Pub Date : 2025-01-01DOI: 10.1016/j.wnsx.2024.100425
Saurabh Gupta, Deepak Agrawal, Shweta Kedia, Shashank Sharad Kale
Objective
This study aims to analyse clinical and radiological outcomes in patients receiving adjuvant gamma knife radiosurgery (GKRS) for residual craniopharyngiomas. It compares these outcomes with patients who did not receive post-operative GKRS.
Methods
In this retro-prospective case–control study, we enrolled all consecutive patients who received adjuvant GKRS for recurrent/residual craniopharyngiomas from.
2011 to 2019, with a minimum 12 month radiological follow-up. Consecutive surgically treated craniopharyngioma patients between 2018 and 2019, who did not receive any post-operative radiotherapy constituted the control group. The clinical, and radiological outcomes were compared between the two groups.
Results
A total of 79 patients were analyzed. 35 patients received GKRS in the post-operative period, with a median age of 21 years (range 6–55 years). At a median follow-up of 60.1 months (range 24–118 months), the tumor control rate was 91.4 % (n = 32). In the control group there were a total of 44 patients, with a median age of 16 years (range 3–48 years), and a median follow-up of 47.4 months (range 12.7–61.7 months). Kaplan–Meier analysis, and log-rank tests showed better 3-year PFS (92.3 % vs. 77.7 %, p = 0.03), and 3-year OS (97.1 % vs. 74.6 %, p = 0.009) for patients who received post-operative GKRS. Cox proportional-hazards showed post-operative GKRS (HR = 0.055, 95 % CI = 0.008–0.363) to be an independent prognostic factor for OS in craniopharyngioma patients.
Conclusion
This study shows that GKRS offers improved clinical and radiological outcomes as compared to surgery alone, and should be considered in all patients with residual disease.
{"title":"Erratum to ‘Should post-operative stereotactic radiosurgery be the standard of care in Craniopharyngioma patients?’ [World Neurosurgery: X (22C) (2024) 100327]","authors":"Saurabh Gupta, Deepak Agrawal, Shweta Kedia, Shashank Sharad Kale","doi":"10.1016/j.wnsx.2024.100425","DOIUrl":"10.1016/j.wnsx.2024.100425","url":null,"abstract":"<div><h3>Objective</h3><div>This study aims to analyse clinical and radiological outcomes in patients receiving adjuvant gamma knife radiosurgery (GKRS) for residual craniopharyngiomas. It compares these outcomes with patients who did not receive post-operative GKRS.</div></div><div><h3>Methods</h3><div>In this retro-prospective case–control study, we enrolled all consecutive patients who received adjuvant GKRS for recurrent/residual craniopharyngiomas from.</div><div>2011 to 2019, with a minimum 12 month radiological follow-up. Consecutive surgically treated craniopharyngioma patients between 2018 and 2019, who did not receive any post-operative radiotherapy constituted the control group. The clinical, and radiological outcomes were compared between the two groups.</div></div><div><h3>Results</h3><div>A total of 79 patients were analyzed. 35 patients received GKRS in the post-operative period, with a median age of 21 years (range 6–55 years). At a median follow-up of 60.1 months (range 24–118 months), the tumor control rate was 91.4 % (n = 32). In the control group there were a total of 44 patients, with a median age of 16 years (range 3–48 years), and a median follow-up of 47.4 months (range 12.7–61.7 months). Kaplan–Meier analysis, and log-rank tests showed better 3-year PFS (92.3 % vs. 77.7 %, p = 0.03), and 3-year OS (97.1 % vs. 74.6 %, p = 0.009) for patients who received post-operative GKRS. Cox proportional-hazards showed post-operative GKRS (HR = 0.055, 95 % CI = 0.008–0.363) to be an independent prognostic factor for OS in craniopharyngioma patients.</div></div><div><h3>Conclusion</h3><div>This study shows that GKRS offers improved clinical and radiological outcomes as compared to surgery alone, and should be considered in all patients with residual disease.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"25 ","pages":"Article 100425"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-05DOI: 10.1016/j.wnsx.2024.100413
Lívio Pereira de Macêdo , Glaudir Donato , Maria Eduarda d’Almeida Lins Regis , Isabela Fernandes de Melo Pereira , Gustavo Rodrigues Paulo , Kamilla Azevedo Bringel , Gabriel Carvalho Andrade Gadelha , Fábio Antônio Serra de Lima Júnior , Yally Dayanne Oliveira Ferreira , Renata de Castro Tavares , Arlindo Ugulino Netto , Kauê Franke , Pierre Vansant Oliveira Eugênio , Auricélio Batista Cezar-Junior , Igor Vilela Faquini , Eduardo Vieira de Carvalho Júnior , Nivaldo Sena de Almeida , Francisco Alfredo Bandeira e Farias , Marcelo Moraes Valença , Hildo Rocha Cirne Azevedo-Filho
Background
Low vitamin D levels have been associated with an increased risk in patients with cerebrovascular diseases. However, solid evidence linking intracranial aneurysm (IA) to hypovitaminosis D is still lacking. This review aims to evaluate if there is a relationship between vitamin D deficiency and the incidence and rupture of IA.
