Neurosurgery practice最新文献

{"title":"Resident Opinions on Image Guidance for External Ventricular Drain Placement: A National Survey.","authors":"Thomas Noh, Parikshit Juvekar, Gina Watanabe, Alexandra J Golby","doi":"10.1227/neuprac.0000000000000097","DOIUrl":"https://doi.org/10.1227/neuprac.0000000000000097","url":null,"abstract":"<p><strong>Background and objectives: </strong>Low-quality data on image-guided external ventricular drain (EVD) accuracy are in large part due to a lack of widespread usage of this system for EVD placement. The potential disconnect between user preferences and existing technologies should be explored to guide future developments. The goal of this study was to survey neurosurgical residents regarding their EVD practices and determine the acceptable amount of setup time for an ideal neuronavigation system.</p><p><strong>Methods: </strong>A 4-question survey was sent to approximately 1512 residents at 108 Acreditation Council for Graduate Medical Education-approved medical doctor neurosurgical training programs in the United States. The responses were received electronically, tabulated, and analyzed using descriptive statistics.</p><p><strong>Results: </strong>A total of 130 respondents (9%) completed the survey, reflecting the highest number of neurosurgical resident respondents in an electronic qualitative survey of EVD practices thus far. Residents were willing to accept 6.39 min (SD = 3.73 min) on average for the setup of a bedside EVD image guidance system. The majority chose to use image guidance during EVD placement for cases of narrow slit-like ventricles (86.92%) over intraventricular hemorrhage (13.08%) and hydrocephalus (0%). A total of 90% of all resident respondents misplaced at least 1 EVD with 74% of post-graduate year-7 respondents misplacing more than 3 EVDs in their career. A total of 88.46% of respondents deemed more than a single pass as acceptable.</p><p><strong>Conclusion: </strong>Future EVD neuronavigation technologies should focus on achieving rapid registration times. These systems may be prioritized for patients with anatomic distortions. Current resident attitudes are accepting multiple EVD passes, likely because of the inherent limitations of the traditional freehand approach. Efforts should be made to encourage the best course for the patient.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 3","pages":"e00097"},"PeriodicalIF":0.0,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Focused Ultrasound as Rescue Treatment of Essential Tremor After Deep Brain Stimulation: 2 Case Reports.","authors":"Antonio Gonzalez, Manel Tardáguila, Lourdes Ispierto, Jorge Muñoz, Mireia Gea, Serge Jaumà, Gerard Plans, Ramiro Álvarez, Dolores Vilas Rolán","doi":"10.1227/neuprac.0000000000000101","DOIUrl":"https://doi.org/10.1227/neuprac.0000000000000101","url":null,"abstract":"<p><strong>Background and importance: </strong>Approximately 25% to 55% of patients with essential tremor will eventually develop medication-refractory tremor. Currently, the standard surgical treatment for this condition is deep brain stimulation (DBS) of the ventralis intermedius nucleus of the thalamus and, more recently, the posterior subthalamic area. However, MRI-guided focused ultrasound (FUS) thalamotomy has shown promising results in improving tremor in patients with refractory essential tremor.</p><p><strong>Clinical presentation: </strong>We present 2 cases of patients with a disabling action tremor, recurring after DBS. A 55-year-old right-handed male and a 52-year-old woman presented with bilateral medically refractory action tremor, which began in their second decade of life. Both underwent bilateral DBS-ventralis intermedius, with the first patient showing a good initial response but the second patient showing a suboptimal response within the first year after DBS. In both cases, the DBS system was removed and the patients subsequently underwent left-sided FUS thalamotomy with a dramatic improvement of their tremor.</p><p><strong>Conclusion: </strong>These cases demonstrate the feasibility of performing FUS thalamotomy as a rescue treatment for disabling tremor after DBS.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 3","pages":"e00101"},"PeriodicalIF":0.0,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Second-Set Surgeries for Multiple Unruptured Aneurysms Do Not Increase Perioperative Complications.","authors":"Yohei Nounaka, Kazutaka Shirokane, Fumihiro Matano, Kenta Koketsu, Asami Kubota, Akio Morita, Yasuo Murai","doi":"10.1227/neuprac.0000000000000100","DOIUrl":"https://doi.org/10.1227/neuprac.0000000000000100","url":null,"abstract":"<p><strong>Background and objectives: </strong>Intracranial aneurysms affect 3% to 4% of the population, with 20% to 25% having multiple aneurysms. Aggressive treatment is warranted for multiple unruptured aneurysms because of their higher risk of rupture and enlargement compared with single aneurysms. However, the risks and appropriate timing of secondary clipping surgeries are underreported. We assessed the prognosis and risks of treating multiple cerebral aneurysms with a second surgery and determined the differences in prognosis based on the timing of these surgeries.