Acta Neurochirurgica最新文献

{"title":"How I do it — focused Sylvian approach for clipping of middle cerebral artery aneurysms","authors":"Milad Neyazi,&nbsp;Rajiv Kumar Khajuria,&nbsp;Sajjad Muhammad","doi":"10.1007/s00701-025-06423-9","DOIUrl":"10.1007/s00701-025-06423-9","url":null,"abstract":"<div><h3>Background</h3><p>The Focused Sylvian Approach (FSA) is a refined, minimally invasive technique for clipping small to medium-sized middle cerebral artery (MCA) aneurysms, prioritizing safety and aesthetics.</p><h3>Method</h3><p>The craniotomy remains confined to the superior temporal line, with the incision concealed within the temporal muscle. The Sylvian fissure is carefully dissected to preserve venous structures.</p><h3>Conclusion</h3><p>FSA achieves optimal vascular control with superior cosmetic outcomes while maintaining adequate exposure for safe aneurysm clipping.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06423-9.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142939296","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":"Aneurysm dome and vessel pressure measurements with coiling, stent assisted coiling and flow diversion","authors":"Timothy A. Becker,&nbsp;Kailey L. Lewis,&nbsp;Holly F. Berns,&nbsp;Sophia E. Robertson,&nbsp;Wyatt E. Clark,&nbsp;Jesse C. Wells,&nbsp;Mohammed K. Alnajrani,&nbsp;Christopher Rapoport,&nbsp;Patrick Barhouse,&nbsp;Felipe Ramirez-Velandia,&nbsp;Jean Filo,&nbsp;Michael Young,&nbsp;Sandeep Muram,&nbsp;Justin H. Granstein,&nbsp;Christopher S. Ogilvy","doi":"10.1007/s00701-024-06392-5","DOIUrl":"10.1007/s00701-024-06392-5","url":null,"abstract":"<div><h3>Background</h3><p>Variability in long-term endovascular treatment outcomes for intracranial aneurysms has prompted questions regarding the effects of these treatments on aneurysm hemodynamics. Endovascular techniques disrupt aneurysmal blood flow and shear, but their influence on intra-aneurysmal pressure remains unclear. A better understanding of aneurysm pressure effects may aid in predicting outcomes and guiding treatment decisions.</p><h3>Methods</h3><p>Medium and large aneurysm models with intramural pressure taps on the dome and parent artery were designed and 3D-printed with vessel-like physical properties from UV-cured materials. The models were connected to a comprehensive flow system consisting of a pulsatile pump and a viscosity-matched blood analog. The system provided physiological pressure and flow control. Real-time pressures were recorded in the aneurysm dome and parent artery during initial placement of coils, stents, flow diverters, and temporary balloons under simulated surgical conditions. Coiling, stent-assisted coiling, and flow diverter placement were performed in both aneurysm sizes. Temporary balloon placement was performed in a large aneurysm model.</p><h3>Results</h3><p>Coiling resulted in 24–30% packing density and diminished intra-aneurysmal flow. Flow diverter placement reduced intra-aneurysmal flow with near complete flow interruption after placement of three consecutive devices across the aneurysm neck. Compared to untreated controls, real-time pressure measurements during coiling and flow diversion showed minimal changes (&lt; 5%) in intra-aneurysmal pressures. Temporary balloon occlusion blocked the parent artery, increasing the pressure proximal to the site of occlusion (by 9%), and reducing the pressure distally (by 14%). This maneuver also dampened intra-aneurysmal pressure to the average distal vessel pressure measurement. Positive control aneurysm models were 3D-printed with a sealed, “healed” neck. These controls verified a sealed neck eliminates intra-aneurysmal pressure.</p><h3>Conclusion</h3><p>Findings quantified minimal changes in intra-aneurysmal pressure during and immediately post-coiling and flow diversion. Intra-aneurysmal flow disruption alone has negligible impact on intra-aneurysmal pressures.