Journal of neurosurgery
-
Journal of neurosurgery · Nov 2024
Multicenter StudyStratified assessment of treatment approach for craniocervical junction arteriovenous fistulas: a multicenter cohort study and literature review.
Craniocervical junction arteriovenous fistulas (CCJ-AVFs) are complex vascular shunts that present a challenge for treatment. The aim of this study was to compare the clinical outcomes of microsurgery and endovascular embolization for CCJ-AVFs and to determine whether the treatment approach affected the obliteration rate and neurological improvement. ⋯ This study supports microsurgery as the best treatment modality for CCJ-AVFs, exhibiting the highest rates of complete obliteration. Conversely, embolization via the VA can result in a lower occlusion rate and less neurological improvement. In CCJ-AVFs with CA feeders, embolization via the CA can be a safe and effective alternative to microsurgery.
-
Journal of neurosurgery · Nov 2024
Risk of late radiation necrosis more than 5 years after stereotactic radiosurgery.
Radiation necrosis (RN) is a well-recognized late complication most commonly occurring within 2 years of stereotactic radiosurgery (SRS); however, late RN (LRN), RN occurring or recurring > 5 years after SRS, has been poorly described. This study analyzes the incidence of and risk factors for LRN occurring > 5 years after SRS. ⋯ RN risk persists well beyond 5 years after SRS, and recognizing LRN as an entity has important implications in managing these patients. LRN risk was highest in those with a brain V12Gy > 5 cm3 and a history of early RN after SRS, warranting close follow-up in perpetuity for select patients.
-
Journal of neurosurgery · Nov 2024
Characterization of cerebrospinal fluid markers as indicators of spinal cord ischemia following an endovascular aortic aneurysm repair procedure.
Spinal cord ischemia (SCI) remains one of the most devastating complications in both open and endovascular stent graft repair of thoracoabdominal aortic aneurysms. The endovascular aortic aneurysm repair (EVAR) can be either thoracic (TEVAR) when it targets the thoracic aortic aneurysm or fenestrated branched when repair involves the visceral and/or renal arteries. Even though EVAR interventions are less invasive than open repair, they are still associated with a significant risk of SCI. The current primary strategy to prevent SCI after TEVAR is to increase and/or maintain spinal cord perfusion pressure (blood flow) by increasing the mean arterial pressure while simultaneously draining CSF. Although the benefit of CSF drainage in EVAR procedures remains uncertain, it provides an opportunity to study the changes in cytokine and oxidative stress markers that may signal the pathophysiology of SCI following EVAR. The aim of this study was to evaluate the temporal relationship between stent deployment and CSF cytokine and oxidative stress marker levels as predictors of delayed SCI in patients undergoing an EVAR procedure. ⋯ There appears to be a temporal relationship between lumbar CSF drainage and CSF cytokines and oxidative stress markers that may help 1) identify patients at risk for developing delayed SCI and 2) modify patient management to prevent the damage from delayed SCI.
-
Wound dehiscence following craniotomy is a complication for which patients are subjected to additional procedures to achieve wound closure. During surgery for epilepsy, a craniotomy is performed at various sites to cure or palliate seizures in patients with intractable epilepsy. Collaborations between medicine and engineering have provided many surgical devices and materials for various stages of craniotomy, from skin incision to wound closure. The risk factors for wound dehiscence remain undetermined. Here, the authors attempt to identify risk factors associated with wound dehiscence after surgery for epilepsy. ⋯ Surgical devices and materials contribute to wound dehiscence after epilepsy surgery. To avoid wound dehiscence, the use of an electrocautery scalpel is not recommended when performing skin incisions, nor is dural closure using a nonabsorbable artificial dura.
-
Journal of neurosurgery · Nov 2024
Surgical anatomy of the carotid sympathetic plexus in endoscopic endonasal approaches: strategies for preventing Horner syndrome.
Endoscopic endonasal approaches (EEAs) specifically for procedures involving manipulation of the internal carotid artery (ICA), such as the transcavernous and translacerum approaches, confer a potential risk of carotid sympathetic plexus injury, potentially leading to postganglionic Horner syndrome. The primary aim of this study was to delineate the surgical anatomy of the carotid sympathetic plexus from an endoscopic endonasal perspective, offering insights to facilitate intraoperative anatomical identification and injury prevention. ⋯ This article provides a comprehensive anatomical description of the carotid sympathetic plexus in EEAs, highlighting key anatomical segments and patterns for intraoperative identification. A better understanding of anatomical landmarks for the carotid sympathetic plexus could help reduce the incidence of postganglionic Horner syndrome, augmenting the safety and efficacy of endoscopic endonasal transcavernous surgery.