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Biportal endoscopic transforaminal lumbar interbody fusion using a large cage for degenerative spondylolisthesis with stenosis 双腔内窥镜经椎间孔腰椎椎体间融合术(使用大椎笼)治疗伴有狭窄的退行性脊椎滑脱症
Pub Date : 2024-04-01 DOI: 10.3171/2024.1.FOCVID23231
Dong Hwa Heo
Recently, biportal endoscopic transforaminal lumbar interbody fusion (TLIF) has been used to treat lumbar degenerative diseases, such as lumbar instability and spondylolisthesis. Biportal endoscopic TLIF may have the advantages of endoscopic spine approaches and minimally invasive lumbar fusion surgeries. In this biportal endoscopic TLIF, large cages similar to oblique lumbar interbody fusion (OLIF) cages have been used. Biportal endoscopic TLIF using a large cage can be successfully performed in the lower lumbar area. The author presents the surgical technique of biportal endoscopic TLIF using a large cage. The video can be found here: https://stream.cadmore.media/r10.3171/2024.1.FOCVID23231
最近,双ortal 内窥镜经椎间孔腰椎椎体融合术(TLIF)被用于治疗腰椎退行性疾病,如腰椎不稳和脊椎滑脱症。双ortal内窥镜TLIF可能具有内窥镜脊柱方法和微创腰椎融合手术的优点。在这种双ortal 内窥镜 TLIF 中,使用了类似于斜行腰椎椎体间融合(OLIF)笼的大笼。双ortal 内窥镜 TLIF 使用大型椎体笼,可在下腰椎区域成功实施。作者介绍了使用大型保持架的双ortal内窥镜TLIF手术技术。视频请点击: https://stream.cadmore.media/r10.3171/2024.1.FOCVID23231
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引用次数: 0
Minimally invasive anterior cervical foraminotomy for unilateral radiculopathy 微创颈椎前路椎板切除术治疗单侧根性神经根病
Pub Date : 2024-04-01 DOI: 10.3171/2024.1.FOCVID23196
Duncan J. Trimble, D. Sheinberg, Joseph A. Cochran
Anterior cervical foraminotomy (ACF) is an alternative surgical option for the treatment of refractory unilateral radiculopathy due to disc herniation or spondylosis. The efficacy and adverse event rate in experienced practitioners are comparable to those of anterior cervical discectomy and fusion, total disc arthroplasty, and posterior foraminotomy. However, this technique has not been widely adopted, likely because of the proximity of the working zone and the vertebral artery. The authors present a detailed operative video of a patient successfully treated with an ACF. They also present a review of the ACF literature. The video can be found here: https://stream.cadmore.media/r10.3171/2024.1.FOCVID23196
颈椎前路椎板切除术(ACF)是治疗椎间盘突出症或脊椎病引起的难治性单侧根性神经病的另一种手术选择。在经验丰富的医生中,其疗效和不良事件发生率与颈椎椎间盘前路切除融合术、全椎间盘关节成形术和后椎板切除术相当。然而,这项技术尚未被广泛采用,可能是因为工作区与椎动脉距离较近。作者展示了一位成功接受 ACF 治疗的患者的详细手术视频。他们还对 ACF 文献进行了回顾。视频可在此处找到: https://stream.cadmore.media/r10.3171/2024.1.FOCVID23196
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引用次数: 0
Percutaneous full-endoscopic bullet removal from the C2 vertebra in a pediatric patient 一名儿童患者的 C2 脊椎经皮全内窥镜子弹取出术
Pub Date : 2024-04-01 DOI: 10.3171/2024.1.focvid23230
Özkan Çeliker, Yücel Doğruel
Gunshot injuries (GSIs) to the spine constitute approximately 17% to 21% of all traumatic spinal injuries, with the cervical spine being the second most frequently affected region. There is a lack of approved algorithms for patients with GSIs to the spine. Surgical intervention is controversial; however, it is generally considered in cases involving neurological deterioration with incomplete deficit, externalized liquor fistula, instability, installed toxicity, and risk of migration. Detailed information on pediatric patients is limited, primarily due to the predominance of adult patients. This study presents the full-endoscopic removal of a bullet in the C2 vertebra of a pediatric patient. The video can be found here: https://stream.cadmore.media/r10.3171/2024.1.FOCVID23230
