Pub Date : 2024-10-01DOI: 10.1227/ons.0000000000001372
Ryan M Naylor, Eugene S Bah, Giorgos Michalopoulos, Jeremy K Cutsforth-Gregory, Ajay A Madhavan, Jeremy L Fogelson
{"title":"Ventral Thoracic Cerebrospinal Fluid Leak Repair in Spontaneous Intracranial Hypotension Complicated by Superficial Siderosis: 2-Dimensional Operative Video.","authors":"Ryan M Naylor, Eugene S Bah, Giorgos Michalopoulos, Jeremy K Cutsforth-Gregory, Ajay A Madhavan, Jeremy L Fogelson","doi":"10.1227/ons.0000000000001372","DOIUrl":"https://doi.org/10.1227/ons.0000000000001372","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1227/ons.0000000000001336
Diego Mendez-Rosito, Cristian Alberto Pérez-Carrillo, Jaime Jecsan Serrano-Verduzco, Iván Alejandro Méndez-Guerrero, Gustavo Melo-Guzmán, James K Liu, Jesús Abraham Ibarra-Ramos, Nadin J Abdala-Vargas
{"title":"Maximizing the Carotid-Oculomotor Triangle and Oculomotor-Trochlear Corridor for Microsurgical Clipping of a Large Wide-Neck Low-Lying Basilar Apex Aneurysm: 2-Dimensional Operative Video.","authors":"Diego Mendez-Rosito, Cristian Alberto Pérez-Carrillo, Jaime Jecsan Serrano-Verduzco, Iván Alejandro Méndez-Guerrero, Gustavo Melo-Guzmán, James K Liu, Jesús Abraham Ibarra-Ramos, Nadin J Abdala-Vargas","doi":"10.1227/ons.0000000000001336","DOIUrl":"https://doi.org/10.1227/ons.0000000000001336","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01Epub Date: 2024-03-18DOI: 10.1227/ons.0000000000001135
Jeremy Kam, Mendel Castle-Kirszbaum, Celine Hounjet, Hannah Schoenroth, Benjamin Brakel, Serge Makarenko, Peter Gooderham, Ryojo Akagami
{"title":"Vertebral Artery Mobilization During Transcondylar Extreme Far Lateral Approach for Excision of Large Foramen Magnum Meningioma: 2-Dimensional Operative Video.","authors":"Jeremy Kam, Mendel Castle-Kirszbaum, Celine Hounjet, Hannah Schoenroth, Benjamin Brakel, Serge Makarenko, Peter Gooderham, Ryojo Akagami","doi":"10.1227/ons.0000000000001135","DOIUrl":"10.1227/ons.0000000000001135","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140144568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01Epub Date: 2024-03-27DOI: 10.1227/ons.0000000000001131
Cihan Isler, Huseyin Mert Cerci, Semih Baghaki, Yekta Servet Aydin, Süreyya Toklu, Mehmet Murat Hanci
Background and objectives: Intrathecal baclofen (ITB) for severe spasticity can encounter complications such as wound dehiscence and ulcers because of elevated intracompartmental pressure within the abdominal subcutaneous and subfascial pocket housing the pump. We propose an innovative technique to manage ITB wound ulcers.
Methods: Resecting the umbilicus create a more spacious and less tension-prone pocket for the ITB pump.
Results: Between 2015 and 2023, we implanted ITB pumps in 65 patients. Among them, 5 patients presented with skin ulcer or dehiscence underwent surgery using the novel technique. Postoperative follow-up revealed successful wound healing, with no further wound-related complications.
Conclusion: The proposed technique provides effective and practical solution to wound and skin complications related to ITB pump. Moreover, it may serve as a viable preemptive strategy during the initial implantation of the ITB pump in selected patients.
