Advances and technical standards in neurosurgery最新文献

{"title":"Preoperative Assessments for Selective Dorsal Rhizotomy.","authors":"Olivia Shien Hui Lee","doi":"10.1007/978-3-031-86441-4_7","DOIUrl":"https://doi.org/10.1007/978-3-031-86441-4_7","url":null,"abstract":"<p><p>Selective dorsal rhizotomy (SDR) in cerebral palsy care aims to improve gait and function in ambulatory children and enhance comfort in nonambulatory children. This assessment and planning process for SDR requires a multidisciplinary team to work closely with patients and families to weigh the benefits and risks of SDR. Preoperative assessments allow the clinical team to select suitable candidates, set realistic goals, and optimise outcomes. These evaluations include physical measures, assessment of gross motor function and functional daily living skills, and gait analysis to better quantify the impact of spasticity in the SDR candidate. Further orthopaedic evaluations are required to identify pain and musculoskeletal issues, guiding subsequent post-SDR interventions. Additionally, assessments of quality-of-life assessments ensure a comprehensive rehabilitation plan that includes psychosocial support. This chapter discusses the comprehensive preoperative rehabilitation assessments that assist clinicians and families in making shared decisions about SDR.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"51 ","pages":"81-96"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188591","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":"Dorsal Rhizotomy at the Intradural Juxtaforaminal Zone.","authors":"George Georgoulis, Anthony Joud, Marc Sindou","doi":"10.1007/978-3-031-86441-4_11","DOIUrl":"https://doi.org/10.1007/978-3-031-86441-4_11","url":null,"abstract":"<p><p>To optimize the efficacy of dorsal rhizotomy (DRh) in treating spasticity associated with cerebral palsy, the authors advocate for individual access (intradurally) to all roots from L2 to S2. The initial step involves the use of electrical stimulation of the ventral root (VR) to confirm their anatomical identity and determine their corresponding myotomal territory of innervation, which is known to exhibit interindividual variability (anatomical mapping). The primary objective is then to employ dorsal root (DR) stimulation to assess their respective reflexive excitability levels (physiological testing). To mitigate the risk of spine destabilization, access is gained through enlarged interlaminar openings while preserving the spinous processes and interspinous ligaments. This approach is termed Keyhole Interlaminar Dorsal rhizotomy (KIDr). Intradural access to the roots is achieved at their preforaminal zone, through a L1-L2 opening for the L2 and L3 roots, L3-L4 opening for the L4 and L5 roots, and L5-S1 opening for the L5 and S1 roots. Under microsurgical visualization, at each exposed root level, the VR is stimulated to verify its myotomal distribution, and the DR is stimulated to estimate the segmental reflexive excitability using Fasano's grading system, allowing for the adjustment of the number of rootlets per root to be severed. In our practice, indications are primarily based on the Gross Motor Function Classification System (GMFCS): for individuals classified as levels III and IV, the goal is to enhance functional status and prevent or halt deformities; for those at level V and quadriplegic patients, the aim is to improve comfort, reduce pain, facilitate care, and alleviate upper limb disability through the \"distant effects\" often observed following lumbo-sacral rhizotomy. The timing of surgery is determined not only by age-related locomotor development but also by the plateau or deterioration of the Gross Motor Function Measure (GMFM) curve despite intensive rehabilitation efforts. As with all specialized centers, the surgical schedule is established in collaboration with a multidisciplinary team and documented in a comprehensive chart, alongside the Gain Attainment project.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"51 ","pages":"139-163"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188582","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":"Patient Selection in Selective Dorsal Rhizotomy (SDR).","authors":"Benjamin J Hall, Conor S Gillespie, Christine Sneade, Deborah Quirk, Dawn Hennigan, Benedetta Pettorini","doi":"10.1007/978-3-031-86441-4_16","DOIUrl":"https://doi.org/10.1007/978-3-031-86441-4_16","url":null,"abstract":"<p><p>For almost as long as selective dorsal rhizotomy (SDR) has existed, there has been debate surrounding which patients should be eligible to undergo the procedure. The selection criteria used to identify suitable surgical candidates have remained largely unchanged for the last three decades, despite the popularity and use of the procedure increasing. Historically, those aged between 3 and 9 years, those of GMFCS level 2 or 3, and those without evidence of dystonia were considered for SDR. In recent years, as the procedure has continued to develop, however, these parameters are expanding, with evidence to suggest a much broader cohort of patients may benefit from SDR than once thought. This chapter seeks to review current practice in patient selection for SDR, as well as the potential directions that this controversial discussion may move towards in the future.