Advances and technical standards in neurosurgery最新文献

{"title":"Endoscopic Endonasal Resection of Clival Chordomas.","authors":"Mariam Al-Mutawa, Jörg Baldauf, Jan-Uwe Müller, Henry W S Schroeder","doi":"10.1007/978-3-031-90762-3_6","DOIUrl":"10.1007/978-3-031-90762-3_6","url":null,"abstract":"<p><p>The endoscopic endonasal approach is a major step forward in the treatment of clival chordomas. It has improved the resection rate and in the same time reduced the complications. Chordomas located in the upper and mid-clival regions are well-suited for a purely endoscopic endonasal resection. Although with angulated endoscopes and curved high-speed drills, lateral parts of the tumor can be resected, lower clival lesions often necessitating a combination of both endonasal and transcranial approaches. A major limitation is a caudal tumor extension beyond the dens axis. For more caudally located lesions, a transoral approach might be needed. Since chordomas of the lower clivus may destroy the condyles or the dens axis, a posterior stabilization is frequently required in a second step of the surgery. Even though a gross total resection has been achieved, chordoma has the tendency to recur. Therefore, the current standard of care is postoperative proton or carbon ion radiation. Chemotherapy is not effective in classic chordomas, but has its place in poorly differentiated tumor which mostly occur in children. Recently, molecular targeted therapies have given hope for effective medical treatment options in the future.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"55 ","pages":"111-136"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555914","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":"Surgical Treatment of Cushing's Disease: The Lessons Learned.","authors":"L de Nijs, E Fomekong, D Maiter, C Raftopoulos","doi":"10.1007/978-3-031-90762-3_3","DOIUrl":"10.1007/978-3-031-90762-3_3","url":null,"abstract":"<p><p>This chapter aims to provide insightful guidance drawn from an updated litera ture search and the long experience of our multidisciplinary team in the surgical management of Cushing's disease. We will first compare the two primary TSS tech niques-microscopic and endoscopic-emphasizing the importance of surgical expertise. We will also discuss new imaging modalities, which may improve the preoperative localization of corticotroph microadenomas. Addressing scenarios where extensive imaging fails to detect pituitary tumors, the chapter analyzes diag nostic challenges, offering guidance on improving localization and effective surgi cal strategies, including the contribution of neuronavigation systems and intraoperative MRI (iMRI). This comprehensive exploration aims to empower clini cians in managing the complexities of Cushing's disease, from accurate localization to advanced surgical techniques and beyond.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"55 ","pages":"47-73"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555989","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":"History of Dorsal Rhizotomy for Spasticity.","authors":"Nobuhito Morota","doi":"10.1007/978-3-031-86441-4_2","DOIUrl":"https://doi.org/10.1007/978-3-031-86441-4_2","url":null,"abstract":"<p><p>The history of dorsal rhizotomy for the treatment of spasticity was reviewed, from its inception to future perspectives. The evolution of this surgical intervention was staged into five distinct phases: \"Dawn and Decline,\" \"Revival,\" \"Establishment,\" \"Development,\" and \"Future.\" Key contributions during each period were highlighted, with particular focus on the progression of surgical techniques and the evolution of intraoperative neurophysiological procedure. Insights leant from this historical review provide valuable guidance for the future development of dorsal rhizotomy in the management of spasticity.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"51 ","pages":"5-13"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188584","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":"Long-Term Outcome of Selective Dorsal Rhizotomy for Spastic Children.","authors":"Nelleke G Langerak, Berendina E Veerbeek, Robert P Lamberts","doi":"10.1007/978-3-031-86441-4_15","DOIUrl":"https://doi.org/10.1007/978-3-031-86441-4_15","url":null,"abstract":"<p><p>Given the concerns associated with the ageing process in adults with cerebral palsy (CP) and the significant number of children who have undergone selective dorsal rhizotomy (SDR) in the recent decades, there is an important clinical need to evaluate both the short- and long-term impacts of this invasive and irreversible neurosurgical procedure. To gain insight in the health condition, the International Classification of Functioning, Disability and Health (ICF) model was used. The ICF serves as a biopsychosocial model for evaluating individuals with disabilities, providing a comprehensive perspective that encompasses understanding both the 'body structure and function' of individuals and determining the level of 'activity and participation' within the community. Furthermore, this review incorporates the dimension 'quality of life' as an essential factor to be discussed in relation to the outcomes of SDR. Based on a narrative literature review, this chapter outlines the outcomes observed at 5-15 years and 15-25 years post-SDR. Additionally, insights into outcomes beyond 25 years after SDR have been provided, drawing on the experiences of the Cape Town research group in South Africa, where SDR was reintroduced on a large scale by Warwick Peacock in the 1980s. The chapter concludes with a discussion on complications following SDR. This review will provide the clinical community and parents with information about the short- and long-term outcomes of this neurosurgical intervention.