Methods
A systematic search of papers was performed in the following databases: MEDLINE, EMBASE, LILACS, and Web of Science. The selected papers covered data on vitamin D levels and the occurrence or rupture of IA and/or other complications of this condition. The risk of bias analysis was performed with tools developed by the National Heart, Lung, and Blood Institute. Tables were developed to synthesize the qualitative analysis of the data.
Results
Six studies from five different countries were included covering a total of 14,184 participants. A relationship between low vitamin D levels and IA incidence was detected in all studies. In terms of rupture and complications, there was a tendency of association with hypovitaminosis.
Discussion
Among the limitations of the papers, the following are noteworthy: sample size and selection, recording flaws inherent to retrospective designs, failure to consider confounding variables, and heterogeneity of data produced among the researches, making a quantitative analysis of the evidence unfeasible. From the results obtained, we can identify a higher incidence of hypovitaminosis D in patients with IA. Yet, further studies need to be conducted in investigating the relationships between low vitamin D levels and rupture or other complications (CRD42022363369).
背景维生素D水平低与脑血管疾病患者的风险增加有关。然而，目前仍缺乏将颅内动脉瘤（IA）与维生素 D 不足联系起来的确凿证据。本综述旨在评估维生素 D 缺乏与颅内动脉瘤的发病率和破裂之间是否存在关系：方法在以下数据库中对论文进行了系统检索：MEDLINE、EMBASE、LILACS 和 Web of Science。所选论文涵盖了有关维生素 D 水平与胰岛素瘤的发生或破裂和/或其他并发症的数据。使用美国国家心肺血液研究所开发的工具进行了偏倚风险分析。结果来自五个不同国家的六项研究共纳入了 14,184 名参与者。所有研究均发现维生素 D 水平低与胰岛素瘤发病率之间存在关系。讨论在这些论文的局限性中，以下几点值得注意：样本大小和选择、回顾性设计固有的记录缺陷、未考虑混杂变量以及研究数据的异质性，这使得对证据进行定量分析变得不可行。从获得的结果中，我们可以发现，IA 患者维生素 D 过低的发生率较高。然而，还需要进一步研究维生素 D 水平低与破裂或其他并发症之间的关系 (CRD42022363369)。
{"title":"Vitamin D deficiency and intracranial aneurysms: Systematic Review","authors":"Lívio Pereira de Macêdo , Glaudir Donato , Maria Eduarda d’Almeida Lins Regis , Isabela Fernandes de Melo Pereira , Gustavo Rodrigues Paulo , Kamilla Azevedo Bringel , Gabriel Carvalho Andrade Gadelha , Fábio Antônio Serra de Lima Júnior , Yally Dayanne Oliveira Ferreira , Renata de Castro Tavares , Arlindo Ugulino Netto , Kauê Franke , Pierre Vansant Oliveira Eugênio , Auricélio Batista Cezar-Junior , Igor Vilela Faquini , Eduardo Vieira de Carvalho Júnior , Nivaldo Sena de Almeida , Francisco Alfredo Bandeira e Farias , Marcelo Moraes Valença , Hildo Rocha Cirne Azevedo-Filho","doi":"10.1016/j.wnsx.2024.100413","DOIUrl":"10.1016/j.wnsx.2024.100413","url":null,"abstract":"<div><h3>Background</h3><div>Low vitamin D levels have been associated with an increased risk in patients with cerebrovascular diseases. However, solid evidence linking intracranial aneurysm (IA) to hypovitaminosis D is still lacking. This review aims to evaluate if there is a relationship between vitamin D deficiency and the incidence and rupture of IA.</div></div><div><h3>Methods</h3><div>A systematic search of papers was performed in the following databases: MEDLINE, EMBASE, LILACS, and Web of Science. The selected papers covered data on vitamin D levels and the occurrence or rupture of IA and/or other complications of this condition. The risk of bias analysis was performed with tools developed by the National Heart, Lung, and Blood Institute. Tables were developed to synthesize the qualitative analysis of the data.</div></div><div><h3>Results</h3><div>Six studies from five different countries were included covering a total of 14,184 participants. A relationship between low vitamin D levels and IA incidence was detected in all studies. In terms of rupture and complications, there was a tendency of association with hypovitaminosis.</div></div><div><h3>Discussion</h3><div>Among the limitations of the papers, the following are noteworthy: sample size and selection, recording flaws inherent to retrospective designs, failure to consider confounding variables, and heterogeneity of data produced among the researches, making a quantitative analysis of the evidence unfeasible. From the results obtained, we can identify a higher incidence of hypovitaminosis D in patients with IA. Yet, further studies need to be conducted in investigating the relationships between low vitamin D levels and rupture or other complications (CRD42022363369).</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"25 ","pages":"Article 100413"},"PeriodicalIF":0.0,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142432835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.wnsx.2024.100408
Walid A. Abdel Ghany , Iman H. Hewedi , George Halim , Mostafa G. Mahran , Sahar Talaat , Dina Amin Saleh , Mazen T. Al Karras , Mohamed E. Elhawi , Mohamed Ashraf Mahmoud , Marwa A. Nassef , Aly Ibrahim
Background
Epidermoid cysts are rare and account for only 1 % of primary spinal tumors. It's due to inclusion of ectodermal tissue during the third and fourth weeks of gestation. Infected epidermoid cysts are exceedingly rare with very few reports in literature. The clinical presentations include radicular symptoms, motor weakness, sphincteric disturbance, and repeated chemical meningitis. Surgery of this kind of tumor remained a challenge and of a considerable recurrence rate.
