World Neurosurg
-
Spinal arteriovenous fistulae (AVFs) of the craniocervical junction are rare lesions that have variable angioarchitecture. These lesions are generally characterized by arteriovenous shunting at a single fistulous point, the disconnection of which is generally curative.1 We present a case of bilateral dural AVF at the C2 level treated with surgical ligation (Video 1). Our patient was an elderly woman who presented after cervical magnetic resonance imaging was performed as part of work-up for right-sided shoulder tingling. ⋯ She was then taken back to surgery for ligation of the second fistula. Instances of multiple, distinct, and synchronous arteriovenous fistulae have been rarely reported in the literature.2 In addition to demonstrating the nuances of surgical treatment of AVFs at this location, this case demonstrates the potential for synchronous AVFs and emphasizes the importance of thorough postoperative angiography. The patient provided consent to the production of this surgical video.
-
The aim was to conduct a comprehensive bibliometric analysis of meningioma research, focusing on publication trends, top authors, universities, countries, and thematic analysis of keywords. ⋯ Our findings may provide insights into the evolution of meningioma research and its scholarly impact. The analysis underscores the pivotal contributions of top authors and institutions, outlines thematic research trends, and highlights areas of significant interest and growth in the field. Our study may contribute to understanding the landscape of meningioma research, guiding future research directions and collaborations.
-
Pineal tumors are rare but surgically challenging due to their deep location and proximity to major veins and brainstem.1,2 Getting a biopsy along with an endoscopic third ventriculostomy is essential before surgical resection.3,4 The supracerebellar infratentorial approach provides direct symmetrical exposure of the pineal region inferior to the vein of Galen.5,6 3-Dimensional (3D) exoscopes are increasingly used due to better ergonomics, greater depth of field, and equivalent image quality of microscope. The endoscope provides angled optics to visualize hidden areas of tumor adherent to neurovascular structures, avoiding blind dissection. These become especially advantageous during suboccipital keyhole surgery in the sitting position, which averts both cerebellar retraction and frequent soiling of the endoscope. ⋯ Histopathology was a high-grade papillary tumor. Magnetic resonance imaging confirmed gross total resection. This is probably the first report of a supracerebellar infratentorial keyhole approach for gross total resection of a giant pineal tumor, effectively using the better ergonomics and depth of field of a 3D exoscope along with angled optics provided by an endoscope, resulting in an excellent outcome.
-
Given the benefits of neuroendovascular simulation to resident education, this study aimed to assess the efficacy of simulation-based training for neuroendovascular intervention with primary and secondary catheters using a transradial approach (TRA). ⋯ Residents demonstrated proficiency at Simmons catheter formation and vessel selection in a type II arch over a short time period (4 attempts and <1 hour total). Residents can use simulator-based training to increase their proficiency of vessel selection using a primary or secondary catheter for a TRA.
-
Anterior intradural extramedullary meningiomas are intimidating, especially in the thoracic spine due to the spinal cord impeding conventional surgical corridor, restricted space, and precarious cord vascularity.1,2 This is possibly the first report in the literature of a minimally invasive surgery: far-lateral hybrid exoscopic and angled endoscopic approach for an anterior thoracic spine meningioma. A 60-year-old woman presented with an anterior T1-2 meningioma with a flattened cord draping over the tumor more toward the right, leaving a potential corridor on the left lateral aspect (Video 1). Under a three-dimensional exoscope, a minimally invasive retractor was placed through the left paramedian incision centered on the lamina-transverse process junction; lateral fenestration and T1-2 facetectomy were carried out with a high-speed drill and rongeurs, meticulously preserving C7-T1 articulations.3,4 Following coagulation of the anterolateral dura over the tumor, a lateral longitudinal durotomy with a T-shaped anterolateral extension was performed around the tumor. ⋯ This was followed by coagulation and excision of the dural tail. A 45° endoscope was then inserted to look for any residual tumor or dural tail.5 As the durotomy was lateral with excision of the dural tail, a multilayered soft tissue closure without dead space was sufficient to prevent cerebrospinal fluid leak.3 Fixation was not needed as only a single thoracic spine facet was disrupted.4 The patient recovered fully with radiology confirming total excision. This minimally invasive lateral rolling technique is safe and effective for anterior meningioma with the ergonomics of exoscope & the angled optics of endoscope complementing each other.