Journal of neurosurgery
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Journal of neurosurgery · Nov 2024
The feasibility and clinical outcome of endoscopic transorbital transcavernous approaches with or without petrosectomy for petroclival lesions.
Petroclival tumors such as petroclival meningiomas or trigeminal schwannomas extending to the posterior cranial fossa are challenging to treat due to their deep-seated location and proximity to critical neurovascular structures. This study aimed to evaluate the feasibility, safety, and clinical outcomes of endoscopic transorbital surgery for the resection of central skull base tumors involving the petroclival area. ⋯ Endoscopic transorbital surgery appears to be a safe and effective technique for the resection of petroclival lesions, offering excellent visualization and access to the tumor while minimizing morbidity. However, further studies with larger patient cohorts and longer follow-up are warranted to validate the long-term efficacy and safety of this approach. This study contributes to the growing body of evidence supporting the utility of endoscopic transorbital techniques in skull base surgery.
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Journal of neurosurgery · Nov 2024
Development and validation of a predictive scoring model for complications following endoscopic endonasal skull base surgery.
The endoscopic endonasal approach (EEA) has evolved into an established technique in skull base surgery. The authors previously examined 1002 EEA procedures and reported factors associated with postoperative complications. Here they report the development and validation of a scoring model based on risk factors to better predict complications following EEA. ⋯ This EEA complications scoring model accurately categorizes patients into low-, medium-, and high-risk groups with readily obtained variables. A high score in this complications model does not suggest that a patient is ineligible for surgery, but rather highlights the importance of thorough case selection, operating with caution, and appropriate preoperative counseling.
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Journal of neurosurgery · Nov 2024
Multicenter StudySex-dependent characteristics and outcomes after clipping of unruptured intracranial aneurysms: a multicenter propensity score-matched study.
Disparities in the epidemiology and growth rates of aneurysms between the sexes are known. However, little is known about sex-dependent outcomes after microsurgical clipping of unruptured intracranial aneurysms (UIAs). The aim of this study was to examine sex differences in characteristics and outcomes after microsurgical clipping of UIAs and to perform a propensity score-matched analysis using an international multicenter cohort. ⋯ Despite overall differences between male and female patients in demographics, comorbidities, and treated aneurysm location, sex did not relevantly affect surgical performance or perioperative complication rates.
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Journal of neurosurgery · Nov 2024
Management of intracavitary bleeding during ultra-early minimally invasive intracerebral hemorrhage evacuation.
Surgical evacuation of intracerebral hemorrhage (ICH) at early time points contributes to improved functional outcomes. However, ultra-early evacuation has been associated with postoperative rebleeding, a devastating complication that contributes to worse outcomes. Minimally invasive endoscopic techniques allow for intraoperative management of active bleeding, potentially allowing for safe and effective hemostasis at ultra-early time points. The authors proposed and prospectively assigned an intraoperative grading scale that quantified the severity of bleeding encountered intraoperatively. They hypothesized that ultra-early evacuation would correlate to increased intraoperative bleeding but not postoperative rebleeding or worse long-term clinical outcomes in a cohort of patients undergoing minimally invasive endoscopic evacuation. ⋯ Ultra-early evacuation within 5 hours of ictus is associated with increased intraoperative bleeding but not postoperative rebleeding or worse clinical outcomes. These findings suggest that the benefits of ultra-early evacuation can be explored without an increased risk of postoperative rebleeding when utilizing a minimally invasive endoscopic technique with good intraoperative visualization, active irrigation for targeted tamponade, and direct cauterization of bleeding vessels.