Neurosurgery practice最新文献

{"title":"Severe Vertebrobasilar Vasospasm After Iatrogenic Rupture of a Posterior Fossa Epidermoid Cyst: A Case Report of a Rare Complication Managed With Endovascular Intervention.","authors":"Steven B Housley, Wady T Jacoby, Zoe Farkash, Andre Monteiro, Jaims Lim, Jason M Davies, Elad I Levy","doi":"10.1227/neuprac.0000000000000048","DOIUrl":"10.1227/neuprac.0000000000000048","url":null,"abstract":"<p><strong>Background and importance: </strong>Aseptic meningitis and hydrocephalus have been reported after intracranial epidermoid cyst rupture. We present a rare case of clinically symptomatic vasospasm after iatrogenic rupture.</p><p><strong>Clinical presentation: </strong>A middle-aged woman presenting with headache, facial paresthesia, and dizziness was found to have a 5-cm posterior fossa epidermoid cyst on magnetic resonance imaging. Resection was achieved through suboccipital craniectomy and C1 laminectomy. On postoperative day (POD) 1, the patient became unresponsive. After ventriculostomy placement for developing hydrocephalus, she failed to improve. Digital subtraction angiography revealed severe vertebrobasilar vasospasm, which was treated successfully with intra-arterial verapamil and milrinone. She experienced multiple episodes of recurrent vasospasm, all successfully treated with verapamil-milrinone. After ventriculoperitoneal shunt placement on POD 31, her condition stabilized; she was discharged to a rehabilitation center on POD 38.</p><p><strong>Conclusion: </strong>This successful treatment of rare, clinically symptomatic vasospasm postiatrogenic epidermoid cyst rupture may help guide treatment in similar scenarios.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"4 3","pages":"e00048"},"PeriodicalIF":0.0,"publicationDate":"2023-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434589","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":"Glymphatics for the Neurosurgeon.","authors":"Randall W Treffy, Akram M Eraky, Omar Hussain, Hirad S Hedayat","doi":"10.1227/neuprac.0000000000000051","DOIUrl":"10.1227/neuprac.0000000000000051","url":null,"abstract":"<p><p>The glymphatic system is a recently described open vascular system within the brain that allows cerebrospinal fluid to flow into brain parenchyma through perivascular spaces and clears interstitial solutes into the traditional closed vascular system. Although it was initially difficult to study, new evidence suggests that the glymphatic system plays a pivotal role in the pathophysiology of multiple diseases of the central nervous system including traumatic brain injury, hydrocephalus, dementia, and malignancy. In this review, we cover the basics of cerebrospinal fluid dynamics and explore the role of the glymphatic system in traumatic brain injury, post subarachnoid hemorrhage hydrocephalus, normal pressure hydrocephalus, and malignancy. We believe that further understanding of the glymphatic system will lead to new and better therapeutic options for these diseases moving forward.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"4 3","pages":"e00051"},"PeriodicalIF":0.0,"publicationDate":"2023-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11810010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434572","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":"Cisterno-Ventricular Lavage After Aneurysm Clipping for the Prevention of Delayed Infarction in Patients With Subarachnoid Hemorrhage.","authors":"Christian Scheiwe, Jürgen Grauvogel, István Csók, Panagiotis Fistouris, Christian Fung, Jürgen Beck, Peter C Reinacher, Roland Roelz","doi":"10.1227/neuprac.0000000000000049","DOIUrl":"10.1227/neuprac.0000000000000049","url":null,"abstract":"<p><strong>Background and objectives: </strong>Cerebral infarction due to delayed cerebral ischemia (DCI) is an important source of morbidity after aneurysmal subarachnoid hemorrhage (aSAH). Breakdown products of cisternal and ventricular blood are putative triggers of cerebral vasospasm, which may progress to cerebral infarction. Therefore, intracranial blood clearance is a promising treatment approach. Surgical clipping of aneurysms of the anterior circulation grants access to the basal cisterns of the brain, allowing placement of cisterno-ventricular catheters (CVCs) for postoperative irrigation therapy. Here, we report on the implementation of this simple technique to enable clearance of subarachnoid and ventricular blood.