Pub Date : 2023-06-01DOI: 10.1097/01.cne.0000943040.10862.60
{"title":"“Four Legs of a Table”: Building a Stable Foundation and Systematic Approach to Diagnosing Peripheral Nerve Disorders","authors":"","doi":"10.1097/01.cne.0000943040.10862.60","DOIUrl":"https://doi.org/10.1097/01.cne.0000943040.10862.60","url":null,"abstract":"","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135777483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1097/01.CNE.0000936048.37373.a4
C. Mollica, S. Bonasia, F. Marchi, T. Robert
Spinal pial arteriovenous fistulas (spAVFs) are rare, high-flow vascular malformations consisting of a single dilated pial artery connecting directly to an enlarged draining vein. This article describes the anatomic, clinical, and diagnostic features of spAVFs, to help clinicians to select the best treatment option. Both surgical and endovascular treatments are effective; microsurgery has a higher success rate. To maximize the exclusion rate, a multidisciplinary approach and adequate preoperative study are mandatory.
{"title":"Spinal Pial Arteriovenous Fistulas: Angioarchitecture and Management","authors":"C. Mollica, S. Bonasia, F. Marchi, T. Robert","doi":"10.1097/01.CNE.0000936048.37373.a4","DOIUrl":"https://doi.org/10.1097/01.CNE.0000936048.37373.a4","url":null,"abstract":"Spinal pial arteriovenous fistulas (spAVFs) are rare, high-flow vascular malformations consisting of a single dilated pial artery connecting directly to an enlarged draining vein. This article describes the anatomic, clinical, and diagnostic features of spAVFs, to help clinicians to select the best treatment option. Both surgical and endovascular treatments are effective; microsurgery has a higher success rate. To maximize the exclusion rate, a multidisciplinary approach and adequate preoperative study are mandatory.","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":" ","pages":"1 - 6"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45864474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-01DOI: 10.1097/01.cne.0000927976.96728.c2
{"title":"Audiology for the Neurosurgeon","authors":"","doi":"10.1097/01.cne.0000927976.96728.c2","DOIUrl":"https://doi.org/10.1097/01.cne.0000927976.96728.c2","url":null,"abstract":"","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":"43 12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134987550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-01DOI: 10.1097/01.CNE.0000927972.40363.82
Sarah Kingsbury, Jamie M. Bogle, P. Weisskopf, N. Deep
Many conditions that neurosurgeons manage are associated with audiologic symptoms. Unilateral hearing loss and tinnitus, poor suprathreshold speech understanding, and dizziness are hallmarks of retrocochlear lesions. Understanding the difference between air and bone conduction thresholds and the importance of speech discrimination helps differentiate types of hearing loss and their neurological importance. Acoustic reflex, otoacoustic emissions, and auditory brainstem response testing are objective measures used to determine function of the auditory structures. Accurate interpretation of these results can aid neurosurgeons in making differential diagnoses and determining surgical approaches. Cooperation among neurosurgeons, otolaryngologists, and audiologists ensures abnormal auditory symptoms are assessed correctly.