{"title":"Expansion of the Subcutaneous Compartment by Umbilicus Resection for Intrathecal Pump Placement: The \"Karagoz-Hacivat Technique\".","authors":"Cihan Isler, Huseyin Mert Cerci, Semih Baghaki, Yekta Servet Aydin, Süreyya Toklu, Mehmet Murat Hanci","doi":"10.1227/ons.0000000000001131","DOIUrl":"10.1227/ons.0000000000001131","url":null,"abstract":"<p><strong>Background and objectives: </strong>Intrathecal baclofen (ITB) for severe spasticity can encounter complications such as wound dehiscence and ulcers because of elevated intracompartmental pressure within the abdominal subcutaneous and subfascial pocket housing the pump. We propose an innovative technique to manage ITB wound ulcers.</p><p><strong>Methods: </strong>Resecting the umbilicus create a more spacious and less tension-prone pocket for the ITB pump.</p><p><strong>Results: </strong>Between 2015 and 2023, we implanted ITB pumps in 65 patients. Among them, 5 patients presented with skin ulcer or dehiscence underwent surgery using the novel technique. Postoperative follow-up revealed successful wound healing, with no further wound-related complications.</p><p><strong>Conclusion: </strong>The proposed technique provides effective and practical solution to wound and skin complications related to ITB pump. Moreover, it may serve as a viable preemptive strategy during the initial implantation of the ITB pump in selected patients.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140295312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-27DOI: 10.1227/ons.0000000000001357
Jie Lin, Yonghua Cai, Hai Wang, Xianqiu Liang, Wei Xu, Qixiong Zhou, Sidi Xie, Songtao Qi, Chaohu Wang, Xi'an Zhang
Background and objectives: Surgical resection of jugular foramen (JF) schwannomas with minimal neurological complications is challenging because of their difficult-to-access location and complex relationships with surrounding neurovascular structures, even for experienced neurosurgeons. In this article, we elucidate the membranous anatomy of JF schwannomas, with the aim of reducing iatrogenic injury to the lower cranial nerves (LCNs) during surgery.
Methods: The clinical data of 31 consecutive patients with JF schwannomas were reviewed. The relationship between the tumor and the surrounding membranous structures was observed during dissection. Samples were analyzed using Masson's trichrome and immunofluorescence staining to study the membranous characteristics. Histological-radiographic correlations were also summarized.
Results: In this series, we found that all 3 type B, 2 type C, and 8 type D tumors (according to the Kaye-Pellet grading system) were entirely extradural in location, whereas the 18 type A tumors could be subdural (9 cases) or extradural (9 cases), which frequently could not be predicted preoperatively based on whether the tumor had intraforaminal extension. The dural capsule, when present, could be used as an insulating layer to protect LCNs. With this subcapsular dissection technique, postoperative LCN dysfunction occurred in 10 patients (32.3%), which was usually temporary and mild.
Conclusion: The different relationships between the tumor and membranous structures of the JF is related to the distinct point of tumor origin and the complex anatomy of the meningeal dura within the JF. Subcapsular dissection technique is recommended for better preservation of LCNs when the dural capsule is identified.
{"title":"The Relationship Between Jugular Foramen Schwannoma and Surrounding Membrane Structures and Its Surgical Application.","authors":"Jie Lin, Yonghua Cai, Hai Wang, Xianqiu Liang, Wei Xu, Qixiong Zhou, Sidi Xie, Songtao Qi, Chaohu Wang, Xi'an Zhang","doi":"10.1227/ons.0000000000001357","DOIUrl":"https://doi.org/10.1227/ons.0000000000001357","url":null,"abstract":"<p><strong>Background and objectives: </strong>Surgical resection of jugular foramen (JF) schwannomas with minimal neurological complications is challenging because of their difficult-to-access location and complex relationships with surrounding neurovascular structures, even for experienced neurosurgeons. In this article, we elucidate the membranous anatomy of JF schwannomas, with the aim of reducing iatrogenic injury to the lower cranial nerves (LCNs) during surgery.