</p><p><strong>Methods: </strong>We retrospectively reviewed patients who underwent secondary clipping surgery for multiple unruptured cerebral aneurysms at our hospital and affiliated institutions. The number, size, and location of aneurysms, patient demographics, and antithrombotic drug history were compared between the first and second surgeries. The modified Rankin Scale score and postoperative complications, including ischemia, hemorrhage, seizures, chronic subdural hematoma requiring surgery, infection, and postoperative hospital days, were investigated.</p><p><strong>Results: </strong>A total of 38 patients (mean age, 65 years) were included. No significant differences were observed in modified Rankin Scale score worsening, postoperative hospital stay, or complication rates between the 2 surgeries. Older patients tended to undergo the second surgery within 6 months, with no significant difference in complication rates. The first surgery targeted larger aneurysms.</p><p><strong>Conclusion: </strong>The absence of complications between surgeries and the absence of rupture or re-treatment during follow-up emphasize the importance of choosing the most appropriate approach for each aneurysm. The first and second surgeries for multiple cerebral aneurysms did not significantly affect postoperative complications. Performing 2 craniotomies may facilitate the curative and safe treatment of aneurysms.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 3","pages":"e00037"},"PeriodicalIF":0.0,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Directional Deep Brain Stimulation Lead Rotation in the Early Postoperative Period.","authors":"Huy Q Dang, Gabriel Reyes, Ethan Devara, Nisha Giridharan, Anthony K Allam, Garrett P Banks, Ashwin Viswanathan, Ben Shofty, Sameer A Sheth","doi":"10.1227/neuprac.0000000000000102","DOIUrl":"https://doi.org/10.1227/neuprac.0000000000000102","url":null,"abstract":"<p><strong>Background and objectives: </strong>Directional deep brain stimulation (DBS) enables treatment optimization by current steering using segmented leads. Identification of the lead's rotational orientation is critical to guide programming decisions. Orientation is often assessed during or immediately after implant, but the degree of lead rotation in the following weeks is not well appreciated. Our objective was to measure the degree of DBS lead rotational orientation changes within the first few weeks after surgery.</p><p><strong>Methods: </strong>We retrospectively reviewed the clinical records of patients who were implanted with segmented DBS leads at our institution. All included patients had at least 1 immediate postoperative computed tomography (CT) (CT1) and another CT at least 1 week later (CT2). We assessed lead rotational orientation angles on CT1 and CT2 and calculated the degrees of rotation change between the scans. We also assessed for any effect of the time interval between scans by calculating the correlation between CT1-CT2 latency and degrees of lead rotation.</p><p><strong>Results: </strong>We assessed a total of 75 DBS lead orientations for 38 patients. The average change in lead orientation between CT1 and CT2 was 8.6° (median = 2.9°, range = 0.11-168.2°). Only 8 percent of patients (3/38) were found to have a significant change in orientation (>30°); however, when it occurred, it occurred bilaterally. There was no correlation between CT1-CT2 latency and lead rotation (r(74) = 0.04, <i>P</i> = .73).</p><p><strong>Conclusion: </strong>Our study finds that changes in lead orientation occurring over the first few weeks after surgery are rare. Thus, for most patients, the immediate postoperative CT is adequate for determining the orientation angles for clinical programming. However, if programming is found to be difficult, a repeat CT scan could be beneficial for a minority of patients.