There seems to be a pathogenetic link between hemodynamics and inflammatory arterial wall alteration leading to the development and rupture of intracranial aneurysms (IAs). Noninvasive assessment of ...the inflammatory status of the aneurysm wall may guide the management of unruptured IAs by identifying reliable markers for increased rupture risk.
We conducted a qualitative systematic review following the ENTREQ (Enhancing Transparency in Reporting the Synthesis of Qualitative Research) framework. A search was made in MEDLINE/PubMed, Embase, and CINAHL from database inception to October 2017 using the terms “intracranial aneurysm” and “cerebral aneurysm” linked with the following key words: inflammation, hemodynamic(s), remodeling, macrophages, neutrophils, lymphocytes, complement system, vascular smooth muscle cells, mast cells, cytokines, and inflammatory biomarkers.
One hundred and twenty-three articles were included in the review.
In this systematic review, we explore the relationship between hemodynamic stress, inflammation, vascular remodeling, and the formation and rupture of IAs to develop novel strategies to predict the individual risk of aneurysmal rupture.
•Hemodynamic changes cause infiltration of inflammatory cells into arterial wall.•Simultaneously mechanisms of arterial wall protection are activated.•Imbalance in favor of arterial wall degradation promote IA formation and rupture.•Regulation of endothelial NF-κB expression is a key event in keeping the balance.•Noninvasive test of IA wall inflammation may predict the individual rupture risk.
•Full-endoscopic posterior cervical foraminotomy (FEPCF) is a valuable option in treating foraminal stenosis.•It is equally suitable for stenosis consequent to lateral disc herniation and ...osteophytes.•In FEPCF, blood loss is negligible, and outcomes are the same as traditional open cervical foraminotomy.•Foraminal enlargement is comparable to those of open foraminotomy, proving to be a valid alternative to such a techniques.
FEPCP for lateral disc herniation or osteophytes is becoming a valuable technique. In 2008, the first study describing full-endoscopy posterior cervical foraminotomy (FEPCF) to treat lateral disc herniations was published. The technique has gained popularity over the last decade, and the outcomes have been compared to open or minimally invasive techniques, proving to be similarly effective. Later in 2016, FEPCF was also applied for bony foraminal stenosis. We randomized a sample of patients with cervical radiculopathy to either FEPCF or open posterior cervical foraminotomy (OPCF) to compare postoperative outcomes and foraminal size parameters.
we prospectively collected data from 37 patients with cervical radiculopathy consequent to foraminal stenosis due to lateral disc herniation or osteophytes formation, failed conservative treatment, and adequate imaging (pre and postoperative three-dimensional 1 mm thick slices computer tomography (CT)). Patients were randomly assigned to FEPCF (17) or OPCF (20). Data were collected on demographics, arm and neck pain, disability, complications, and follow-up time. Foraminal size analysis was performed manually using 3D-Slicer software. The clinical outcomes and foramen dimension data were subsequently compared between the two groups.
There were no statistical differences in intraoperative parameters and postoperative outcomes in terms of mean postoperative arm VAS (p-value: 0.709) and mean NDI values (p-value:0.925), but postoperative mean neck pain values were lower in FEPCF patients (3.6 vs. 6.1 for OPCF, p-value:<0.001). In the FEPCF group, foraminal height, width, and area were increased by a mean value of 17.2%, 22.5%, and 19%, respectively, with no differences between FEPCF and OPCF.
FEPCF has overlapping results in postoperative findings and foraminal size enlargement than OPCF, either for lateral disc protrusion or foraminal osteophytes.
Prophylactic low weight molecular subcutaneous heparin combined with mechanical devices and elastic stockings has already been correlated to a low incidence of deep venous thrombosis. However, there ...is still concern with the use of heparin in the neurosurgical field due to the potential hemorrhagic risks. We would like to update this topic with new data coming from a larger cohort of patients operated on at our Department in the last 8 years both for cranial and spinal procedures. We collected information on 5347 patients: 1497 were cranial and 3850 were spinal cases. We recorded 35 clinically symptomatic DVTs (0.6%) and 18 cases (0.3%) of hemorrhagic complications and no cases of pulmonary embolus. It is our opinion that the protocol we have implemented in our Unit for the prevention of deep venous thrombosis and pulmonary embolus is safe and effective and does not seem to increase the incidence of hemorrhagic complications.
Abstract
The intraventricular location of a cavernoma is a rare entity and accounts for approximately 2.5% of all cavernomas of the central nervous system. They are commonly found in the lateral ...ventricle followed by the third and fourth ventricles. The location in the septum pellucidum is rare, and only four cases have been reported in the international literature. An open craniotomy was performed in all these cases. To the best of our knowledge, this is the first case of a cavernoma of the septum pellucidum successfully resected using a purely endoscopic transventricular approach.
