with them. Practicing ethical, rational, and evidence-based medicine can minimize medicolegal problems. It is suggested to avoid treating patients beyond one's competence. In this review, the concept of negligence is defined, and the common allegations and causes of litigation in neurosurgical practice are identified. The importance of keeping meticulous patient records in preventing medicolegal problems is emphasized. The value of obtaining informed consent and operation-specific consent is highlighted. It is advised not to overpromise the results of treatment. The roles of effective communication and display of empathy toward treated individuals are important factors in averting litigation by them. Communication failure results in breakdown of the doctor-patient relationship. The protective value of professional liability insurance to deal with potential problems is stressed. Finally, the practice of \"jousting,\" or bad-mouthing a colleague, is strongly condemned, as it can provoke malpractice litigation.</p>","PeriodicalId":6913,"journal":{"name":"Acta neurochirurgica. Supplement","volume":"130 ","pages":"221-224"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10007393","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":"Extreme Lateral Interbody Fusion (XLIF) with Lateral Modular Plate Fixation: Preliminary Report on Clinical and Radiological Outcomes.","authors":"Daniele Armocida, Andrea Perna, Fabio Cofano, Marco Cimatti, Umberto Aldo Arcidiacono, Nicola Marengo, Marco Ajello, Diego Garbossa, Luca Proietti, Francesco Ciro Tamburrelli, Marco Maiotti, Antonio Santoro, Alessandro Frati","doi":"10.1007/978-3-031-36084-8_66","DOIUrl":"10.1007/978-3-031-36084-8_66","url":null,"abstract":"<p><p>The lateral transpsoas approach (extreme lateral interbody fusion, or XLIF) allows surgeons to use various lordotic cage sizes to help restore intervertebral disk height, correct sagittal alignment, and improve fusion rates. The use of standalone devices has consistently raised doubts due to the high risk of complications and inadequate functional recovery that a circumferential arthrodesis can support. The recent introduction of a novel XLIF cage with adapted lateral plate fixation (XLPF) may further enhance the structural rigidity, consolidating the cage and plate into a singular modular entity. Nine patients from our surgical centers underwent a procedure of 1-level XLIF with XLPF in selected cases. We observed that XLPF does not extend the intraoperative footprint and provides immediate rigidity to the anterior column without any additional risk of complications and with minimal increased time compared to the traditional cage implant procedure. Although it has been shown that the use of interbody fusion cages with supplemental posterior fixation improves stabilization in all directions, the technique of standalone lateral cages may also have a place in spine surgery in that the stability may be sufficient in selected cases, such as junctional syndrome and in some forms of degenerative scoliosis.</p>","PeriodicalId":6913,"journal":{"name":"Acta neurochirurgica. Supplement","volume":"135 ","pages":"431-437"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139048056","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":"Petroclival Clinoidal Folds and Relationships with Arachnoidal Membranes of Medial Incisural Space: Old Neuroanatomical Terms for a New Neurosurgical Speech in Cadaver Labs with Limited Resources Era. Part III: Arachnoid Membranes, Cranial Nerves, and Surgical Implications.","authors":"Pescatori Lorenzo, Tropeano Maria Pia, Lorenzo Gitto, Massimiliano Visocchi, Francesco Signorelli, Ciappetta Pasqualino","doi":"10.1007/978-3-031-36084-8_17","DOIUrl":"10.1007/978-3-031-36084-8_17","url":null,"abstract":"<p><p>BACKGROUND Anatomical dissections play an irreplaceable role in the training of new generations of effective neurosurgeons, especially when addressing skull base lesions is required.The Authors describe an inter-laboratory dissection study aimed at improving the knowledge of a complex region of the skull base. The anterior and middle incisural spaces are of remarkable anatomical and surgical interest due to complex relationships between bony, dural, arachnoidal, and neurovascular structures. The primary purposes of this study are to describe the anatomy of this region with particular emphasis on the relationships between the anterior margin of the free edge of the tentorium and the sphenoid and petrous bone; to identify surgical implications in many different types of neurosurgical procedures dealing with this challenging complex anatomic area.METHODS Thirteen anatomical specimens, including five injected specimens, were dissected in this study. In the formalin-fixed specimens, vessels were injected with colored silicone.RESULTS The anatomical study focused on the description of the relationships between bony dural, arachnoid, and neurovascular structures. Surgical implications are described accordingly.CONCLUSIONS Detailed anatomical knowledge of this region finds concrete applications in neurosurgical practice since the anterior and middle incisural spaces are often surgically exposed in neoplastic and vascular diseases. The high-definition pictures reported in this study could represent useful support to understand the anatomy of this complex region.Finally, our study could provide guidance to neurosurgical centers in which resources are limited that are either planning to establish their own cadaver dissection laboratory or failed to do so because of the supposed high-costs.</p>","PeriodicalId":6913,"journal":{"name":"Acta neurochirurgica. Supplement","volume":"135 ","pages":"101-107"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139048094","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":"Rheumatoid Diseases Involving the Cervical Spine I. History, Definition, and Diagnosis: New Trends and Technologies.","authors":"Andrea Zoli, Flavia Leone, Angelo Zoli, Massimiliano Visocchi","doi":"10.1007/978-3-031-36084-8_30","DOIUrl":"10.1007/978-3-031-36084-8_30","url":null,"abstract":"<p><p>The cervical spine might be involved in several conditions: congenital, traumatic, and chronic inflammatory and or degenerative rheumatic disorders. Among the inflammatory rheumatic conditions that can affect the cervical spine, rheumatoid arthritis (RA) is the most common, affecting up to 86% of patients and leading to cervical spine instability and subsequent myelopathy. Other inflammatory diseases include juvenile idiopathic arthritis (JIA) and the spondyloarthritis group (SpA), including psoriatic arthritis. Since many patients do not show symptoms of cervical involvement, diagnosis is often delayed. Radiographs are the first line imaging modality used to detect such involvement, but MRI and CT are superior in terms of early diagnosis and surgical planning.In this review, we provide an overview of cervical involvement in RA, JIA, and SpA.</p>","PeriodicalId":6913,"journal":{"name":"Acta neurochirurgica. Supplement","volume":"135 ","pages":"197-202"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139048097","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}