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142939080","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":"Intra-individual comparison of long-term outcomes between combined and indirect bypass surgery in adult moyamoya disease","authors":"Yuwhan Chung,&nbsp;Jeong Eun Kim,&nbsp;Hyun-Seung Kang,&nbsp;Tae Young Kim,&nbsp;Jin Chul Paeng,&nbsp;Won-Sang Cho,&nbsp;Sung Ho Lee,&nbsp;Eun Jin Ha,&nbsp;Kangmin Kim","doi":"10.1007/s00701-024-06391-6","DOIUrl":"10.1007/s00701-024-06391-6","url":null,"abstract":"<div><h3>Purpose</h3><p>Bypass surgery is regarded as the standard treatment option for symptomatic and hemodynamically unstable moyamoya disease (MMD). However, there is ongoing debate about the most effective type of bypass surgery. We aimed to analyze the long-term outcomes of combined and indirect bypasses for MMD patients through intra-individual comparisons.</p><h3>Methods</h3><p>Of the 896 patients who underwent 1084 bypass surgeries between 2007 and 2021, 24 patients with MMD who underwent combined bypass on one side and indirect bypass on the other side were ultimately enrolled in this study. Clinical, angiographic and hemodynamic outcomes were retrospectively evaluated.</p><h3>Results</h3><p>Three asymptomatic strokes (12.5%) occurred within 30 postoperative days in each group. Postoperative strokes after 30 days occurred in 3 patients (12.5%) with 3 hemorrhagic events and 1 cerebral infarction, only in indirect bypass, while no stroke occurred in hemispheres treated with combined bypass. The revascularization area relative to supratentorial area was significantly greater in combined bypass than in indirect bypass, both in short-term and long-term periods (64.9% versus 43.9% in short-term and 75.7% versus 54.9% in long-term; <i>P</i> &lt; .001, respectively). Hemodynamic outcomes showed significantly greater increases in acetazolamide-challenged cerebral blood flow (CBF_acz) during short-term follow-up (<i>P</i> = .04) and in both basal CBF (CBF_bas) and CBF_acz during long-term follow-up (<i>P</i> = .014 and <i>P</i> = .009, respectively) in combined bypass than in indirect bypass.</p><h3>Conclusion</h3><p>Combined bypass may be a more effective treatment option for MMD based on its higher revascularization area and favorable hemodynamic results compared to indirect bypass in the same patient.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-024-06391-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142939081","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":"When and how are complications suspected after shunt surgery in patients with normal pressure hydrocephalus?","authors":"Johan Virhammar,&nbsp;Oskar Fasth,&nbsp;Fredrik Vedung","doi":"10.1007/s00701-024-06415-1","DOIUrl":"10.1007/s00701-024-06415-1","url":null,"abstract":"<div><h3>Purpose</h3><p>The follow-up routine for patients with idiopathic normal pressure hydrocephalus (iNPH) after shunt surgery differs across medical centers. Shunt surgery is not without risks, with complications emerging at various times after the procedure. The aim was to explore the timing and methods of detecting complications following ventriculoperitoneal shunt surgery for iNPH.</p><h3>Methods</h3><p>This retrospective study examined patients who underwent shunt surgery for iNPH at Uppsala University Hospital between 2011 and 2018. The cohort comprised 491 patients. Postoperative complications within the first 12 months were recorded from medical records. Complications were classified by type, and the method or event that first indicated the complication was documented.</p><h3>Results</h3><p>Of the 491 patients, 102 (20.8%) experienced complications during the one-year follow-up period, with a shunt revision rate of 15.5% (76 patients requiring reoperation). Subdural hematomas/hygromas were the most common complications, with 27 cases; only three required surgical intervention. Most complications were identified through additional appointments triggered by patient-reported symptoms (31.4%), while the planned follow-up routine with CT scans and planned follow-up visits together accounted for 56% of the detections. The 3-month and 12-month follow-up visits detected similar proportions of complications (12.7% and 11.8%, respectively).</p><h3>Conclusion</h3><p>The majority of the complications were detected at a planned visit or investigation. Given the cognitive impairments in iNPH patients and that signs of shunt dysfunction can be subtle, a structured follow-up routine is important for timely detection of complications. The findings suggest that both CT scans and planned follow-up visits are critical components of effective postoperative monitoring.