</p><p><strong>Methods: </strong>Twenty patients with aSAH were selected for intraoperative placement of a CVC through the fenestrated lamina terminalis after aneurysm clipping. Continuous irrigation was performed using the fibrinolytic urokinase and, on detection of vasospasm, nimodipine. All consecutive patients with aSAH with aneurysm clipping admitted between 2008 and 2015 served as controls. The primary end point was occurrence of cerebral infarction due to DCI.</p><p><strong>Results: </strong>Placement of the CVC and application of lavage therapy were feasible and safe in all patients because no adverse events were observed. Cerebral infarction due to DCI occurred in 0/20 patients (0%) selected for lavage therapy vs 46/223 patients (20.6%) in the control cohort (<i>P</i> = .017). Shunt-dependent hydrocephalus occurred in 2/17 survivors (12%) from the CVC group vs 44/187 (23.5%) in the control group (<i>P</i> = .37).</p><p><strong>Conclusion: </strong>Clipping of ruptured aneurysms of the anterior circulation allows placement of a CVC through the fenestrated lamina terminalis and postoperative lavage therapy. The risks of infarction due to DCI can be mitigated using this simple intraoperative approach.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"4 3","pages":"e00049"},"PeriodicalIF":0.0,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11810029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434515","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":"Stereotactic DOTATATE Positron Emission Tomography/Computed Tomography-Guided Resection of a Multiply Recurrent World Health Organization Grade 2 Parasagittal Meningioma: A Technical Case Report.","authors":"Khizar R Nandoliya, Pouya Jamshidi, Rudolph J Castellani, Matthew C Tate, Ryan J Avery, Stephen T Magill","doi":"10.1227/neuprac.0000000000000047","DOIUrl":"10.1227/neuprac.0000000000000047","url":null,"abstract":"<p><strong>Background and importance: </strong>Resection of parasagittal meningiomas is challenging due to venous and superior sagittal sinus involvement. Recurrent tumors can be particularly challenging given scar tissue from prior surgery and radiation, which can be difficult to differentiate from active tumor on preoperative MRI. Cu-64-1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA)-octreotate (DOTATATE) is a somatostatin receptor (SSTR) ligand detectable on positron emission tomography (PET) imaging. SSTR is expressed by most meningiomas. While DOTATATE-PET has been investigated for radiotherapy planning, its use in guiding oncological meningioma resection is understudied. Here, we present a case example demonstrating its use in guiding surgical planning and maximizing the extent of resection.</p><p><strong>Clinical presentation: </strong>A 45-year-old man with a World Health Organization grade 2 bilateral parasagittal meningioma presented with recurrence after 2 prior resections, wound infection and washout, and fractionated radiotherapy with boost to residual disease. Preoperative angiography demonstrated an occluded sagittal sinus beyond the extent of the residual tumor. Stereotactic DOTATATE PET-computed tomography (CT) imaging was integrated with the neuro-navigation and used intraoperatively to identify extent of active tumor, differentiating it from scar tissue and gliosis. This was used to facilitate oncological tumor resection with negative pathological margins that correlated with the absence of DOTATATE signal.</p><p><strong>Conclusion: </strong>Stereotactic DOTATATE PET-CT is a valuable addition to the neurosurgeon's toolkit, particularly when integrated into the neuro-navigation, for achieving complete resections of recurrent meningiomas, or meningiomas where the extent of tumor invasion can be challenging to define on preoperative MRI.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"4 3","pages":"e00047"},"PeriodicalIF":0.0,"publicationDate":"2023-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434593","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":"Association Between Neurological Outcomes and Timing of Physical Therapy Initiation Among Patients Treated for Aneurysmal Subarachnoid Hemorrhage: A Propensity-Adjusted Analysis.","authors":"Joshua S Catapano, Stefan W Koester, Kavelin Rumalla, Stephen J Dabrowski, Ethan A Winkler, Robert F Rudy, Tyler S Cole, Jacob F Baranoski, Christopher S Graffeo, Visish M Srinivasan, Ruchira M Jha, Ashutosh P Jadhav, Andrew F Ducruet, Felipe C Albuquerque, Michael T Lawton","doi":"10.1227/neuprac.0000000000000046","DOIUrl":"10.1227/neuprac.0000000000000046","url":null,"abstract":"<p><strong>Background: </strong>Aneurysmal subarachnoid hemorrhage (aSAH) is a debilitating neurological disease associated with poor neurological outcomes.