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 3","pages":"e00087"},"PeriodicalIF":0.0,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimodal and Repeated Localization of Primary Hand Motor Function to the Lateral Postcentral Gyrus in a Case of Frontal Motor Area Brain Metastasis.","authors":"Timothy F Boerger, Andrew L DeGroot, Stephanie Schwartz, Nada Botros, Brian D Schmit, Max O Krucoff","doi":"10.1227/neuprac.0000000000000095","DOIUrl":"https://doi.org/10.1227/neuprac.0000000000000095","url":null,"abstract":"<p><strong>Background and importance: </strong>The human motor homunculus is a well-known topographical map of the functional-anatomical relationships of the precentral gyrus. Within this homunculus, the primary hand motor area is considered one of the least plastic functional-anatomical relationships. Only a few cases in the literature describe relocation of functional hand representation away from the classical anatomical location. These cases have been reported in the context of children, primary gliomas, or arteriovenous malformations.</p><p><strong>Clinical presentation: </strong>Here, we describe a unique case where the area of lowest hand motor stimulation threshold (ie, hand motor representation) was found in the <i>post</i>central gyrus in an older adult with a metastasis in the premotor area of the brain. This localization was based on intraoperative cortical stimulation-evoked motor potentials and confirmed with electrophysiological phase reversal and MRI-based neuronavigation. This mapping was repeated and consistent 2 months later during a reoperation for recurrence. In addition, the remapped anatomical location was found in an area that was active during finger tapping on preoperative functional MRI.</p><p><strong>Conclusion: </strong>These findings suggest that neuroplastic remapping of hand motor cortex to the postcentral gyrus can occur in brain metastases even in adults. This has implications for planning tumor resections and interventional neurorehabilitation strategies, and it suggests that the motor homunculus may have more plastic potential in adulthood than previously recognized.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Reliable Closure Technique for Retromastoid Craniotomy to Avoid Cerebrospinal Fluid Leaks and Meningitis.","authors":"Garni Barkhoudarian, R Justin Garling, Regin Jay Mallari, Walavan Sivakumar, Daniel F Kelly","doi":"10.1227/neuprac.0000000000000086","DOIUrl":"https://doi.org/10.1227/neuprac.0000000000000086","url":null,"abstract":"<p><strong>Background and objectives: </strong>Postoperative cerebrospinal fluid (CSF) leaks and meningitis are well-known risks of retromastoid craniotomy. Use of abdominal fat grafts, collagen allografts, and rigid or semirigid buttresses have demonstrated efficacy in preventing CSF leaks and meningitis in endoscopic endonasal surgery. This study aims to determine the utility of a similar multilayered reconstruction technique for retromastoid craniotomy.</p><p><strong>Methods: </strong>We retrospectively reviewed 212 consecutive patients who underwent retromastoid craniotomy for tumor removal or microvascular decompression from 2007 to 2022. Scalp incisions were linear or slightly curved, muscle and facia opening was performed sharply avoiding monopolar cautery; craniotomies had a maximum dimension of 3 cm. A primary water-tight dural closure was rarely achieved favoring collagen sponge overlay often augmented with autologous fat. Clinical factors including pathology, mastoid air cell entry, and reconstruction material were analyzed. Outcomes including postoperative CSF leakage and meningitis were assessed.</p><p><strong>Results: </strong>Of 212 patients (mean age 56 ± 16 years; 60% female; 10% with prior surgery), 148 (70%) had tumor resection and 64 (30%) had microvascular decompression. Mastoid air cells were breached in 67%. Collagen sponge dural overlay was used in 201/212 (95%). A fat graft was placed in 116 (55%) cases: 69% with air cell entry, 27% without air cell entry; 158 (75%) patients had their bone flap replaced, 46 (21%) had titanium mesh cranioplasty, 8 (4%) had no bone flap or titanium mesh. There were no CSF leaks or meningitis. One patient had a lumbar drain placement preoperatively, none postoperatively. Median length of stay was 2 days.</p><p><strong>Conclusion: </strong>Retromastoid craniotomy multilayered reconstruction with liberal use of collagen sponge and abdominal fat grafts seems to reliably avoid postoperative CSF leaks and meningitis including in the setting of nonwatertight dural closure and mastoid cell entry. Use of shorter incisions, avoidance of monopolar cautery, and a relatively small craniotomy may contribute to the absence of CSF leaks in this series.