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"51 ","pages":"209-222"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188586","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":"Role of Dorsal Rhizotomy in the Comprehensive Management of Childhood Spasticity.","authors":"Nobuhito Morota","doi":"10.1007/978-3-031-86441-4_4","DOIUrl":"https://doi.org/10.1007/978-3-031-86441-4_4","url":null,"abstract":"<p><p>Spasticity, characterized by muscle hypertonia, in children poses long-term challenges, leading to motor dysfunction, joint contractures, and a decline in overall quality of life (QOL). This underscores the critical need for effective spasticity management in disabled children. Various interventions, including oral medications, neurorehabilitation, and surgical procedures, have been used in the management of childhood spasticity. Dorsal rhizotomy, a neurosurgical intervention, plays a vital role in this context, selectively and functionally severing roots/rootlets to manage spasticity. Treatment modalities for spasticity encompass basic and active management, with interventions like dorsal rhizotomy, intrathecal baclofen infusion (ITB), and local injection of botulinum toxin (BTX). A strategic approach involves a \"spasticity first\" policy, prioritizing spasticity reduction, followed by active management and functional improvement through neurorehabilitation and orthopedic surgery. Comparative assessment of treatments, considering factors like age and joint involvement, guides the selection of interventions. Dorsal rhizotomy stands out for its sustainable and cost-effective reduction of spasticity, offering broad applicability across severity levels and diverse pathologies. Despite its efficacy, dorsal rhizotomy has limitations, including its invasiveness, irreversible nature, and the need for postoperative lifelong neurorehabilitation. Careful patient selection by a multidisciplinary spasticity clinic is crucial. The procedure's distinctive role, effectiveness, and cost-effectiveness place dorsal rhizotomy as a valuable tool in comprehensive childhood spasticity management.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"51 ","pages":"43-52"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188593","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":"Pediatric Brainstem Tumor Biopsy: Surgical Planning and Execution for Maximal Safety and Tissue Yield.","authors":"Mahalia Dalmage, Melissa A LoPresti, Michael DeCuypere","doi":"10.1007/978-3-031-67077-0_9","DOIUrl":"https://doi.org/10.1007/978-3-031-67077-0_9","url":null,"abstract":"<p><p>Brainstem tumors account for 10-20% of pediatric brain tumors with a peak age of diagnosis between 7 and 9 years old and are often fatal. Historically, diagnosis of brainstem tumors has been largely based on imaging; however, recent studies have demonstrated the incongruities between preoperative MRI diagnosis and postoperative pathological findings highlighting the importance of brainstem biopsy for diagnostic accuracy. Stereotactic brainstem biopsy for pediatric brainstem tumors has been proven to be safe with a high diagnostic yield (96.1-97.4%) and relatively low morbidity and mortality. Successful pediatric brainstem tumor biopsy demands intricate knowledge of brainstem anatomy, cranial nerves and vasculature, and common pediatric brainstem tumors by the performing surgeon. Additionally, understanding of the surgical indications and techniques (e.g., frame-based versus frameless, robotic assistance, surgical approach, and targets selection) helps to ensure maximal safety and tissue yield. Pediatric brainstem biopsy permits histological conformation of brainstem lesions leading to accurate diagnosis and the potential for personalized treatment and future therapeutic research.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"53 ","pages":"139-157"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302194","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":"Complication Avoidance in Chiari Malformation Surgery.","authors":"Holly S Gilmer","doi":"10.1007/978-3-031-67077-0_10","DOIUrl":"https://doi.org/10.1007/978-3-031-67077-0_10","url":null,"abstract":"<p><p>Posterior fossa decompression for symptomatic Chiari malformation is an effective and frequently performed procedure, but it does carry risks of significant complications including cerebrospinal fluid leak and craniocervical instability. Patients sometimes do not improve or worsen after decompression, which may discourage neurosurgeons from performing Chiari decompression surgery. In this chapter, management strategies and surgical approaches are discussed that minimize the risks of complications and maximize favorable outcomes in Chiari malformation surgery.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"53 ","pages":"159-183"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302186","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":"Database Review of 514 Patients with Os Odontoideum. Detailed Analysis of 258 Surgically Treated (1978-2019).","authors":"Arnold H Menezes, Brian J Dlouhy","doi":"10.1007/978-3-031-67077-0_12","DOIUrl":"https://doi.org/10.1007/978-3-031-67077-0_12","url":null,"abstract":"<p><strong>Objective: </strong>Database review (1978-2019) is to identify the cause of os odontoideum, its presentation, associated abnormalities, and management recommendations.</p><p><strong>Methods and materials: </strong>Review of referral database of 514 patients and 258 surgically treated patients ages 4-64 years. Detailed history of early childhood trauma and initial encounter record retrieval were made. Patients had dynamic motion radiographs, dynamic motion MRI and also CT to identify pathology and reducibility of craniocervical instability. Preoperative crown halo traction was made before the year 2000 except in children. Intraoperative traction with O-arm/CT documentation was made since 2001. Reducible and partially reducible cases underwent halo traction under general anesthesia distraction, dorsal stabilization, and rib graft augmentation for fusion. Later semi-rigid instrumentation and subsequently rigid instrumentation was made. Irreducible compression of cervicomedullary junction was treated with ventral decompression. The follow up was 3-20 years.