Neurosurgery
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Meta Analysis Comparative Study
A Meta-Analysis of Medication Reduction and Motor Outcomes After Awake Versus Asleep Deep Brain Stimulation for Parkinson Disease.
There remains significant debate regarding the performance of deep brain stimulation (DBS) procedures for Parkinson disease (PD) under local or general anesthesia. The aim of this meta-analysis was to compare the clinical outcomes between "asleep" DBS (general anesthesia) and "awake" DBS (local anesthesia) for PD. ⋯ There was no significant difference in the primary motor outcomes and LEDD improvement between asleep vs awake DBS. The variables of target selection and MER use had no statistically significant impact on outcome. We find that asleep techniques are both safe and effective compared with the awake technique.
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Clinical guidelines direct healthcare professionals toward evidence-based practices. Evaluating guideline impact can elucidate information penetration, relevance, effectiveness, and alignment with evolving medical knowledge and technological advancements. As the American Association of Neurological Surgeons/Congress of Neurological Surgeons Section on Tumors marks its 40th anniversary in 2024, this article reflects on the tumor guidelines established by the Section over the past decade and explores their impact on other publications, patents, and information dissemination. ⋯ Non-Functioning Pituitary Adenoma led Mendeley reads. News, patent, or policy publications were led by low-grade glioma at 1.5/year. Our study shows that the American Association of Neurological Surgeons/Congress of Neurological Surgeons Section on Tumors guidelines go beyond citations in peer-reviewed publications to include patents, online engagement, and information dissemination to the public.
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The transforaminal lumbar interbody fusion (TLIF) technique, pioneered by Harms and Rolinger in 1982 and further refined in the early 2000s by Rosenberg and Mummaneni and later by Foley and Lefkowitz, uses Kambin triangle to access the disc space, thecal sac, and nerve roots. The minimally invasive surgery (MIS) approach to TLIF minimizes soft tissue disruption and spinal segment destabilization, offering benefits such as reduced operative times, blood loss, complications, and postoperative opiate use, with comparable fusion rates to open techniques. Despite these advantages, MIS interbody selection poses challenges, with the MIS TLIF preferred for L4-5 fusions when lordosis restoration is not needed. ⋯ Awake MIS TLIF, incorporating conscious sedation and local anesthesia, offers additional benefits of faster discharge and reduced postoperative pain. Some authors have also started using endoscopic techniques as well to further minimize tissue trauma. The integration of these advanced techniques and technologies in MIS TLIF continues to improve surgical outcomes and expands the applicability of this minimally invasive approach, making it a valuable tool in spine surgery.
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Review Case Reports
Biportal Versus Uniportal Lumbar Decompression-Indications and Efficacy: A Review With Case Examples.
Minimally invasive lumbar decompression surgery offers many advantages including reduced patient morbidity and quicker return to normal life. Endoscopic lumbar spine surgery, sometimes termed "ultra" minimally invasive, further pushes the envelope on reducing operative time, blood loss, and recovery time. ⋯ Biportal approach involves two incisions, one for the endoscope and one for the instruments. In what follows we review the indications and efficacy of these procedures with case examples.
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Image guidance has transformed minimally invasive spine surgery (MISS), allowing for safer procedures without excessive bony exposure and reducing radiation exposure for the surgical team. Robotic platforms have enhanced the benefits of navigation by providing high precision and accuracy. Here we describe a case series to demonstrate the accuracy and low complication rates of real-time image-guided robotic-assisted (RA) MISS at a tertiary referral center. In addition, we performed a narrative review on how robotics and navigation facilitate MISS. ⋯ Robotic platforms have further enhanced navigation benefits by providing high precision and accuracy, with low complication rates.