World Neurosurg
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Achieving watertight dural closure without grafts via the retrosigmoid approach can be challenging, contributing to a significant rate of postoperative cerebrospinal fluid (CSF) leaks. This study describes a dural incision technique for achieving primary dural closure without grafts following the retrosigmoid approach and presents clinical data from the authors' experience. ⋯ In the authors' preliminary experience, the linear dural incision described herein was effective for achieving a no-graft, watertight primary dural closure in the retrosigmoid approach, with no CSF leaks or meningitis in our series. Validation of these preliminary data in a larger patient cohort is necessary.
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Review Historical Article
Sir William Macewen (1848-1924): Pioneering the Field of Neurosurgery with Early Breakthroughs in Tumour Resection.
Sir William Macewen, a Scottish surgeon, made significant contributions to neurosurgery, beginning with his successful brain tumor resection in 1879. Born in 1848, Macewen's upbringing in a maritime family fostered a practical approach to learning. Macewen's pivotal brain tumor surgery demonstrated his adherence to antiseptic practices and precise localization techniques. ⋯ Beyond neurosurgery, Macewen was innovative in asepsis, hernia repair, and bone surgery. His legacy as a clinical educator and advocate for surgical advancements earned him widespread recognition. This historical review aimed to explore and evaluate the published literature regarding Macewen's early brain tumor surgeries, seeking to establish his precedence over later surgeons including Godlee and Bennett.
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One of the pressing constraints in the treatment of arteriovenous malformations (AVM) is the potential development of new neurologic deficits, mainly when the AVM is in an eloquent area. The risk of ischemia when an en passage arterial supply is present is not negligible. In this regard, awake surgery holds promise in increasing the safety of low-grade AVM resection. ⋯ Awake craniotomies are safe procedures and may be helpful in avoiding ischemic complications in low-grade AVMs, either affecting eloquent areas and/or when en passage feeders are present.
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Full-endoscopic lumbar interbody fusion (FELIF) is a critical yet challenging procedure. However, extensive analyses of discectomy and cartilage endplate preparation techniques are limited. This can be attributed to the lack of universal protocols owing to diverse surgical practices and equipment preferences. ⋯ The approaches and techniques vary significantly among physicians, but overall, these instruments and techniques aim to achieve a safe and efficient disc-scraping outcome. Thus, this review may offer a comprehensive guidance to surgeons in selecting the most efficient practices for FELIF. Uniform procedural protocols are needed to ensure broader adoption and standardized practice.
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The potential advantages of exoscopy have been discussed theoretically for a long time. Such a concept holds significance, especially in the specific setting of the posterior cranial fossa (PCF), characterized by complex anatomy and long and narrow surgical corridors with relatively extreme working angles. We aimed to: 1) analyze the institutional preliminary case-based data on the use of the Robotic 3D Exoscope AEOS Aesculap in three different PCF approaches: retrosigmoid (RSA), midline suboccipital (MSA), and supracerebellar infratentorial via feedbacks was collected using a 20-point questionnaire, and 2) perform a comprehensive review of the literature concerning the use of EX in PCF surgery. ⋯ In conclusion, our study provides a comprehensive evaluation of the advantages and challenges associated with using the exoscope in posterior fossa surgery, setting a precedent as the first to report on a questionnaire-based analysis of exoscope utilization in this specific domain.