Acta Neurochirurgica最新文献

{"title":"Gamma Knife Radiosurgery for symptomatic eloquently deep-seated cystic pilocytic astrocytoma mural nodules: Retrospective case series of effective outcomes.","authors":"Raef F A Hafez, Osama M Fahmy, Hamdy T Hassan, Jeremy Christopher Ganz","doi":"10.1007/s00701-024-06366-7","DOIUrl":"https://doi.org/10.1007/s00701-024-06366-7","url":null,"abstract":"<p><strong>Background: </strong>Although most pilocytic astrocytomas grow slowly, their progression in critical sites such as the brainstem or hypothalamus may prove fatal much more rapidly. Cystic progression may be more problematic than solid tumor. Patients with progressive cystic PAs located in eloquent deep areas of the brain are the best candidates for stereotactic radiosurgery.</p><p><strong>Objective: </strong>This retrospective case series aims to present the effective outcomes obtained from GKRS, targeting the mural nodules of symptomatic eloquently deep-seated cystic PAs in 9 consecutive patients treated at the IMC Gamma Knife Centre in Cairo, Egypt, between 2003 and 2021.</p><p><strong>Patient and methods: </strong>The median follow-up period was 84 months (range 24-240 months). The median treated mural nodule volume was 1.25 cm³ (range 0.32-1.97 cm³), treated with a median peripheral prescription dose of 12 Gy and a median maximum dose of 24 Gy. The median cyst volume in treated patients was 7.64cm³(range 1.66-40.6cm³).</p><p><strong>Results: </strong>At the last follow-up, 7 out of 9 patients (78%) achieved tumor control (marked reduction > 50% of the entire tumor volume in 6 patients and moderate tumor reduction < 50% in one patient) in addition to clinical improvement. The median time of confirmed tumor reduction was 18 months (range 12-32 months). Two patients reported progression of the treated tumor. The overall tumor control rates at 2, 5, and 7 years of follow-up were 88.9%, 78%, and 78%, respectively.</p><p><strong>Conclusion: </strong>The encouraging results of this series indicate that limiting the GKRS to the mural nodule of eloquently deep-seated cystic PAs may be a practical and effective pattern in the salvage of its treatment. Our data do not support radiation for extensive, large symptomatic cysts in deep-seated cystic PA or patients where microsurgical removal is feasible.</p>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"166 1","pages":"466"},"PeriodicalIF":1.9,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142674873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Technical challenges and outcomes of stereotactic biopsies in the posterior fossa: Experience with ZD-inomed and leksell vantage frames","authors":"Insa Prilop,&nbsp;Stephan B. Sobottka,&nbsp;Clara Buszello,&nbsp;Ilker Y. Eyüpoglu,&nbsp;Witold H. Polanski","doi":"10.1007/s00701-024-06329-y","DOIUrl":"10.1007/s00701-024-06329-y","url":null,"abstract":"<div><h3>Introduction</h3><p>Stereotactic brain biopsies are essential for obtaining tissue samples from brain lesions, crucial for comprehensive histological analysis and subsequent adjuvant therapies. While most biopsies target supratentorial lesions, those involving the posterior fossa are less frequent but pose significant technical and surgical challenges, necessitating careful patient management.</p><h3>Methods</h3><p>We present our experience with stereotactic biopsies of the posterior fossa using the Leksell Vantage frame (Elekta, Stockholm, Sweden) and the ZD Inomed frame (Inomed Medizintechnik GmbH, Emmendingen, Germany). For the ZD frame, we either mounted it upside down or employed a frontal approach, while for the Leksell Vantage frame, we utilized a reverse x-axis orientation. Planning was based on 3-T MRI scans and preoperative MRI merged with stereotactic CT for coordinate generation.