World Neurosurg
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Little is known about the effectiveness of recombinant human bone morphogenetic proteins (rhBMPs) in reducing the demand for opioids after surgery. We investigated the association between rhBMP use and the likelihood of achieving opioid independence and changes in opioid demand in the first postoperative year. ⋯ We found no evidence to suggest that rhBMP use during spinal fusion procedures is associated with either the discontinuation or decrease of opioid analgesic therapy. The continued opioid use after surgery warrants further clinical and research attention.
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Comparative Study
Can Percutaneous Biportal Endoscopic Surgery Achieve Enough Canal Decompression for Degenerative Lumbar Stenosis? Prospective Case-Control Study.
Recently, full-endoscopic lumbar decompression has shown encouraging clinical outcomes. However, there are no reports as to whether sufficient lumbar decompression through full-endoscopic procedures can be achieved. The purpose of this study is to investigate the radiologic outcomes of percutaneous biportal endoscopic decompression compared with those of conventional microscopic decompressive surgery. ⋯ Full-endoscopic lumbar decompression using percutaneous biportal endoscopic approach is a safe and effective treatment for lumbar spinal stenosis. Decompression can be achieved with the percutaneous endoscopic technique at a similar rate to that achieved by the microscopic approach.
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This retrospective study aimed to investigate the effect of quantitative enlargement of spinal canal by anterior controllable antedisplacement and fusion (ACAF) for cervical ossification of the posterior longitudinal ligament (OPLL). ⋯ The quantitative enlargement of the spinal canal by ACAF may provide a positive and favorable effect on enlarging the spinal canal and achieving better neurologic recovery for the treatment of cervical OPLL with myelopathy. CR can facilitate the achievement of better and more quantitative spinal canal enlargement.
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Observational Study
What is the best electrophysiological marker of the outcome of the subthalamic nucleus stimulation in Parkinson's disease?
Deep brain stimulation of the subthalamic nucleus (STN) is advocated in patients with advanced Parkinson disease. Intraoperative microelectrode recordings (MER) and stimulation or imaging are applied to confirm electrode targeting. The study objective was to evaluate which intraoperative electrophysiologic marker, MER, stimulation, or local field potentials (LFP) was the most predictive of the clinical efficacy. ⋯ Motor improvements emerged as most related to β oscillations, before trajectory length within the STN, whereas stimulation thresholds of rigidity or of motor tract excitation failed to show any relationship. The study encourages LFP measurement to confirm STN electrode location.
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Case Reports
Expanded endoscopic endonasal approach to the inframeatal area: anatomic nuances with surgical implications.
The inframeatal area represents a challenging region for skull base surgeons. Various surgical corridors have been described to access this area and frequently are used in combination. Recent studies describe the expanded endoscopic endonasal approach (EEA) as an established route for midline regions, particularly medial to the internal carotid arteries (ICA). We sought to evaluate the accessibility, maneuverability, and freedom of movement of the expanded endoscopic endonasal approach to the inframeatal region. ⋯ The EEA is a feasible route to the inframeatal area. This approach provides a safe working corridor for lesions in this region, as shown by the anatomical and clinical findings presented here. Comparative studies and large case series are warranted to further establish its clinical value.