</p><p><strong>Methods: </strong>The clinical data of 31 consecutive patients with JF schwannomas were reviewed. The relationship between the tumor and the surrounding membranous structures was observed during dissection. Samples were analyzed using Masson's trichrome and immunofluorescence staining to study the membranous characteristics. Histological-radiographic correlations were also summarized.</p><p><strong>Results: </strong>In this series, we found that all 3 type B, 2 type C, and 8 type D tumors (according to the Kaye-Pellet grading system) were entirely extradural in location, whereas the 18 type A tumors could be subdural (9 cases) or extradural (9 cases), which frequently could not be predicted preoperatively based on whether the tumor had intraforaminal extension. The dural capsule, when present, could be used as an insulating layer to protect LCNs. With this subcapsular dissection technique, postoperative LCN dysfunction occurred in 10 patients (32.3%), which was usually temporary and mild.</p><p><strong>Conclusion: </strong>The different relationships between the tumor and membranous structures of the JF is related to the distinct point of tumor origin and the complex anatomy of the meningeal dura within the JF. Subcapsular dissection technique is recommended for better preservation of LCNs when the dural capsule is identified.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-27DOI: 10.1227/ons.0000000000001383
Ryan R Song, Akshay Sharma, Nehaw Sarmey, Stephen Harasimchuk, Juan Bulacio, Richard Rammo, William Bingaman, Demitre Serletis
Background and objectives: Stereoelectroencephalography (SEEG) is an important method for invasive monitoring to establish surgical candidacy in approximately half of refractory epilepsy patients. Identifying factors affecting lead placement can mitigate potential surgical risks. This study applies multivariate analyses to identify perioperative factors affecting stereotactic electrode placement.
Methods: We collected registration and accuracy data for consecutive patients undergoing SEEG implantation between May 2022 and November 2023. Stereotactic robotic guidance, using intraoperative imaging and a novel frame-based fiducial, was used for planning and SEEG implantation. Entry-point (EE), target-point (TE), and angular errors were measured, and statistical univariate and multivariate linear regression analyses were performed.
Results: Twenty-seven refractory epilepsy patients (aged 15-57 years) undergoing SEEG were reviewed. Sixteen patients had unilateral implantation (10 left-sided, 6 right-sided); 11 patients underwent bilateral implantation. The mean number of electrodes per patient was 18 (SD = 3) with an average registration mean error of 0.768 mm (SD = 0.108). Overall, 486 electrodes were reviewed. Univariate analysis showed significant correlations of lead error with skull thickness (EE: P = .003; TE: P = .012); entry angle (EE: P < .001; TE: P < .001; angular error: P = .030); lead length (TE: P = .020); and order of electrode implantation (EE: P = .003; TE: P = .001). Three multiple linear regression models were used. All models featured predictors of implantation region (157 temporal, 241 frontal, 79 parietal, 9 occipital); skull thickness (mean = 5.80 mm, SD = 2.97 mm); order (range: 1-23); and entry angle in degrees (mean = 75.47, SD = 11.66). EE and TE error models additionally incorporated lead length (mean = 44.08 mm, SD = 13.90 mm) as a predictor. Implantation region and entry angle were significant predictors of error (P ≤ .05).
Conclusion: Our study identified 2 primary predictors of SEEG lead error, region of implantation and entry angle, with nonsignificant contributions from lead length or order of electrode placement. Future considerations for SEEG may consider varying regional approaches and angles for more optimal accuracy in lead placement.
