World Neurosurg
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Comparative Study
Outcome after extreme lateral transpsoas approach: corpectomies vs. interbody fusion.
The lateral transpsoas approach (LTPA) has gained popularity in thoracolumbar spine surgery procedures; however, there is an insufficient amount of data pertaining to motor and sensory complications that arise when a corpectomy is performed through the LTPA approach. ⋯ Patients who underwent an LTPA corpectomy have a higher risk to suffer from postoperative complications. The results at the 6-month follow-up did not significantly differ between the groups.
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While multisession dose fractionated Gamma Knife radiosurgery (DFGKS) is common, its use has never been described for jugular paragangliomas (JP), which are notoriously difficult to treat. ⋯ DFGKS for large-volume JP leads to acceptable progression-free survival, tumor control rate, and symptomatic improvement. It may be preferred to surgery or fractionated radiotherapy given its better safety, efficacy, and complication profile.
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In recent years, advances in cortical-subcortical mapping, intraoperative neurophysiology, and neuropsychology have increased the ability to remove intrinsic brain tumors, expanding indications and maximizing the extent of resection. This has provided a significant improvement in progression-free survival, time of malignant transformation (in low-grade gliomas), and overall survival. ⋯ In this regard, an extensive preoperative and postoperative neuropsychological evaluation is strongly suggested to assess cognitive impairment due to tumor growth, to assess surgical result, and to plan cognitive rehabilitation. This article discusses the main recent innovations introduced for cognitive mapping with the aim to preserve cognitive functions, which are essential to maintain a high quality of life.
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Sacral fractures are a challenge regarding treatment and classification. Surgical techniques using spinal navigation systems can improve treatment, especially if used in collaboration among different specialists. ⋯ Navigation systems in instrumented spinopelvic and sacropelvic reconstruction provide greater safety, reducing learning times and malpositioning. Multidisciplinary management allows us to achieve optimal results, especially when the sacral fracture is combined with spinal and pelvic lesions. The use of navigation systems could represent an important advancement.