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 3","pages":"e00086"},"PeriodicalIF":0.0,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine Learning for Individualized Risk Estimation in Anterior Lumbar Interbody Fusion.","authors":"Mert Karabacak, Pemla Jagtiani, Alexander J Schupper, Matthew T Carr, Jeremy Steinberger, Konstantinos Margetis","doi":"10.1227/neuprac.0000000000000099","DOIUrl":"https://doi.org/10.1227/neuprac.0000000000000099","url":null,"abstract":"<p><strong>Background and objectives: </strong>Although the anterior approach to the spine for anterior lumbar interbody fusion (ALIF) has been shown to be an effective procedure, there are different surgical risks compared with conventional posterior fusion. ALIF patients could potentially receive more personalized care plans that minimize the risk of negative outcomes by forecasting short-term postoperative results before the surgical procedure. The objective of this research was to evaluate the performance of machine learning (ML) algorithms in predicting short-term unfavorable postoperative outcomes after ALIF and to develop an easy-to-use and readily available instrument for this purpose.</p><p><strong>Methods: </strong>Using the American College of Surgeons National Surgical Quality Improvement Program database, we identified ALIF patients and used 6 ML algorithms to build models predicting postoperative outcomes. These models were then incorporated into an open-access web application.</p><p><strong>Results: </strong>The analysis included 8304 ALIF patients. The LightGBM models achieved area under the receiver operating characteristic scores of 0.735 for prolonged length of stay and 0.814 for nonhome discharges. The random forest models achieved area under the receiver operating characteristics of 0.707 for 30-day readmissions and 0.701 for major complications. These top-performing models were integrated into a web application for individualized patient predictions.</p><p><strong>Conclusion: </strong>ML techniques show promise in predicting postoperative outcomes for ALIF surgeries. As data in spinal surgery expand, these predictive models could significantly improve risk assessment and prognosis. We present an accessible predictive tool for ALIF surgeries to achieve the goals mentioned above.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 3","pages":"e00099"},"PeriodicalIF":0.0,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783634/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GLP-1 Receptor Agonists: Beyond Diabetes-What the Neurosurgeon Needs to Know.","authors":"Hael Abdulrazeq, Mazen Taman, Rohaid Ali, Cody Doberstein, Patricia Sullivan, Prakash Sampath, Albert Telfeian, Ziya Gokaslan, Jared Fridley, Wael Asaad","doi":"10.1227/neuprac.0000000000000098","DOIUrl":"https://doi.org/10.1227/neuprac.0000000000000098","url":null,"abstract":"<p><strong>Background and objectives: </strong>Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have gained increasing popularity since the approval of semaglutide by the United States Food and Drug Administration for chronic weight management. Significant benefits have been noted in glycemic control and cardiovascular health. However, as increasing numbers of patients are started on these medications, it is important for neurosurgeons to have knowledge of any perioperative considerations and side effects related to this class of drugs.</p><p><strong>Methods: </strong>We performed a qualitative literature review using the PubMed and Embase databases, using the following key words: GLP-1 RAs adverse events; GLP-1 RAs and anesthesia; substance use disorders; and addiction, functional neurosurgery, nervous system rehabilitation, and spinal cord injury. Articles of relevance to perioperative management of these medications and specific benefits in the neurosurgical field were discussed.</p><p><strong>Results: </strong>Recent guidance from the American Society of Anesthesiologists demonstrates the importance of tailored management of GLP-RA drugs for surgical patients. In addition, certain positive effects have been noted with relation to substance use disorders, neural protection and rehabilitation, and neurodegenerative disorders such as Alzheimer's disease.</p><p><strong>Conclusion: </strong>In this article, we review what the neurosurgeon needs to know about the perioperative management of GLP-1 RAs and discuss existing literature in clinical and preclinical studies for potential indications and benefits of these medications, which can influence the management of conditions treated by neurosurgeons.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 3","pages":"e00098"},"PeriodicalIF":0.0,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does an Unintended Durotomy in Metastatic Spine Surgery Lead to Shorter Survival?","authors":"Lakshmi Suryateja Gangavarapu, Hani Chanbour, Gabriel A Bendfeldt, Iyan Younus, Soren Jonzzon, Silky Chotai, Amir M Abtahi, Byron F Stephens, Scott L Zuckerman","doi":"10.1227/neuprac.0000000000000096","DOIUrl":"https://doi.org/10.1227/neuprac.0000000000000096","url":null,"abstract":"<p><strong>Background and objectives: </strong>Whether unintended durotomy in metastatic spine surgery seeds tumor in the central nervous system (CNS) remains unknown. Our objectives were to (1) determine the rate of unintended durotomy, (2) identify the preoperative and perioperative factors that increase the risk of unintended durotomy, and (3) determine whether unintended durotomy affected local recurrence (LR), any spinal recurrence, and overall survival.