Advances and technical standards in neurosurgery最新文献

{"title":"New Developments in the Surgery for Spasticity.","authors":"J M N Enslin","doi":"10.1007/978-3-031-86441-4_18","DOIUrl":"https://doi.org/10.1007/978-3-031-86441-4_18","url":null,"abstract":"<p><p>We still base spasticity management on rehabilitation and lesional surgical procedures. These techniques have been well-studied, and long-term follow-up data is available. However, we can still not treat the cause of the spasticity with any of these modalities, and advances in neuromodulation and genetic therapies are promising this in the future. In this chapter, the author describes the new developments in spasticity surgery. The focus is on advances in lesioning techniques, neuromodulation strategies-cerebral, spinal, and peripheral techniques-and genetic and stem cell research. There is still no conclusive evidence showing better outcomes and improved long-term data than our current medication and lesion-based approach, but as the technology improves, this may change. We hope to reach a point where we aim to care for patients with spasticity at the individual cause of each person's spasticity and cure them.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"51 ","pages":"245-254"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188588","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":"Microsurgical Anterior Transcallosal Resection of Colloid Cysts of the Third Ventricle.","authors":"Orhun M Cevik, Murat Sakir Eksi, Mustafa Guduk, Murat Imre Usseli, Ayça Erşen-Danyeli, Alp Dincer, Koray Ozduman, M Necmettin Pamir","doi":"10.1007/978-3-031-90762-3_4","DOIUrl":"10.1007/978-3-031-90762-3_4","url":null,"abstract":"<p><p>Colloid cysts of the third ventricle are benign and rare lesions of the central nervous system. Although gross total resection is the standard treatment of these lesions, there are multiple surgical routes proposed and discussed in the literature. Similarly, the origin of these colloid cysts remains a topic of debate. Long-term outcomes of anterior transcallosal approach have been analyzed and compared with the recent meta-analyses published in the literature. Additionally, the origin of these cysts is explored using immunohistochemical analysis.Eighty operations on 76 patients by a single surgeon over 37 years have been studied and the long-term outcomes have been presented. Additionally, ependyma, choroid plexus, and colloid cyst specimen have been compared using immunohistological staining with cytokeratin, S100, and PAX-7.The long-term outcomes with comparison with the literature show that microsurgical gross total resection using anterior transcallosal approach is the ideal treatment over other modalities. Preoperative hydrocephalus is a strong indicator for the location of the colloid cyst within the anterior third ventricle and for the selection of transforaminal versus interforniceal approach. In pathological study, the clear staining with PAX-7 points to this pathology being a remnant of the paraphysis.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"55 ","pages":"75-91"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555987","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 Role of Lobectomy in Glioblastoma Management.","authors":"Christina K Arvaniti, Maria D Karagianni, Manthia A Papageorgakopoulou, Alexandros G Brotis, Anastasia Tasiou, Kostas N Fountas","doi":"10.1007/978-3-031-90762-3_7","DOIUrl":"10.1007/978-3-031-90762-3_7","url":null,"abstract":"<p><strong>Introduction: </strong>Glioblastoma (GB) remains the most prevalent and aggressive primary tumor of the central nervous system, with median overall survival between 14 and 20 months. Maximal extent of resection is associated with extended overall survival. Lobectomy may lend itself in the management of patients with glioblastomas in certain anatomical areas for accomplishing maximal or even supramaximal resection.</p><p><strong>Patient selection: </strong>Patients with good preoperative KPS, with a tumor confined to one lobe, and no infiltration of the subependymal zone are good candidates for lobectomy.Preoperative considerations: A thorough medical history, a detailed neurological examination, along with diagnostic work-up is essential in decision-making and proper surgical planning. Neurocognitive evaluation is also of paramount importance.Frontal lobectomy: High-speed drill is used for performing a frontotemporal craniotomy in non-dominant cases, while a more extensive fronto-parieto-temporal osseous flap is required in dominant cases for detailed cortical and subcortical mapping via an awake procedure. A corticectomy is then performed along with subpial resection of the white matter of the involved lobe.Temporal lobectomy: The same craniotomy strategy is used in temporal lobectomies. A corticectomy is performed through the inferior temporal gyrus, removal of the underlying white matter, and entrance to the ipsilateral temporal horn. After the neocortical resection, the mesial temporal structures have to be removed under the microscope. The importance of subpial resection technique cannot be overemphasized.</p><p><strong>Complications: </strong>Complications such as neurocognitive deficits, paresis, dysphasia, infections, hydrocephalus, and hemorrhage are mainly reported in lobectomies performed for epilepsy. In GB lobectomy studies, no statistically significant differences were observed regarding complications.</p><p><strong>Results: </strong>In the pertinent literature, lobectomy demonstrates a mean overall survival of 25 months, compared to 13.72 months for gross total resection (GTR), and a progression-free survival of 16.13 months, compared to 8.77 months for GTR.