World Neurosurg
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Laser interstitial thermal therapy (LITT) is a minimally invasive ablative technique with specific indications for neuro-oncology, especially in the case of lesions in eloquent areas. Even being performed through a small catheter under stereotactic conditions, the risk of damaging vital structures such as white matter tracts or cortical eloquent areas is not negligible. The mechanism of damage can be related to catheter insertion or to excessive laser ablation. An accurate preoperative workup, aimed at locating the eloquent structures, can be combined with a real-time intraoperative neurophysiologic monitoring to reduce surgical morbidity while maximizing the efficacy of LITT. ⋯ An integrated approached guided by neurophysiology is able to reduce the surgical morbidity even in a relatively accurate technique such as LITT. To the best of our knowledge, this represents the first report on this synergistic approach which could really impact the treatment of tumors in eloquent areas. Future studies are needed in the effort to implement this approach in functional or epilepsy neurosurgery as well.
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An entrapped temporal horn (ETH) is one of the critical complications after tumor removal in the lateral ventricle trigone that sometimes becomes life threatening. ⋯ PIP might be beneficial to prevent ETH because constant osmotic pressure and constant cerebrospinal fluid pulse wave transmission are maintained between each compartment of the lateral ventricle.
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Unilateral biportal endoscopic (UBE) spine surgery for spinal diseases has been increasing in popularity because of its favorable outcomes. The goal of this systemic review is to analyze the status of outcomes and complications in lumbar disc herniation during UBE discectomy. ⋯ Even with the small number of studies and reports analyzed, biases were the main limitation of this analysis; overall, the clinical outcomes and complication rates associated with UBE discectomy were relatively good. It is clear that UBE discectomy is a good treatment choice for lumbar disc herniation, but to prevent unique UBE surgery complications, a clear understanding of the surgical procedures and careful efforts to overcome the learning curve are necessary.
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Despite lack of nationwide Medicare coverage by the Centers for Medicare and Medicaid Services, the utilization of cervical disc arthroplasty (CDA) has risen in popularity. The purpose was to compare primary and revision CDA from 2010 to 2020 with respect to: (1) utilization trends, (2) patient demographics, and (3) health care reimbursements. ⋯ There is a high rate of annual growth in CDA utilization and revision CDA in the United States. Reimbursements for revision CDA were more than double primary cases.
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Cerebral infarction is a major contributor to poor outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH). Timing of treatment has been discussed as a possible contributor. We aimed to analyze the impact of treatment timing on the risk of cerebral infarction and poor outcome after aSAH. ⋯ Our data confirm a considerable risk of cerebral infarction and poor outcome in cases of aneurysm treatment between day 4 and 14 after aSAH. A more intense surveillance and prophylactic treatment of cerebral vasospasm might be necessary in cases of aneurysm treatment in the vasospasm phase.