{"title":"A Multivariate Approach to Quantifying Risk Factors Impacting Stereotactic Robotic-Guided Stereoelectroencephalography.","authors":"Ryan R Song, Akshay Sharma, Nehaw Sarmey, Stephen Harasimchuk, Juan Bulacio, Richard Rammo, William Bingaman, Demitre Serletis","doi":"10.1227/ons.0000000000001383","DOIUrl":"https://doi.org/10.1227/ons.0000000000001383","url":null,"abstract":"<p><strong>Background and objectives: </strong>Stereoelectroencephalography (SEEG) is an important method for invasive monitoring to establish surgical candidacy in approximately half of refractory epilepsy patients. Identifying factors affecting lead placement can mitigate potential surgical risks. This study applies multivariate analyses to identify perioperative factors affecting stereotactic electrode placement.</p><p><strong>Methods: </strong>We collected registration and accuracy data for consecutive patients undergoing SEEG implantation between May 2022 and November 2023. Stereotactic robotic guidance, using intraoperative imaging and a novel frame-based fiducial, was used for planning and SEEG implantation. Entry-point (EE), target-point (TE), and angular errors were measured, and statistical univariate and multivariate linear regression analyses were performed.</p><p><strong>Results: </strong>Twenty-seven refractory epilepsy patients (aged 15-57 years) undergoing SEEG were reviewed. Sixteen patients had unilateral implantation (10 left-sided, 6 right-sided); 11 patients underwent bilateral implantation. The mean number of electrodes per patient was 18 (SD = 3) with an average registration mean error of 0.768 mm (SD = 0.108). Overall, 486 electrodes were reviewed. Univariate analysis showed significant correlations of lead error with skull thickness (EE: P = .003; TE: P = .012); entry angle (EE: P < .001; TE: P < .001; angular error: P = .030); lead length (TE: P = .020); and order of electrode implantation (EE: P = .003; TE: P = .001). Three multiple linear regression models were used. All models featured predictors of implantation region (157 temporal, 241 frontal, 79 parietal, 9 occipital); skull thickness (mean = 5.80 mm, SD = 2.97 mm); order (range: 1-23); and entry angle in degrees (mean = 75.47, SD = 11.66). EE and TE error models additionally incorporated lead length (mean = 44.08 mm, SD = 13.90 mm) as a predictor. Implantation region and entry angle were significant predictors of error (P ≤ .05).</p><p><strong>Conclusion: </strong>Our study identified 2 primary predictors of SEEG lead error, region of implantation and entry angle, with nonsignificant contributions from lead length or order of electrode placement. Future considerations for SEEG may consider varying regional approaches and angles for more optimal accuracy in lead placement.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-27DOI: 10.1227/ons.0000000000001362
Tyler Zeoli, Hani Chanbour, Scott L Zuckerman
{"title":"Commentary: Iliac Accessory Rod Technique for Rod Fracture Prevention in Long Fusion Constructs: 2-Dimensional Operative Video.","authors":"Tyler Zeoli, Hani Chanbour, Scott L Zuckerman","doi":"10.1227/ons.0000000000001362","DOIUrl":"https://doi.org/10.1227/ons.0000000000001362","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-27DOI: 10.1227/ons.0000000000001374
Arjun R Adapa, Anthony J Tang, Andrew K Chan
{"title":"Resection of a Dorsal Arachnoid Web of the Cervical Spine: 2-Dimensional Operative Video.","authors":"Arjun R Adapa, Anthony J Tang, Andrew K Chan","doi":"10.1227/ons.0000000000001374","DOIUrl":"https://doi.org/10.1227/ons.0000000000001374","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-27DOI: 10.1227/ons.0000000000001380
Juan P Navarro-Garcia de Llano, Macarena Fuentes-Fernandez Cueto, Andrew P Roberts, Jesus E Sanchez-Garavito, Siddharth Shah, Gaetano De Biase, Harshvandan Iyer, Ogechuku Ariwodo, Loizos Michaelides, Jennifer S Patterson, Kate E White, Elird Bojaxhi, Rodrigo Navarro-Ramirez, Ian A Buchanan, Alfredo Quinones-Hinojosa, Kingsley O Abode-Iyamah
Background and objectives: Awake minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) generates minimal surrounding tissue damage and has been shown to be a safe, time-effective, and cost-reductive technique in single-level procedures. The purpose of this study was to advocate for the utilization of multilevel MIS-TLIF even in challenging cases as it has demonstrated positive outcomes.
Methods: Chart review was conducted for consecutive patients undergoing awake multilevel MIS-TLIF from 2020 to 2023. Various demographic, preoperative, and postoperative variables were collected and descriptively analyzed.