•Outcomes and complications after PELD are not different from traditional microdiscectomy.•PELD is safe and feasible in elderly patients (>75 years old).•PELD can be performed under spinal anesthesia ...in high-risk patients.•Elders who cannot undergo microdiscectomy, because of comorbidities, are good candidates for PELD.
endoscopic spinal techniques are becoming widely used for lumbar disc prolapse treatment. The advantages are a milder invasivity, a shorter recovery time, lesser scar tissue formation, and the possibility to be performed under spinal or locoregional anesthesia. All of these make endoscopy suitable even in elderly patients with severe comorbidities. However, few studies have described outcomes of percutaneous endoscopic discectomy in the elderly. Here we describe and compare two prospectively collected cohorts of patients, an elderly (>75 years) and a younger one, to highlights outcomes differences between age groups. We then discuss our results with the outcomes of similar studies published in the literature.
Patients older than 75 years, with a confirmed diagnosis of lumbar disc prolapse, treated by an endoscopic technique between January 2015 and June 2017, were prospectively enrolled (Group E). Clinical and demographic data were collected, as well as data on the postoperative Visual Analogue Scale and Oswestry Disability Index at 3, 6 and 18 months. We then analyze a prospectively collected cohort of younger patients (≤50 years, Group Y), to allow for comparison of postoperative results.
Percutaneous endoscopic lumbar discectomy was successful in 89% of elderly patients after a median follow-up of 14 months, with half of the cases discharged home after a median time of 28 h. Only two surgical complications occurred. No differences in mean postoperative leg pain was found between the two groups. A significant higher number of medical complications was found in the elderly group compared to the younger ones, and more frequently in ASA 3 or 4 patients who underwent general anesthesia.
Our study suggests that percutaneous endoscopic lumbar discectomy is a safe and feasible procedure for disc prolapse treatment in elderly patients, especially if combined with spinal anesthesia.
We describe our experience in the endoscopic treatment of cervical spondylosis. We present a "hybrid" technique that is similar to an open anterior cervical discectomy with fusion but is performed ...endoscopically. We also analyzed data from studies on endoscopic cervical discectomies published in the past 2 decades.
We prospectively collected and analyzed data on all patients who underwent endoscopic cervical discectomy and fusion from January 2017 to January 2019. Data included age, sex, location, diagnosis, arm pain, degree of myelopathy and disability, and adverse events. Also, several databases were explored from January 1998 to December 2018, and 11 studies describing data about the anterior endoscopic treatment of cervical spondylosis, with and without fusion, were retrieved. We pooled these studies into a meta-analysis.
Arm pain decreased from a preoperative mean visual analogue scale value of 7 to a postoperative value of 2.1, and Nurick grade improved from a mean value of 3.1 to 1.8 at 12 months. 36-Item Short Form Survey scores increased from a mean preoperative value of 67 to 83.2, whereas the mean Oswestry Disability Index score decreased from 65.7 to a final mean value of 23.1 at 12 months. Median hospitalization time was 36 hours. Our meta-analysis found a satisfactory outcome in 88% of patients at last follow-up, an overall recurrence rate of 3%, and a revision rate of 5%.
We described the feasibility and safety of anterior hybrid endoscopic cervical discectomy, overcoming some of the limitations of the previously described percutaneous discectomies and shifting the standard open technique into an endoscopic procedure.
We present the case of a 49 years old man operated as emergency for cervical spinal cord compression for a Pott disease. We had planned a limited anterior cervical decompression with plating and a ...second stage posterior decompression and stabilization, a few days after the first operation in case of residual compression. Unfortunately, because of the extensive and consistency of dural compression we ended up in removing 4 vertebral bodies. We did not have, in house, a such long cage and plate for the reconstruction. We managed to achieve a good fixation making a “home made” titanium telescopic mesh as well as building a long plate too. The patient did extremely well with a prompt resolution of the neurological deficits. We describe how we manage to solve this problem stressing, in the same time, the importance of a careful plan, when possible, for such difficult cases.
•Surgical treatment of spinal tuberculosis is indicated in case of neurological deterioration or unstable fractures•Autologous bone grafts and titanium meshes are the two possible options after corpectomies•A “home made” telescopic mesh can be built using a smaller mesh nested into a bigger one. A long plate can be built fixing two smaller plates together•In any surgical case preparedness is mandatory in order to cover any situation. We described how we managed the case with an unusual solution
With increased experience and the availability of new technical instrumentations, the surgical endoscopic indications for lumbar spinal pathologies have moved from simple prolapsed disk to canal ...stenosis. The available endoscopes come in two different sizes (10 mm and 6.3 mm in diameter); however, one is too bulky to use inside the spinal canal and the other is too small to achieve a fast bone decompression. In order to overcome such problems, we developed and used a different surgical technique called: double endoscopic technique.