</p><h3>Results</h3><p>From 2006 to 2023, we performed 25 stereotactic biopsies of the posterior fossa in our department—9 with the ZD Inomed frame and 16 with the Leksell Vantage frame. The cohort included 14 male and 11 female patients, with an average age of 60.6 years (range 36—80 years). The average surgery duration was shorter with the Leksell Vantage frame (32.6 min vs. 44.8 min, p = 0.05). The average length of the planned trajectory was 41.7 mm for the Leksell Vantage frame and 52.2 mm for the ZD Inomed frame. Postoperativ bleeding occurred in two cases—one managed conservatively, the other required surgical intervention. Additionally, two other cases presented new postoperative focal neurological deficit. The overall mortality rate was 34.8% and a 40-day postoperative mortality rate of 13.0%.</p><h3>Conclusion</h3><p>Our experience demonstrates that stereotactic biopsies of lesions in the posterior fossa can be effectively managed with different frame systems, though they present a higher degree of complexity. Notably, the Leksell Vantage frame was associated with a significantly shorter surgery duration. This technical note provides valuable insights and detailed technical guidance for neurosurgeons facing similar challenges.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"166 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-024-06329-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142672598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical management of spinal dural arteriovenous fistulae: systematic review of current practices and open questions","authors":"Sergio Garcia-Garcia,&nbsp;Hrvoje Barić,&nbsp;Mika Niemelä","doi":"10.1007/s00701-024-06360-z","DOIUrl":"10.1007/s00701-024-06360-z","url":null,"abstract":"<div><h3>Background</h3><p>Spinal dural arteriovenous fistulae(sDAVF) represent the most common spinal vascular malformation. Therapeutic strategies include both surgical and endovascular approaches. Surgical interruption of the fistula is crucial to prevent the onset and progression of neurological symptoms. Despite a range of surgical techniques, little research has evaluated their relative efficacy. This review aims to summarize the available surgical techniques and identify open questions for future research.</p><h3>Methods</h3><p>A systematic review was conducted on PubMed, Ovid, and Web of Science databases to identify surgically treated cohorts of sDAVF. Five commonly reported surgical steps were analyzed: type of approach, temporary clipping, shunt disruption method, fistulous vein management, and epidural vessel management. In addition, open questions lacking consensus or evidence were identified for pre, intra and postoperative stages.</p><h3>Results</h3><p>63 of 115 analyzed cohorts described surgical techniques. The most commonly used approach was single-level laminectomy (52.4%). Temporary clipping was used in 11.1% of cases, while 15.9% of studies reported excision of intradural arterialized veins. There was wide variation in the methods used to close the fistula, with the most frequent being coagulation alone (27.5%). The management of epidural vessels was reported in 11.1% of studies. Sixteen major open questions were identified with a wide variety of technical nuances.</p><h3>Discussion</h3><p>Surgical treatment of sDAVF is not a standardized procedure but rather encompasses significantly different techniques. The lack of controlled trials leaves many questions unanswered, including optimal surgical strategies and the role of adjunct imaging and monitoring techniques. Further research is required to address these gaps and refine treatment protocols.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"166 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Volumes and velocities: Meta-analysis of PC-MRI studies in normal pressure hydrocephalus","authors":"Helen Whitley,&nbsp;Petr Skalický,&nbsp;Awista Zazay,&nbsp;Adéla Bubeníková,&nbsp;Ondrej Bradáč","doi":"10.1007/s00701-024-06333-2","DOIUrl":"10.1007/s00701-024-06333-2","url":null,"abstract":"<div><h3>Purpose  </h3><p>Phase contrast magnetic resonance imaging (PC-MRI) represents an opportunity to non-invasively investigate cerebral spinal fluid (CSF) flow in patients with idiopathic normal pressure hydrocephalus (iNPH). Studies in recent years have explored the diagnostic and prognostic value of PC-MRI derived parameters. This review aims to identify all PC-MRI studies of iNPH published since 2010, synthesise a review based on collated results, and analyse specific flow parameters identified in the selected studies.