Results: Sixteen patients underwent multilevel awake MIS-TLIF at our institution during the specified period. Among them, 87.5% underwent a two-level procedure and 12.5% a three-level procedure. The median age ± IQR was 69.5 ± 11 years, with a slight male predominance (56.25%). Common comorbidities included hypertension (56.25%), obesity (37.5%), sleep apnea (25%), and type 2 diabetes (18.75%). The American Society of Anesthesiologists risk was 2 in 43.75% of patients and 3 in 56.25%. All patients presented pain, and 12.5% showed motor deficit. Intraoperative data showed a median of 196 minutes in the operating room where 156 ± 27.75 minutes corresponded to actual procedure time. The median estimated blood loss was 50 ± 70 cc. In the immediate postoperative period, 1 patient had nausea and emesis, and 1 reported fatigue. The median pain score during this period was 4.6 ± 2.03. Pain control medications were required for various patients, with methocarbamol (50%), hydromorphone (37.5%), and oxycodone (25%) being the most commonly prescribed in the postanesthesia care unit. No patient had new neurological deficits after the surgical intervention. The median length of stay was 2 days ±1.25. All patients were discharged with no complications.
Conclusion: Multilevel awake MIS-TLIF emerges as a safe and effective technique for complex cases, enhancing patient quality of life with minimal blood loss and postoperative pain.
{"title":"Spinal Anesthesia for Multilevel Awake Minimally Invasive Transforaminal Lumbar Interbody Fusion: Single-Center Experience.","authors":"Juan P Navarro-Garcia de Llano, Macarena Fuentes-Fernandez Cueto, Andrew P Roberts, Jesus E Sanchez-Garavito, Siddharth Shah, Gaetano De Biase, Harshvandan Iyer, Ogechuku Ariwodo, Loizos Michaelides, Jennifer S Patterson, Kate E White, Elird Bojaxhi, Rodrigo Navarro-Ramirez, Ian A Buchanan, Alfredo Quinones-Hinojosa, Kingsley O Abode-Iyamah","doi":"10.1227/ons.0000000000001380","DOIUrl":"https://doi.org/10.1227/ons.0000000000001380","url":null,"abstract":"<p><strong>Background and objectives: </strong>Awake minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) generates minimal surrounding tissue damage and has been shown to be a safe, time-effective, and cost-reductive technique in single-level procedures. The purpose of this study was to advocate for the utilization of multilevel MIS-TLIF even in challenging cases as it has demonstrated positive outcomes.</p><p><strong>Methods: </strong>Chart review was conducted for consecutive patients undergoing awake multilevel MIS-TLIF from 2020 to 2023. Various demographic, preoperative, and postoperative variables were collected and descriptively analyzed.</p><p><strong>Results: </strong>Sixteen patients underwent multilevel awake MIS-TLIF at our institution during the specified period. Among them, 87.5% underwent a two-level procedure and 12.5% a three-level procedure. The median age ± IQR was 69.5 ± 11 years, with a slight male predominance (56.25%). Common comorbidities included hypertension (56.25%), obesity (37.5%), sleep apnea (25%), and type 2 diabetes (18.75%). The American Society of Anesthesiologists risk was 2 in 43.75% of patients and 3 in 56.25%. All patients presented pain, and 12.5% showed motor deficit. Intraoperative data showed a median of 196 minutes in the operating room where 156 ± 27.75 minutes corresponded to actual procedure time. The median estimated blood loss was 50 ± 70 cc. In the immediate postoperative period, 1 patient had nausea and emesis, and 1 reported fatigue. The median pain score during this period was 4.6 ± 2.03. Pain control medications were required for various patients, with methocarbamol (50%), hydromorphone (37.5%), and oxycodone (25%) being the most commonly prescribed in the postanesthesia care unit. No patient had new neurological deficits after the surgical intervention. The median length of stay was 2 days ±1.25. All patients were discharged with no complications.</p><p><strong>Conclusion: </strong>Multilevel awake MIS-TLIF emerges as a safe and effective technique for complex cases, enhancing patient quality of life with minimal blood loss and postoperative pain.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-27DOI: 10.1227/ons.0000000000001361
Timothy J Kaufmann, Vance T Lehman, Jamie J Van Gompel, Lily C Wong-Kisiel, Kai J Miller
Background and objectives: Corpus callosotomy is an effective procedure approach for treating medication-resistant drop seizures, which pose a significant challenge in patients with epilepsy. Laser interstitial thermal therapy offers an alternative to open surgery for performing corpus callosotomy that may limit approach-related comorbidities. Practices vary regarding the number of laser filaments used and staging; outcome data for pediatric patients remain relatively limited.
