World Neurosurg
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Various nonvascularized or vascularized techniques have been adopted in endoscopic endonasal surgery (EES) for repairing intraoperative cerebrospinal fluid (CSF) leaks after tumor resection. Vascularized nasoseptal flaps, free nasoseptal grafts, free turbinate grafts, and fascia lata and mashed muscle are frequently used. Outcomes of those grafts applied in the defects of different regions need to be clarified. ⋯ Vascularized nasoseptal flap, free nasoseptal graft, free turbinate graft, and fascia lata and mashed muscle are reliable autologous materials for repairing the dural defects in different regions during EES. Clivus reconstruction remains a great challenge, which had a higher RFR and meningitis rate. Repair failure is significantly associated with postoperative meningitis.
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The aim of this study was to evaluate the occurrence and factors predisposing to delirium following brain tumor resection. ⋯ Many factors were associated with the occurrence of delirium after brain tumor resection. Therefore, clinicians should identify high-risk patients prone to delirium in a timely manner and take effective management measures to reduce adverse outcomes.
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This study compared the effectiveness of the endoscopic endonasal approach (EEA) with the conventional transcranial approach (TCA) for treating tuberculum sellae meningiomas (TSMs), aiming to identify the superior surgical method and the risk factors affecting outcomes. ⋯ EEA is a safe and effective treatment approach for small to medium TSMs, with outcomes comparable to TCA in terms of resection but superior in visual improvement and fewer complications. Selection of surgical approach should consider patient and tumor characteristics as well as surgeon experience.
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As value-based care grows in popularity across the United States, more payers have turned toward bundled payment models for surgical procedures. Though episode costs in spine are highly variable, physical therapy (PT) has been identified as a driver of 90-day cost. The goal of this study is to assess the impact of postoperative PT on patient-reported outcomes and cost after lumbar fusion surgery using bundled insurance data. ⋯ Our study finds that PT after lumbar fusion is not associated with significant improvement in Oswestry Disability Index, PCS, mental component score, or visual analog scale pain scores. Additionally, the number of PT sessions a patient attends has no correlation with improvement in these outcomes.
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Tubular retractors in minimally invasive lumbar stenosis permit surgeons to achieve satisfactory neural decompression while minimizing the morbidity of the surgical access.1-3 Transtubular lumbar decompression requires intraoperative image guidance and microscopic magnification to achieve precise and reproductible surgical results. Use of 2-dimensional image guidance in transtubular lumbar decompression has a major limitation due to the lack of multiplanar orientation. Consequently, there is a risk of incomplete decompression and excessive bone removal resulting in iatrogenic instability. ⋯ This tailors the bone resection to achieve adequate neural decompression while minimizing the risks of potential spine instability. After precise placement of the tubular retractor, bone removal and neural decompression are accomplished under robotic exoscope magnification with 4k 3D images. Using a 3D robotic exoscope (Modus V, Synaptive, Toronto, Canada) allows better tissue magnification and improves surgeon ergonomics during lumbar decompression through tubular retractors.5,6.