Neurological Surgery最新文献

Posterior cervical decompression surgery is safe and effective. It was developed to safely and reliably decompress nerve tissues. Maximising the reconstruction and maintenance of the posterior neck tissue has been reported and developed. Complete reconstruction of the posterior musculoskeletal unit can minimise postoperative complications and spinal alignment changes. Here, we introduced laminoplasty which completely preserved the posterior cervical spinal tissue, and discussed its variations. Although posterior cervical decompression is a basic and safe surgical technique that can be used in many diseases, it has limitations. The factors of nerve compression should be carefully examined, and the most appropriate procedure should be selected considering total spinal alignment.

Lateral lumbar interbody fusion(LLIF), including extreme lateral interbody fusion(XLIF) and oblique lateral interbody fusion(OLIF), constitute a treatment option for many lumbar disorders that predominantly cause degenerative disc disease. LLIF is beneficial for managing conditions, such as lumbar spondylolisthesis, degenerative disc disease, and adult spinal deformities. LLIF is preferred for enabling indirect decompression of the spinal canal and nerve root foramen, without inducing immediate postoperative damage to the peri-vertebral tissues. To minimize the risk of lumbosacral plexopathy, neuromonitoring and X-ray fluoroscopy are routinely used, and can confer significant radiation exposure on surgeons and surgical staff. Intraoperative imaging-guided spinal navigation during LLIF increases accuracy and reduces radiation exposure. Nonetheless, the risk of serious LLIF-associated complications, such as lumbosacral plexopathy, vascular problems, ureteral damage, and intestinal damage, warrant a precise preoperative plan. To improve the operative safety of LLIF, this report elucidates the procedural details of XLIF and OLIF and highlights the potential pitfalls of LLIF.

Full endoscopic spine surgery is a technique to perform hernia extraction using a single-hole-type endoscope with a coaxial operation system of a sheath, endoscope, and surgical instrument in reflux water. In the lumbar region, the ventral side of the dura mater can be directly approached via the lateral route. Not only is the skin incision small, but damage to muscle tissue is also minimal, which is why it is a minimally invasive surgery. For beginners, the learning curve is gentle because the operation field(2D image, ultra-magnified field of view, underwater), which differs from microsurgery, is developed and a special tool is used. It is important to understand the structure of a tool and select an appropriate tool according to the situation. By rotating the sheath and endoscope, it is possible to ensure the safety of important structures and expand the operation range.

This study reviews the diagnostic criteria and treatment strategies for spinal malignant gliomas, particularly glioblastoma with IDH-wildtype and diffuse midline gliomas with H3-K27 alteration, according to the World Health Organization 2021 classification. Surgical resection remains challenging owing to the diffuse nature of these tumors. Even with the Stupp regimen(temozolomide and radiotherapy), the prognosis remains poor, with an average survival of 12 months. New therapeutic approaches, such as photodynamic therapy, and targeted molecular therapies, such as ONC201 and anlotinib, are currently under investigation. These innovations may improve the outcome of patients with malignant spinal gliomas, highlighting the importance of molecular profiling and collaborative research efforts to advance treatment.

Lumbar posterior fixation is a fundamental spinal technique typically performed in patients with instability, although no absolute criteria exist for diagnosing instability. Interbody fusion procedures, such as posterior lumbar interbody fusion and transforaminal lumbar interbody fusion involve the insertion of cages or grafts between vertebrae to achieve solid bone fusion. These techniques provide strong stabilization of the spine. Instrumentation methods, such as pedicle screw placement, require meticulous preparation to ensure safe insertion and optimal outcomes.

Spinal extramedullary tumors are the most common types of schwannomas and meningiomas. Therefore, most spinal cord surgeons should safely perform surgeries for these tumors. The posterior approach with conventional laminectomy is sufficient for the safe resection of almost all spinal extramedullary tumors. However, for specific tumors, it is necessary to consider mechanical stress on the spinal cord during surgery, invasion of the surrounding tissues, and postoperative spinal instability. In addition, if part of the tumor is left behind, the risk of recurrence should be considered in the treatment strategy. This study aimed to understand the key anatomical features and surgical techniques to choose the optimal approach for spinal extramedullary tumors, including dumbbell-shaped schwannomas and ventral meningiomas, which require a safer and more secure surgical approach.

