查看更多>>摘要：? 2022 Elsevier Inc.Vertebral artery dolichoectasia may produce a variety of clinical scenarios depending on the level of compression of several nervous structures along its course. Despite the fact that the pathophysiology is not fully clarified, it would seem that this pathologic elongation and dilation of the artery are acquired and determined by a thinning of the internal elastic lamina exposed to chronic arterial hypertension or as a result of degeneration and atherosclerosis of the arterial wall with age. When treatment is indicated, several techniques to relieve compression have been proposed, but they are usually challenging and nonstandardized. We present a case of a 78-year-old female with a 4-year history of left trigeminal neuralgia resistant to adequate dosage of multiple anticonvulsant medications and allergic to carbamazepine. She presented with a surgical history of a percutaneous microcompression of the Gasserian ganglion and 2 consecutive percutaneous radiofrequency thermorizotomies of the trigeminal nerve with transient benefit. The symptomatology was present for most of the day and impaired her quality of life, leading to severe mood decline. The patient underwent a left suboccipital retrosigmoid craniotomy (Video 1). A Teflon sling was wrapped around the vertebral artery. The 2 ends of the sling were anchored to the lateral dura by cyanoacrylate glue (Glubran 2, GEM Italy, Viareggio, Italy), pulling the vertebral artery away from the trigeminal nerve and brainstem. The patient reported complete suppression of facial pain. The case presentation, surgical anatomy, operative nuances, and postoperative course and outcome are reviewed. The patient gave written consent for participating in the procedure, surgical video, and publication of her images. Unfortunately, we did not take the picture of patient positioning for this specific case. For this reason, in order to better illustrate this surgical phase, we used the picture of another patient, who expressed her consent for publication and was operated on for a microvascular decompression with the same position as the one used for the patient described in this paper.
查看更多>>摘要：? 2022 Elsevier Inc.Objective: In recent years, biportal endoscopic lumbar interbody fusion (BE-LIF) has been increasingly used in the treatment of lumbar degenerative diseases. BE-LIF combines the benefits of minimally invasive fusion with endoscopic spine surgery. However, there is little evidence on whether BE-LIF is superior to posterolateral lumbar interbody fusion (PLIF). The purpose of this meta-analysis is to compare the clinical outcomes, complications, and fusion rates of BE-LIF and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF)/PLIF in treating lumbar degenerative diseases. Methods: A comprehensive assessment of the literature was conducted, and the quality of the retrieved studies was evaluated using the Newcastle-Ottawa Scale. Clinical parameters were investigated using a visual analog scale (VAS) for pain levels and the Oswestry Disability Index for disability levels. The operative times, estimated blood loss, fusion rates, and complications were also analyzed. Results: This meta-analysis comprised 5 studies with a total of 444 participants. No significant differences between the techniques were seen in VAS scores for legs, Oswestry Disability Index, complications, or fusion rates. There were significantly lower VAS scores for back pain in the BE-LIF group than the MI-TLIF/PLIF group, postoperatively. In addition, BE-LIF resulted in significantly less blood loss but required a longer operative time than did MI-TLIF/PLIF. Conclusions: The benefits of BE-LIF and MI-TLIF/PLIF were approximately equivalent in terms of clinical outcomes and achievement of fusion, and complication rates were similar in both groups. However, BE-LIF reduced postoperative back pain and blood loss, despite longer operative times.
查看更多>>摘要：? 2022 Elsevier Inc.Dural arteriovenous fistulas are rare acquired vascular lesions that represent 15% of the vascular malformations. While endovascular treatment has recently became the first line of treatment, microsurgical ligation may still be indicated in specific cases. We present the case of a 75-year-old patient who presented a progressive tetraparesis culminating in a spastic paraplegia and urinary retention. Cranial and spinal magnetic resonance imaging showed a T2 hypersignal in the cervical spinal cord and lower brainstem associated with flow voids in the subarachnoid space. Brain angiography demonstrated a dural arteriovenous fistula of the right petrous apex fed by the inferior lateral and meningohypophyseal trunks of the right cavernous internal carotid artery and draining in the lateral vein of the pons and the anterior medullary vein. Given the small size and tortuous feeders, endovascular treatment was considered too risky and microsurgical ligation was offered to the patient. The main issue of the microsurgical ligation of the dural arteriovenous fistula is the precise identification of the fistulous point, and therefore a detailed study of the specific vascular anatomy of the cerebellopontine angle is compulsory. Indocyanine green angiography plays a major role in confirming the location of the fistula and its correct occlusion. We discuss the technical nuances of the fistula ligation through a retrosigmoid approach and present Video 1 illustrating these principles. Given the retrospective nature of this report, informed consent was not required.
