Pub Date : 2020-09-01Epub Date: 2020-07-17DOI: 10.1093/neuopn/okaa008
Blake E S Taylor, Priyank Khandelwal, Michael S Rallo, Purvee Patel, Lindsey Smith, Hai Sun, Anil Nanda, Amit Singla, Sudipta Roychowdhury, Roger C Cheng, Kiwon Lee, Gaurav Gupta, Stephen A Johnson
Background: Preliminary data suggest that Coronavirus Disease-2019 (COVID-19) is associated with hypercoagulability and neurovascular events, but data on outcomes is limited.
Objective: To report the clinical course and outcomes of a case series of COVID-19 patients with a variety of cerebrovascular events.
Methods: We performed a multicentric, retrospective chart review at our three academic tertiary care hospitals, and identified all COVID-19 patients with cerebrovascular events requiring neuro-intensive care and/or neurosurgical consultation.
Results: We identified 26 patients between March 1 and May 24, 2020, of whom 12 (46%) died. The most common event was a large-vessel occlusion (LVO) in 15 patients (58%), among whom 8 died (8/15, 53%). A total of 9 LVO patients underwent mechanical thrombectomy, of whom 5 died (5/9, 56%). A total of 7 patients (27%) presented with intracranial hemorrhage. Of the remaining patients, 2 had small-vessel occlusions, 1 had cerebral venous sinus thrombosis, and another had a vertebral artery dissection. Acute Respiratory Distress Syndrome occurred in 8 patients, of whom 7 died. Mortalities had a higher D-dimer on admission (mean 20 963 ng/mL) than survivors (mean 3172 ng/mL). Admission Glasgow Coma Scale (GCS) score was poor among mortalities (median 7), whereas survivors had a favorable GCS at presentation (median 14) and at discharge (median 14).
Conclusion: COVID-19 may be associated with hemorrhage as well as ischemia, and prognosis appears poorer than expected-particularly among LVO cases, where outcome remained poor despite mechanical thrombectomy. However, a favorable neurological condition on admission and lower D-dimer may indicate a better outcome.
{"title":"Outcomes and Spectrum of Major Neurovascular Events Among COVID-19 Patients: A 3-Center Experience.","authors":"Blake E S Taylor, Priyank Khandelwal, Michael S Rallo, Purvee Patel, Lindsey Smith, Hai Sun, Anil Nanda, Amit Singla, Sudipta Roychowdhury, Roger C Cheng, Kiwon Lee, Gaurav Gupta, Stephen A Johnson","doi":"10.1093/neuopn/okaa008","DOIUrl":"https://doi.org/10.1093/neuopn/okaa008","url":null,"abstract":"<p><strong>Background: </strong>Preliminary data suggest that Coronavirus Disease-2019 (COVID-19) is associated with hypercoagulability and neurovascular events, but data on outcomes is limited.</p><p><strong>Objective: </strong>To report the clinical course and outcomes of a case series of COVID-19 patients with a variety of cerebrovascular events.</p><p><strong>Methods: </strong>We performed a multicentric, retrospective chart review at our three academic tertiary care hospitals, and identified all COVID-19 patients with cerebrovascular events requiring neuro-intensive care and/or neurosurgical consultation.</p><p><strong>Results: </strong>We identified 26 patients between March 1 and May 24, 2020, of whom 12 (46%) died. The most common event was a large-vessel occlusion (LVO) in 15 patients (58%), among whom 8 died (8/15, 53%). A total of 9 LVO patients underwent mechanical thrombectomy, of whom 5 died (5/9, 56%). A total of 7 patients (27%) presented with intracranial hemorrhage. Of the remaining patients, 2 had small-vessel occlusions, 1 had cerebral venous sinus thrombosis, and another had a vertebral artery dissection. Acute Respiratory Distress Syndrome occurred in 8 patients, of whom 7 died. Mortalities had a higher D-dimer on admission (mean 20 963 ng/mL) than survivors (mean 3172 ng/mL). Admission Glasgow Coma Scale (GCS) score was poor among mortalities (median 7), whereas survivors had a favorable GCS at presentation (median 14) and at discharge (median 14).