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"55 ","pages":"137-151"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555992","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":"Start-Up of Rhizotomy Program in a Developing Country.","authors":"Tufan Hiçdönmez","doi":"10.1007/978-3-031-86441-4_17","DOIUrl":"https://doi.org/10.1007/978-3-031-86441-4_17","url":null,"abstract":"<p><p>The selective dorsal rhizotomy (SDR) procedure is an efficient surgical treatment of spasticity in children with cerebral palsy. My training background of pediatric neurosurgery at the British Columbia's Children's Hospital, an experienced center for spasticity, allowed me to contribute to the start-up of the rhizotomy program in Ulaanbaatar, Mongolia, in September 2022. Five spastic children with cerebral palsy with GMFCS levels 2-4 were chosen for the first SDR procedures. Intensive physiotherapy and rehabilitation program were given to children after SDR. After 6 months, early results were satisfactory.My personal experience of performing first SDR surgeries in another country is that the minimum of a SDR surgery team consists of a neurosurgeon, an electrophysiology technician responsible for selection of nerve rootlets, and an anesthesiologist. The physiotherapist responsible for patient selection and rehabilitation follow-up and rehabilitation facilities and family support are essential.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"51 ","pages":"239-244"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188559","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":"Minimalistic Approaches to Craniovertebral Junction Tumors.","authors":"Mario Ammirati, Roberto Colasanti","doi":"10.1007/978-3-031-90762-3_9","DOIUrl":"10.1007/978-3-031-90762-3_9","url":null,"abstract":"<p><p>Craniovertebral junction (CVJ) tumor removal is challenging due to their close relationships with critical neurovascular structures and the brainstem. First attempts at removal of these lesions through the midline posterior suboccipital route were associated with significant postoperative morbidity and mortality. Hence, various neurosurgical approaches have been proposed for dealing with such lesions more safely. Anterolateral, extreme, and far lateral approaches have been developed with the aim to move more anterolaterally the angle of dissection, thus minimizing the retraction needed to reach CVJ tumors. However, there is still no clear evidence about the optimal approach for dealing with such lesions. If the brainstem retraction is minimized by more lateral routes, these approaches are time-consuming and are linked with a high risk of approach-related complications that is proportionate to the extent of bony drilling and to the neural and vascular manipulations.Here we present our technique for the microsurgical removal of CVJ tumors through a simple posterolateral approach. In addition, we briefly summarize the pros and cons of the different surgical approaches for CVJ lesions.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"55 ","pages":"165-179"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555988","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":"Targeted Treatment of Pediatric Craniopharyngioma: Lesson Learnt After 20-Year Experience with Intracystic Interferon Alpha.","authors":"Paolo Frassanito, Luca Massimi, Federico Bianchi, Gianpiero Tamburrini","doi":"10.1007/978-3-031-90762-3_5","DOIUrl":"10.1007/978-3-031-90762-3_5","url":null,"abstract":"<p><p>Intracystic IFNα proved to be a safe and effective option in the multimodal management of cystic craniopharyngioma (CRF).In our institutional experience, controversial cases have arisen concern and unanswered questions, that are becoming more common with the availability of new target therapies for other brain tumors.Reliable criteria to define the response to treatment should be defined. Additionally, the best timing of surgical resection after target therapy is not clear. Surgery is postponed in case of favorable response, but tumor relapse may present a different architecture eventually increasing surgical morbidity. Finally, in case of good response to the target therapy a close follow-up is required, since rebound may occur in exceptional cases.These data should represent the benchmark for future studies using either systemic administration of IFN or other intracystic drugs.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"55 ","pages":"93-110"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555991","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":"Functional Posterior Rhizotomy with the Use of Intraoperative Neurophysiology.","authors":"Nobuhito Morota","doi":"10.1007/978-3-031-86441-4_13","DOIUrl":"https://doi.org/10.1007/978-3-031-86441-4_13","url":null,"abstract":"<p><p>Intraoperative neurophysiology (ION) plays a crucial role in dorsal rhizotomy, a procedure aimed at reducing spasticity while preserving neural function. ION encompasses monitoring and mapping, with the mapping of the root/rootlet constituting a significant component. Despite the acknowledged roles of ION, persistent controversies exist, and a universally accepted standard for integrating ION procedures into dorsal rhizotomy remains elusive. This chapter provides a detailed explanation of the author's approach to dorsal rhizotomy, with a primary focus on the decision-making process for root/rootlet cutting. This process involves tetanic electrical stimulation of dorsal root/rootlet for rhizotomy, pudendal mapping to prevent urological complications, and monitoring the bulbocavernosus reflex (BCR). Additionally, the chapter introduces the use of the F-wave for assessing spasticity. The author terms this ION-guided dorsal rhizotomy as \"functional posterior rhizotomy,\" signifying a shift toward a more functionally oriented procedure extending beyond root selection. The application of ION in this procedure is systematic, ensuring both spasticity reduction and the preservation of urinary function. Decision-making for root/rootlet cutting is a multifactorial process, incorporating ION results, spasticity distribution, patient age, and preoperative function. This functional approach aims to minimize the cutting rate through the comprehensive utilization of ION procedures and a cutting rate formula correlating with the GMFM-88 score. In conclusion, ION proves integral to dorsal rhizotomy, facilitating functional root/rootlet selection for spasticity reduction, preserving neural function, and offering predictive insights into surgical outcomes.