</p><p><strong>Results: </strong>Database; acute worsening after trauma 262, insidious neurological deficit 252. Minimal/normal motion with neurological deficit was present in 18, previous C1-C2 fusion with worsening in 18. 28 patients of 64 without treatment worsened in 4 years. An intact odontoid process was seen in 52 children of 156 who had early craniovertebral junction trauma and later developed os odontoideum.</p><p><strong>Surgical experience: </strong>There were 174 patients with reducible lesions and partially reducible were 22. Irreducible lesions were 62. Of the reducible, 50 underwent transarticular C1-C2 fusion, 26 C1 lateral mass, and C2 pars screw fixation. 182 had occipitocervical fusion (19 had extension of previous C1-C2 fusion and 43 after transoral decompression). 62 with irreducible ventral compression of the cervicomedullary junction underwent transoral decompression; 43 had a trapped transverse ligament between the os and C2 body and 19 previous C1-C2 fusions. Compression was by the axis body, os odontoideum, and the posterior C2 arch. Syndromic and skeletal/connective tissue abnormalities were found in 86 (36%).</p><p><strong>Complications: </strong>2 patients worsened, age 10 and 62, due to failure of semi-rigid construct.</p><p><strong>Conclusions: </strong>The etiology of os odontoideum is multifactorial considering the associated abnormalities, reports of congenital-familiar occurrence, and early childhood craniovertebral trauma which also plays a role in the etiology. Patients with reducible lesions require stabilization. Asymptomatic patients are at risk for later instability. Patients who underwent childhood C1-C2 fusion must be followed for later problems. The irreducibility was seen due to trapped transverse ligament, pannus, or previous dorsal C1-C2 fusion.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"53 ","pages":"217-234"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302187","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":"Endoscopic Microvascular Decompression.","authors":"Sonia Ajmera, Rachel Blue, John Y K Lee","doi":"10.1007/978-3-031-61925-0_17","DOIUrl":"https://doi.org/10.1007/978-3-031-61925-0_17","url":null,"abstract":"<p><p>Microvascular decompression is a widely accepted surgical treatment for compressive cranial nerve pathologies such as trigeminal neuralgia, hemifacial spasm, glossopharyngeal neuralgia, and other craniofacial pain syndromes. Endoscopy has risen as a safe and effective minimally invasive tool to optimize microvascular decompression. Endoscopy offers improved visualization, minimizes retraction, and allows for smaller surgical openings compared to traditional microscopic approaches. There are several reports of improved neuralgia outcomes and reduced post-operative complications after endoscopic microvascular decompression. In skilled surgical hands, endoscopy is an excellent option for microvascular decompression as stand-alone tool or adjunct to the microscope. An overview of the history, operative considerations, and techniques is provided in this chapter.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"52 ","pages":"245-252"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141629393","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":"Full Endoscopic Transcranial Resection of Meningiomas.","authors":"Sebastian Senger, Karen Radtke, Joachim Oertel","doi":"10.1007/978-3-031-61925-0_10","DOIUrl":"https://doi.org/10.1007/978-3-031-61925-0_10","url":null,"abstract":"<p><strong>Objective: </strong>Tumors of the skull base can be accessed through different routes. Recent advantages in minimally invasive techniques have shown that very different routes can be applied for optimal tumor resection depending on the technical equipment, the surgeon's preference, and the individual anatomy of the pathology. Here, the authors present their technique for pure endoscopic transcranial tumor resection in meningiomas.</p><p><strong>Methods: </strong>Out of the cases of the Department of Neurosurgery, Homburg Saar Germany of the last 10 years, all endoscopic procedures for meningiomas were analyzed. Particular attention was given to evaluating the peculiarities of those meningiomas that were treated purely endoscopically.</p><p><strong>Results: </strong>While the endoscope was used in a large number of skull base meningiomas in endonasal approaches or for endoscopic inspection in transcranial skull base surgery, only a small number of meningiomas was selected for a purely endoscopically performed resection. The characteristics of these cases were rather a small lesion, straight access, and a keyhole position of the craniotomy. A complete resection of the tumor was achieved in all cases. Conversion to the microscope was not necessary in any case. There were no technical issues or complications associated with a fully endoscopic resection.</p><p><strong>Discussion: </strong>The endoscope is a valuable tool for visualization in meningioma surgery. In most cases, it is applied for an endonasal route or for endoscopic inspection in transcranial microsurgical cases. However, small to medium-sized meningiomas that can be accessed through the keyhole approach are good candidates for pure endoscopic resection. Because of the very high magnification and the minimally invasive nature of this approach, it should be considered more frequently in suitable lesions.</p>","PeriodicalId":72077,"journal":{"name":"Advances and technical standards in neurosurgery","volume":"52 ","pages":"129-138"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141629396","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}