</p><p><strong>Conclusion: </strong>COVID-19 may be associated with hemorrhage as well as ischemia, and prognosis appears poorer than expected-particularly among LVO cases, where outcome remained poor despite mechanical thrombectomy. However, a favorable neurological condition on admission and lower D-dimer may indicate a better outcome.</p>","PeriodicalId":93342,"journal":{"name":"Neurosurgery open","volume":"1 3","pages":"okaa008"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/neuopn/okaa008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39506842","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}
Shotaro Yoshioka, Takeshi Miyamoto, J. Satomi, Y. Tada, K. Yagi, Kenji Shimada, K. Naruishi, E. Shikata, Izumi Yamaguchi, Tadashi Yamaguchi, M. Korai, Y. Okayama, M. Harada, K. Kitazato, Y. Kanematsu, S. Nagahiro, Y. Takagi
The pathophysiology of subarachnoid hemorrhages (SAHs) due to ruptured intracranial aneurysms (IAs) remains unclear. Although a relationship between SAHs and periodontal disease (PD) has been suggested, the mechanism requires clarification. To evaluate the relationship between PD and SAHs and to identify periodontal pathogens associated with SAHs. This prospective study included consecutive patients with ruptured (n = 11) and unruptured (n = 14) IAs and healthy controls (n = 8). The plasma and plaque subgingival bacterial deoxyribonucleic acid (DNA) levels in PD were evaluated by a dentist using the Community Periodontal Index of Treatment Needs (CPITN). Plasma levels of matrix metalloproteinase (MMP-9), tissue inhibitors of matrix metalloproteinase (TIMP2), and procollagen I were analyzed. Patients with ruptured IAs, had significantly higher CPITN scores than the controls, suggesting that ruptured IAs were associated with severe PD. Although no rupture-specific bacteria were identified, the positive rate of plaque subgingival bacterial DNA was significantly higher in patients with severe PD than in those without severe PD. Multivariate logistic regression analysis indicated that bleeding on probing (BOP) was associated with ruptured IAs (odds ratio, 1.10; 95% confidence interval 1.04–1.20; P = .0001). BOP was positively associated with plasma MMP-9 levels and a disequilibrium in the MMP-9/TIMP2 ratio. BOP was negatively correlated with plasma procollagen I levels (P < .05, for each). This suggested that local inflammation with severe PD might have systemic effects and lead to ruptured IAs. Disequilibrium of plasma protease/anti-protease associated with a high BOP rate in severe PD may be attributable to IA rupture.
{"title":"Disequilibrium of Plasma Protease/Anti-Protease Due to Severe Periodontal Disease Contributes to Human Subarachnoid Hemorrhage","authors":"Shotaro Yoshioka, Takeshi Miyamoto, J. Satomi, Y. Tada, K. Yagi, Kenji Shimada, K. Naruishi, E. Shikata, Izumi Yamaguchi, Tadashi Yamaguchi, M. Korai, Y. Okayama, M. Harada, K. Kitazato, Y. Kanematsu, S. Nagahiro, Y. Takagi","doi":"10.1093/neuopn/okaa007","DOIUrl":"https://doi.org/10.1093/neuopn/okaa007","url":null,"abstract":"\u0000 \u0000 \u0000 The pathophysiology of subarachnoid hemorrhages (SAHs) due to ruptured intracranial aneurysms (IAs) remains unclear. Although a relationship between SAHs and periodontal disease (PD) has been suggested, the mechanism requires clarification.