</p><p><strong>Objective: </strong>To evaluate the association between timing of physical therapy (PT) initiation and neurological outcomes among patients treated for aSAH.</p><p><strong>Methods: </strong>Patients receiving definitive aneurysm treatment at a single quaternary center (January 1, 2014-July 31, 2019) with data available on PT initiation and the number of sessions were analyzed. Patients were compared based on whether PT initiation was delayed (>24 hours after definitive aneurysm treatment) or nondelayed (≤24 hours after treatment). The primary outcome was a poor neurological outcome at last follow-up (modified Rankin Scale [mRS] score >2). A propensity-adjusted score was generated and included as a covariate in a logistic regression analysis.</p><p><strong>Results: </strong>Among 382 patients, 260 (68%) had delayed and 122 (32%) had nondelayed PT initiation. A significantly greater percentage of patients in the delayed PT group had an mRS score of >2 at last follow-up (42% [n = 110] vs 20% [n = 24]; <i>P</i> < .001). Among 298 patients with a Hunt and Hess (HH) grade <4, the percentage with an mRS score of >2 at last follow-up was significantly higher in the delayed (34% [62/184]) than nondelayed (18% [21/114]) PT group (<i>P</i> = .006). The logistic regression analysis showed that, among patients with an HH grade of <4, delayed PT initiation increased the risk of having an mRS score of >2 at follow-up (odds ratio = 1.90, 95% CI = 1.02-3.62, <i>P</i> = .047).</p><p><strong>Conclusion: </strong>Delayed PT initiation after definitive aneurysm treatment was associated with poor neurological outcomes regardless of patient characteristics, neurological presentation, or aneurysm characteristics.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"4 3","pages":"e00046"},"PeriodicalIF":0.0,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434485","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 Risk Analysis Index Has Superior Discrimination Compared With the Modified Frailty Index-5 in Predicting Worse Postoperative Outcomes for the Octogenarian Neurosurgical Patient.","authors":"Alyssa G Yocky, Oluwafemi P Owodunni, Evan N Courville, Syed Faraz Kazim, Meic H Schmidt, Susan L Gearhart, Diana L Greene-Chandos, Naomi George, Christian A Bowers","doi":"10.1227/neuprac.0000000000000044","DOIUrl":"10.1227/neuprac.0000000000000044","url":null,"abstract":"<p><strong>Background and importance: </strong>Healthcare systems continuously strive to improve quality and value of care. Advances in surgical technologies, enhanced perioperative surgical planning, and multidisciplinary care strategies are increasing the number of elective procedures in the geriatric population. However, frail older adults are still more likely to have poor postoperative outcomes. We examined the impact of frailty on postoperative outcomes, we compared the discriminative thresholds for the Risk Analysis Index (RAI), modified Frailty Index-5 (mFI-5), and increasing patient age.</p><p><strong>Clinical presentation: </strong>Octogenarian patients undergoing spine, cranial, and other procedures captured in the American College of Surgeons National Surgical Quality Improvement Program between 2012 and 2020 were included. We used receiver operating characteristic curve to examine discriminative thresholds of RAI, mFI-5, and increasing patient age. Multivariable analyses were performed. Our primary outcomes were 30-day mortality, extended length of stay (eLOS [≥75th percentile]), and continued inpatient care >30 days (pLOS). Secondary outcomes were skilled care facility (skilled nursing facility [SNF]) discharges and readmissions.</p><p><strong>Discussion: </strong>In total, 20 710 octogenarians were included, with a mean age of 83 years (SD, 2.5) and a men (52.7%) and White (79.8%) majority. The RAI had higher predictive discriminative thresholds for 30-day mortality (C-statistic of 0.743), eLOS (C-statistic: 0.692), and pLOS (C-statistic: 0.697) compared with the mFI-5 (C-statistic: 0.574, 0.556, and 0.550, respectively), and increasing patient age (C-statistic: 0.577, 0.546, and 0.504, respectively), <i>P</i> < .001. On multivariable analyses, RAI showed a larger effect size with adverse postoperative outcomes by increasing frailty strata than mFI-5 and increasing patient age. Nonetheless RAI showed decreased risk for SNF discharges.