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"51 ","pages":"225-237"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188589","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":"Rhizotomy Surgery at the Conus Medullaris.","authors":"Kevin Paul Ferraris, Ash Singhal","doi":"10.1007/978-3-031-86441-4_8","DOIUrl":"https://doi.org/10.1007/978-3-031-86441-4_8","url":null,"abstract":"<p><p>Selective dorsal rhizotomy (SDR) has been an important surgical treatment for spasticity for decades. Broadly, there are two surgical technique options-via a multilevel laminotomy/laminectomy or via a single-level laminectomy and conus approach. This latter approach is described in detail in this chapter, with discussion of patient selection and a focus on surgical techniques including the integration of electromyography (EMG).</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"51 ","pages":"99-112"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188592","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":"Selection of Children with Spasticity Other Than Cerebral Palsy: Indications, Long-Term Outcome, and Exclusion Criteria.","authors":"Pramath Kakodkar, Nooshin Shekari, Madhura Thipse, Debajyoti Datta, Albert Tu","doi":"10.1007/978-3-031-86441-4_6","DOIUrl":"https://doi.org/10.1007/978-3-031-86441-4_6","url":null,"abstract":"<p><strong>Background: </strong>Selective dorsal rhizotomy (SDR) has been instrumental in improving functionality and mitigating lower extremity spasticity originating from a myriad of central nervous system (CNS) etiologies. Existing literature on SDR extensively discusses its utility in cerebral palsy (CP)-associated spasticity management. There is a void on the utility and guidance in patient selection for SDR in pediatric patients with non-CP-related spasticity.</p><p><strong>Methods: </strong>A systematic review was performed on studies describing SDR outcomes in pediatric patients identified from Medline and Embase databases. Publications between January 1970 and August 2023 were included. Combinations of search terms \"selective dorsal rhizotomy,\" \"selective posterior rhizotomy,\" and \"spasticity\" were utilized. Pediatric patient studies with clinical data on spasticity, ambulation, procedural variables, and follow-up outcomes were included. Articles including patients without cerebral palsy as a primary diagnosis were reviewed in detail for outcomes after intervention.</p><p><strong>Results: </strong>A total of 114 publications were identified, and of these, 11 fit inclusion criteria for a total of 127 patients. Most common non-CP etiologies for spasticity included hereditary spastic paraparesis (27.8%, n = 34), congenital syndrome (n = 7), and spinal cord injury (21.9%, n = 6). Compared to their baseline, SDR in non-CP-related etiologies demonstrated tone normalization (93%, n = 43 out of 45 patients) in most and improvement in ambulation (49.2%, n = 58 out of 118 patients) in a significant proportion of patients.</p><p><strong>Conclusion: </strong>This systematic review on SDR in pediatric patients revealed effective spasticity control and improvement in ambulatory functionality in selected patients without cerebral palsy. Appropriate patient selection is keystone in achieving sustained benefits in functionality and quality of life.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"51 ","pages":"65-80"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188557","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":"Selective Dorsal Rhizotomy: What, When, and Why to Cut.","authors":"Federico Bianchi, Giuliano Di Monaco, Gianpiero Tamburrini","doi":"10.1007/978-3-031-86441-4_12","DOIUrl":"https://doi.org/10.1007/978-3-031-86441-4_12","url":null,"abstract":"<p><p>Selective dorsal rhizotomy represents one of the major neurosurgical tools in treating pediatric spasticity. Intraoperative rootlet selection is the key step of the procedure in order to achieve good outcomes. Intraoperative monitoring (IOM) and anatomical selection of the rootlets are the gold standard in the aforementioned selection leading the surgeon during the procedure. The tendency toward minimally invasive procedures further increases IOM importance, warranting the use of electrophysiology in choosing the more suitable rootlets for cutting. Discharge pattern and percentage of resection represent the most important topics in surgical guidance, relying onto the very same pathophysiological mechanism causing spasticity to choose targets.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"51 ","pages":"165-171"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188558","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":"Introduction.","authors":"Nobuhito Morota, Paul Steinbok","doi":"10.1007/978-3-031-86441-4_1","DOIUrl":"https://doi.org/10.1007/978-3-031-86441-4_1","url":null,"abstract":"<p><p>In this chapter, the current status of dorsal rhizotomy is reviewed, highlighting its significant evolution over the past four decades. The first major advancement was sparked by Fasano's introduction of intraoperative neurophysiological procedures and Peacock's modification of the surgical site to the cauda equina. Subsequent advancements in surgical and neurophysiological techniques have expanded the indications for rhizotomy beyond spastic cerebral palsy, a condition affecting 0.2% of live births worldwide. Dorsal rhizotomy can significantly benefit children with spasticity by improving their mobility, daily activities, and social participation.