\u0000 \u0000 \u0000 \u0000 To evaluate the relationship between PD and SAHs and to identify periodontal pathogens associated with SAHs.\u0000 \u0000 \u0000 \u0000 This prospective study included consecutive patients with ruptured (n = 11) and unruptured (n = 14) IAs and healthy controls (n = 8). The plasma and plaque subgingival bacterial deoxyribonucleic acid (DNA) levels in PD were evaluated by a dentist using the Community Periodontal Index of Treatment Needs (CPITN). Plasma levels of matrix metalloproteinase (MMP-9), tissue inhibitors of matrix metalloproteinase (TIMP2), and procollagen I were analyzed.\u0000 \u0000 \u0000 \u0000 Patients with ruptured IAs, had significantly higher CPITN scores than the controls, suggesting that ruptured IAs were associated with severe PD. Although no rupture-specific bacteria were identified, the positive rate of plaque subgingival bacterial DNA was significantly higher in patients with severe PD than in those without severe PD. Multivariate logistic regression analysis indicated that bleeding on probing (BOP) was associated with ruptured IAs (odds ratio, 1.10; 95% confidence interval 1.04–1.20; P = .0001). BOP was positively associated with plasma MMP-9 levels and a disequilibrium in the MMP-9/TIMP2 ratio. BOP was negatively correlated with plasma procollagen I levels (P < .05, for each). This suggested that local inflammation with severe PD might have systemic effects and lead to ruptured IAs.\u0000 \u0000 \u0000 \u0000 Disequilibrium of plasma protease/anti-protease associated with a high BOP rate in severe PD may be attributable to IA rupture.\u0000","PeriodicalId":93342,"journal":{"name":"Neurosurgery open","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/neuopn/okaa007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47717411","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}
P. Nazari, P. Golnari, M. Sukumaran, A. Shaibani, M. Hurley, S. Ansari, M. Potts, B. Jahromi
Middle meningeal artery (MMA) pseudoaneurysms and middle meningeal arteriovenous fistulas (MMAVFs) are rarely reported after head injury. We report an unusual case of delayed MMA pseudoaneurysm formation after spontaneous thrombosis of an MMAVF, and review existing literature on MMAVF treatment and results. A 59-yr-old male presented with a 5-d history of worsening left-sided headaches, followed by nausea, lethargy, and difficulty with speech. Non-contrast computed tomography demonstrated a left temporal intraparenchymal hemorrhage (IPH) and an acute left-sided subdural hematoma (SDH). Cerebral angiography found abnormal shunting between the right MMA and the right sphenoparietal sinus, consistent with an MMAVF. During the course of admission, the patient's neurological condition deteriorated requiring craniotomy for evacuation of SDH and IPH. Given the presumed incidental nature of the contralateral MMAVF, conservative management was recommended. Follow-up imaging 2 mo after surgery revealed spontaneous thrombosis of the right MMAV. Repeat imaging 5 mo later revealed an MMA pseudoaneurysm at the prior fistulous site, which was subsequently embolized with Onyx, occluding the pseudoaneurysm and the MMA both proximal and distal to the pseudoaneurysm. Spontaneous thrombosis of an MMAVF is rare and only seen in 13.1% of cases. However, subsequent delayed formation of an MMA pseudoaneurysm has not been described. Our case therefore demonstrates that MMAVF thrombosis may not indicate complete healing of the underlying injury to the MMA, and suggests the need for continued follow-up of such lesions despite initial apparent resolution.
