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

Background:  A choristoma is defined as the accumulation of normal tissue in an abnormal location. Salivary gland choristomas are a rare entity that is most frequently described in the middle ear. However, there are a few reported cases of salivary gland choristomas in other locations like the pituitary gland and the optic nerve dural sheath. To the best of our knowledge, we present the first case of a patient with an intraconal salivary gland choristoma. A brief but comprehensive review of literature is offered, additionally.

Methods:  A 19-year-old male patient presented with disturbance of ocular motility, ptosis, and exophthalmos of the right eye. The subsequent imaging by magnetic resonance imaging (MRI) demonstrated an intraconal lesion that infiltrated the lateral and medial rectal muscles of the right eye. The lesion showed intensive gadolinium enhancement in T1-weighted sequence and the fluid-attenuated inversion recovery (FLAIR) sequence showed no intracranial edema. The interdisciplinary neuro-oncologic tumor board recommended a biopsy and partial removal of the lesion.

Results:  Partial resection of the choristoma was successfully performed via lateral orbitotomy. No new neurologic or visual deficits occurred postoperatively. During the 2-week follow-up examination, the exophthalmos had completely regressed and the patient only reported a slight retrobulbar pressure sensation. The histopathologic examination of the tissue revealed seromucous glandular tissue.

Conclusion:  Salivary gland choristomas have been occasionally described intracranially before, but this is the first case of an intraconal accumulation of salivary gland tissue. Partial resection was achieved, resulting in complete recovery of the ophthalmologic symptoms.

Background:  Chronic subdural hematoma (cSDH) is a common neurosurgical condition of growing importance due to the aging population and increasing use of antithrombotic agents. Due to the lack of guidelines, great variability is observed in the treatment of cSDH. We conducted a multicenter, nationwide survey to assess the differences in treatment across Germany in the context of surgical practices discussed in the literature.

Methods:  A web-based survey was designed using the REDCap electronic data capture tool hosted at the Charité - Universitätsmedizin Berlin. The survey was divided into four parts: preoperative management and indication for surgery, perioperative management of medication, surgical technique, and postoperative management. The survey was distributed to German neurosurgical departments through the newsletter of the German Society of Neurosurgery and direct e-mail contact and could be answered by one member of each department between March 1 and May 31, 2023.

Results:  Overall, representatives of 46 German neurosurgical departments completed the survey. Participants needed a mean time of 16:25 minutes (standard deviation [SD] ± 27:47 minutes) to complete the survey. The mean caseload of the participating departments was 1,831.5 (range: 300-6,000; SD ± 1,130.7) operations per year, including 87.8 procedures for cSDH (range: 15-300; SD ± 73.6). Evidence found in the literature regarding the performance of a burr hole craniotomy, use of a drain, passive drainage, removal of the drain 48 hours after surgery, and early mobilization after surgery was consistently implemented in the management of the surveyed departments. On the contrary, recommendations regarding the performance of surgery under local anesthesia, use of subgaleal drains, postoperative Valsalva maneuvers, and avoidance of postoperative computed tomography (CT) if possible were not universally implemented.

Conclusion:  This survey indicates that there is no consensus on the treatment of cSDH in Germany and that the steadily increasing evidence from clinical trials must be implemented in national and international guidelines. The development of tailored treatment strategies for older patients with multiple risk factors and comorbidities is of particular importance.

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.