脊柱枪伤(GSI)约占所有脊柱外伤的 17% 至 21%,颈椎是第二大最常受影响的部位。目前还没有针对脊柱 GSI 患者的公认算法。手术干预是有争议的;但是,一般在涉及神经系统恶化并伴有不完全缺损、外瘘、不稳定、安装毒性和移位风险的病例中会考虑手术干预。有关儿童患者的详细信息非常有限,这主要是由于成人患者居多。本研究介绍了在全内窥镜下取出一名儿童患者C2椎体内子弹的手术。视频请点击: https://stream.cadmore.media/r10.3171/2024.1.FOCVID23230
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引用次数: 0
MIS technique for separation surgery in lumbar spine metastatic disease 腰椎转移性疾病分离手术的 MIS 技术
Pub Date : 2024-04-01 DOI: 10.3171/2024.1.FOCVID23222
Vicente de Paulo Martins Coelho Junior, Joravar Dhaliwal, Vikram B. Chakravarthy
Around 40% of cancer patients present with spinal metastases (SM), the lumbar spine being the second most involved site (15%–30%) after the thoracic (60%–80%). Since the development of separation surgery, minimally invasive surgery (MIS) has increasingly been applied to approach SM, mirroring benefits yielded in the degenerative realm. Moreover, preoperative embolization potentially enhances local control for certain radioresistant histologies. Carbon fiber–reinforced PEEK hardware reduces image artifact, facilitating more accurate follow-up and radiotherapeutic planning. Additionally, short-segment cement-augmented constructs may be beneficial to decrease surgical morbidity and operative risk in this population. The authors present a lumbar spinal metastasis treated with MIS techniques. The video can be found here: https://stream.cadmore.media/r10.3171/2024.1.FOCVID23222
约 40% 的癌症患者会出现脊柱转移(SM),腰椎是第二大受累部位(15%-30%),仅次于胸椎(60%-80%)。自分离手术发展以来,微创手术(MIS)越来越多地被应用于脊柱转移瘤的治疗,这与退行性病变领域所取得的疗效如出一辙。此外,术前栓塞可增强对某些抗放射组织的局部控制。碳纤维加固的PEEK硬件可减少图像伪影,便于进行更准确的随访和放射治疗规划。此外,短节段水泥增强结构可能有利于降低这类人群的手术发病率和手术风险。作者介绍了用 MIS 技术治疗腰椎转移瘤的情况。视频请点击: https://stream.cadmore.media/r10.3171/2024.1.FOCVID23222
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引用次数: 0
Combined unilateral biportal endoscopy and video-assisted thoracoscopic surgery for complete excision of a T3–T4 right ganglioneuroma 联合单侧双ortal内窥镜和视频辅助胸腔镜手术彻底切除右侧T3-T4神经节瘤
Pub Date : 2024-04-01 DOI: 10.3171/2024.2.focvid23210
Enrico Giordan, Changik Lee, Dimas Rahman Setiawan, Phattareeya Pholprajug, Jin-Sung Kim
Ganglioneuroma (GN) is a rare solid neoplasm developing from neural crest cells of sympathetic ganglia or adrenal medulla. It usually presents as an asymptomatic mass in the retroperitoneal space and mediastinum. Resection through open surgery or minimal access is recommended. The video illustrates the case of a 23-year-old female with an incidental finding of thoracic GN. The authors performed a combined, staged approach to ensure complete resection, which involved unilateral T3–4 biportal endoscopy (UBE) for rhizotomy and nerve root decompression, followed by video-assisted thoracoscopic surgery (VATS) for complete excision. The procedure was uneventful, with full recovery and no postoperative complications. The video can be found here: https://stream.cadmore.media/r10.3171/2024.2.FOCVID23210
神经节瘤(GN)是一种罕见的实体瘤,由交感神经节或肾上腺髓质的神经嵴细胞发展而来。它通常表现为腹膜后间隙和纵隔内无症状的肿块。建议通过开腹手术或微创手术进行切除。视频中的病例是一名 23 岁女性,偶然发现胸部 GN。作者采用了分阶段的联合方法确保彻底切除,包括单侧 T3-4 双ortal 内镜(UBE)根治术和神经根减压,然后采用视频辅助胸腔镜手术(VATS)彻底切除。手术过程顺利,患者完全康复,术后无并发症。视频请点击: https://stream.cadmore.media/r10.3171/2024.2.FOCVID23210