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-024-06415-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142939252","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":"Digital 3D exoscope is an effective tool for the surgery of falx and parasagittal meningiomas","authors":"Ville Vasankari,&nbsp;Sergio Garcia,&nbsp;Hrvoje Baric,&nbsp;Mika Niemelä,&nbsp;Martin Lehecka","doi":"10.1007/s00701-024-06419-x","DOIUrl":"10.1007/s00701-024-06419-x","url":null,"abstract":"<div><h3>Purpose</h3><p>Digital 3D exoscopes are promising tools for microneurosurgery. The results of exoscope-assisted resection of intracranial meningiomas have only been addressed in few case reports. We retrospectively compared the results of exoscope and microscope-assisted surgery of falx and parasagittal meningiomas.</p><h3>Methods</h3><p>We included all consecutive adult patients (<i>n</i> = 36) with falx or parasagittal meningioma who were operated with curative intention during an 8-year period by one senior neurosurgeon. The operations were performed either with a surgical microscope (<i>n</i> = 16; Zeiss Kinevo or Pentero 900) or a digital 3D exoscope (<i>n</i> = 20, Aesculap Aeos). We reviewed the pre- and postoperative radiological images, clinical examinations and surgical reports to assess clinical outcomes and complications. We also analyzed surgical videos.</p><h3>Results</h3><p>Gross-total resection (Simpson grade I-II) was achieved in approximately 90% of the patients in both groups (89% in exoscope and 92% in microscope group). The duration of the operation was slightly longer (117 vs. 88 min) in the exoscope group. Surgical outcomes were comparable, despite there being larger tumors (median diameter 53 vs. 38 mm) with higher grades (WHO Grade 2–3: 45% vs. 19%) in the exoscope group. Transient postoperative complications were more frequent in the exoscope group (40 vs. 25%) mainly related to the larger tumor size.</p><h3>Conclusion</h3><p>The digital 3D exoscope is an effective tool for performing surgery on falx and parasagittal meningiomas. The extent of removal, clinical results and complications seem to be comparable to surgical microscope even in large tumors. Larger prospective studies are required to confirm this result.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-024-06419-x.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142938915","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":"From spasms to smiles: how facial recognition and tracking can quantify hemifacial spasm severity and predict treatment outcomes","authors":"Ahmed Al Menabbawy,&nbsp;Lennart Ruhser,&nbsp;Ehab El Refaee,&nbsp;Martin E. Weidemeier,&nbsp;Marc Matthes,&nbsp;Henry W. S. Schroeder","doi":"10.1007/s00701-024-06407-1","DOIUrl":"10.1007/s00701-024-06407-1","url":null,"abstract":"<div><h3>Purpose</h3><p>Currently available grading and classification systems for hemifacial spasm either rely on subjective assessments or are excessively intricate. Here, we make use of facial recognition and facial tracking technologies towards accurately grouping patients according to severity and characteristics of the spasms.</p><h3>Methods</h3><p>A retrospective review of our prospectively maintained preoperative videos database for hemifacial spasm was done. Videos were analyzed using an Apple AR kit-based App. A facial mesh is automatically allocated to specific biometric facial points. Videos are analyzed using Blender software for measuring the amplitude and frequency of the spasms. Classification of the patients into groups was done using both divisive k-means and agglomerative hierarchical clustering. Correlation-Analysis with preoperative quality of Life (Qol) using SF-36 questionnaire and HFS-8 score was performed. Additionally, correlation with postoperative outcome was calculated.</p><h3>Results</h3><p>79 preoperative videos were included. Both up-bottom and bottom-up clustering approaches grouped the patients into 3 different clusters according to 4 variables (eye closure, mouth distance change, rate, and repetition of the spasms). Correlation of the groups with the Qol was done for 46/79 patients (58.2%). Spasms could be classified into mild, moderate clonic and severe tonic spasms. Patients with mild spasms showed better Qol scores. Moderate clonic spasms experienced best outcomes following microvascular decompression.