World Neurosurg
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Multicenter Study
Extreme lateral interbody fusion (XLIF) as a feasible treatment for thoracolumbar spondylodiscitis: a multicenter Belgian case-series.
Spondylodiscitis is, after tissue sampling, initially managed with intravenous antibiotics. In patients with treatment failure, surgical debridement and stabilization is considered. An anterior or posterior approach has already been reported as a successful surgical access, but is associated with a large exposure and a significant morbidity. ⋯ These results indicate that extreme lateral interbody fusion topped off with a percutaneous pedicle screw fixation might be a feasible, safe and valuable choice to surgically treat patients with spondylodiscitis with fast and important improvement in VAS. Further prospective research might strengthen the sparsely existing literature of minimally invasive surgery for spondylodiscitis to provide the best possible care.
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Case Reports
The "Microcisternal Drainage" technique for clipping a middle cerebral artery aneurysm.
Arachnoid dissection is often challenging because of tight corridors, microvasculature crossing the membranes, and a narrow operative field.1-4 It is often said that "splitting" the sylvian fissure measures the talent of a cerebrovascular neurosurgeon, and there are as many styles of sylvian fissure dissection as neurosurgical schools.4-8 Our principle is to dissect the subarachnoid space sharply and with minimal trauma to neither the microvasculature nor the pia matter.4,7-10 We have developed a technique that allows efficient and safe sharp dissection through the subarachnoid space: the "microcisternal drainage" technique. This technique (Video 1) consists of applying a pledget to a narrow cistern and suctioning the cerebrospinal fluid while maintaining uplifting retraction with the suction shaft. Clear trabeculae are dissected sharply to release microvessels at the convexity of their turns. ⋯ We report an example of the "microcisternal drainage" technique to split the sylvian fissure during treatment of an irregular middle cerebral artery bifurcation aneurysm on a 56-year-old woman. The patient tolerated the procedure well, was discharged without neurologic deficits, and resumed normal life with no aneurysm remnant. The patient consented to the procedure and video and photography publication.
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"Reverse cortical sign" is a rare entity described in lumbar burst fracture that corresponds to the fracture fragment of the posterior wall of vertebral body, which has rotated 180 degrees with the cortical surface facing anteriorly and the cancellous surface facing posteriorly in the canal. Identifying this sign is crucial in deciding the line of management as it is a contraindication for ligamentotaxis. The advent of computed tomography scans with axial and sagittal reconstruction has allowed us to better describe these rare entities. We present a lumbar burst fracture with a reverse cortical sign describing its appearance in axial computed tomography scans, sagittal reconstruction, and magnetic resonance imaging.
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Management of large vestibular schwannoma (VS) is controversial. Surgery has historically been the treatment of choice, but emerging literature suggests that definitive stereotactic radiosurgery is feasible. We report our institutional experience of control and morbidity outcomes treating Koos grade 3-4 VS with Gamma Knife radiosurgery (GKRS). ⋯ In well-selected patients with Koos grade 3-4 VS, definitive stereotactic radiosurgery may be an appropriate strategy with excellent control and minimal toxicity. Our data suggest that the need for surgical decompression should be considered based on pretreatment symptom burden rather than tumor size.
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Surgical approaches to the sellar and parasellar regions are highly challenging due to the densely packed nature of the traversing neurovasculature. The frontotemporal-orbitozygomatic approach offers a wide angle of exposure for the management of lesions involving the cavernous sinus, parasellar region, upper clivus, and adjacent neurovascular structures. ⋯ We provide a stepwise description of how we perform the fronto-orbitozygomatic approach and an associated series of surgical maneuvers and techniques that can be utilized in a variety of anterior and anterolateral approaches, either alone or in combination, to tailor exposure to a given lesion. These techniques are not limited to traditional skull base approaches and represent a valuable addition to every neurosurgeon's armamentarium as enhancements to common surgical approaches.