</p><h3>Methods</h3><p>Our protocol was prospectively registered on PROSPERO [CRD42020180826]. We systematically searched four databases: Pubmed, Web of Science, Ovid, and Cochrane library to identify all eligible studies. Quality assessment was performed using a modified Newcastle–Ottawa Scale [19]. Systematic review was conducted according to Prisma guidelines. A random-effects model was used to perform meta-analysis on the available flow parameters.</p><h3>Results</h3><p>Eighteen records were identified for inclusion. Five studies were eligible for meta-analysis, representing 107 iNPH patients and 82 controls. CSF flow parameters available for analysis were stroke volume and peak velocity. Both were significantly higher than controls (p = 0.0007 and p = 0.0045 respectively) according to our random-effects analysis, consistent with a model of hyper-dynamic CSF in iNPH. Our systematic review revealed average stroke volumes in iNPH ranging from 43uL to over 200uL. Peak velocity values ranged from 5.9 cm/s to 12.8 cm/s.</p><h3>Conclusion</h3><p>Significant increases in stroke volume and peak velocity values in iNPH patients suggest a place for PC-MRI as supplementary evidence in the diagnostic work-up of iNPH. Although shunting reduces aqueductal stroke volume and peak velocity, the ability of pre-shunt values to reliably predict treatment response remains complicated. We suggest that it may be more appropriate to consider a range of values that reflect varying probabilities of shunt success. We recommend that future studies should prioritise standardising PC-MRI protocols, and before then PC-MRI findings should be considered supportive rather than determinative.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"166 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-024-06333-2.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk score for early prognostication of aseptic bone flap necrosis","authors":"Lennart Barthel,&nbsp;Susann Hetze,&nbsp;Oliver Gembruch,&nbsp;Mehdi Chihi,&nbsp;Marvin Darkwah Oppong,&nbsp;Yahya Ahmadipour,&nbsp;Philipp Dammann,&nbsp;Ulrich Sure,&nbsp;Ramazan Jabbarli","doi":"10.1007/s00701-024-06342-1","DOIUrl":"10.1007/s00701-024-06342-1","url":null,"abstract":"<div><h3>Purpose</h3><p>Aseptic bone flap necrosis (ABFN) is a common complication of autologous cranioplasty that often requires reoperation. This study aimed to create a risk score for ABFN using relevant demographic, clinical, and laboratory markers.</p><h3>Methods</h3><p>We included all patients who underwent autologous cranioplasty after decompressive surgery between 2007 and 2019. We collected laboratory data, initial clinical diagnoses, and demographic parameters before autologous bone flap reimplantation. The significant predictors of ABFN identified in the final multivariate analysis were used to develop a risk score.</p><h3>Results</h3><p>Of the 412 patients who underwent craniectomy, 58 (14%, 32 females: 55.2%) developed ABFN. The following independent predictors of ABFN were included in the risk score (0–7 points): craniectomy due to trauma or hemorrhagic stroke (2 points), younger age (&lt; 40 years, 2 points), cranioplasty timing (&gt; 95 days post-craniectomy, 1 point), glutamate-pyruvate transferase &lt; 18 U/L (1 point), and serum creatinine level &lt; 0.815 mg/dL (1 point). The ABFN rates in patients with scores of 0–2, 3–4, and 5–7 points were 4.2%, 16.1%, and 34.6%, respectively. The risk score demonstrated moderate diagnostic accuracy for predicting ABFN, with an area under the curve of 0.739.</p><h3>Conclusion</h3><p>The proposed risk score may help in early identification of individuals prone to ABFN. These data suggest that future studies should investigate the significance of metabolic syndromes related to ABFN occurrence. Understanding the potential impact of metabolic factors on ABFN can enhance risk assessment and targeted preventive measures for patients undergoing cranioplasty procedures.