</p><p><strong>Conclusion: </strong>We found that RAI was a more accurate predictor than mFI-5 and increasing patient age for 30-day mortality, eLOS, and pLOS in octogenarian neurosurgery patients. More research is needed on RAI's performance in different specialized neurosurgical populations. Moreover, it is increasingly clear that comprehensive risk assessment strategies tailored to optimize perioperative care should be prioritized to potentially improve outcomes for this at-risk population.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"4 3","pages":"e00044"},"PeriodicalIF":0.0,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434594","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":"Peripheral Nerve Stimulation for Chronic Foot Pain Induced by Morton Neuroma: A Novel, Personalized Approach in One Patient.","authors":"Brian Fabian Saway, Reese Townsend Terry, Aimee C Weber, Nathan C Rowland","doi":"10.1227/neuprac.0000000000000043","DOIUrl":"10.1227/neuprac.0000000000000043","url":null,"abstract":"<p><strong>Background and importance: </strong>Morton neuroma (MN) is a condition characterized by pain that is located within one or more intermetatarsal spaces of the forefoot. Numerous conservative measures are available for the management of mild-to-moderate MN cases. In more severe presentations, surgical interventions may be considered, including neuroma excision, cryogenic or radiofrequency ablation, and decompression. However, no standard treatments exist for occurrences of recurrent MN after surgery. Peripheral nerve stimulation is a neuromodulatory treatment that is highly effective for other neuropathic pain syndromes but remains underutilized for MN.</p><p><strong>Clinical presentation: </strong>Here, we present the operative technique and clinical outcome in a patient with chronic pain induced by MN who underwent bilateral implantation of peripheral nerve stimulation devices. In less than 12 months, the patient had near-complete resolution of chronic foot pain with no postoperative complications.</p><p><strong>Discussion: </strong>We present the first published case and operative technique of successful peripheral nerve stimulator implantation as an effective treatment of MN.</p><p><strong>Conclusion: </strong>Peripheral nerve stimulator implantation is a promising and effective intervention that can be considered for refractory MN.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"4 3","pages":"e00043"},"PeriodicalIF":0.0,"publicationDate":"2023-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11810003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434582","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":"Emergent Revascularization After Transposition of an Unexpected Intraosseous Anomalous Subarcuate Loop During Vestibular Schwannoma Surgery: A Case Report.","authors":"Kiyohiko Sakata, Aya Hashimoto, Hidenobu Yoshitake, Sosho Kajiwara, Kimihiko Orito, Hideo Nakamura, Motohiro Morioka","doi":"10.1227/neuprac.0000000000000045","DOIUrl":"10.1227/neuprac.0000000000000045","url":null,"abstract":"<p><strong>Background and importance: </strong>The presence of an anomalous anteroinferior cerebellar artery (AICA) embedded within the subarcuate fossa increases the difficulty of cerebellopontine angle (CPA) tumor surgery. Iatrogenic injury of posterior fossa arteries can result in serious morbidity.</p><p><strong>Clinical presentation: </strong>A 70-year-old man presented with right-sided hearing loss and facial dysesthesia. Magnetic resonance imaging showed a tumor with solid and cystic components and 35-mm maximum diameter in the right CPA. The AICA traveled just dorsal to the tumor and was well-developed because the ipsilateral vertebral artery and posteroinferior cerebellar artery (PICA) were aplastic. During surgery, we unexpectedly encountered an anomalous loop of the AICA-PICA which was embedded in the subarcuate fossa. This loop was mobilized using an ultrasonic bone curette to enable further tumor resection. However, it occluded immediately after mobilization and required open thrombectomy and end-to-end anastomosis. After revascularization, near-complete tumor resection was achieved without causing facial nerve dysfunction or brainstem/cerebellar infarction. Pathological examination of the resected anomalous loop showed abnormal focal hypertrophy of the adventitia and the presence of external elastic lamina.</p><p><strong>Conclusion: </strong>Mobilization of an anomalous AICA-PICA loop embedded within the subarcuate fossa during VS resection can result in arterial occlusion which requires thrombectomy and revascularization. Surgeons should be aware of this vascular anomaly and be prepared to deal with its ramifications.