Neurosurgery
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Comparative Study
Predictors of peritumoral edema after stereotactic radiosurgery of supratentorial meningiomas.
Anecdotal evidence suggests that radiosurgical ablation of parasagittal meningiomas may be associated with increased risk of subsequent edema. Potential predictors of postradiosurgical peritumoral edema, including parasagittal tumor location, tumor size, and treatment dose, were evaluated. ⋯ Patients with parasagittal meningiomas are at greater risk of developing peritumoral symptomatic edema after SRS. Close follow-up after SRS may be particularly important in such patients. These results highlight the need to pursue strategies that could decrease the incidence of postradiosurgical edema in patients with parasagittal meningioma.
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Comparative Study
Radiological findings and clinical course of conus lipoma: implications for surgical treatment.
A significant variety in morphology of conus lipomas may underlie differences in clinical presentation of the patients and controversy in surgical management. We retrospectively studied 58 patients with conus lipomas at our institutions. The purpose of this study was to infer the clinical course from the radiological findings and to provide information for decision-making in planning for surgical treatment. ⋯ This study demonstrates that the location and morphology of conus lipomas influence the neurological presentation of the patients. Early prophylactic surgery is a reasonable treatment option if early deterioration is predicted by imaging studies.
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Long spinal constructs that extend to the sacrum place added stress on sacral screws. To prevent premature loosening of sacral fixation in these cases, the addition of pelvic screw (iliac screw) fixation has gained in popularity. Pelvic screw fixation has also been used in cases where sacral screw fixation is not possible (e.g., in sacral tumors). Pelvic screw fixation is more straightforward than prior pelvic rod fixation techniques (e.g., the Galveston technique). We describe our technique for pelvic screw fixation and review our experience with this technique. ⋯ Pelvic screw fixation is a safe and effective technique that provides added structural support to S1 screws in long-segment spinal fusions. Furthermore, pelvic screw fixation provides a distal point of fixation in cases where sacral screw fixation is not possible. The use of polyaxial screws and connectors makes this technique easier than Galveston rod fixation of the pelvis.
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Meyer's loop, the most vulnerable part of the optic radiations during approaches to the temporomedial region, extends to the tip of the temporal horn and is often encountered in epilepsy surgery. The risk of damaging Meyer's loop during transsylvian selective amygdalohippocampectomy peaks while accessing the temporal horn through its roof by opening the inferior limiting sulcus of the insula. In this prospective study, we sought to evaluate and identify the incidence of visual field deficits in a homogeneous group of patients who had temporal lobe epilepsy with hippocampal sclerosis and who underwent transsylvian selective amygdalohippocampectomy. ⋯ We have shown that there is a considerable risk of having visual field deficits after standard transsylvian selective amygdalohippocampectomy owing to the interruption of the anterior bundle of the optic radiation fibers, which most likely occurs while opening the temporal horn through the inferior limiting sulcus of the insula.
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Case Reports
Intra-abdominal vascular injury during trocar-assisted ventriculoperitoneal shunting: case report.
Laparoscopic trocar injury is a relatively well-described complication of cholecystectomies and gynecological procedures. However, this type of injury has not been reported in association with adult neurological surgery. To increase awareness of this very serious risk, we report a case of intra-abdominal vascular injury during a shunt procedure involved with a common neurosurgical procedure. ⋯ An abdominal trocar should be used with caution in ventriculoperitoneal shunt surgery. Even with meticulous technique, vascular injury can occur with any trocar-based abdominal procedure. The neurosurgeon who uses this technique must be prepared to initiate emergent vascular access and repair, with a vascular surgery team available should such an injury occur. Alternatively, open placement of peritoneal catheters avoids blind peritoneal instrumentation and is an effective method for minimizing potentially catastrophic vascular injuries.