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"166 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-024-06342-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142646811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term outcomes following posterior fossa decompression in pediatric patients with Chiari malformation type 1, a population-based cohort study","authors":"Victor Gabriel El-Hajj,&nbsp;Erik Öhlén,&nbsp;Ulrika Sandvik,&nbsp;Jenny Pettersson-Segerlind,&nbsp;Elias Atallah,&nbsp;Pascal Jabbour,&nbsp;Mohamad Bydon,&nbsp;David J. Daniels,&nbsp;Adrian Elmi-Terander,&nbsp;Erik Edström","doi":"10.1007/s00701-024-06332-3","DOIUrl":"10.1007/s00701-024-06332-3","url":null,"abstract":"<div><h3>Objective</h3><p>Posterior fossa decompression for Chiari malformation type I (Chiari 1) is effective and associated with a low risk of complication. However, up to 20% of patients may experience continued deficits or recurring symptoms after surgical intervention. For pediatric patients, there are no established tools to predict outcomes, and the risk factors for unfavorable postoperative outcomes are poorly understood. Hence, our aim was to investigate baseline data and early postoperative predictors of poor outcomes as determined by the Chicago Chiari outcome scale (CCOS).</p><h3>Methods</h3><p>All pediatric patients (&lt; 18 years) receiving a posterior fossa decompression for Chiari 1 between the years of 2005 and 2020 at the study center were eligible for inclusion. Patients with congenital anomalies were excluded.</p><h3>Results</h3><p>Seventy-one pediatric patients with a median age of 9 years were included. Most patients (58%) were females. Chiari 1 was associated with syringomyelia (51%), scoliosis (37%), and hydrocephalus (7%). Perioperative complications occurred in 13 patients (18%) of which two required additional procedures under general anesthesia. On multivariable proportional odds logistic regression, motor deficits (OR: 0.09; CI95%: [0.01–0.62]; <i>p</i> = 0.015), and surgical complications (OR: 0.16; CI95%: [0.41–0.66]; <i>p</i> = 0.011) were significant predictors of worse outcomes. The presence of syringomyelia was identified as a predictor of better outcomes (OR: 4.42 CI95% [1.02–19.35]; <i>p</i> = 0.048). A persistent hydrocephalus during the early postoperative period after posterior fossa decompression was a strong predictor of worse long-term CCOS (OR: 0.026; CI95%: [0.002–0.328]; <i>p</i> = 0.005).</p><h3>Conclusion</h3><p>Results from this study indicate that the existence of motor deficits and syringomyelia prior to surgery, and surgical complications and persistent hydrocephalus despite posterior fossa decompression, were useful predictors of long-term outcome.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"166 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-024-06332-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142646810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Triangular titanium implants for sacroiliac joint fusion","authors":"Nikolai G. Rainov,&nbsp;Reinhard Schneiderhan,&nbsp;Dimitar Haritonov","doi":"10.1007/s00701-024-06357-8","DOIUrl":"10.1007/s00701-024-06357-8","url":null,"abstract":"<div><h3>Background</h3><p>The sacroiliac joint (SIJ) is a common source of chronic low back pain. Published cohorts have reported favorable outcomes after SIJ fusion. We report the 12-month follow-up from SIJ fusion of the so far largest single-center and single-surgeon group.</p><h3>Methods</h3><p>Over 15,000 outpatients were evaluated for chronic low back and leg pain, of whom 3,477 underwent SIJ blocks. 541 patients were stringently selected to undergo SIJ fusion with triangular titanium implants (TTI). 483 patients had a follow-up of 12 months. Patients were seen every 3 months and completed visual analog scale (VAS) and Oswestry Disability Index (ODI) ratings.</p><h3>Results</h3><p>Mean age of all patients was 61 years, and the majority (65%) were women. 44% had undergone prior lumbar fusion and 10% had a spinal cord stimulator (SCS) in place at the time of SIJ surgery. 26% underwent non-simultaneous bilateral SI joint fusion. At 12 months, the proportion of patients with clinically important improvements in pain (<i>≥</i> 2 points) was very high (100%). The proportion with substantial improvement (<i>≥</i> 4 points) was 98%. Similarly, improvement in ODI was high, with nearly 99% having an improvement of <i>≥</i> 15 points by month 12. The proportions of patients with VAS ≤ 2 or ODI ≤ 15 was also high (92.8% and 48.9%).