查看更多>>摘要：? 2022 Elsevier Inc.Moyamoya disease is a progressive pathology that generally presents with ischemic complications in the pediatric age group.1 Direct and indirect revascularization procedures have been shown to augment the cerebral blood flow and prevent disease progression. Some studies have reported better angiographic outcomes with direct revascularization, though its translation into clinical benefit is yet to be proven in prospective studies.1-4 In addition, direct revascularization is surgically challenging among the pediatric age group due to smaller vessel caliber. We present a case of a 10-year-old girl who presented with symptoms suggestive of transient cerebral ischemia (Video 1). We use a fine bipolar forceps for dissection of superficial fascia over superficial temporal artery (STA) and needle monopolar for elevating the temporalis muscle. The recipient vessel of the appropriate caliber, matching the donor vessel, is selected. An arteriotomy is made in the recipient vessel, following which end-to-side anastomosis of STA to M4 middle cerebral artery is done using 10-0 monofilament nylon suture at a magnification of 15×. First, the heel and toe stitches are taken, followed by an initial central stitch in the front wall, which decreases the likelihood of a through stitch while taking interrupted sutures in the back wall. Anastomosis is then completed with interrupted stitches in the front wall. The patency of bypass is confirmed using indocyanine green angiography. In this article, we attempt to highlight our surgical technique of low-flow STA to M4?middle cerebral artery bypass with special emphasis on tips and tricks for young neurosurgeons to efficiently perform microvascular anastomosis.
查看更多>>摘要：? 2022 Elsevier Inc.Background: Maximizing the patient's onco-functional balance is the central tenet of brain tumor surgery. Consequently, numerous surgical adjuncts have been developed to facilitate identification of the tumor–brain interface and preservation of functional anatomy. Among these, intraoperative neurophysiologic monitoring (IONM) with direct cortical stimulation (DCS) and subcortical stimulation (SCS) remains the gold standard for real-time, functional mapping of motor and language activity. Stimulation techniques are not standardized and vary significantly across institutions, however. This is particularly true with SCS for mapping motor function. Methods: We reviewed the state of subcortical IONM and mapping techniques, including historical and predicate literature as well as new and emerging techniques. Here we discuss their evolution, clinical utility, and limitations to direct future research and application. Results: Our evaluation of the background and current clinical use of DCS and SCS techniques and protocols and identification of current trends and limitations focuses specifically on methods of SCS, given the heterogeneity in the published literature. We suggest directions to optimize the clinical utility of these tools. Conclusions: Despite significant heterogeneity in published techniques, trends support use of the Taniguchi method for SCS. Novel dynamic stimulation techniques may improve accuracy. Prospective studies to define standardized guidelines are needed.
查看更多>>摘要：? 2022 Elsevier Inc.Background: Recently many different endoscopic techniques have been used in spontaneous intracerebral hemorrhage evacuation. However, most of these techniques require expensive special equipment or a well-coordinated assistant. We present a simple and effective binding technique for endoscopic hemorrhage evacuation, which is especially useful during emergency treatment and suitable for use in less-developed areas. Methods: Our goal was to achieve easy and accurate hemostasis when using an endoscopic technique in which a single surgeon could operate 3 instruments (endoscope, suction tube, and bipolar forceps) with both hands simultaneously in the transparent tubular retractor. This modification, which we called the binding technique, was achieved by bundling the endoscope and suction tube with a sterile rubber band. Results: We performed the binding technique for endoscopic removal of hematoma in 6 patients, including 3 basal ganglia hemorrhages, 2 brain lobe hemorrhages, and 1 cerebellar hemorrhage. The mean operative time was 117.5 minutes (range, 96–155 minutes). One patient died of postoperative delayed brainstem infarction. The Glasgow Outcome Scale score at 3 months was 5 in 3 patients, 3 in 2 patients and 1 (death) in 1 patient. The modified Rankin Scale score at 3 months was 0 in 3 patients, 4 in 2 patients, and 6 (death) in 1 patient. Conclusions: The binding technique is a modification that allows a single surgeon to achieve easy and accurate hemostasis in endoscopic surgery of intracerebral hematomas. This technique is easy to learn and suitable for emergency surgery, especially in less developed areas.