Methods
This is a retrospective study reviewing the records of six children who were treated for filum terminale infected epidermoid cysts. All patients underwent microsurgery, and the surgical outcomes were studied through a follow up period of at least 24 months.
Results
All children had a low back dermal sinus with purulent discharge. One child was a recurrent presentation after the previous two surgeries for evacuation of pus collection, and the other five children were operated for the first time. All the six children had an associated neurological deficit; one child presented with active central nervous system infection, and one child had a history of meningitis and admission to hospital prior to our surgery. Regular follow up revealed no recurrence in any of the six patients. The five patients, who presented with motor weakness, showed significant improvement of the motor power with regular post-operative physical therapy.
Conclusion
Epidermoid cysts are rare benign lesions that may lead to significant morbidity when infected. The aim of microsurgical excision is to remove the cyst content and its capsule without inducing or increasing neurological deficit by the aid of intraoperative neuromonitoring and microsurgery techniques.
{"title":"Filum terminale infected epidermoid cysts in pediatric age group; A case series","authors":"Walid A. Abdel Ghany , Iman H. Hewedi , George Halim , Mostafa G. Mahran , Sahar Talaat , Dina Amin Saleh , Mazen T. Al Karras , Mohamed E. Elhawi , Mohamed Ashraf Mahmoud , Marwa A. Nassef , Aly Ibrahim","doi":"10.1016/j.wnsx.2024.100408","DOIUrl":"10.1016/j.wnsx.2024.100408","url":null,"abstract":"<div><h3>Background</h3><div>Epidermoid cysts are rare and account for only 1 % of primary spinal tumors. It's due to inclusion of ectodermal tissue during the third and fourth weeks of gestation. Infected epidermoid cysts are exceedingly rare with very few reports in literature. The clinical presentations include radicular symptoms, motor weakness, sphincteric disturbance, and repeated chemical meningitis. Surgery of this kind of tumor remained a challenge and of a considerable recurrence rate.</div></div><div><h3>Methods</h3><div>This is a retrospective study reviewing the records of six children who were treated for filum terminale infected epidermoid cysts. All patients underwent microsurgery, and the surgical outcomes were studied through a follow up period of at least 24 months.</div></div><div><h3>Results</h3><div>All children had a low back dermal sinus with purulent discharge. One child was a recurrent presentation after the previous two surgeries for evacuation of pus collection, and the other five children were operated for the first time. All the six children had an associated neurological deficit; one child presented with active central nervous system infection, and one child had a history of meningitis and admission to hospital prior to our surgery. Regular follow up revealed no recurrence in any of the six patients. The five patients, who presented with motor weakness, showed significant improvement of the motor power with regular post-operative physical therapy.</div></div><div><h3>Conclusion</h3><div>Epidermoid cysts are rare benign lesions that may lead to significant morbidity when infected. The aim of microsurgical excision is to remove the cyst content and its capsule without inducing or increasing neurological deficit by the aid of intraoperative neuromonitoring and microsurgery techniques.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"24 ","pages":"Article 100408"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142357137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-29DOI: 10.1016/j.wnsx.2024.100409
Jovanna A. Tracz , Matthew L. Farmer , Mark Hughes , Debraj Mukherjee , Paul M. Brennan
Objective
Return to play (RTP) decisions after cranial surgery are important to patients. Most published data relate to RTP following sports-related brain injury. This study investigated factors that influence neurosurgical RTP decision-making following craniotomy for non-traumatic brain lesions.
Methods
A patient scenario-based survey was distributed to U.S. and Europe-based neurosurgeons via the American Association of Neurological Surgeons/Congress of Neurological Surgeons Tumor Section and the European Association of Neuro-Oncology. From one core patient scenario, 5 further scenarios were developed involving patients of varying age, sport preference, tumor pathology, and craniotomy approach. Respondents provided RTP recommendations and factors important in forming these recommendations.