{"title":"Audiology for the Neurosurgeon","authors":"Sarah Kingsbury, Jamie M. Bogle, P. Weisskopf, N. Deep","doi":"10.1097/01.CNE.0000927972.40363.82","DOIUrl":"https://doi.org/10.1097/01.CNE.0000927972.40363.82","url":null,"abstract":"Many conditions that neurosurgeons manage are associated with audiologic symptoms. Unilateral hearing loss and tinnitus, poor suprathreshold speech understanding, and dizziness are hallmarks of retrocochlear lesions. Understanding the difference between air and bone conduction thresholds and the importance of speech discrimination helps differentiate types of hearing loss and their neurological importance. Acoustic reflex, otoacoustic emissions, and auditory brainstem response testing are objective measures used to determine function of the auditory structures. Accurate interpretation of these results can aid neurosurgeons in making differential diagnoses and determining surgical approaches. Cooperation among neurosurgeons, otolaryngologists, and audiologists ensures abnormal auditory symptoms are assessed correctly.","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":"45 1","pages":"1 - 7"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41741083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-01DOI: 10.1097/01.CNE.0000922672.62799.6f
M. Hudson, M. Neal
large percentage of the world population and can significantly alter a patient’s quality of life. The presentation can vary but it generally consists of axial neck pain, radiculopathy, or myelopathy depending on the degree and location of the pathology. The incidence of cervical radiculopathy has been shown to peak between 50 and 54 years of age, with the average annual incidence rate per 100,000 patients being 83.2.1 Cervical myelopathy has a lower incidence rate, with an estimated hospital admission rate of 4.04/100,000 people in the United States.2 Cervical spondylosis and cervical disc disease with associated central or foraminal stenosis (Figure 1) have commonly been treated with anterior cervical discectomy and fusion (ACDF). This procedure allows for direct decompression of the disc space and thecal sac and combined direct and indirect decompression of the neural foramina. Cervical disc arthroplasty (CDA) seeks to mitigate many of the pitfalls of the ACDF procedure such as decreased cervical range of motion and development of adjacent segment degeneration (ASD). There have been many types of cervical disc prostheses with varying degrees of freedom, and they are generally categorized as constrained, unconstrained, and semiconstrained designs. Unconstrained designs allow the device to move independently and along all 3 rotational and translational axes. This device type allows for greater range of motion but also increases the force applied to the associated facet joints and ligaments that are required to stabilize that motion. Semiconstrained devices have some limitation in their degrees of freedom of movement but still have motion in both the translational and rotational planes. Constrained devices typically have a center of rotation but only allow movement in the 3 rotational axes, and these devices typically involve a ball and socket joint-type articulation rather than a mobile core, which is seen in unconstrained and semiconstrained designs. Due to the more immobile nature of semiconstrained and constrained devices, device placement must be more precise, midline, and centered. Constrained devices tend to also apply more force to the adjacent endplates with less translational force transferred to the soft tissues and facets.3,4 All of the designs aim to imitate a more physiologic stress distribution and range of motion.5 By maintaining normal biomechanical function and range of motion at the index level, CDAs may distribute physiologic loads more evenly among motion segments in the cervical spine and reduce the risk of degeneration within the adjacent disc and facet joints. Arthrodesis of the cervical spine has been found to limit the patient’s range of motion in the sagittal plane up to 0.66 ± 0.58 degrees at the index level.6,7 In contrast,
{"title":"Cervical Arthroplasty: A Clinical Update","authors":"M. Hudson, M. Neal","doi":"10.1097/01.CNE.0000922672.62799.6f","DOIUrl":"https://doi.org/10.1097/01.CNE.0000922672.62799.6f","url":null,"abstract":"large percentage of the world population and can significantly alter a patient’s quality of life. The presentation can vary but it generally consists of axial neck pain, radiculopathy, or myelopathy depending on the degree and location of the pathology. The incidence of cervical radiculopathy has been shown to peak between 50 and 54 years of age, with the average annual incidence rate per 100,000 patients being 83.2.1 Cervical myelopathy has a lower incidence rate, with an estimated hospital admission rate of 4.04/100,000 people in the United States.2 Cervical spondylosis and cervical disc disease with associated central or foraminal stenosis (Figure 1) have commonly been treated with anterior cervical discectomy and fusion (ACDF). This procedure allows for direct decompression of the disc space and thecal sac and combined direct and indirect decompression of the neural foramina. Cervical disc arthroplasty (CDA) seeks to mitigate many of the pitfalls of the ACDF procedure such as decreased cervical range of motion and