Alves Junior A.C.Botta F.P.Hamamoto Filho P.T.Zanini M.A....
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查看更多>>摘要：? 2022 Elsevier Inc.Meningiomas represent 8%?10% of all pineal region (PR) tumors. When they arise from the falx, tentorium, or tentorial incisura, they are not always considered a true PR tumor, as they do not originate from it but instead only grow toward the region. The true meningioma of PR must be originated from the arachnoid envelope of the pineal gland or from the 2 leaflets of the velum interpositum. In both conditions there are no dural attachments.1,2 Occipital interhemispheric transtentorial and supracerebellar infratentorial are the 2 main approaches for tumors within this region. Aside from the surgeon's preference, the position of the venous system and the direction of the tumor growth guide the approach choice. Endoscope assistance can help reach areas unable to be visualized under the microscope.3-5 We report the case of a 37-year-old female with a large PR meningioma (velum interpositum) presenting with intense dysphagia, dysphonia, and bilateral tongue palsy. Given the affected bilateral upper motor tracts associated with bulbar symptoms, a diagnosis of pseudobulbar palsy was considered.6,7 Preoperative imaging also showed compression of the deep venous system. The patient underwent a total resection of the tumor via an occipital interhemispheric transtentorial approach and exhibited a dramatic recovery of neurologic symptoms after the surgery (Video 1). Postoperative venogram showed restoration of the usual deep venous system pattern, which may be associated with significant neurologic improvement. Careful management of the deep veins is mandatory during the resection of PR meningiomas. The venous system improvement after the surgery may be associated with the dramatic recovery seen in this unique case. The patient consented to publication of her images.
查看更多>>摘要：? 2022 Elsevier Inc.The Neuro-Psycho-Pathology Center (NPPC) in the Democratic Republic of Congo is a 450-bed neuropsychiatric clinic that pioneered efforts to synergize various disciplines: neurology, neurosurgery, neuropsychiatry, and psychiatry. It serves the brain and behavioral health needs of Congolese patients, and at its peak, the NPPC was a major domestic neuropsychiatry center that averaged 320 admissions annually. Financial and resources shortages have curtailed its functions at 10% of its real capacity. Our report accounts the NPPC's early vision, and we also highlight the ongoing challenges faced by this institution.
查看更多>>摘要：? 2022 Elsevier Inc.Background: Unilateral biportal endoscopic (UBE) laminotomy with bilateral decompression is a high-risk operation when performed in the cervical spine. In this study, we aimed to design an auxiliary portal for treatment of cervical spondylotic myelopathy using a percutaneous biportal endoscopic approach. Methods: Six patients with cervical spondylotic myelopathy were consecutively treated using an auxiliary portal (Zhang's portal) during percutaneous biportal endoscopic surgery between June 2020 and July 2021. Clinical outcomes were assessed by comparing preoperative and postoperative Japanese Orthopaedic Association scores and status based on modified Macnab criteria. Results: The study enrolled 6 patients (2 men and 4 women; mean age, 51.6 ± 10.8 years). The mean operative time was 78.6 ± 37.4 minutes. There were no cases of infection, cerebrospinal fluid leakage, or neurological complications. The mean Japanese Orthopaedic Association score improved from 7.5 to 12.1. At final follow-up, outcomes were considered excellent for all patients based on modified Macnab criteria. Conclusions: Zhang's portal can allow for safe, flexible, and convenient contralateral decompression without the need to remove excessive portions of bone from the spinous process. Our results suggest that applying Zhang's portal in unilateral biportal endoscopy surgery represents an alternative when aiming to decompress the contralateral canal in patients with cervical spondylotic myelopathy caused by hypertrophy of the ligamentum flavum.
查看更多>>摘要：? 2022 Elsevier Inc.Spinal cord injury (SCI) is a serious disease of the central nervous system, often with irreversible loss of motor or sensory functions. Failure of axon connection and inhibition of the microenvironment after SCI severely hinder the regeneration of damaged tissue and neuron function. Therefore, a new perspective in the treatment of SCI is reconstruction of the neural circuit. Stem cells are a type of cells with differentiation potential. They reconstruct local circulation by differentiating into neurons to replace damaged cells. They also can secrete various factors to regulate the host microenvironment and play a therapeutic role. Biomaterials can fill the cavity at the site of SCI, load therapeutic drugs, provide adsorption sites for transplanted cells, and play a bridging role. In this review, the therapeutic role of stem cells and biomaterials is discussed, together with their properties, advantages, limitations, and future perspectives, providing a reference for basic and clinical research on SCI treatment.