{"title":"Spontaneous Thrombosis of a Middle Meningeal Arteriovenous Fistula With Subsequent Pseudoaneurysm Formation: Case Report and Review of Literature","authors":"P. Nazari, P. Golnari, M. Sukumaran, A. Shaibani, M. Hurley, S. Ansari, M. Potts, B. Jahromi","doi":"10.1093/neuopn/okaa006","DOIUrl":"https://doi.org/10.1093/neuopn/okaa006","url":null,"abstract":"\u0000 \u0000 \u0000 Middle meningeal artery (MMA) pseudoaneurysms and middle meningeal arteriovenous fistulas (MMAVFs) are rarely reported after head injury. We report an unusual case of delayed MMA pseudoaneurysm formation after spontaneous thrombosis of an MMAVF, and review existing literature on MMAVF treatment and results.\u0000 \u0000 \u0000 \u0000 A 59-yr-old male presented with a 5-d history of worsening left-sided headaches, followed by nausea, lethargy, and difficulty with speech. Non-contrast computed tomography demonstrated a left temporal intraparenchymal hemorrhage (IPH) and an acute left-sided subdural hematoma (SDH). Cerebral angiography found abnormal shunting between the right MMA and the right sphenoparietal sinus, consistent with an MMAVF. During the course of admission, the patient's neurological condition deteriorated requiring craniotomy for evacuation of SDH and IPH. Given the presumed incidental nature of the contralateral MMAVF, conservative management was recommended. Follow-up imaging 2 mo after surgery revealed spontaneous thrombosis of the right MMAV. Repeat imaging 5 mo later revealed an MMA pseudoaneurysm at the prior fistulous site, which was subsequently embolized with Onyx, occluding the pseudoaneurysm and the MMA both proximal and distal to the pseudoaneurysm.\u0000 \u0000 \u0000 \u0000 Spontaneous thrombosis of an MMAVF is rare and only seen in 13.1% of cases. However, subsequent delayed formation of an MMA pseudoaneurysm has not been described. Our case therefore demonstrates that MMAVF thrombosis may not indicate complete healing of the underlying injury to the MMA, and suggests the need for continued follow-up of such lesions despite initial apparent resolution.\u0000","PeriodicalId":93342,"journal":{"name":"Neurosurgery open","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/neuopn/okaa006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45519417","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}
O. Goren, R. Sampath, Akshal S. Patel, C. Griessenauer, C. Schirmer, D. Newell
The Coupler microanastomotic device (Medical Companies Alliance, Birmingham, Alabama) aims at facilitating safe and efficient end-to-end reconstruction of the native vessel ends following resection of intracranial aneurysms. We report the first case of the Coupler device used to treat a ruptured posterior inferior cerebellar artery (PICA) aneurysm. Following aneurysmal trapping and excision, the native parent vessel ends were connected in an end-to-end fashion. The microanastomotic Coupler device is an acceptable option for end-to-end anastomosis and was successfully applied in the management of a ruptured fusiform PICA aneurysm.
{"title":"Use of the Coupler Microanastomotic Device for the Treatment of a Distal Posterior Inferior Cerebellar Artery Aneurysm Via Excision and End-to-End Anastomosis—A Case Report","authors":"O. Goren, R. Sampath, Akshal S. Patel, C. Griessenauer, C. Schirmer, D. Newell","doi":"10.1093/neuopn/okaa002","DOIUrl":"https://doi.org/10.1093/neuopn/okaa002","url":null,"abstract":"\u0000 \u0000 \u0000 The Coupler microanastomotic device (Medical Companies Alliance, Birmingham, Alabama) aims at facilitating safe and efficient end-to-end reconstruction of the native vessel ends following resection of intracranial aneurysms.\u0000 \u0000 \u0000 \u0000 We report the first case of the Coupler device used to treat a ruptured posterior inferior cerebellar artery (PICA) aneurysm. Following aneurysmal trapping and excision, the native parent vessel ends were connected in an end-to-end fashion.\u0000 \u0000 \u0000 \u0000 The microanastomotic Coupler device is an acceptable option for end-to-end anastomosis and was successfully applied in the management of a ruptured fusiform PICA aneurysm.\u0000","PeriodicalId":93342,"journal":{"name":"Neurosurgery open","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/neuopn/okaa002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48413926","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}
M. Safaee, C. D. Ore, K. Corso, J. Ruppenkamp, Darryl Lau, C. Ames
Posterior cervical decompression and fusion (PCF) is a common treatment for cervical spondylotic myelopathy. Treatment paradigms are shifting from simple decompression and fusion to correcting cervical deformities. To identify trends in PCF with an emphasis on cervical deformity and surgical complexity. Adults who underwent PCF from 2000 to 2017 were retrospectively identified in the Premier Healthcare Database (PHD) using International Classification of Disease Codes (ICD) 9 and 10. Patients were dichotomized into those with or without deformity diagnosis. PCF complexity was defined by adjunct surgical codes, including anterior cervical fusion, extension to thoracic levels, and osteotomy. Patient characteristics, including demographics, functional comorbidity index (FCI), and hospital characteristics, were extracted and annual procedures were projected to the US population. A total of 68 415 discharges for PCF were identified. Compound annual growth rate (CAGR) of PCF from 2000 to 2017 for nondeformity cases was 9.7% and 16.5% for deformity. The demographics with the greatest growth were deformity patients aged 65 to 74 yr (15.1%). The CAGR of anterior cervical fusion and extension to thoracic levels was higher for deformity patients compared to nondeformity patients, 13.6% versus 3.9% and 20.4% versus 16.6%, respectively. Rates of PCF for deformity are increasing at a greater rate than nondeformity PCF. The most growth was seen among deformity patients aged 65 to 74 yr. Surgical complexity is also changing with increasing use of anterior cervical fusion and extension of PCF to include thoracic levels.