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"51 ","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188585","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":"Postoperative Functional Recovery and Rehabilitation Following Selective Dorsal Rhizotomy.","authors":"Neil Wimalasundera","doi":"10.1007/978-3-031-86441-4_14","DOIUrl":"https://doi.org/10.1007/978-3-031-86441-4_14","url":null,"abstract":"<p><p>Selective dorsal rhizotomy (SDR) has been practiced for many years; however, standardization of processes such as the surgical technique and rehabilitation protocols are only relatively recent phenomenon. Comparing data from various studies can be limited due to temporal changes in practice, different selection criteria for SDR, the heterogeneity of cerebral palsy and variable rehabilitation protocols. This chapter reviews the available evidence in relation to best practice for rehabilitation following SDR and explores factors affecting the short- and long-term outcome following SDR. This includes more easily measurable factors, such as the child's preoperative Gross Motor Function Measurement (GMFM) and severity of spasticity, to social and cognitive factors which can affect participation in rehabilitation.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"51 ","pages":"193-208"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188590","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":"Cauda Equina-Level Selective Dorsal Rhizotomy.","authors":"J M N Enslin","doi":"10.1007/978-3-031-86441-4_9","DOIUrl":"https://doi.org/10.1007/978-3-031-86441-4_9","url":null,"abstract":"<p><p>There are many approaches to performing selective dorsal rhizotomy (SDR). The two most commonly performed approaches are the cauda equina approach, popularized by Warwick Peacock in 1980, and the conus medullaris approach, as used initially by Foerster and later Gros, and having its modern incarnation in the work of Tae Sun Park. Peacock changed from the traditional conus approach as he felt this approach led to unpredictable outcomes and bladder and bowel complications in some patients at the time. With the modern addition of intraoperative neurophysiology and further advances in the selection of patients for SDR, this technique of performing selective dorsal rhizotomy at the level of the cauda equina lives on with long-term data in support of its use. The author elaborates on the cauda equina approach to SDR in this chapter.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"51 ","pages":"113-122"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188580","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":"Neurophysiological and Neuroanatomical Background of Spasticity: Surgical Implication for Dorsal Rhizotomy in Cerebral Palsy.","authors":"Marc Sindou, Anthony Joud, George Georgoulis","doi":"10.1007/978-3-031-86441-4_3","DOIUrl":"https://doi.org/10.1007/978-3-031-86441-4_3","url":null,"abstract":"<p><p>Spasticity arises from the exaggeration of the monosynaptic reflex, attributed to the loss of inhibitory influences from descending supraspinal structures, though not exclusively. Defined by its resistance to muscle stretching, spasticity yields two significant outcomes. Firstly, muscles tend to remain in a shortened position, restricting movement. Secondly, hypertonia, coupled with a lack of mobilization, leads to soft tissue changes, including a loss of viscoelasticity. This non-velocity-dependent biomechanical aspect limits movements, even at slow velocities, rendering them unresponsive to antispastic agents. Proactively addressing hypertonia/spasticity is crucial to prevent the fixation of disorders and the potential irreducibility of this vicious circle. Understanding the role of the reticular formation, its afferent projections, and efferent pathways is essential for comprehending circadian tone variations and the variability in clinical presentations among patients. The mechanism of hypertonia in children with cerebral palsy is twofold: a neural component due to spasticity (velocity dependent) and a biomechanical component linked to soft tissue changes. Although clinically challenging to differentiate, this distinction is crucial, as only the former responds to antispastic treatments, while the latter requires physiotherapy. Additionally, spasticity is often accompanied by dystonia, a sustained hypertonic state induced by voluntary motion attempts. Distinguishing spasticity from dystonia is essential, as dorsal rhizotomy minimally affects the dystonic component. Spasticity, by opposing muscle stretching and lengthening, leads to muscles remaining in a shortened position, resulting in soft tissue changes and contracture, ultimately restricting movements. Hypertonia and lack of mobilization create a vicious circle, culminating in severe locomotor disability due to irreducible musculotendinous retraction and joint ankylosis/bone deformities. These evolving consequences must be carefully considered during a child's assessment for decision-making. The hypotonic effects of lumbosacral dorsal rhizotomy, acting not only at a segmental level on the lower limbs but also supra-segmentally through the reticular formation, are also discussed.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"51 ","pages":"15-39"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188587","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}