查看更多>>摘要：? 2022Pericallosal artery aneurysms are rare, accounting for 2%–9% of all intracranial aneurysms. They are most commonly saccular and wide necked. Although typically small, they are more prone to rupture compared with other aneurysms in the anterior circulation. They are more common in people with unpaired or azygous arteries. Rupture of pericallosal artery aneurysm results in intracerebral hematoma in approximately 50% of patients, usually in the frontal lobe, anterior interhemispheric fissure, pericallosal cistern, or cingulate gyrus. Compared with other supratentorial aneurysms, surgical clipping of pericallosal aneurysms carries a higher morbidity and mortality. A 47-year-old female presented with sudden-onset worst headache of her life followed by dizziness, syncope, transient weakness, and numbness over the left lower extremity. She was neurologically intact, and imaging revealed a right pericallosal artery aneurysm. The patient consented to the procedure. The 2-dimensional Video 1 demonstrates the interhemispheric approach for clipping of a pericallosal artery aneurysm. These aneurysms are approached in the distal-to-proximal direction along with the distal anterior cerebral artery. Meticulous dissection avoids rupture without proximal control. We highlight the key surgical steps and microsurgical techniques in approaching these aneurysms. The patient tolerated the operation well with an uneventful postoperative course.
查看更多>>摘要：? 2022 Elsevier Inc.Background: Cerebrospinal fluid (CSF)-venous fistula presents a pathologic connection between spinal subarachnoid space and adjacent epidural vein or veins. It is one of the 3 main causes of spontaneous intracranial hypotension along with dural defects and meningeal diverticulum. We performed a systematic review of the literature and analyzed individual participants’ data focusing on clinical outcomes after different treatment modalities of CSF-venous fistula. Methods: Systematic review was conducted according to PRISMA recommendations. Literature search was performed in PubMed and Web of Science databases with following key phrases: “CSF-venous fistula”, “Spontaneous intracranial hypotension”. Overall, 97 articles were found during the initial search; 15 were included for the final analysis, with a total number of 137 patients. Results: Epidural blood patch (EBP) was performed as a first-line treatment in 37.1% of patients in individual data group, often not combined with fibrin glue (61.5%). Either partial (69.2%) or no resolution (30.8%) of symptoms was achieved after EBP injection. Nerve root ligation was the most common method of exclusion of CSF-venous fistula. Complete resolution of symptoms was achieved in 69.0% of patients, in 21.4% it was partial and in 9.5% no regress was found. Endovascular treatment was described only in 1 study. Conclusions: Surgical ligation of fistula is a treatment of choice. In approximately 70% of patients complete long-term resolution of symptoms is achieved after surgery. Endovascular treatment and fibrin glue injections are prospective and evolving options, which require further investigation.
查看更多>>摘要：? 2022 Elsevier Inc.Background: In patients with Pfeiffer syndrome, several corrections are required to correct facial retrusion, maxillary deficiency, or even hypertelorism. The frontofacial monobloc advancement (FFMA) and the facial bipartition (FB) are the gold standard surgeries. We present the correction of this deformity using a simultaneous computer-assisted FFMA and FB. Methods: The 3-dimensional surgical planning defined the virtual correction and bone-cutting guide in view of the FFMA and FB. Coronal and intraoral approaches were combined to perform the osteotomies. Four internal distractors were also placed for the postoperative distraction osteogenesis. Results: We reported 2 cases of computer-assisted surgery with satisfying outcomes. The sagittal deficiency (fronto-facial retrusion) was corrected by FFMA and the transversal abnormality (i.e., hypertelorism and maxillary deficiency) by the FB, then followed by an internal distraction osteogenesis. Conclusions: Computer-assisted surgery is helpful and a reliable option for the management of complex faciocraniosynostosis such as hypertelorism and frontofacial retrusion.
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