{"title":"Trends in Posterior Cervical Fusion for Deformity in the United States from 2000 to 2017","authors":"M. Safaee, C. D. Ore, K. Corso, J. Ruppenkamp, Darryl Lau, C. Ames","doi":"10.1093/neuopn/okaa001","DOIUrl":"https://doi.org/10.1093/neuopn/okaa001","url":null,"abstract":"\u0000 \u0000 \u0000 Posterior cervical decompression and fusion (PCF) is a common treatment for cervical spondylotic myelopathy. Treatment paradigms are shifting from simple decompression and fusion to correcting cervical deformities.\u0000 \u0000 \u0000 \u0000 To identify trends in PCF with an emphasis on cervical deformity and surgical complexity.\u0000 \u0000 \u0000 \u0000 Adults who underwent PCF from 2000 to 2017 were retrospectively identified in the Premier Healthcare Database (PHD) using International Classification of Disease Codes (ICD) 9 and 10. Patients were dichotomized into those with or without deformity diagnosis. PCF complexity was defined by adjunct surgical codes, including anterior cervical fusion, extension to thoracic levels, and osteotomy. Patient characteristics, including demographics, functional comorbidity index (FCI), and hospital characteristics, were extracted and annual procedures were projected to the US population.\u0000 \u0000 \u0000 \u0000 A total of 68 415 discharges for PCF were identified. Compound annual growth rate (CAGR) of PCF from 2000 to 2017 for nondeformity cases was 9.7% and 16.5% for deformity. The demographics with the greatest growth were deformity patients aged 65 to 74 yr (15.1%). The CAGR of anterior cervical fusion and extension to thoracic levels was higher for deformity patients compared to nondeformity patients, 13.6% versus 3.9% and 20.4% versus 16.6%, respectively.\u0000 \u0000 \u0000 \u0000 Rates of PCF for deformity are increasing at a greater rate than nondeformity PCF. The most growth was seen among deformity patients aged 65 to 74 yr. Surgical complexity is also changing with increasing use of anterior cervical fusion and extension of PCF to include thoracic levels.\u0000","PeriodicalId":93342,"journal":{"name":"Neurosurgery open","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/neuopn/okaa001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48646210","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 : 2016-09-01Epub Date: 2016-02-17DOI: 10.3109/10428194.2016.1139703
Vincent Camus, Nasrin Sarafan-Vasseur, Elodie Bohers, Sydney Dubois, Sylvain Mareschal, Philippe Bertrand, Pierre-Julien Viailly, Philippe Ruminy, Catherine Maingonnat, Emilie Lemasle, Aspasia Stamatoullas, Jean-Michel Picquenot, Marie Cornic, Ludivine Beaussire, Christian Bastard, Thierry Frebourg, Hervé Tilly, Fabrice Jardin
Diffuse large B-cell lymphoma (DLBCL) is an aggressive and heterogeneous malignancy harboring frequent targetable activating somatic mutations. Emerging evidence suggests that circulating cell-free DNA (cfDNA) can be used to detect somatic variants in DLBCL using Next-Generation Sequencing (NGS) experiments. In this proof-of-concept study, we chose to develop simple and valuable digital PCR (dPCR) assays for the detection of recurrent exportin-1 (XPO1) E571K, EZH2 Y641N, and MYD88 L265P mutations in DLBCL patients, thereby identifying patients most likely to potentially benefit from targeted therapies. We demonstrated that our dPCR assays were sufficiently sensitive to detect rare XPO1, EZH2, and MYD88 mutations in plasma cfDNA, with a sensitivity of 0.05%. cfDNA somatic mutation detection by dPCR seems to be a promising technique in the management of DLBCL, in addition to NGS experiments.