</p><h3>Conclusion</h3><p>This novel classification using facial-tracking and augmented-reality is easy to use and apply. It quantifies the severity and type of the spasms and relates it to the quality of life of patients, postoperative outcome, and could guide our management strategy.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-024-06407-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142938953","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":"Defining the caudal limits of the endoscopic endonasal approach to the craniovertebral junction: anatomic study correlating radiographic measures","authors":"Mohammad Bilal Alsavaf,&nbsp;Moataz D. Abouammo,&nbsp;Jaskaran Singh Gosal,&nbsp;Govind S. Bhuskute,&nbsp;Chandrima Biswas,&nbsp;Guilherme Mansur,&nbsp;Kyle K. VanKoevering,&nbsp;Kyle C. Wu,&nbsp;Ricardo L. Carrau,&nbsp;Daniel M. Prevedello","doi":"10.1007/s00701-024-06389-0","DOIUrl":"10.1007/s00701-024-06389-0","url":null,"abstract":"<div><h3>Objective</h3><p>The endoscopic endonasal approach (EEA), has become the preferred alternative to traditional open and transoral approaches to the ventral craniovertebral junction (CVJ) region. However, preoperative prediction of the limitations of caudal reach remains challenging. This cadaveric study aimed to quantify the CVJ area of exposure and access afforded by the EEA, evaluate the accuracy of previously described radiographic anthropometric lines, and identify the lowest limit of the EEA corridor.</p><h3>Methods</h3><p>Endoscopic endonasal dissections of the CVJ were completed in 35 cadaveric specimens. The area of exposure (AoE) and caudal-most reach were measured using a navigation system. Radiographic measurements included the distance of the odontoid process from the hard palate, length of the hard palate, distance of the lowest point reached from the hard palate level, and angles such as the nasopalatine line (NPL) angle, nasoaxial line (NAxL) angle, nostril-hard palate line (NTL) angle, and rhinopalatine line (RPL) angle.</p><h3>Results</h3><p>The mean CVJ AoE was 931.22 ± 79.36 mm2. The NPL, NAxL, and RPL angles showed significant negative correlations with the distance of the odontoid process from the hard palate line (<i>r</i> = -0.521, <i>p</i> = 0.001; <i>r</i> = -0.538, <i>p</i> = 0.001; <i>r</i> = -0.500, <i>p</i> = 0.002, respectively), while the NTL angle did not (<i>r</i> = -0.241, <i>p</i> = 0.162). No significant correlation was found between achieved AoE via EEA and NPL, NAxL, NTL, or RPL (<i>p</i> &gt; 0.05). Importantly, hard palate length was the sole predictor of CVJ AoE variability (<i>r</i> = -0.416, <i>p</i> = 0.013), with shorter lengths associated with increased exposure. The mean distance of the lowest point reached in the AoE from the hard palate level was 9.47 ± 1.24 mm.</p><h3>Conclusions</h3><p>This anatomic study highlights the variability in CVJ anatomy and the limitations of using previously defined radiographic anthropometric lines for predicting the caudal limits of the EEA. Hard palate length emerged as the only reliable predictor of the surgical area of exposure via the endonasal corridor. Clinical studies are warranted to validate these findings and define the potential need for adjunctive surgical routes in managing complex CVJ pathologies.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-024-06389-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142938952","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":"Cancer neuroscience and glioma: clinical implications","authors":"Manfred Westphal,&nbsp;Richard Drexler,&nbsp;Cecile Maire,&nbsp;Franz Ricklefs,&nbsp;Katrin Lamszus","doi":"10.1007/s00701-024-06406-2","DOIUrl":"10.1007/s00701-024-06406-2","url":null,"abstract":"<div><p>In recent years, it has been increasingly recognized that tumor growth relies not only on support from the surrounding microenvironment but also on the tumors capacity to adapt to – and actively manipulate – its niche. While targeting