Results
Forty-one responses were received; Europe (48%), U.S. (37%). The most commonly cited factors influencing RTP decision-making across scenarios were symptomatic recovery (85.4%), resolution of blood and/or air on imaging (43.4%), and patient demand (31.7%). The sports with the longest average RTP timeline were boxing (10.3 months), rugby (8.7 months), and American football (8.5 months) in the core patient scenario. Twenty-nine percent of neurosurgeons requested neuroimaging before determining RTP recommendations in this scenario, more commonly in America than Europe (46.7% and 5.0% respectively, p = .006).
Conclusions
Although limited by sample size, the data provides a foundation to support development of a systematic approach to RTP decision-making following craniotomy for brain lesions of non-traumatic etiology. Future work to develop consensus guidelines will benefit from objective data about outcomes, particularly in relation to repeat imaging prior to RTP.
{"title":"Return to play following craniotomy for non-traumatic brain lesions","authors":"Jovanna A. Tracz , Matthew L. Farmer , Mark Hughes , Debraj Mukherjee , Paul M. Brennan","doi":"10.1016/j.wnsx.2024.100409","DOIUrl":"10.1016/j.wnsx.2024.100409","url":null,"abstract":"<div><h3>Objective</h3><div>Return to play (RTP) decisions after cranial surgery are important to patients. Most published data relate to RTP following sports-related brain injury. This study investigated factors that influence neurosurgical RTP decision-making following craniotomy for non-traumatic brain lesions.</div></div><div><h3>Methods</h3><div>A patient scenario-based survey was distributed to U.S. and Europe-based neurosurgeons via the American Association of Neurological Surgeons/Congress of Neurological Surgeons Tumor Section and the European Association of Neuro-Oncology. From one core patient scenario, 5 further scenarios were developed involving patients of varying age, sport preference, tumor pathology, and craniotomy approach. Respondents provided RTP recommendations and factors important in forming these recommendations.</div></div><div><h3>Results</h3><div>Forty-one responses were received; Europe (48%), U.S. (37%). The most commonly cited factors influencing RTP decision-making across scenarios were symptomatic recovery (85.4%), resolution of blood and/or air on imaging (43.4%), and patient demand (31.7%). The sports with the longest average RTP timeline were boxing (10.3 months), rugby (8.7 months), and American football (8.5 months) in the core patient scenario. Twenty-nine percent of neurosurgeons requested neuroimaging before determining RTP recommendations in this scenario, more commonly in America than Europe (46.7% and 5.0% respectively, <em>p</em> = .006).</div></div><div><h3>Conclusions</h3><div>Although limited by sample size, the data provides a foundation to support development of a systematic approach to RTP decision-making following craniotomy for brain lesions of non-traumatic etiology. Future work to develop consensus guidelines will benefit from objective data about outcomes, particularly in relation to repeat imaging prior to RTP.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"25 ","pages":"Article 100409"},"PeriodicalIF":0.0,"publicationDate":"2024-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142416944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-28DOI: 10.1016/j.wnsx.2024.100406
Juan Carlos Acevedo-González , Alex Taub-Krivoy , Julian Alfonso Sierra-Peña , Julian Geronimo Lizarazo
Objective
Primary Hemifacial Spasm (PHFS) significantly impacts quality of life, necessitating effective treatment like microvascular decompression of the facial nerve. This study aims to identify prognostic factors related to surgical treatment to enhance outcomes and minimize complications. A systematic review of literature from the past five years was conducted.
Methods
Following PRISMA guidelines, we systematically searched databases like PubMed, Embase, Scopus, Ovid, EBSCO, and Cochrane using keywords such as 'Hemifacial spasm,' 'Microvascular decompression,' 'Neurovascular conflict,' and 'Surgical techniques.' The search spanned January 2018 to November 2023. The 'Rayyan' program facilitated data compilation. Each author reviewed abstracts, applying inclusion criteria like systematic reviews, clinical trials, observational studies, and case series, while excluding theoretical or non-English articles.
Results
Of 26 selected articles, those solely addressing PHFS treatment with botulinum toxin and lacking surgical procedure data were excluded. Thus, our analysis focused on 16 articles, including meta-analyses, systematic reviews, clinical trials, and observational studies.
Discussion
Microvascular decompression at the cerebellar pontine angle is the mainstay treatment for hemifacial spasm. Despite limited statistically significant prognostic factors in the literature, overarching recommendations aim to improve outcomes, minimize complications, and prevent recurrences. Key considerations include surgeon expertise, precise techniques, thorough nerve exploration, identifying the conflict's cause, and intraoperative monitoring.
Conclusions
PHFS significantly impacts patients' lives, necessitating timely surgical intervention if initial treatments fail. While statistically significant prognostic factors may be lacking, this study highlights crucial considerations for successful treatment.