development of adjacent segment degeneration (ASD). There have been many types of cervical disc prostheses with varying degrees of freedom, and they are generally categorized as constrained, unconstrained, and semiconstrained designs. Unconstrained designs allow the device to move independently and along all 3 rotational and translational axes. This device type allows for greater range of motion but also increases the force applied to the associated facet joints and ligaments that are required to stabilize that motion. Semiconstrained devices have some limitation in their degrees of freedom of movement but still have motion in both the translational and rotational planes. Constrained devices typically have a center of rotation but only allow movement in the 3 rotational axes, and these devices typically involve a ball and socket joint-type articulation rather than a mobile core, which is seen in unconstrained and semiconstrained designs. Due to the more immobile nature of semiconstrained and constrained devices, device placement must be more precise, midline, and centered. Constrained devices tend to also apply more force to the adjacent endplates with less translational force transferred to the soft tissues and facets.3,4 All of the designs aim to imitate a more physiologic stress distribution and range of motion.5 By maintaining normal biomechanical function and range of motion at the index level, CDAs may distribute physiologic loads more evenly among motion segments in the cervical spine and reduce the risk of degeneration within the adjacent disc and facet joints. Arthrodesis of the cervical spine has been found to limit the patient’s range of motion in the sagittal plane up to 0.66 ± 0.58 degrees at the index level.6,7 In contrast,","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":" ","pages":"1 - 7"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45803662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-01DOI: 10.1097/01.CNE.0000920224.42306.22
D. Patra, Evelyn L. Turcotte, H. Stonnington, Destiny L. Green, H. Batjer, B. Bendok
The two most common approaches to the fourth ventricle that have been described in the literature are the transvermian approach and the telovelar approach, with the latter used increasingly used during the past decade because of its superior complication profile. The telovelar approach, also called the “telovelotonsillar” approach, utilizes the splitting of the cerebellomedullary fissure (CMF) as a natural corridor to the fourth ventricle. A detailed microsurgical anatomy of the CMF and its related structures was discussed in the previous article in this series: The Telovelar Approach: Part 1—Historical Perspectives and Anatomic Considerations (vol. 45 no. 1). In this article, we will discuss the microsurgical steps needed for this approach, technical pearls, and case illustrations. We will also discuss the additional potential benefits of opening the uvulotonsillar fissures which allows greater superior and lateral exposure.
{"title":"The Telovelar Approach: Part 2—Surgical Techniques","authors":"D. Patra, Evelyn L. Turcotte, H. Stonnington, Destiny L. Green, H. Batjer, B. Bendok","doi":"10.1097/01.CNE.0000920224.42306.22","DOIUrl":"https://doi.org/10.1097/01.CNE.0000920224.42306.22","url":null,"abstract":"The two most common approaches to the fourth ventricle that have been described in the literature are the transvermian approach and the telovelar approach, with the latter used increasingly used during the past decade because of its superior complication profile. The telovelar approach, also called the “telovelotonsillar” approach, utilizes the splitting of the cerebellomedullary fissure (CMF) as a natural corridor to the fourth ventricle. A detailed microsurgical anatomy of the CMF and its related structures was discussed in the previous article in this series: The Telovelar Approach: Part 1—Historical Perspectives and Anatomic Considerations (vol. 45 no. 1). In this article, we will discuss the microsurgical steps needed for this approach, technical pearls, and case illustrations. We will also discuss the additional potential benefits of opening the uvulotonsillar fissures which allows greater superior and lateral exposure.","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":"45 1","pages":"1 - 7"},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61651029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.1097/01.cne.0000912476.62881.b8
D. Patra, Evelyn L. Turcotte, H. Stonnington, Destiny L. Green, H. Batjer, B. Bendok
Learning Objectives: After participating in this CME activity, the neurosurgeon should be better able to:
学习目标:神经外科医生在参加本持续医学教育活动后，应能更好地:
{"title":"The Telovelar Approach: Part 1—Historical Perspectives and Anatomic Considerations","authors":"D. Patra, Evelyn L. Turcotte, H. Stonnington, Destiny L. Green, H. Batjer, B. Bendok","doi":"10.1097/01.cne.0000912476.62881.b8","DOIUrl":"https://doi.org/10.1097/01.cne.0000912476.62881.b8","url":null,"abstract":"Learning Objectives: After participating in this CME activity, the neurosurgeon should be better able to:","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":"45 1","pages":"1 - 5"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46133891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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