</p><h3>Conclusions</h3><p>In our clinical practice, SIJ fusion with TTI produces significant improvement in pain and disability. The most important factor for achieving these clinical results may be the very stringent multistep selection of patients for surgery, which is described in detail, as well as the highly standardized and streamlined surgical procedure and the particular postoperative management.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"166 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intensive 2-days training on perfused human placenta for microvascular anastomoses","authors":"Elisa Colombo,&nbsp;Fabian Wolf,&nbsp;Fiona Helg,&nbsp;Lara Höbner,&nbsp;Jennifer A. Watson,&nbsp;Martina Sebök,&nbsp;Christian Haslinger,&nbsp;Tristan van Doormaal,&nbsp;Luca Regli,&nbsp;Giuseppe Esposito","doi":"10.1007/s00701-024-06286-6","DOIUrl":"10.1007/s00701-024-06286-6","url":null,"abstract":"<div><h3>Background and Purpose</h3><p>We report on an intensive two-day training program on microanastomoses performed on perfused human placenta models. A specific scoring system was elaborated to evaluate the participants’ microsurgical skills and report the participants’ results.</p><h3>Materials and Methods</h3><p>Trainees who attended the Zurich Microsurgery Courses in 2023 were included in the study. Before performing the microanastomoses, each participant received a visual didactic training. Training was made on perfused human placenta models. To perform the microvascular anastomoses, vessels of different diameters were chosen, and 9–0 and 10–0 microsutures were used. The course was structured in two days. On day one, participants practiced microvascular dissection, microsuturing and end-to-end anastomoses, while the second day was dedicated to end-to-side and to repeat the most useful microanastomosis depending on the specialty. A score system for the evaluation of a successful microanastomosis was developed and applied to assess the participants’ anastomoses. User satisfaction was measured by means of a survey-based questionnaire.</p><h3>Results</h3><p>Fifty-two participants from different institutions, specializations and levels of experience were included. A significant improvement in the overall microsurgical skills of the included cohort was documented (<i>p</i> &lt; 0.005). The initial average score per anastomosis of 3.56 points (SD 0.71) increased to an average of 3.8 points (SD 0.87) at the end of the course. The steepest learning curve was observed in the placement of knots (Δ 0.48 points, <i>p</i> = 0.003) and microvascular dissection (Δ 0.44 points, <i>p</i> = 0.002). Most participants rated the fidelity and importance of the placental microsuturing course as extremely high.</p><h3>Conclusion</h3><p>The two-day training program is efficient to teach microvascular dissection and microanastomosis techniques. A significant improvement of participants’ microsurgical skills was reported. The human placenta model proved to be a high-fidelity simulator with great user satisfaction.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"166 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-024-06286-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-time intraoperative ultrasound imaging of the posterior pituitary gland during endoscopic endonasal approach","authors":"Ryan B. Juncker,&nbsp;Guilherme Finger,&nbsp;Mark A. Damante,&nbsp;Luciano M. Prevedello,&nbsp;Daniel M. Prevedello,&nbsp;Kyle C. Wu","doi":"10.1007/s00701-024-06353-y","DOIUrl":"10.1007/s00701-024-06353-y","url":null,"abstract":"<div><h3>Purpose</h3><p>Pituitary adenomas are amongst the most common benign central nervous system tumors, and often require resection via an endoscopic endonasal approach (EEA). Two of the most common associated complications are central diabetes insipidus (DI) and syndrome of inappropriate antidiuretic hormone secretion (SIADH). Both are thought to be caused by manipulation of the posterior pituitary gland (PPG), making intraoperative visualization and preservation of this structure critical. Intraoperative endoscopic endonasal ultrasound (IEUS) may present an optimal tool for this purpose. This study aims to describe the appearance and morphology of the PPG on IEUS.