目的原发性面肌痉挛（PHFS）严重影响患者的生活质量，因此需要进行有效的治疗，如面神经微血管减压术。本研究旨在确定与手术治疗相关的预后因素，以提高疗效并减少并发症。我们对过去五年的文献进行了系统性回顾。方法根据PRISMA指南，我们使用'面肌痉挛'、'微血管减压'、'神经血管冲突'和'外科技术'等关键词对PubMed、Embase、Scopus、Ovid、EBSCO和Cochrane等数据库进行了系统性检索。搜索时间跨度为 2018 年 1 月至 2023 年 11 月。Rayyan "程序为数据汇编提供了便利。每位作者都对摘要进行了审阅，采用了系统综述、临床试验、观察性研究和病例系列等纳入标准，同时排除了理论性文章或非英文文章。Results of 26 selected articles, those only addressing PHFS treatment with botulinum toxin and lack surgical procedure data were excluded.讨论小脑桥脑角微血管减压术是治疗半面痉挛的主要方法。尽管文献中具有统计学意义的预后因素有限，但总体建议旨在提高疗效、减少并发症和防止复发。关键的考虑因素包括外科医生的专业知识、精确的技术、彻底的神经探查、确定冲突的原因以及术中监测。虽然可能缺乏具有统计学意义的预后因素，但本研究强调了成功治疗的关键因素。
{"title":"Determining prognostic factors in the treatment of primary hemifacial spasm: Clinical outcomes and complications. A literature review","authors":"Juan Carlos Acevedo-González , Alex Taub-Krivoy , Julian Alfonso Sierra-Peña , Julian Geronimo Lizarazo","doi":"10.1016/j.wnsx.2024.100406","DOIUrl":"10.1016/j.wnsx.2024.100406","url":null,"abstract":"<div><h3>Objective</h3><div>Primary Hemifacial Spasm (PHFS) significantly impacts quality of life, necessitating effective treatment like microvascular decompression of the facial nerve. This study aims to identify prognostic factors related to surgical treatment to enhance outcomes and minimize complications. A systematic review of literature from the past five years was conducted.</div></div><div><h3>Methods</h3><div>Following PRISMA guidelines, we systematically searched databases like PubMed, Embase, Scopus, Ovid, EBSCO, and Cochrane using keywords such as 'Hemifacial spasm,' 'Microvascular decompression,' 'Neurovascular conflict,' and 'Surgical techniques.' The search spanned January 2018 to November 2023. The 'Rayyan' program facilitated data compilation. Each author reviewed abstracts, applying inclusion criteria like systematic reviews, clinical trials, observational studies, and case series, while excluding theoretical or non-English articles.</div></div><div><h3>Results</h3><div>Of 26 selected articles, those solely addressing PHFS treatment with botulinum toxin and lacking surgical procedure data were excluded. Thus, our analysis focused on 16 articles, including meta-analyses, systematic reviews, clinical trials, and observational studies.</div></div><div><h3>Discussion</h3><div>Microvascular decompression at the cerebellar pontine angle is the mainstay treatment for hemifacial spasm. Despite limited statistically significant prognostic factors in the literature, overarching recommendations aim to improve outcomes, minimize complications, and prevent recurrences. Key considerations include surgeon expertise, precise techniques, thorough nerve exploration, identifying the conflict's cause, and intraoperative monitoring.</div></div><div><h3>Conclusions</h3><div>PHFS significantly impacts patients' lives, necessitating timely surgical intervention if initial treatments fail. While statistically significant prognostic factors may be lacking, this study highlights crucial considerations for successful treatment.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"25 ","pages":"Article 100406"},"PeriodicalIF":0.0,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142416943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-27DOI: 10.1016/j.wnsx.2024.100402
Ryan W. Sindewald , Michael G. Brandel , Arvin R. Wali , Carol H. Yan , David R. Santiago-Dieppa
Encephaloceles are considered rare with an approximate incidence of 1 in 35,000, and sphenoid encephaloceles are even more uncommon.2 Two types of sphenoid encephaloceles exist: medial perisellar encephaloceles, and lateral sphenoidal encephaloceles. Surgical correction of the lateral sphenoid recess encephalocele is achieved via one of two endoscopic approaches: extended sphenoidotomy or transpterygopalatine. Extended sphenoidotomy is preferred if the angle between the access door and lateral extension of bone defect is greater than 35°1. Otherwise, the transpterygopalatine approach is used. Intraoperative video demonstrating an extended sphenoidotomy approach to correcting a lateral recess sphenoidal encephalocele has not previously been published.