Methods: We illustrate a set of 4 standardized trajectories for performing MRI-guided stereotactic laser corpus callosotomy (SLCC). For this retrospective cohort study in a pediatric neurosurgery practice, the medical records and imaging were reviewed for 10 consecutive patients who had medication-refractory drop seizures and underwent SLCC. Data collected and analyzed included patient and epilepsy characteristics, procedural details, surgical approaches, and clinical follow-up results.
Results: Over 2 years, complete, single-stage SLCC was performed in 8 patients, and posterior completion SLCC was performed in 2 patients who had previously had open anterior corpus callosotomy. Four laser fibers were used in four-eighth complete SLCC, and 3 fibers were used in four-eighth complete SLCC. Seven of 10 patients were discharged from the hospital on postoperative day 1, with only 1 requiring a maximum stay of 6 days. Five of 9 evaluable patients reported no drop seizures at the last clinical follow-up. In the other 4 patients, 1 experienced them only rarely, another experienced less than 25% preoperative frequency, and the remaining 2 had less than a 50% improvement. In addition, improvement in other seizure types exceeded 50% in 8 of 9 patients. Notably, no perioperative or postoperative complications were observed, nor were there any sustained neurological deficits reported.
Conclusion: Complete SLCC can be safely and effectively performed in pediatric patients. It is comparable in effectiveness with open surgery but has lower complication rates and shorter hospitalization.
{"title":"A Standardized Approach to MRI-Guided Stereotactic Laser Corpus Callosotomy: Technical Description and Pediatric Case Series.","authors":"Timothy J Kaufmann, Vance T Lehman, Jamie J Van Gompel, Lily C Wong-Kisiel, Kai J Miller","doi":"10.1227/ons.0000000000001361","DOIUrl":"https://doi.org/10.1227/ons.0000000000001361","url":null,"abstract":"<p><strong>Background and objectives: </strong>Corpus callosotomy is an effective procedure approach for treating medication-resistant drop seizures, which pose a significant challenge in patients with epilepsy. Laser interstitial thermal therapy offers an alternative to open surgery for performing corpus callosotomy that may limit approach-related comorbidities. Practices vary regarding the number of laser filaments used and staging; outcome data for pediatric patients remain relatively limited.</p><p><strong>Methods: </strong>We illustrate a set of 4 standardized trajectories for performing MRI-guided stereotactic laser corpus callosotomy (SLCC). For this retrospective cohort study in a pediatric neurosurgery practice, the medical records and imaging were reviewed for 10 consecutive patients who had medication-refractory drop seizures and underwent SLCC. Data collected and analyzed included patient and epilepsy characteristics, procedural details, surgical approaches, and clinical follow-up results.</p><p><strong>Results: </strong>Over 2 years, complete, single-stage SLCC was performed in 8 patients, and posterior completion SLCC was performed in 2 patients who had previously had open anterior corpus callosotomy. Four laser fibers were used in four-eighth complete SLCC, and 3 fibers were used in four-eighth complete SLCC. Seven of 10 patients were discharged from the hospital on postoperative day 1, with only 1 requiring a maximum stay of 6 days. Five of 9 evaluable patients reported no drop seizures at the last clinical follow-up. In the other 4 patients, 1 experienced them only rarely, another experienced less than 25% preoperative frequency, and the remaining 2 had less than a 50% improvement. In addition, improvement in other seizure types exceeded 50% in 8 of 9 patients. Notably, no perioperative or postoperative complications were observed, nor were there any sustained neurological deficits reported.</p><p><strong>Conclusion: </strong>Complete SLCC can be safely and effectively performed in pediatric patients. It is comparable in effectiveness with open surgery but has lower complication rates and shorter hospitalization.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}