</p><h3>Methods</h3><p>This study included all pituitary adenoma surgeries during which IEUS was utilized and the PPG was visualized between 1/1/2022, and 12/31/2023. Demographic, clinical, pathological, and radiological data were retrospectively collected. The PPG was described as either hypoechoic, isoechoic, or hyperechoic as compared to the anterior pituitary gland and adenoma, and the morphology of the PPG was further classified as ellipse or crescent shaped.</p><h3>Results</h3><p>The PPG was hypoechoic in all 43 cases included in our final cohort (100.0%). Morphologically, the PPG appeared elliptical in 27 cases (62.8%), and crescent shaped in 16 cases (37.2%).</p><h3>Conclusion</h3><p>The PPG can typically be visualized by IEUS as a hypoechoic structure immediately anterior to the posterior wall of the sella turcica, with elliptical morphology being the most common appearance. These characteristics can be used by the skull base surgeon to more confidently identify the position and morphology of the PPG intraoperatively for its’ preservation.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"166 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142636745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sequential adaptive e-learning and hands-on simulator training for unilateral biportal endoscopy (UBE) of the lumbar spine - results from an EANS Young Neurosurgeons hands-on course","authors":"Stefan Motov,&nbsp;X. Santander,&nbsp;F. C. Stengel,&nbsp;M. Mohme,&nbsp;M. Schwake,&nbsp;C. Zoia,&nbsp;V. M. Butenschoen,&nbsp;M. Bauer,&nbsp;L. Lippa,&nbsp;D. Belo,&nbsp;S. Kaprovoy,&nbsp;M. Lepič,&nbsp;D. Stastna,&nbsp;E. Drosos,&nbsp;T. Spiriev,&nbsp;M. Giamundo,&nbsp;F. Torregrossa,&nbsp;C. Aldea,&nbsp;G. Raffa,&nbsp;C. Ostendorp,&nbsp;O. Bozinov,&nbsp;Martin N. Stienen","doi":"10.1007/s00701-024-06359-6","DOIUrl":"10.1007/s00701-024-06359-6","url":null,"abstract":"<div><h3>Introduction</h3><p>Unilateral biportal endoscopy (UBE) is a minimally invasive surgical (MIS) technique utilized for lumbar decompression, which has recently gained popularity in Europe. We aimed to explore the value of sequential adaptive e-learning, followed by simulator-based hands-on training modules for UBE at the occasion of the 2024 EANS Young Neurosurgeons meeting.</p><h3>Materials and methods</h3><p>An adaptive e-learning was designed by learning engineers (Area 9 Lyceum), based on theoretical content provided by two endoscopic spine surgeons. A two-module simulator training, consisting of an insight-the-box model (basic tasks for eye-hand coordination), followed by a realistic lumbar spine model (execution of an endoscopic decompression) was developed. Course participants completed the e-learning before the hands-on training course. Course experience was evaluated through a standardized self-assessment questionnaire containing a 5-point Likert scale and a 10-point numeric rating scale.</p><h3>Results</h3><p>Eleven of eighteen (61%) participants with different levels of professional education (62.5% residents in 1^st -6^th year of training, 37.5% board-certified) completed both trainings. Thirteen participants (72%) had no prior experience with UBE. The perception of knowledge after the e-learning module increased from 2.5 (SD 2) to 6.5 (SD 1.8; <i>p</i> = 0.039). The usefulness, enjoyment, and efficiency of the courses averaged a score of 8.0 (SD 1.8). Regarding the hands-on training, participants estimated an average increase in their skills from 2.9 (SD 1.8) to 6.8 (SD 2, <i>p</i> = 0.028). The overall rating of the two-module course was 7.9 (SD 2.2).</p><h3>Discussion and conclusion</h3><p>Sequential e-learning and simulator training appear to be an effective educational adjunct to establish novel, MIS-techniques such as UBE.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"166 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-024-06359-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}