Here we present a case of a 41-year-old female who presented with meningitis, a cerebrospinal fluid leak, and an incidental sphenoid mass. Brain MRI redemonstrated the mass in the sphenoid sinus consistent with an encephalocele occupying Sternberg's Canal. The patient consented to the procedure. The video demonstrates the skull base approach, encephalocele extraction, collagen inlay, and nasal septal bone and vascularized pedicled nasoseptal flap placement. Postoperative imaging confirmed the placement of the collagen inlay and nasal septal bone autograft. The patient recovered from surgery and was discharged on post-operative day 3 with no cerebrospinal fluid (CSF) leak recurrence. Postoperative follow up demonstrated viable nasoseptal graft without evidence of CSF leak.
For patients with favorable anatomy, an extended sphenoidotomy approach to lateral sphenoid sinus encephalocele resection is a preferred alternative to the transpterygoid approach. This surgical video demonstrates the technique for managing lateral sphenoid sinus encephaloceles occupying Sternberg's canal, including endonasal approach, encephalocele resection and posterior sphenoid wall repair.
{"title":"Surgical management of a lateral sphenoid sinus encephalocele: 2-Dimensional operative video","authors":"Ryan W. Sindewald , Michael G. Brandel , Arvin R. Wali , Carol H. Yan , David R. Santiago-Dieppa","doi":"10.1016/j.wnsx.2024.100402","DOIUrl":"10.1016/j.wnsx.2024.100402","url":null,"abstract":"<div><div>Encephaloceles are considered rare with an approximate incidence of 1 in 35,000, and sphenoid encephaloceles are even more uncommon.<sup>2</sup> Two types of sphenoid encephaloceles exist: medial perisellar encephaloceles, and lateral sphenoidal encephaloceles. Surgical correction of the lateral sphenoid recess encephalocele is achieved via one of two endoscopic approaches: extended sphenoidotomy or transpterygopalatine. Extended sphenoidotomy is preferred if the angle between the access door and lateral extension of bone defect is greater than 35°<sup>1</sup>. Otherwise, the transpterygopalatine approach is used. Intraoperative video demonstrating an extended sphenoidotomy approach to correcting a lateral recess sphenoidal encephalocele has not previously been published.</div><div>Here we present a case of a 41-year-old female who presented with meningitis, a cerebrospinal fluid leak, and an incidental sphenoid mass. Brain MRI redemonstrated the mass in the sphenoid sinus consistent with an encephalocele occupying Sternberg's Canal. The patient consented to the procedure. The video demonstrates the skull base approach, encephalocele extraction, collagen inlay, and nasal septal bone and vascularized pedicled nasoseptal flap placement. Postoperative imaging confirmed the placement of the collagen inlay and nasal septal bone autograft. The patient recovered from surgery and was discharged on post-operative day 3 with no cerebrospinal fluid (CSF) leak recurrence. Postoperative follow up demonstrated viable nasoseptal graft without evidence of CSF leak.</div><div>For patients with favorable anatomy, an extended sphenoidotomy approach to lateral sphenoid sinus encephalocele resection is a preferred alternative to the transpterygoid approach. This surgical video demonstrates the technique for managing lateral sphenoid sinus encephaloceles occupying Sternberg's canal, including endonasal approach, encephalocele resection and posterior sphenoid wall repair.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"25 ","pages":"Article 100402"},"PeriodicalIF":0.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142437778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-26DOI: 10.1016/j.wnsx.2024.100416
Tomas Ferreira , Sakshi Roy , Joecelyn Kirani Tan , Wireko Andrew Awuah , Vallabh Shet , Favour Tope Adebusoye , Adrenito Nicolas , Toufik Abdul-Rahman
Spine surgery is a critical field that seeks to alleviate pain and restore function in patients with various spinal pathologies. Over the years, spine surgery has seen advancements such as minimally invasive techniques with operative microscopes and robotic surgeries. These techniques, however, demand better visualisation during the procedure. Recently, exoscope-assisted spine surgery has emerged as a promising technological advancement that may revolutionise the field due to its ability to facilitate precise and advanced visualisation techniques that ensure successful outcomes in spine surgeries. The application of exoscopes have improved spine surgeries such as spinal fusion procedures, decompression surgeries, instrumentation surgeries, minimally invasive and complex surgeries. These improvements include enhanced visualisation, improved ergonomics, improved surgical precision, reduced operation times and postoperative infection rates. The integration of robotics in exoscope-assisted spine surgery enables autofocus function, ensuring the integrity of the sterile field, providing superior image quality, resolution and three-dimensional perception. However, challenges such as decrease in depth perception and the lack of long-term follow-up data hinder its widespread adoption. Ethical considerations regarding patient safety, technology dependency, and health inequity add another dimension to these challenges. Despite these challenges, exoscope-assisted spine surgery holds significant potential for transforming clinical practice and improving patient outcomes. This review seeks to provide a concise overview of the benefits and limits of exoscope-assisted spine surgeries, while highlighting its challenges and ethical considerations. Addressing these limitations by conducting large-scale clinical trials and exploring the integration of artificial intelligence (AI) could assist in realising the potential of exoscopes in spine surgery.