</p><p><strong>Methods: </strong>A single-center, retrospective cohort study of patients undergoing metastatic spine surgery between January 2010 to January 2021 was undertaken. The primary exposure variable was the occurrence of unintended durotomy. Multivariable logistic/linear regression were performed controlling for age, body mass index, tumor size, other organ metastases, and preoperative radiotherapy/chemotherapy.</p><p><strong>Results: </strong>Of 354 patients undergoing surgery for extradural spinal metastasis, 19 patients (5.4%) had an unintended durotomy. Preoperatively: No difference was found between patients with and without unintended durotomy regarding basic demographics, comorbidities (<i>P</i> = .645), or tumor histology (<i>P</i> = .642). Preoperative chemotherapy/radiotherapy were similar between the 2 groups. Perioperatively: Although patients with unintended durotomy had more costotransversectomies (36.8% vs 12.8%, <i>P</i> = .010), no difference was found in tumor characteristics, operative time (337.4 vs 310.6 minutes, <i>P</i> = .150), blood loss (1012.8 vs 883.8 mL, <i>P</i> = .157), length of stay (6.4 vs 6.9 days, <i>P</i> = .452), or overall reoperation/readmission. Long-term: No difference was seen in CNS spread between those with unintended durotomy and no durotomy (10.5% vs 3.0%, <i>P</i> = .077). LR (5.3% vs 12.2%, <i>P</i> = .712), time to LR (388.0 vs 213.3 ± 359.8 days, log-rank; <i>P</i> = .709), any spinal recurrence (26.3% vs 34.0%, <i>P</i> = .489), overall survival (21.05% vs 34.3%, <i>P</i> = .233), and time to death (466.9 ± 634.7 vs 465.8 ± 665.4 days, log-rank; <i>P</i> = .394) were similar on multivariable Cox regressions.</p><p><strong>Conclusion: </strong>In patients undergoing surgery for extradural spinal metastases, 5% had an unintended durotomy, and costotransversectomies were associated with increased risk of an unintended durotomy. Unintended durotomies did not lead to increased LR or shorter survival. Taken together, shortened survival due to seeding tumor into the CNS after an unintended durotomy was not observed.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 3","pages":"e00096"},"PeriodicalIF":0.0,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783639/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Repair of Cerebrospinal Fluid Leak.","authors":"Lindsey Schwartz, Ismail Mohiuddin, Sibi Rajendran, Meng Huang","doi":"10.1227/neuprac.0000000000000093","DOIUrl":"https://doi.org/10.1227/neuprac.0000000000000093","url":null,"abstract":"<p><strong>Background and importance: </strong>The evolution of endoscopic techniques in spine has allowed novel approaches to various pathologies. We describe the use of endoscopy for repair of refractory cerebrospinal fluid (CSF) leak after lumbar puncture (LP).</p><p><strong>Clinical presentation: </strong>A 31-year-old female presented with refractory postural headaches after undergoing LP. The patient underwent 4 total epidural blood patches (EBPs) with minimal symptomatic relief. The LP opening pressure was found to be 18 cm of water, inconsistent with underlying pseudotumor cerebri. A myelogram demonstrated persistent CSF leak and contrast accumulation within the dorsal epidural space at L2-3. Endoscopic exploration was ultimately performed, which demonstrated well-placed EBPs; however, continuous CSF egressed from a pinhole site. This was repaired with coagulation using a radiofrequency probe, DuraSeal (Integra LifeSciences) and DuraGen (Integra LifeSciences). Postoperatively, the patient noted resolution of debilitating intracranial hypotension symptoms and was able to return to work.</p><p><strong>Conclusion: </strong>Postdural puncture headaches occur in about 1/3 of patients after LP. Symptoms are often debilitating and can include nausea, neck pain, dizziness, tinnitus, visual changes, and hearing loss. Multiple pharmacological and invasive treatments, such as EBP, have been used historically with success, but Postdural puncture headaches refractory to these interventions can put patients at risk for serious complications including seizures and subdural hematomas. We present the first reported case of an endoscopic approach to repair refractory CSF leak in the lumbar spine. Our approach highlights the potential of minimally invasive endoscopic techniques in the repair of refractory CSF leak from the puncture site after LP.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 3","pages":"e00093"},"PeriodicalIF":0.0,"publicationDate":"2024-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}