查看更多>>摘要：? 2022 Elsevier Inc.Antoine Shako Hiango Omokanda Djunga was the pioneer of neurosurgery in the Democratic Republic of Congo (DRC), a country located in Central Africa. He was born in 1938 in Sankuru, a province of the DRC. He graduated from the Free University of Brussels medical school and later trained there in neurosurgery. Thereafter, he completed a fellowship at Bellevue Hospital in New York. As a neurosurgeon, he worked at the Kinshasa University Clinic of Lovanium School of Medicine in the DRC, where he introduced neurosurgery and advocated for the construction of the first dedicated neurosurgical operating room. His leadership helped ensure sustainability in the field in the DRC. He died at the age of 48, leaving a void in neurosurgery and an unfulfilled mission of advocating for the construction of an independent neurosurgery hospital in the DRC.
Porto E.Revuelta Barbero J.M.Medina E.Garzon-Muvdi T....
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查看更多>>摘要：? 2022 Elsevier Inc.Background: Meniere disease (MD) is an idiopathic peripheral pathology involving the acoustic apparatus. One of the most critical challenges in managing MD is intractable vertigo. In this context, retrosigmoid vestibular neurectomy has been described as a safe and effective technique to manage this symptom when it is resistant to first- and second-line treatments. This article analyzed the alternative treatment options, specific surgical anatomy, and relevant details of vestibular neurectomies performed for intractable MD. Methods: Relevant neurovascular landmarks, critical surgical steps, adequate indications, and potential pitfalls of retrosigmoid vestibular neurectomy were analyzed based on an illustrative clinical case of intractable MD. Results: The illustrative case demonstrated how early recognition of the facial nerve and the vestibulocochlear plane is fundamental to performing retrosigmoid vestibular neurectomy. This procedure is indicated in cases of resistant MD with preoperative hearing integrity. Potential pitfalls of this technique are incomplete neurotomy, nerve regeneration, comorbidities in the contralateral ear, adverse anatomy, the possibility of nonotologic vertigo, and incomplete vestibular compensation. Conclusions: Vestibular neurectomy represents a safe and effective technique to manage MD that is resistant to medical treatment, allowing symptom control and hearing preservation. Nevertheless, detailed knowledge of surgical anatomy and possible pitfalls is of paramount importance to achieve a good outcome.
查看更多>>摘要：? 2022 Elsevier Inc.Background: Surgical site infections (SSIs) are surgical complications leading to increased antibiotic usage, higher rates of readmission, prolonged hospitalization, and repeat operations. Use of intraoperative antibiotic irrigation as a form of SSI prophylaxis in neurosurgery may have potential. We aim to review the literature surrounding antibiotic irrigation usage in neurosurgical operations to guide current practice and inform future recommendations. Methods: We performed a scoping review of the literature search on PubMed, Ovid, Cochrane, Web of Science, and ClinicalTrials.gov using the terms: (“Neurosurgery” or “Cranial” or “Spinal”) and “Antibiotic” and “Irrigation.” Data, results, and conclusions were extracted from these studies, analyzed, and summarized. Results: Seventeen studies were included. The use of antibiotic irrigation was first popularized in 1979 with the use of streptomycin irrigation by Leonard Malis. Fourteen studies compared SSI rates with a control or historical cohort, and 13 of these studies demonstrated a decrease in SSI rate with antibiotic irrigation. There was greater efficacy of irrigation with vancomycin, gentamicin, or streptomycin use. Results are limited due to variations in choice of antibiotic, type of procedure, instrumentation, and sites of infection across studies. Adverse events based on specific antibiotic use should also be considered. Conclusions: Current evidence supports the utility of antibiotic irrigation in preventing neurosurgical SSIs. However, study variability and limitations reduce the generalizability of these results. Given the high morbidity and cost associated with SSIs, randomized control trials are needed to further clarify the best evidence-based practices regarding antibiotic irrigation use in neurosurgical procedures.
