Journal of neurological surgery. Part A, Central European neurosurgery最新文献

Background:  We analyzed clinical and radiographic outcomes in patients undergoing anterior lumbar interbody fusions (ALIFs) using a new biomimetic titanium fusion cage (Titan nanoLOCK interbody, Medtronic, Minneapolis, Minnesota, United States). This specialized cage employs precise nanotechnology to stimulate inherent biochemical and cellular osteogenic reactions to the implant, aiming to amplify the rate of fusion. To our knowledge, this is the only study to assess early clinical and radiographic results in ALIFs.

Methods:  We conducted a retrospective review of data for patients who underwent single or multilevel ALIF using this implant between October 2016 and April 2021. Indications for treatment were spondylolisthesis, postlaminectomy syndrome, or spinal deformity. Clinical and radiographic outcome data for these patients were collected and assessed.

Results:  A total of 84 patients were included. The mean clinical follow-up was 36.6 ± 14 months. At 6 months, solid fusion was seen in 97.6% of patients. At 12 months, solid fusion was seen in 98.8% of patients. Significant improvements were seen in patient-reported outcome measures (PROMs; visual analog scale and Oswestry Disability Index) at 6 and 12 months compared with the preoperative scores (p < 0.001). One patient required reoperation for broken pedicle screws 2 days after the ALIF. None of the patients required readmission within 90 days of surgery. No patients experienced an infection.

Conclusions:  ALIF using a new titanium interbody fusion implant with a biomimetic surface technology demonstrated high fusion rates (97.6%) as early as 6 months. There was significant improvement in PROMs at 6 and 12 months.

Background:  Neurovascular conflict between the oculomotor nerve and a posterior circulation cerebral artery is a relatively frequent radiologic finding; however, it manifests minimally clinically (by slower photoreaction on the ipsilateral side). Sustained paresis of the oculomotor nerve that arose directly due to neurovascular conflict between the superior cerebral artery (SCA) and the oculomotor nerve, and resolved after microvascular decompression, is extremely rare and has not yet been published.

Methods:  A 34-year-old female patient presented with an advancing ptosis and downward gaze on one side. Differential diagnostics ruled out all other causes of the oculomotor paresis. Magnetic resonance imaging showed significant compression of the oculomotor nerve by an aberrant SCA on the ipsilateral side. Neurovascular decompression performed microsurgically resulted in near complete resolution of the symptoms.

Results:  This case report aims to present a case of a rare clinical condition caused by a generally common anatomical variation. This variation proved to be the only cause of the patient's symptoms, which resolved after microsurgical restoration of the neuroanatomy.

Conclusions:  Oculomotor nerve paresis caused directly by neurovascular conflict is an extremely rare diagnosis. Microvascular decompression should be considered in these cases, if other causes have been excluded.

Background:  The present study aimed to compare the clinical and radiologic outcomes of oblique lumbar interbody fusion (OLIF) combined with lateral screw fixation and minimally invasive transforaminal lumbar interbody fusion (Mis-TLIF) for the treatment of single-level degenerative lumbar spondylolisthesis (DLS).

Methods:  Data regarding clinical and radiologic outcomes for single-level DLS treated using OLIF combined with lateral screw fixation or Mis-TLIF between November 2017 and June 2020 were retrospectively analyzed.

Results:  Seventy-five patients with single-level DLS (≥2 years' follow-up) were included and divided into two groups according to the surgical method used: OLIF (n = 33) and Mis-TLIF (n = 42). Operative time, intraoperative blood loss, and length of hospital stay were significantly lower in the OLIF group than that in the Mis-TLIF group. There were no significant differences in preoperative low back pain (LBP), leg pain (LP), visual analog scale (VAS) scores, and Oswestry Disability Index (ODI) between the two groups, although the OLIF group had significantly lower LBP VAS scores at 1, 3, and 6 months postoperatively. Additionally, the LP VAS score was significantly lower in the Mis-TLIF group than that in the OLIF group at 1 month postoperatively, and the ODI of the OLIF group at 3 months postoperatively was significantly lower than that of the Mis-TLIF group. There was no significant difference in the preoperative and postoperative lumbar lordosis angles between the two groups, whereas the postoperative surgical segmental lordosis angle and disk height (at 1, 6, 12, and 24 months) in the OLIF group were significantly higher than those in the Mis-TLIF group. Additionally, there was no significant difference in complication rates between the two groups (18.2% in the OLIF group vs. 11.9% in the Mis-TLIF group; p = 0.520).

Conclusion:  OLIF combined with lateral screw fixation yielded better clinical and radiologic outcomes than Mis-TLIF in patients with single-level DLS.

Background:  Venous varices in the draining vein of arteriovenous malformations (AVMs) can result in compression symptoms. This condition is extremely rare, and its treatments and long-term outcomes are unresolved.

Methods:  Herein, we describe the treatment of a thrombosed venous varix in a draining vein and review the relevant literature.

Results:  The patient presented with progressive right-sided hemiparesis and aphasia. Magnetic resonance imaging revealed flow void accumulation from the corpus callosum to the left ventricle and a 30-mm mass in the left putamen. The patient underwent targeted transarterial embolization to reduce the blood flow to the venous varix and relieve the neurologic symptoms. The patient had recovered completely from the right hemiparesis and aphasia 4 years after treatment, with a modified Rankin scale score of 0.