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引用次数: 0
Full endoscopic resection of large bilateral synovial cysts in lumbar spine 腰椎双侧大滑膜囊肿全内窥镜切除术
Pub Date : 2024-04-01 DOI: 10.3171/2024.1.FOCVID23208
Jannik Leyendecker, Nelson Sofoluke, C. P. Hofstetter, Sanjay Konakondla
Synovial spinal cysts cause radiculopathy and back pain, with rare reports of cauda equina syndrome. Hypermobility and instability are cornerstones for synovial cyst formation. The incidence is around 5%, and data for bilateral cysts are lacking. Surgery is indicated after conservative measures fail. Recurrence is common and is potentially due to joint violation and destabilization from open surgery. This could be prevented via ultra-minimally invasive approaches. The authors present full endoscopic removal of bilateral synovial cysts in a patient with grade 1 stable spondylolisthesis and include a 360° view for confirmation of complete decompression. Postoperatively, the patient reported immediate pain relief. The video can be found here: https://stream.cadmore.media/r10.3171/2024.1.FOCVID23208
滑膜脊柱囊肿会引起脊髓病变和背痛,马尾综合征的报告也很少见。过度活动和不稳定是滑膜囊肿形成的基础。发病率约为 5%,缺乏双侧囊肿的数据。在保守治疗无效后,应进行手术治疗。复发很常见,可能是由于开放手术造成的关节侵犯和不稳定。通过超微创方法可以避免复发。作者介绍了在内窥镜下切除双侧滑膜囊肿的病例,患者的脊柱滑脱程度为 1 级,病情稳定,并提供了 360° 视图以确认完全减压。术后,患者表示疼痛立即得到缓解。视频请点击:https://stream.cadmore.media/r10.3171/2024.1.FOCVID23208
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引用次数: 0
Feasibility of exoscopic keyhole surgery: case series 外窥镜锁孔手术的可行性:病例系列
Pub Date : 2024-01-01 DOI: 10.3171/2023.10.focvid23116
Miguel Sáez-Alegre, Christian I. Rios-Vicil, Keaton Piper, Edinson Najera, Walter C Jean
Keyhole approaches, performed with the endoscope, microscope, or exoscope, aim to minimize tissue traumatization while maximizing surgical view. The exoscope can provide better ergonomics than the microscope without restricting the space inside of the keyhole, as when using the endoscope. However, a frequently quoted reason for intraoperative exoscope-to-microscope conversion is the absence of sufficient light. In this video, the authors present 4 patients who underwent posterior fossa keyhole surgery without intraoperative conversion. The surgical objective was achieved in all patients without associated morbidity. After adequate adaptation, the exoscope allows sufficient light in the surgical field to perform safe keyhole surgery. The video can be found here: https://stream.cadmore.media/r10.3171/2023.10.FOCVID23116
使用内窥镜、显微镜或外窥镜进行的锁孔手术,旨在最大限度地减少组织创伤,同时最大限度地增加手术视野。外窥镜比显微镜更符合人体工程学,而且不会像使用内窥镜那样限制锁孔内的空间。然而,术中外视镜转换为显微镜的一个经常被引用的原因是缺乏足够的光线。在这段视频中,作者介绍了 4 位在没有术中转换的情况下接受后窝锁孔手术的患者。所有患者都达到了手术目的,没有相关的发病率。经过充分适应后,外窥镜可在手术区域提供足够的光线,从而安全地进行锁孔手术。视频请点击: https://stream.cadmore.media/r10.3171/2023.10.FOCVID23116
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引用次数: 0
Exoscopic extradural anterior clinoidectomy 硬膜外硬膜外前端克氏切除术
Pub Date : 2024-01-01 DOI: 10.3171/2023.10.focvid23118
A. M. Auricchio, Francesco Calvanese, M. Lehecka