This paper examines advancements in minimally invasive posterior decompression techniques for lumbar degenerative diseases. It focuses on the unilateral approach for bilateral decompression and bilateral approach for contralateral decompression, in which the entry side is determined independently of the symptomatic side to achieve a facet joint preservation rate of ≥ 70%, while also emphasizing contralateral foraminal decompression(CFD). These techniques address spinal instability by minimizing facet joint resection, reducing postoperative instability. CFD is noteworthy because it enables single-stage decompression in the same surgical field as foraminal stenosis, which frequently coexists with spinal canal stenosis. Additionally, this paper discusses the effectiveness of real-time 3D CT navigation in enhancing surgical precision, especially in complex cases, to improve long-term outcomes by minimizing postoperative instability. Furthermore, exoscopic surgery is evaluated as a future standard, highlighting its superior ergonomics and flexible viewing angles, including steep oblique angles, which are challenging with conventional microscopes. Although exoscopic technology offers many advantages, it also has certain drawbacks and remains in the developmental stage; however, it holds the potential to become a new paradigm in spinal surgery. Balancing minimally invasive approaches with spinal stability remains critical for optimizing patient recovery, reducing complications, and minimizing reliance on spinal fusion surgery.

In Japan, cervical artificial disc replacement was approved by the Pharmaceuticals and Medical Devices Agency in December 2017, and two products, Mobi-C by Zimmer Biomet and Prestige LP by Medtronic, are on the market. Cervical artificial disc replacement preserves cervical motion; however, the device must be place carefully on the midline to take full advantage of its features. In addition, a reliable foraminotomy is required to cure or prevent radiculopathy due to residual foraminal stenosis. Artificial disc replacement(ADR) is now available for up to two consecutive intervertebral spaces, and it is now possible to combine ADR with anterior cervical discectomy(decompression) and fusion or anterior cervical discectomy as a hybrid procedure. Although the number of surgical options has increased, it may be difficult to choose a surgical method until further experience is gained. Even with cervical artificial disc replacement, age-related facet degeneration progresses reduce the range of motion, and cause adjacent segment disease. In addition, heterotopic ossification, a frequent complication of ADR, also causes a reduction in the range of motion; therefore, further investigation of its causes and improvements in equipment is needed.

Surgery for spinal intramedullary tumors remains a major challenge for neurosurgeons. Successful surgery requires experience, skill, and intraoperative imaging support. Fluorescence imaging technology has become a valuable support in neurosurgical procedures of not only the brain but also the spinal cord. Indocyanine green videoangiography(IVG-VA) is becoming popular for the qualitative assessment of blood flow dynamics during spinal intramedullary tumor surgery. IVG-VA can provide real-time information and help surgeons localize the normal circulation of the spinal cord as well as the feeding arteries and draining veins, particularly in highly vascular tumors. It can also be used for the objective quantitative evaluation of microvascular blood flow in the spinal cord parenchyma after tumor removal. Photodynamic diagnosis using 5-aminolevulinic acid(PDD) is an essential intraoperative imaging guide for brain glioma surgery. PDD has gradually been used in spinal intramedullary tumor surgery. However, some aspects of its usefulness must be verified. This chapter focuses on the current consensus and challenges in fluorescence imaging technology for spinal intramedullary tumor surgery.

It is important to be aware of the indications, surgical procedure selection, and associated complications. This chapter focuses on basic screw placement techniques, emphasizing on safety with each anchor placement. Familiarity with managing surgical accidents is also important. After learning the fundamental methods for placing anchors in posterior cervical fixation, surgeons should proceed stepwise to more complex fixation procedures.