•VoA – DBS is effective on both dystonia and tremor.•VoA – DBS benefits are not impaired by tolerance or side effects.•The variable VoA-DBS outcome previously reported were not proven by VTA ...simulation.•Application of new consensus on tremor classification may improve patient selection.
Background
The current use of external cervical orthoses (ECO) after cervical discectomy is still based on a common practice than a solid scientific literature. The aim of this study is to evaluate ...the impact of ECO on radiological and functional outcomes in patients undergoing anterior cervical discectomy and fusion (ACDF).
Methods
We compared two cohorts of consecutive patients who underwent ACDF with and without ECO after surgery. Thirty-six patients operated from January 2015 to June 2016 received an ECO whereas 36 patients, operated from July 2016 to December 2017, did not. Each patient underwent radiological and functional evaluation using plain x-ray at 1, 6, and 12 months after surgery and Neck Disability Index (NDI) at 2 weeks and 3, 6, and 12 months after surgery, respectively.
Results
In the ECO group, 5 patients (13.9%) presented an incomplete fusion and 31 patients (86.1%) presented a complete fusion (CI 0.705–0.953). In the non-ECO group, 8 patients (22.2%) presented an incomplete fusion and 28 patients (77.8% CI 0.608–0.899) had a complete fusion, with no statistically significant differences between two groups. No statistically significant differences were also observed regarding the NDI neither at 2 weeks nor at 3-, 6-, and 12-month follow-up. At multivariate analysis, patients who underwent two-level ACDF showed a five-fold increased risk of worse NDI at 3-, 6-, 12-month (
p
= 0.003, CI 1.770–14.584) follow-up.
Conclusions
We advise against the routine use of ECO after single- or two-level ACDF as we did not find out any significant statistical differences between the two groups.
Endovascular treatment of blister aneurysms is a promising approach, even though they are vascular lesions challenging to treat due to their angioarchitectural characteristics.
Our aim was to ...investigate clinical and radiologic outcomes after endovascular treatment of ruptured blister aneurysms.
PubMed, Ovid MEDLINE, Ovid EMBASE, Scopus, and the Web of Science were screened.
We performed a comprehensive review of the literature from 2010 to 2019 reporting series of patients with blister aneurysms treated with an endovascular approach.
Event rates were pooled across studies using a random effects meta-analysis.
A total of 32 studies reporting on 684 patients (707 aneurysms) were included. Stent placement, stent-assisted coiling, and flow diversion were the most commonly described treatments (282, 256, and 155 patients, respectively). The long-term complete occlusion rate was 76.9% (95% CI, 69.2%-83.9%). The perioperative complication rate was 8.9%, and clinical outcome at final follow-up was mRS <2 in 76.6% (95% CI, 68.2%-84.2%) of patients. The mortality rate was 4.7% (95% CI, 2.30%-7.80%). Among the different techniques, stent-assisted coiling is the one that had the higher rate of immediate occlusion (63.4%); however, the occlusion rate at the final follow-up was comparable among the different techniques.
Different techniques were described and data were reported in a nonhomogeneous way, possibly representing a bias in the present study.
This study suggests that endovascular treatment of blister aneurysms is associated with good long-term occlusion rates and reasonable complication and mortality rates. There is no consensus on the best endovascular techniques in blister aneurysm management.
Orbital surgery has always been disputed among specialists, mainly neurosurgeons, otorhinolaryngologists, maxillofacial surgeons and ophthalmologists. The orbit is a borderland between intra- and ...extracranial compartments; Krönlein's lateral orbitotomy and the orbitozygomatic infratemporal approach are the historical milestones of modern orbital-cranial surgery.
Since its first implementation, endoscopy has significantly impacted neurosurgery, changing perspectives and approaches to the skull base. Since its first application in 2009, transorbital endoscopic surgery opened the way for new surgical scenario, previously feasible only with extensive tissue dissection.
A PRISMA based literature search was performed to select the most relevant papers on the topic.
Here, we provide a narrative review on the current state and future trends in endoscopic orbital surgery.
This manuscript is a joint effort of the EANS frontiers committee in orbital tumors and the EANS skull base section.