{"title":"Digital PCR for quantification of recurrent and potentially actionable somatic mutations in circulating free DNA from patients with diffuse large B-cell lymphoma.","authors":"Vincent Camus, Nasrin Sarafan-Vasseur, Elodie Bohers, Sydney Dubois, Sylvain Mareschal, Philippe Bertrand, Pierre-Julien Viailly, Philippe Ruminy, Catherine Maingonnat, Emilie Lemasle, Aspasia Stamatoullas, Jean-Michel Picquenot, Marie Cornic, Ludivine Beaussire, Christian Bastard, Thierry Frebourg, Hervé Tilly, Fabrice Jardin","doi":"10.3109/10428194.2016.1139703","DOIUrl":"10.3109/10428194.2016.1139703","url":null,"abstract":"<p><p>Diffuse large B-cell lymphoma (DLBCL) is an aggressive and heterogeneous malignancy harboring frequent targetable activating somatic mutations. Emerging evidence suggests that circulating cell-free DNA (cfDNA) can be used to detect somatic variants in DLBCL using Next-Generation Sequencing (NGS) experiments. In this proof-of-concept study, we chose to develop simple and valuable digital PCR (dPCR) assays for the detection of recurrent exportin-1 (XPO1) E571K, EZH2 Y641N, and MYD88 L265P mutations in DLBCL patients, thereby identifying patients most likely to potentially benefit from targeted therapies. We demonstrated that our dPCR assays were sufficiently sensitive to detect rare XPO1, EZH2, and MYD88 mutations in plasma cfDNA, with a sensitivity of 0.05%. cfDNA somatic mutation detection by dPCR seems to be a promising technique in the management of DLBCL, in addition to NGS experiments.</p>","PeriodicalId":93342,"journal":{"name":"Neurosurgery open","volume":"1 1","pages":"2171-9"},"PeriodicalIF":2.6,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3109/10428194.2016.1139703","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83376222","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}
G. Feigl, B. Krischek, R. Ritz, K. Ramina, A. Korn, M. Tatagiba
Standard cranial approaches to the orbit involve lengthy skin incisions, extensive soft tissue dissection, and large craniotomies, increasing morbidity.To evaluate less invasive approaches to the orbit, using endoscopic transconjunctival approaches.Neuronavigated transconjunctival approaches to the orbit were performed on 4 cadavers using 30°/3 mm and 0°/6 mm rigid endoscopes. A special head frame was designed for this study to prevent excessive movement of the endoscope tip in the orbit. Lateral and medial transconjunctival supra- and infrabulbar approaches to the extra- and intraconal spaces were performed. The incision length, maximal penetration depth in the extra- and intraconal spaces, and distance from the orbital rim to the optic nerve were measured.All 4 approaches afforded satisfactory exposure and access to the extra- and intraconal spaces. The mean incision length for the transconjunctival approach was 10.4 mm. The optic nerve could be exposed through all 4 approaches. The mean maximal penetration depths in the extraconal space were 28.6 ± 3.5 mm for the 30°/3 mm and 20.7 ± 4.5 mm for the 0°/6 mm endoscope. In the intraconal space, the mean maximal depth of penetration was 23.8 ± 2.4 mm for the 30°/3 mm and 19.4 ± 3.4 mm for the 0°/6 mm endoscope. Based on these measurements, the orbit was classified into quadrants and zones.Transconjunctival endoscopic approaches to the orbit allow maximal exposure of the extra- and intraconal spaces through a minimally invasive approach requiring no muscle transection. Infrabulbar approaches have better cosmetic results than suprabulbar approaches, which require incision of the eyelid.