angiogenesis and modulating the local immune environment have been explored as therapeutic approaches, these strategies have yet to yield effective treatments for brain tumors and remain under refinement. More recently, the nervous system itself has been explored as a critical environmental support for cancer, with extensive neuro-tumoral interactions observed both intracranially and in extracranial sites containing neural components. In the brain, interactions between glioma cells as well as metastatic lesions with neural components have clinical implications for diagnostics, risk assessments, neurological sequelae, and the development of innovative therapeutics. Here, we review these neuro-tumoral dynamics, emphasizing aspects relevant to neurosurgical practice.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-024-06406-2.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142919064","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":"‘Disc degeneration in distal unfused segments: cause or consequence of adding-on after posterior fusion of lenke 3c, 5c, 6c adolescent idiopathic scoliosis?’","authors":"Ismail Emre Ketenci,&nbsp;Hakan Serhat Yanik,&nbsp;Mert Kahraman Marasli,&nbsp;Sevki Erdem","doi":"10.1007/s00701-024-06412-4","DOIUrl":"10.1007/s00701-024-06412-4","url":null,"abstract":"<div><h3>Background</h3><p>The aim of this study is to examine the association between adding-on (AO) and disc degeneration(DD) of distal unfused levels in Lenke 3 C, 5 C, 6 C adolescent idiopathic scoliosis (AIS) patients with a follow-up of at least two years by comparing preoperative and postoperative magnetic resonance imaging (MRI).</p><h3>Methods</h3><p>47 AIS patients (32 females and 15 males) with structural thoracolumbar/lumbar (TL/L) curves treated with long segment thoracolumbar fusion were retrospectively evaluated. Patients were divided into two groups according to the occurrence of the AO (AO and Non-AO groups). The unfused discs were graded using the MRI images according to the Pfirrmann grading method. The Scoliosis Research Society-22 (SRS-22) questionnaire and Visuel Analog Scale (VAS) were used to determine clinical outcomes.</p><h3>Results</h3><p>The frequency of AO was found to be 29.78%. Postoperative total Pfirrmann score was significantly associated with AO. L5-S1 disc in the AO group had a statistically significant higher Pfirrmann grade than the Non-AO group. No significant association was found between the VAS and SRS-22 scores related to AO, DD or other radiological outcomes.</p><h3>Conclusion</h3><p>Although patients with AO demonstrated higher postoperative Pfirmann scores, no impact on clinical scores was observed. Furthermore, patients with AO developed significantly higher DD in L5-S1 disc, even if it is not the segment adjacent to the fusion. L5-S1 disc, which is already susceptible to degeneration, was further compromised in the presence of AO.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142912995","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":"How i do it: full-endoscopic transsacral approach for the treatment of extraforaminal L5/S1 disc herniation","authors":"Qingqing Xiao,&nbsp;Fuming Chu,&nbsp;Li Huang,&nbsp;Yue Li","doi":"10.1007/s00701-024-06410-6","DOIUrl":"10.1007/s00701-024-06410-6","url":null,"abstract":"<div><h3>Background</h3><p>For L5/S1 extraforaminal disc herniation, how to efficiently expose the herniated nucleus pulposus and reduce facet joint damage remain to be explored.</p><h3>Methods</h3><p>Lumbar discectomy was performed using a full-endoscopic transsacral approach, in which sacral ala and extraforaminal ligament were partially resected to expose the L5/S1 intervertebral disc. Methylene blue was used for disc staining, and the herniated nucleus pulposus was excised through the annular tear. The nerve root decompression was ensured by detecting from extraforaminal region to S1 vertebral outer edge.</p><h3>Conclusion</h3><p>The full-endoscopic transsacral approach for the therapy of L5/S1 extraforaminal disc herniation is safe and effective.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"166 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142906032","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}