World Neurosurg
-
Intramedullary spinal cord tumors (IMSCTs) are rare neoplasms and their management involves tumors resection in most cases. Regarding the surgical procedure, adequate identification of tumor boundaries is paramount to achieve an extensive tumor resection. Fluorescence image-guided surgery (FIGS) has become an increasing popular intraoperative technique used in spine neuro-oncology surgery. However, evidence is lacking of their usefulness and their safety in spinal tumors. Therefore, the aim of the present study is to give an update of the existing literature and systematically review all studies that focus on the most-used fluorophores (5 aminolevulinic acid [5-ALA], sodium fluorescein, and indocyanine green [ICG]) in IMSCTs. ⋯ In intramedullary tumor surgery, 5-ALA has shown its usefulness in identifying the tumor margins and in searching for residues because of its properties as a tumor-specific metabolic marker. Sodium fluorescein and ICG video angiography have shown promising application in ependymoma and hemangioblastomas surgery, respectively. However, the evolving role of fluorescent dyes in guiding surgical strategies in intramedullary spinal tumor has yet to be shown by randomized clinical trials.
-
Review
Review of the prevention and treatment of hydrocephalus after aneurysmal subarachnoid hemorrhage.
Hydrocephalus following a ruptured aneurysm portends a poor prognosis. Patients have to face the risk of infection and shunt obstruction after shunt surgery, which may require a second procedure and greatly reduce the quality of life for survivors. It is crucial to minimize the incidence of hydrocephalus and reduce cerebrospinal fluid shunt dependency. This article reviews current interventions before and after hydrocephalus formation after aneurysmal subarachnoid hemorrhage, focusing on the relationships between treatment options and the incidence of postoperative hydrocephalus, management of cerebrospinal fluid drainage and shunt dependent hydrocephalus, and advocates for the combination of prevention and treatment to develop individualized treatment plans for patients.
-
This article aims to introduce an endoscopic-exoscopic technique for the resection of epidermoid cysts. ⋯ Endoscopic-exoscopic technique is safe and efficient in the resection of intracranial epidermoid cysts with panoramic views and superior maneuverability. With further development and accumulation of practical experiences, the endoscopic-exoscopic technique can also be applied in the resection of other intracranial tumors.
-
Hemangioblastomas in the central nervous system are the most common manifestation of von Hippel-Lindau (VHL) disease. Because the growth rate of hemangioblastomas is unpredictable, regular follow-up is mandatory, focusing on clinical symptoms and imaging of the central nervous system. However, clinical symptoms may be subtle and nonspecific, and data about the relationship between the radiologic findings and clinical symptoms are sparse. This study aims to evaluate if and how findings of magnetic resonance imaging (MRI) regarding spinal hemangioblastomas are associated with symptoms of VHL disease, with special attention to peritumoral edema and spinal cysts. ⋯ The presence of peritumoral edema and/or spinal cysts shown on MRI in VHL patients with spinal hemangioblastomas is associated with symptoms in more than half of the patients and may alert the clinician to intensify clinical and radiologic surveillance.
-
In patients with traumatic cervical spinal cord injury (tCSCI), the potential role of intraoperative neuromonitoring as a prognostic tool has been insufficiently studied. This study aimed to determine if detectable signals during intraoperative neuromonitoring portend a greater likelihood of recovery for patients with tCSCI. ⋯ The presence of upper extremity SSEP signals in patients who present with complete tCSCI portends greater improvement in ASIA motor scores and likelihood of American Spinal Injury Association Impairment Scale grade conversion at final follow-up.