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"4 3","pages":"e00045"},"PeriodicalIF":0.0,"publicationDate":"2023-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434536","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":"Cranial Nerve IX and X Neurectomy for Glossopharyngeal Neuralgia: Case Report and Operative Video.","authors":"Bhuvic Patel, Sangami Pugazenthi, Joshua Dowling","doi":"10.1227/neuprac.0000000000000041","DOIUrl":"10.1227/neuprac.0000000000000041","url":null,"abstract":"<p><strong>Background and importance: </strong>Glossopharyngeal neuralgia (GPN) is a rare condition that is often misdiagnosed as trigeminal neuralgia. The condition is characterized by intermittent, severe pain in the distribution of the glossopharyngeal nerve. We present an illustrative case of GPN with an operative video detailing neurectomy of the glossopharyngeal nerve and the upper rootlets of the vagus nerve for treatment of idiopathic GPN in a patient with a history of squamous cell carcinoma.</p><p><strong>Clinical presentation: </strong>A 62-year-old man with a history of left mandibular alveolar squamous cell carcinoma status postresection presented with left-sided severe, paroxysmal pain in the posterior one-third of his tongue refractory to medical treatment and without evidence of recurrent malignancy or vascular compression on imaging studies. After he failed medical management, glossopharyngeal neurectomy was performed through a left suboccipital craniotomy during which cranial nerves IV, V, VI, VII/VII, IX, X, and XI were visually inspected for malignant recurrence, and the glossopharyngeal nerve and the upper 2 to 3 nerve rootlets of the vagus nerve were severed. The patient had immediate, complete, and durable resolution of his symptoms without any new neurological deficits.</p><p><strong>Conclusion: </strong>Glossopharyngeal neurectomy has been shown to be an efficacious surgical treatment for GPN, as first described by Walter Dandy in 1920. In this report, we describe the workup and treatment of GPN with important diagnostic considerations and present a detailed video demonstrating technical and anatomic considerations when performing glossopharyngeal neurectomy.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"4 3","pages":"e00041"},"PeriodicalIF":0.0,"publicationDate":"2023-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434520","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":"Improving Surgical Outcomes in Middle Cranial Fossa Cerebrospinal Fluid Leak Repair.","authors":"Jia Hui Ng, Arul Bala, Thomas Hendriks, Jafri Kuthubutheen","doi":"10.1227/neuprac.0000000000000042","DOIUrl":"10.1227/neuprac.0000000000000042","url":null,"abstract":"<p><strong>Background: </strong>Spontaneous cerebrospinal fluid (CSF) leaks of the temporal bone occur in the absence of known iatrogenic or traumatic injury and without underlying congenital malformation. Holistic treatment of the condition requires meticulous perioperative evaluation of the patient to mitigate underlying risk factors. Similarly, surgery for CSF leaks requires careful consideration of all potential routes of CSF leakage to improve short- and long-term surgical outcomes.</p><p><strong>Objective: </strong>To describe our surgical technique in this article, which addresses most of the potential routes of spontaneous CSF otorrhea. Perioperative management of the patients is also described.</p><p><strong>Methods: </strong>A total of 65 patients underwent CSF leak repair using a middle cranial fossa approach and the techniques described in this paper. Their surgical outcomes are described.</p><p><strong>Results: </strong>Preoperatively, all patients had either biochemically proven beta trace protein-positive CSF otorrhea or the presence of an encephalocele on preoperative imaging. Using this technique, all patients had short-term successful repair of their CSF leak, whereas a long-term success rate of 87.7% was achieved. No major complications were encountered.</p><p><strong>Conclusion: </strong>Holistic treatment of spontaneous CSF leaks of the temporal bone, together with using a surgical approach that considers all potential routes of CSF leakage, may help to improve long- and short-term surgical outcomes.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"4 3","pages":"e00042"},"PeriodicalIF":0.0,"publicationDate":"2023-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11810018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434576","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}