{"title":"Exoscope-assisted spine surgery: Current applications and future directions–A short review","authors":"Tomas Ferreira , Sakshi Roy , Joecelyn Kirani Tan , Wireko Andrew Awuah , Vallabh Shet , Favour Tope Adebusoye , Adrenito Nicolas , Toufik Abdul-Rahman","doi":"10.1016/j.wnsx.2024.100416","DOIUrl":"10.1016/j.wnsx.2024.100416","url":null,"abstract":"<div><div>Spine surgery is a critical field that seeks to alleviate pain and restore function in patients with various spinal pathologies. Over the years, spine surgery has seen advancements such as minimally invasive techniques with operative microscopes and robotic surgeries. These techniques, however, demand better visualisation during the procedure. Recently, exoscope-assisted spine surgery has emerged as a promising technological advancement that may revolutionise the field due to its ability to facilitate precise and advanced visualisation techniques that ensure successful outcomes in spine surgeries. The application of exoscopes have improved spine surgeries such as spinal fusion procedures, decompression surgeries, instrumentation surgeries, minimally invasive and complex surgeries. These improvements include enhanced visualisation, improved ergonomics, improved surgical precision, reduced operation times and postoperative infection rates. The integration of robotics in exoscope-assisted spine surgery enables autofocus function, ensuring the integrity of the sterile field, providing superior image quality, resolution and three-dimensional perception. However, challenges such as decrease in depth perception and the lack of long-term follow-up data hinder its widespread adoption. Ethical considerations regarding patient safety, technology dependency, and health inequity add another dimension to these challenges. Despite these challenges, exoscope-assisted spine surgery holds significant potential for transforming clinical practice and improving patient outcomes. This review seeks to provide a concise overview of the benefits and limits of exoscope-assisted spine surgeries, while highlighting its challenges and ethical considerations. Addressing these limitations by conducting large-scale clinical trials and exploring the integration of artificial intelligence (AI) could assist in realising the potential of exoscopes in spine surgery.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"25 ","pages":"Article 100416"},"PeriodicalIF":0.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142416952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-26DOI: 10.1016/j.wnsx.2024.100397
Veranis Sotiris , Sathish Muthu , Matt Gary , Sam Cho , So Kato , Stephen J. Lewis , Ho-Joong Kim , Jeffrey Wang , Amit Jain , S. Tim Yoon , AO Spine Knowledge Forum Degenerative
Study design
Cross-sectional study with systematic review of literature.
Objective
There is an increasing interest in the topical use of antibiotics to prevent infection following spine surgery. To extend the antibiotic coverage to the gram-negative spectrum, the usage of tobramycin powder is being considered. We surveyed to analyze the current practice preference on the use of topical tobramycin in lumbar spine surgery and also aimed to analyze the literature for current evidence on the same.
Methods
A multinational cross-sectional survey was conducted among AO Spine members worldwide to understand the use of topical tobramycin in 1 or 2-level open lumbar fusion surgeries. Also, an independent systematic review of four scientific databases (PubMed, Scopus, clinicaltrials.gov, Web of Science) was performed by two authors to identify relevant articles in adherence to the preferred reporting in systematic reviews and meta-analysis (PRISMA) guidelines. Studies reporting the usage of tobramycin in lumbar spine surgeries were included for analysis.
Results
Among the 231 participating surgeons, only 1.7 %(n = 4) reported utilizing tobramycin in 1 or 2-level open lumbar fusion surgery. Upon systematic review of the literature, two studies with 484 patients were included for analysis. With the usage of tobramycin as a topical antibiotic powder, both studies noted a reduction in the incidence of infection with change in the spectrum of infective organisms.
Conclusion
Topical Tobramycin is not the commonly preferred topical antibiotic to prevent SSI among spine surgeons worldwide. There is a lack of sufficient evidence to support the routine use of topical tobramycin in lumbar spine surgery.