•Orbital surgery is a frontier between different specialties: neurosurgeons, otorhinolaryngologists, maxillofacial surgeons, and ophthalmologists. Endoscopy opened a whole new scenario of surgical possibilities.•Trans-Orbital surgery seems to provide useful access to different intracranial compartments, previously reachable only via an extensive tissue dissection, with good functional and oncological outcomes.•Homogeneous nomenclature of approaches and anatomical landmarks, data consistency across studies, broad shared classifications and well-designed randomized clinical trials are strongly advocated.•Next years will be crucial to precise indications, techniques, outcomes and complications of trans-orbital endoscopy through data obtained from high-level scientific studies.•Specific and dedicated applications are needed for transorbital endoscopic surgery to incorporate this topic into the common neurosurgical knowledge of the new generations.
Highlights • It is a review research that focused on the different application of Indocyanine green video angiography in neurosurgery. • This is the first review paper that does not only focuses on ...vascular applications, but several recent uses in other fields of neurosurgery, such as neurooncology and neuro-endoscopy. • It analyses 71 articles and it is updated to May 2014 papers. • It serves as an introduction to the use of ICG-VA, highlighting its potential use and some drawbacks.
Background
Spontaneous, non traumatic subarachnoid hemorrhage (SAH) is a significant clinical problem that occurs most commonly as a result of aneurysm rupture. In approximately 15 % of cases, nor ...aneurysm or other vascular malformation can be identified by cerebral angiography as origin of the hemorrhage, and these are commonly defined as idiopathic SAH (ISAH). Because of the negative angiography, limited extension of the bleeding with prevalent prepontine pattern and the benign prognosis, the venous causes has been preferred rather than the arterial ones. In the literature recent studies have suggested a possible contribution by primitive variants of Basal vein of Rosenthal (BVR) in its the pathogenesis of ISAH, commonly grouped according Watanabe classification (type A, B and C). In this paper we evaluated the prevalence of anatomical variants of BVR in ISAH.
Methods
Venous drainage at angiography was retrospectively analyzed in 40 patients with ISAH and in 40 with unruptured aneurysms as controls.
Results and conclusions
Previous studies displayed a significant prevalence of BVR type C variants in ISAH. Conversely in our study we recognized variant B as prevalent, in which the BVR bifurcates to drain anteriorly into the uncal vein and posteriorly into the Galenic system. Similarly to variant C (in which the BVR drains via perimesencephalic “bridging” veins into cavernous, sphenoparietal, petrosal sinus or directly into transverse sinus) also variant B might be subjected to those stress mechanisms and intrinsic system ‘fragility’ and for reasons yet to determine, sets off a consequent hemorrhage with clinical and radiological features typical of ISAH.
Highlights • In our series, patients without external ventricular drain were found to have a higher occurrence of vasospasm. • Patients who did not receive CSF diversion had a higher risk for ...vasospasm at lower Fisher grades compared to patients with ventricular drainage with higher Fisher grades. • We conclude that CSF diversion may be beneficial in SAH patients, either in the form of a lumbar drain in the absence of hydrocephalus, and in the form of an external ventricular drain when there is hydrocephalus.
Objective
: An odontoid fracture stabilization through an endonasal endoscopy-assisted anterior screw fixation approach (EEA) could represent a minimally invasive alternative to traditional treatment ...for type II Anderson-D'Alonso C2 fractures with radiological evidence of pseudoarthrosis after conservative treatment, with spinal realignment and motion preservation.
Methods
: From January, 2012 to September, 2013, three patients were submitted to a combined EEA screws fixation approach for an inveterate odontoid fracture, showed by preoperative radiological examinations. The operation consists in the anterior transcervical odontoid screw fixation combined, at the same session, with a transnasal endoscopic approach to the odontoid base for inflammatory pannus removal and positioning of bone chips compressed in-between the bone stumps. Finally, under endoscopic control and X-ray verification, the self-tapping screw is inserted up to the odontoid tip to assure the compression of the cleaned bone borders supplemented by good quality harvested bone chips and odontoid realignment.
Results
: A radiological follow-up revealed a regular ossification without any hardware failure and\or breakage. None of the patients required a subsequent posterior fixation. The full range of motion was preserved.
Conclusions
: In this preliminary experience, in case of inveterate odontoid fractures this combined approach could represent the possible solution for a very complex problem preserving spinal realignment and motion.
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