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"51 ","pages":"173-189"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188583","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":"Rootlet Selection by Crescendo Single-Pulse Evoked Compound Muscle Action Potential Interpretation During Selective Dorsal Rhizotomy.","authors":"Bo Xiao","doi":"10.1007/978-3-031-86441-4_10","DOIUrl":"https://doi.org/10.1007/978-3-031-86441-4_10","url":null,"abstract":"<p><p>Selective dorsal rhizotomy (SDR) is a surgical intervention aimed at reducing spasticity in children with cerebral palsy. This chapter introduces an innovative approach to SDR, utilizing crescendo single-pulse evoked compound muscle action potential (CMAP) interpretation for rootlet selection. The method combines preoperative spastic muscle identification, intraoperative neurophysiological monitoring, and a precise stimulation protocol to guide the selective sectioning of sensory nerve roots. The chapter outlines the setup for crescendo single-pulse stimulation-guided SDR, including preoperative muscle group identification, intraoperative monitoring channels, and surgical approach. It details the stimulation protocol and defines criteria for motor nerves, sphincter-associated sensory nerves, and lower limb-associated sensory nerves based on evoked CMAP patterns. The concept of a \"rhizotomy ratio\" is introduced as a potential metric correlating with the severity of the patient's condition. Midterm outcomes of this approach are presented, based on a cohort of 481 cases with a minimum 2-year follow-up across all 5 levels of the Gross Motor Function Classification System (GMFCS). Results show muscle tone decreased by an average of 1.0 level in spastic muscle groups immediately after surgery, with a tendency to continue reducing by an additional 0.8 level in the following 2 years post-SDR. Motor function improved significantly, with 39.1% of patients advancing by one or two GMFCS levels (in 432 cases with preop GMFCS levels II-V), concurrent with intensive rehabilitation programs. The greatest improvements were observed in children who underwent surgery before age six and those with less severe preoperative motor impairments. The chapter also discusses postoperative rehabilitation strategies tailored to the gradual reduction in muscle tone experienced by children following SDR. Gait analysis in mild cases indicates improved walking patterns post-SDR. Overall, this crescendo single-pulse stimulation-guided SDR approach demonstrates promising outcomes in reducing spasticity and improving motor function in children with cerebral palsy, with minimal complications reported.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"51 ","pages":"123-138"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188594","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":"Hybrid Operative Room for Vascular Neurosurgery: Applications, Limits, and Perspectives.","authors":"Luc Kerherve, Tuan Le Van, Ahmed El Cadhi, Edouard Morlaix, Alia Houidi, Clément Millot, Jean François Bellus, Thomas Waelchli, Catherine Cao, Walid Farah, Maxime Lleu, Jacques Beaurain, Francois Lebeaupin, Brivael Lemogne, Pierre Thouant, Frédéric Ricolfi, Pierre Olivier Comby, Giulia Cossu, Moncef Berhouma","doi":"10.1007/978-3-031-90762-3_8","DOIUrl":"10.1007/978-3-031-90762-3_8","url":null,"abstract":"<p><p>Hybrid operating rooms (HORs) combine a conventional state-of-the-art microsurgical theater and advanced imaging technologies, usually an intraoperative digital subtraction angiography (DSA) system. Initially developed for peripheral vascular surgery, HORs are gaining popularity among neurosurgical teams around the world. Based on their recent experience, the authors describe the launch of such a hybrid room in the University Hospital of Dijon Bourgogne and, through a narrative review of the pertinent literature, try to define the specific vascular neurosurgery conditions that may benefit from this highly demanding multidisciplinary environment. The association between intraoperative diagnostic and interventional endovascular capabilities and microsurgical management in the same location provides the possibility of immediate assessment of the surgical results, the immediate conversion to one or other technique if needed without transferring the patient, and appears to provide a very high cure rate of neurovascular malformations while minimizing the morbidity and mortality.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"55 ","pages":"153-163"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555986","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":"Creating a Selective Dorsal Rhizotomy Team.","authors":"Benjamin J Hall, Conor S Gillespie, Christine Sneade, Deborah Quirk, Dawn Hennigan, Benedetta Pettorini","doi":"10.1007/978-3-031-86441-4_5","DOIUrl":"10.1007/978-3-031-86441-4_5","url":null,"abstract":"<p><p>Selective dorsal rhizotomy (SDR) is becoming increasingly popular in the management of spasticity in children. Spasticity itself is a multifaceted clinical entity that requires a holistic approach in order to effectively care for and improve the quality of life of those affected. To deliver these goals, a broad multidisciplinary team is required. From the role of neurosurgery in undertaking the procedure, through to the comprehensive rehabilitation process supported by physiotherapy, this chapter aims to summarise the key features necessary for an SDR unit to succeed as a team when providing care to their patients.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"51 ","pages":"53-63"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188581","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}