Conclusion:  Targeted transarterial embolization for symptomatic venous varix is a palliative treatment that may improve long-term functional outcomes.

The main purpose of this article is to report on the life, work, and achievements of functional neurosurgeons, neurologists, psychiatrists, and neuroanatomists located in Freiburg in the era of the newly founded Federal Republic of Germany along with the depiction of their long-lasting impact for functional stereotactic neurosurgery in Germany and abroad.Review of available literature (PubMed, Scopus, University Archiv of Freiburg, University Archiv Würzburg) and personal records (e.g., communications, biographical reports) was assessed and summarized providing an overview of the Freiburg School of Stereotaxy including the main protagonists Traugott Riechert (1905-1983), Rolf Hassler (1914-1984), Fritz Mundinger (1924-2012) along with Kurt Beringer (1893-1949), and Richard Jung (1911-1986) covering the years around 1950.The rise of stereotactic functional neurosurgery after World War II in Germany was inaugurated mainly by the Department of Neurosurgery in Freiburg through an interplay across neuro-associated disciplines. Close working relationships between the disciplines of neurosurgery (Traugott Riechert, Fritz Mundinger), neurology/psychiatry/neurophysiology (Kurt Beringer, Richard Jung), and neuroanatomy (Rolf Hassler) enabled the foundation, implementation, and further development of stereotactic techniques targeting movement disorders, psychiatric indications, pain, epilepsy, and brain tumors. Furthermore, educational efforts were undertaken to provide state-of-the-art stereotactic neurosurgery, which led to the spread of the so-called Freiburg School of Stereotaxy throughout Germany and beyond (Gert Dieckmann 1925-2007; Fritz Roeder 1906-1988/Hans Orthner 1914-2000; Konrad Nittner 1921-1994; Wilhelm Umbach 1915-1976, and others).The work and fate presented herein underlines the eminent role of the protagonists and the Freiburg School of Stereotaxy for the development and maintenance of functional stereotactic neurosurgery in Germany. This accounts for the broad range of treated neurological disorders along with the passion to steadily strive for innovations and education displayed by the dissemination of stereotactic functional neurosurgeons across German universities ultimately leading to an increased number of stand-alone functional units and/or departments over the coming decades of the past century.

Background:  There is high risk of injury to the olfactory tract and olfactory bulb during surgery of the anterior cranial fossa. The goal of this study was to describe the outer arachnoid envelope around the olfactory bulb, which plays a significant role in approach-related injury of the nerve.

Methods:  A total of 20 fresh human cadaveric heads were examined. Five cadaveric heads were used to describe a gross overview of the topographic anatomy of the outer arachnoid cover of the olfactory bulb. In 15 cadaveric heads, endoscopic surgical approaches were performed to examine the in situ undisrupted anatomy of the outer arachnoid around the olfactory bulb. Four cadaveric heads were used for the lateral subfrontal approach, 5 heads for the medial subfrontal approach, 3 heads for the median subfrontal approach, and 3 heads for the anterior interhemispheric approach.

Results:  The outer arachnoid membrane of the frontal lobe attaches the olfactory bulb strongly to the above lying olfactory sulcus. Only the most rostral portion of the olfactory bulb became slightly detached from the frontal lobe. The outer arachnoid forms a decent protrusion around the tip of the olfactory bulbs. The fila olfactoria have their own outer arachnoid cover as a continuation of the same layer of the olfactory bulb. The effect of brain retraction and manipulation forces on the olfactory bulb and the role of the arachnoid membranes located here were visually analyzed and described in detail through the four different neurosurgical approaches we performed.

Conclusion:  The results of our observations provide important anatomical details for preserving the sense of smell during neurosurgical procedures.

Background:  Intracranial hypertension is a life-threatening condition that can be treated by decompressive craniectomy (DC), which involves removing a part of the skull and intracranial lesions. However, DC has many complications and requires a second surgery to repair the skull. Decompressive bone flap replacement (DBFR) or decompressive cranioplasty is a novel technique that replaces the bone flap with a titanium mesh, providing both decompression and skull integrity.

Methods:  The materials and methods of DBFR are described in detail. A three-dimensional titanium mesh is fabricated based on the computed tomography (CT) data of previous DC patients. An appropriate titanium mesh is selected based on the preoperative and intraoperative assessments. After removing the intracranial lesions, the titanium mesh is fixed over the bone window.

Results:  We successfully performed DBFR in three emergent cases. The postoperative CT scan showed adequate decompression in all cases. No reoperation for skull repair was needed, and there were no surgical complications. The cosmetic outcome was excellent. There were no relevant complications in the operative area.

Conclusions:  DBFR may be a safe and effective alternative to DC in a specific subgroup of patients, in whom complete removal of the bone flap is feasible. DBFR can reduce intracranial pressure while maintaining the integrity of the skull cavity, eliminating the need for additional surgery for skull repair. Possible improvements for DBFR in the future are suggested, such as using a greater curvature of the titanium mesh or a modified DBFR with a hinged titanium mesh.