标准的颅脑入路涉及长时间的皮肤切口、广泛的软组织剥离和大开颅手术，增加了发病率。目的探讨内镜下经结膜入路进入眶部的微创方法。使用30°/ 3mm和0°/ 6mm刚性内窥镜对4具尸体进行神经导航经结膜入路。本研究设计了一个特殊的头架，以防止内窥镜尖端在眶内过度运动。外侧和内侧经结膜球上和球下入路进入球外和球内间隙。测量切口长度、眶外腔和眶内腔的最大穿透深度、眶缘到视神经的距离。所有4种入路均能获得满意的暴露和进入腔外和腔内空间。经结膜入路的平均切口长度为10.4 mm。视神经可通过4种入路显露。30°/3 mm内窥镜的最大穿刺深度为28.6±3.5 mm, 0°/6 mm内窥镜的最大穿刺深度为20.7±4.5 mm。在腔内空间，30°/3 mm内窥镜的平均最大穿透深度为23.8±2.4 mm, 0°/6 mm内窥镜的平均最大穿透深度为19.4±3.4 mm。根据这些测量结果，将轨道划分为象限和区域。经结膜内窥镜入路可通过微创入路最大限度地暴露眶外和眶内间隙，无需横断肌肉。球下入路比需要切开眼睑的球上入路有更好的美容效果。
{"title":"Navigated Transconjunctival Endoscopic Approaches to the Orbit","authors":"G. Feigl, B. Krischek, R. Ritz, K. Ramina, A. Korn, M. Tatagiba","doi":"10.1055/S-0032-1312089","DOIUrl":"https://doi.org/10.1055/S-0032-1312089","url":null,"abstract":"Standard cranial approaches to the orbit involve lengthy skin incisions, extensive soft tissue dissection, and large craniotomies, increasing morbidity.To evaluate less invasive approaches to the orbit, using endoscopic transconjunctival approaches.Neuronavigated transconjunctival approaches to the orbit were performed on 4 cadavers using 30°/3 mm and 0°/6 mm rigid endoscopes. A special head frame was designed for this study to prevent excessive movement of the endoscope tip in the orbit. Lateral and medial transconjunctival supra- and infrabulbar approaches to the extra- and intraconal spaces were performed. The incision length, maximal penetration depth in the extra- and intraconal spaces, and distance from the orbital rim to the optic nerve were measured.All 4 approaches afforded satisfactory exposure and access to the extra- and intraconal spaces. The mean incision length for the transconjunctival approach was 10.4 mm. The optic nerve could be exposed through all 4 approaches. The mean maximal penetration depths in the extraconal space were 28.6 ± 3.5 mm for the 30°/3 mm and 20.7 ± 4.5 mm for the 0°/6 mm endoscope. In the intraconal space, the mean maximal depth of penetration was 23.8 ± 2.4 mm for the 30°/3 mm and 19.4 ± 3.4 mm for the 0°/6 mm endoscope. Based on these measurements, the orbit was classified into quadrants and zones.Transconjunctival endoscopic approaches to the orbit allow maximal exposure of the extra- and intraconal spaces through a minimally invasive approach requiring no muscle transection. Infrabulbar approaches have better cosmetic results than suprabulbar approaches, which require incision of the eyelid.","PeriodicalId":93342,"journal":{"name":"Neurosurgery open","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2012-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/S-0032-1312089","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58050732","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}
R. Louis, Jeanine Cagigas, M. brant-zawadzki, Michael Ricks
{"title":"In Reply: Impact of Neurosurgical Consultation With 360-Degree Virtual Reality Technology on Patient Engagement and Satisfaction","authors":"R. Louis, Jeanine Cagigas, M. brant-zawadzki, Michael Ricks","doi":"10.1093/neuopn/okab010","DOIUrl":"https://doi.org/10.1093/neuopn/okab010","url":null,"abstract":"","PeriodicalId":93342,"journal":{"name":"Neurosurgery open","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/neuopn/okab010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61332127","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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