查看更多>>摘要：? 2022 Elsevier Inc.Background: Ventricular drain insertion is a common neurosurgical procedure, typically performed using a freehand approach. Use of image guidance during drain insertion could improve accuracy and reduce the incidence of drain failure. This review aims to assess the impact of image guidance on drain placement accuracy, failure rate, and number of ventricular cannulation attempts. Methods: We searched MEDLINE, Embase, and Cochrane Library databases from inception to February 2021 for studies comparing image-guided versus freehand ventricular drain insertion. Two reviewers independently screened studies for eligibility, extracted data, and assessed risk of bias and quality of evidence. Pooled data were reported using random effects model. The ROBINS-I tool was used to assess risk of bias and the GRADE approach was used to assess quality of evidence. Results: Of 1102 studies retrieved, 17 were included for a total of 3404 patients. All included studies were of non-randomized design. Pooled data on drain accuracy and drain failure rates showed favorable effect of image guidance, with risk ratio of 1.31 (95% confidence interval [CI] 1.13–1.51, low quality evidence) and 0.63 (95% CI 0.48–0.83, moderate quality evidence), respectively. Pooled data were equivocal for number of attempts with mean difference score of –0.14 times (95% CI –0.44 to 0.15, very low-quality evidence). Heterogeneity was substantial for drain accuracy and failure rate outcomes. Conclusions: In patients undergoing ventricular drain insertion, the use of image guidance may enhance drain accuracy and reduce drain failure rate. The use of image guidance probably does not decrease the number of drain insertion attempts.
查看更多>>摘要：? 2022 Elsevier Inc.Objective: We aim to provide a thorough review of the literature regarding patient characteristics, treatment options, and outcomes of pancreatic cancer metastasis to the spine. We also provide an illustrative case from our institution of a patients with pancreatic adenocarcinoma presenting initially as cervical radiculopathy with an isolated cervical spine lesion. Methods: Using the PRISMA guidelines, the literature in PubMed, Google Scholar, and Web of Science databases was searched. We excluded systematic reviews and meta-analyses that did not provide novel cases, as well as reports of metastatic disease from other nonpancreatic primary cancers. Results: Thirty-two patients across 21 studies met the inclusion criteria. The patients were predominantly male (58%), with a mean age of 59 years. Of patients, 64% presented with back pain, 39% with motor deficits, and 15% with bladder or bowel dysfunction. For treatment, chemotherapy was used in 55% of cases and radiotherapy in 42%. Surgical treatment was performed in 42% of cases, with complete tumor resection achieved in 24% of cases. The mean patient survival after treatment was 28 weeks (range, 1–83 weeks), with patients undergoing treatment involving surgery having increased survival (44 weeks) compared with noninvasive treatment alone (18 weeks). Conclusions: Spinal metastasis of pancreatic cancer is rare and typically portends a poor prognosis. It is vital to recognize the presence of spinal involvement early in the disease course and initiate treatment.
查看更多>>摘要：? 2021 Elsevier Inc.Background: A meta-analysis of patients with sporadic vestibular schwannoma (VS) primarily treated with stereotactic radiosurgery (SRS) or microsurgery (MS) was performed, and hearing preservation outcome (HPO), tumor control (TC), and facial nerve dysfunction (FND) were analyzed. Methods: A systematic review was conducted (Medline and Scopus database) for the period January 2010–June 2020 with appropriate MeSH. English language articles for small to medium sporadic VS (<3 cm) using SRS or MS as primary treatment modality, with minimum follow-up of 3 years, were included. Studies had to report an acceptable standardized hearing metric. Results: Thirty-two studies met the inclusion criteria: 10 MS; 23 radiosurgery, and 1 comparative study included in both. HPO, at approximately 65 months follow-up, were comparable between MS group (10 studies; 809 patients) and SRS group (23 studies; 1234 patients) (56% vs. 59%; P = 0.1527). TC, at approximately 70 months follow-up, was significantly better in the MS group (9 studies; 1635 patients) versus the SRS group (19 studies; 2260 patients) (98% vs. 92%; P < 0.0001). FND, at approximately 12 months follow-up, was significantly higher in the MS group (8 studies; 1101 patients) versus the SRS group (17 studies; 2285 patients) (10% vs. 2%; P < 0.0001). Conclusions: MS and SRS are comparable primary treatments for small (<3 cm) sporadic VS with respect to HPO at 5-year follow-up in patients with serviceable hearing at presentation; approximately 50% of patients for both modalities likely lose serviceable hearing by that time point. High TC rates (>90%) were seen with both modalities; MS 98% versus SRS 92%. The posttreatment FND was significantly less with the SRS group (2%) versus the MS group (10%).
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