{"title":"Practice preference and evidence analysis on topical use of tobramycin powder in lumbar spine surgery: A Multi-National AO spine survey with systematic review of the literature","authors":"Veranis Sotiris , Sathish Muthu , Matt Gary , Sam Cho , So Kato , Stephen J. Lewis , Ho-Joong Kim , Jeffrey Wang , Amit Jain , S. Tim Yoon , AO Spine Knowledge Forum Degenerative","doi":"10.1016/j.wnsx.2024.100397","DOIUrl":"10.1016/j.wnsx.2024.100397","url":null,"abstract":"<div><h3>Study design</h3><div>Cross-sectional study with systematic review of literature.</div></div><div><h3>Objective</h3><div>There is an increasing interest in the topical use of antibiotics to prevent infection following spine surgery. To extend the antibiotic coverage to the gram-negative spectrum, the usage of tobramycin powder is being considered. We surveyed to analyze the current practice preference on the use of topical tobramycin in lumbar spine surgery and also aimed to analyze the literature for current evidence on the same.</div></div><div><h3>Methods</h3><div>A multinational cross-sectional survey was conducted among AO Spine members worldwide to understand the use of topical tobramycin in 1 or 2-level open lumbar fusion surgeries. Also, an independent systematic review of four scientific databases (PubMed, Scopus, <span><span>clinicaltrials.gov</span><svg><path></path></svg></span>, Web of Science) was performed by two authors to identify relevant articles in adherence to the preferred reporting in systematic reviews and meta-analysis (PRISMA) guidelines. Studies reporting the usage of tobramycin in lumbar spine surgeries were included for analysis.</div></div><div><h3>Results</h3><div>Among the 231 participating surgeons, only 1.7 %(<em>n</em> = 4) reported utilizing tobramycin in 1 or 2-level open lumbar fusion surgery. Upon systematic review of the literature, two studies with 484 patients were included for analysis. With the usage of tobramycin as a topical antibiotic powder, both studies noted a reduction in the incidence of infection with change in the spectrum of infective organisms.</div></div><div><h3>Conclusion</h3><div>Topical Tobramycin is not the commonly preferred topical antibiotic to prevent SSI among spine surgeons worldwide. There is a lack of sufficient evidence to support the routine use of topical tobramycin in lumbar spine surgery.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"24 ","pages":"Article 100397"},"PeriodicalIF":0.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142327600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-26DOI: 10.1016/j.wnsx.2024.100411
Timoleon Siempis, Spyridon Voulgaris, George A. Alexiou
Introduction
Jugular Foramen Schwannomas (JFS) have been traditionally treated with surgical resection with an associated significant post-operative morbidity. Stereotactic radiosurgery has been investigated as potentially minimally invasive alternative to microsurgery. The aim of this study was to provide a systematic review and meta-analysis of the available literature regarding the outcomes of cases of JFS treated with radiosurgery.
Methods
A literature review until 28th of March 2023 was performed. All studies looking at the outcomes of radiosurgery for the treatment of JFS were included. Studies including non-vestibular schwannomas without clear distinction of the tumour type were excluded. Risk of bias was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) scale.
Results
Eight (8) studies with a total of 375 patients met the inclusion and exclusion criteria and were included in the analysis. Pooled overall tumour control rate was 93.2 % (95 % CI 89.8–96.6) after a weighted mean follow-up of 54.07 months (95 % CI 46.8–61.3). Patient free survival was reported only in 4 studies and ranged from 87 % to 97 % and 76.9–93.8 % in 5 and 10 years respectively. The radiation induced cranial nerve deficits rates after GKRS were 3.6 % (95%CI 1.7, 5.5 %).
Conclusion
According to our findings, radiosurgery for JFS has favourable clinical outcomes with a high rate of long-term tumour control and low complication rates.
{"title":"Gamma-knife radiosurgery for jugular foramen schwannomas. A systematic review and meta-analysis","authors":"Timoleon Siempis, Spyridon Voulgaris, George A. Alexiou","doi":"10.1016/j.wnsx.2024.100411","DOIUrl":"10.1016/j.wnsx.2024.100411","url":null,"abstract":"<div><h3>Introduction</h3><div>Jugular Foramen Schwannomas (JFS) have been traditionally treated with surgical resection with an associated significant post-operative morbidity. Stereotactic radiosurgery has been investigated as potentially minimally invasive alternative to microsurgery. The aim of this study was to provide a systematic review and meta-analysis of the available literature regarding the outcomes of cases of JFS treated with radiosurgery.</div></div><div><h3>Methods</h3><div>A literature review until 28th of March 2023 was performed. All studies looking at the outcomes of radiosurgery for the treatment of JFS were included. Studies including non-vestibular schwannomas without clear distinction of the tumour type were excluded. Risk of bias was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) scale.</div></div><div><h3>Results</h3><div>Eight <strong>(</strong>8) studies with a total of 375 patients met the inclusion and exclusion criteria and were included in the analysis. Pooled overall tumour control rate was 93.2 % (95 % CI 89.8–96.6) after a weighted mean follow-up of 54.07 months (95 % CI 46.8–61.3). Patient free survival was reported only in 4 studies and ranged from 87 % to 97 % and 76.9–93.8 % in 5 and 10 years respectively. The radiation induced cranial nerve deficits rates after GKRS were 3.6 % (95%CI 1.7, 5.5 %).</div></div><div><h3>Conclusion</h3><div>According to our findings, radiosurgery for JFS has favourable clinical outcomes with a high rate of long-term tumour control and low complication rates.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"25 ","pages":"Article 100411"},"PeriodicalIF":0.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142416953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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