Extradural anterior clinoidectomy is a resourceful technique to decompress the optic nerve as well as increase exposure of the parasellar region during extensive approaches. Despite requiring adjunctive epidural bone work, this technique allows safe optic nerve mobilization and early devascularization for anterior clinoidal meningioma resection. This 2D operative video describes right optic nerve decompression by extradural anterior clinoidectomy and subsequent resection of a right Al-Mefty type III clinoid meningioma under exoscope magnification. The patient was a 50-year-old woman with a 1-year history of right visual acuity impairment and papillary atrophy. The exoscope allows a 360° view around the anterior clinoid, improving maneuverability. The video can be found here: https://stream.cadmore.media/r10.3171/2023.10.FOCVID23118
硬膜外前蝶窦切除术是一种非常有用的技术,可在广泛手术中为视神经减压并增加蝶窦旁区域的暴露。尽管需要辅助硬膜外骨工作,但这种技术可以安全地移动视神经,并在前clinoidal脑膜瘤切除术中尽早去除血管。这段二维手术视频描述了在外科医生放大镜下,通过硬膜外前方蒂切除术为右侧视神经减压,随后切除右侧Al-Mefty III型蒂状脑膜瘤的过程。患者是一名50岁的女性,右眼视力受损和乳头萎缩已有1年病史。外窥镜可以 360° 观察前方的蒂诺瘤,提高了手术的可操作性。视频请点击此处: https://stream.cadmore.media/r10.3171/2023.10.FOCVID23118
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引用次数: 0
Frontotemporal craniotomy with orbital osteotomy for superior hypophyseal artery aneurysm clipping 额颞部开颅加眼眶截骨术治疗叶下上动脉动脉瘤夹闭术
Pub Date : 2024-01-01 DOI: 10.3171/2023.10.focvid23157
Grant Arzumanov, Seung W. Jeong, Bhavika Gupta, Rocco Dabecco, Jose Sandoval, Richard Williamson, Alexander Yu
Superior hypophyseal artery (SHA) aneurysms are rare paraclinoid aneurysms with a mortality rate as high as 3%–6%. Surgical clipping of these aneurysms is technically challenging due to the surrounding anatomy. The large size and complicated surrounding anatomy make endovascular coiling very difficult. Here we present the case of a ruptured right SHA aneurysm. The authors present technical nuances of the clipping using an exoscope rather than a traditional microscope. The video can be found here: https://stream.cadmore.media/r10.3171/2023.10.FOCVID23157
叶状上动脉瘤(SHA)是一种罕见的副椎体动脉瘤,死亡率高达 3%-6%。由于周围解剖结构复杂,手术切除这些动脉瘤在技术上具有挑战性。巨大的尺寸和复杂的周围解剖结构使得血管内卷曲非常困难。这里我们介绍一例右侧 SHA 动脉瘤破裂的病例。作者介绍了使用外窥镜而非传统显微镜进行夹闭的技术细节。视频请点击: https://stream.cadmore.media/r10.3171/2023.10.FOCVID23157
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引用次数: 0
Exoscope-based supracerebellar infratentorial approach for a pineal meningioma in the prone position 俯卧位采用基于外窥镜的小脑上皮下方法治疗松果体脑膜瘤
Pub Date : 2024-01-01 DOI: 10.3171/2023.10.focvid23155
A. Mallela, Tritan J. Plute, Hussam Abou-Al-Shaar, David T. Fernandes Cabral, Constantinos G. Hadjipanayis
The supracerebellar infratentorial (SCIT) approach is a well-described corridor to lesions in the quadrigeminal cistern, pineal gland, and dorsal midbrain. It can be performed in the prone or sitting position. The sitting position offers the benefit of gravity retraction of the cerebellum but comes at the expense of nonergonomic hand positioning and the potential risk of air embolism. The 3D exoscope is an alternative to the operating microscope and permits the SCIT approach in the prone position with excellent visualization. This video demonstrates exoscope-based SCIT approach for resection of a pineal meningioma in the prone position. The video can be found here: https://stream.cadmore.media/r10.3171/2023.10.FOCVID23155
小脑幕上、幕下(SCIT)入路是治疗四侧中脑蝶窦、松果体和背侧中脑病变的一种描述详尽的走廊入路。它可以俯卧位或坐位进行。坐姿的好处是可以重力牵拉小脑,但代价是手的位置不符合人体工程学,而且有空气栓塞的潜在风险。三维外窥镜是手术显微镜的替代品,它允许在俯卧位进行 SCIT 方法,并具有良好的可视性。这段视频演示了在俯卧位采用基于外窥镜的 SCIT 方法切除松果体脑膜瘤。视频请点击: https://stream.cadmore.media/r10.3171/2023.10.FOCVID23155
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引用次数: 0
期刊
Neurosurgical focus: Video
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