Using this approach, we operated and prospectively collected clinical information on 17 patients (Group A) suffering from a mixed (ligament-bone hypertrophy and prolapsed disk) single segmental lumbar canal stenosis. At a median of 13 months from surgery, all the patients in this group had a very good outcome with an improvement of the VAS and ODI.
These clinical results were compared with those from another group of patients who had undergone surgery in the same unit but using standard MIS technique (Group B). Both groups were similar in terms of number, age, symptoms and stenosis location. We compared the pre- and postoperative VAS and ODI values, the amount of postoperative pain killers used during the first week postsurgery, the length of in-hospital stays as well as the blood loss during surgery.
Although our aim was only to present a novel surgical endoscopic technique, the results, with all the study limitations including small numbers and short follow-up, have shown that this procedure is safe and effective, yielding an outcome comparable to the standard MIS approach. Furthermore, it is less disruptive towards the involved anatomy, it gives less postoperative pain, it requires a smaller skin incision, and the blood loss is negligible. Thus, this technique may guarantee a faster clinical recovery.
Rarely, the clipping of uncoilable intracranial aneurysms may be too challenging because of anatomical conformation, size, or orientation. An alternative to traditional techniques such as clipping or ...embolization may be wrapping, a circumferential reinforcement of the aneurism wall with synthetic materials such as muslin. This leads to a local inflammatory reaction resulting in a strong adherent scar tissue. However, the robust fibrotic reaction may cause a foreign body, or muslinomaù, which might be responsible for various neurological complications. Here we describe the temporal evolution of a conservatively managed muslinoma that developed after a ruptured internal carotid artery aneurysm in a 58-year-old woman with multiple aneurysms. A differential diagnosis of a cerebral abscess versus a granulomatous reaction or even a tumor was hypothesized. The absence of abscess clinical, microbiological, and neuroradiological features led to a muslin-induced foreign body granuloma diagnosis. The patient underwent serial contrast-enhanced MRI imaging at 5, 12, 18, 40, and 60 months. In addition, 18F–fluorodeoxyglucose (FDG) positron emission tomography and computed tomography (PET/CT) scans were performed at 6, 24, 42, and 60 months after surgery. Here we highlight how strict clinical and neuroradiological surveillance is mandatory in order to prevent unnecessary treatments. In our case, using an F–FDG-PET/CT scan as an adjunctive follow-up imaging method was helpful in the decision-making process. After reviewing and reporting similar cases in the literature and considering all the actual therapeutic options for intracranial aneurysm treatment, we believe that wrapping with muslin or gauze materials should be carefully weighed against the rare but possible complication muslin-induced foreign body reaction.
In the present randomized prospective study, we compared the surgical invasiveness using a quantitative volumetric analysis of postoperative paravertebral muscle signal intensity changes between ...transforaminal full endoscopic lumbar discectomy (FELD) and open discectomy (OD).
We prospectively collected the data from 50 patients with a single-level lumbar foraminal herniation, invalidating radicular pain, and adequate imaging studies available (postoperative magnetic resonance imaging MRI <24 hours). These patients had been randomly assigned to FELD (n = 25) or OD (n = 25). Data were collected on age, sex, leg and back pain, complications, and follow-up time. Muscle segmentations were performed manually using 3DSlicer software on postoperative isovolumetric T1-weighted contrast-enhanced and T2-weighted short tau inversion recovery MRI scans. Both sequences were processed using multiplanar reconstruction in orthogonal planes. The clinical and demographic characteristics and volumetric data were then compared between the 2 groups.
We found a higher mean volume of paravertebral muscle signal alterations among the OD-treated patients in both T2-weighted short tau inversion recovery MRI (P ≤ 0.001) and T1-weighted contrast-enhanced MRI (P ≤ 0.001) scans than among the FELD-treated patients. No differences were found between the median preoperative and postoperative leg pain between the 2 groups (P = 1.000). The median scores for postoperative back pain were significantly lower for the FELD group (P ≤ 0.001), as was the median interval from surgery to autonomous mobilization (P = 0.001).
We found a significant difference in signal intensity of the paravertebral muscles between the FELD and OD groups, reflective of the minor surgical invasiveness of endoscopic discectomy. FELD resulted in less trauma to the paraspinal muscles, possibly also reducing inflammatory cytokine release and, therefore, is a valuable tool for spinal surgeons.
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