ACTA NEUROCHIRURGICA

Long-term outcomes following posterior fossa decompression in pediatric patients with Chiari malformation type 1, a population-based cohort study
El-Hajj VG, Öhlén E, Sandvik U, Pettersson-Segerlind J, Atallah E, Jabbour P, Bydon M, Daniels DJ, Elmi-Terander A and Edström E
Posterior fossa decompression for Chiari malformation type I (Chiari 1) is effective and associated with a low risk of complication. However, up to 20% of patients may experience continued deficits or recurring symptoms after surgical intervention. For pediatric patients, there are no established tools to predict outcomes, and the risk factors for unfavorable postoperative outcomes are poorly understood. Hence, our aim was to investigate baseline data and early postoperative predictors of poor outcomes as determined by the Chicago Chiari outcome scale (CCOS).
Sequential adaptive e-learning and hands-on simulator training for unilateral biportal endoscopy (UBE) of the lumbar spine - results from an EANS Young Neurosurgeons hands-on course
Motov S, Santander X, Stengel FC, Mohme M, Schwake M, Zoia C, Butenschoen VM, Bauer M, Lippa L, Belo D, Kaprovoy S, Lepič M, Stastna D, Drosos E, Spiriev T, Giamundo M, Torregrossa F, Aldea C, Raffa G, Ostendorp C, Bozinov O and Stienen MN
Unilateral biportal endoscopy (UBE) is a minimally invasive surgical (MIS) technique utilized for lumbar decompression, which has recently gained popularity in Europe. We aimed to explore the value of sequential adaptive e-learning, followed by simulator-based hands-on training modules for UBE at the occasion of the 2024 EANS Young Neurosurgeons meeting.
Triangular titanium implants for sacroiliac joint fusion
Rainov NG, Schneiderhan R and Haritonov D
The sacroiliac joint (SIJ) is a common source of chronic low back pain. Published cohorts have reported favorable outcomes after SIJ fusion. We report the 12-month follow-up from SIJ fusion of the so far largest single-center and single-surgeon group.
Risk score for early prognostication of aseptic bone flap necrosis
Barthel L, Hetze S, Gembruch O, Chihi M, Oppong MD, Ahmadipour Y, Dammann P, Sure U and Jabbarli R
Aseptic bone flap necrosis (ABFN) is a common complication of autologous cranioplasty that often requires reoperation. This study aimed to create a risk score for ABFN using relevant demographic, clinical, and laboratory markers.
Endonasal surgery high-risk carotid injury timeout checklist: implementation, institutional protocol and experience
Barkhoudarian G, Pahlevani M, Ratnam S, Mallari RJ, Griffiths C and Kelly DF
Carotid artery injury is a rare, but major complication of endonasal operations. The morbidity and mortality of such a complication can be mitigated by preparedness and a clear plan set in place to address the hemorrhage expeditiously. This study examines the implementation of such a carotid injury timeout checklist and demonstrates its effectiveness in a patient with possible arterial injury.
Different types of combined endoscopic and transcranial approaches for complex giant pituitary adenomas: how I do it
Shen A, Zhou D, Min Y, Lyu L and Zhou P
Surgery for giant pituitary adenomas (GPAs) poses significant challenges, particularly when the tumor cannot be fully addressed using either the endoscopic endonasal approach (EEA) or the microscopic transcranial approach (MTCA) alone.
Gamma Knife Radiosurgery for symptomatic eloquently deep-seated cystic pilocytic astrocytoma mural nodules: Retrospective case series of effective outcomes
Hafez RFA, Fahmy OM, Hassan HT and Ganz JC
Although most pilocytic astrocytomas grow slowly, their progression in critical sites such as the brainstem or hypothalamus may prove fatal much more rapidly. Cystic progression may be more problematic than solid tumor. Patients with progressive cystic PAs located in eloquent deep areas of the brain are the best candidates for stereotactic radiosurgery.
How I do it: spine jack expansion kyphoplasty for AO spine A4 complete burst fracture with neurological deficit
Beucler N
Some patients suffering from thoracolumbar complete burst fracture causing neurological deficit may be eligible for single-stage posterior-only three column reconstruction with spine jack expansion kyphoplasty.
Comment: how do I do it? Real-time three-dimensional robotic C-arm navigation for ventriculoperitoneal shunting
Van Der Veken J
How I do it: Surgical interruption of high-flow dural arteriovenous fistulas at the foramen magnum region
Egashira Y, Kumagai M, Enomoto Y and Izumo T
Dural arteriovenous fistulas (dAVFs) in the foramen magnum region (FMR) are rare entity of dAVFs. There is no established treatment for FMR-dAVFs owing to their rarity and anatomical complexity. Herein, we report cases of high-flow dAVFs located at the posteromedial part of the FMR that were successfully treated by surgical interruption.
Frail patients require Longer Fusions for Success following Adult Cervical Deformity Surgery
Onafowokan OO, Galetta M, Lorentz N, Yung A, Fisher MR, Shah NV, Diebo BG, Daniels AH, Paulino CB and Passias PG
Adult cervical deformity (ACD) surgery is more frequently being performed in frail patients. Although surgical outcomes are largely successful, there remains significant risk of poor outcomes. The ideal length of fusion constructs in these patients remains debatable.
Early osteointegration in "one-step" resection and reconstruction using porous hydroxyapatite custom implants for skull-infiltrating tumors: a monocentric prospective series
Messina R, Speranzon L, de Gennaro L, Nigri EM, Dibenedetto M, Bozzi MT, Delvecchio C and Signorelli F
Early reconstruction of the skull represents the gold standard after resection of bone infiltrating cranial tumors. Customized hydroxyapatite porous ceramics are an excellent option for covering skull bone defects. The authors illustrate the surgical technique and investigate the effectiveness of the "one-step" procedure in terms of aesthetic results and early degree of osteointegration.
Pushing the boundaries of endoscopic surgery: the extended transodontoid approach for craniovertebral junction pathologies. Comprehensive technique description and comparative result
Yasuda ME, Nguyen T, Moore J, Sommer D and Reddy K
The craniovertebral junction (CVJ) is susceptible to diverse pathologies. While the transoral-transpharyngeal approach has been the primary method for addressing anterior CVJ conditions, it carries significant morbidity. Endoscopic endonasal approach (EEA), has emerged as a Minimally invasive option. However, EEA has potential limitations in providing adequate caudal exposure. This study aims to evaluate the feasibility of enhancing caudal exposure to the endoscopic transodontoid (TO) approach by drilling the posterior part of the central hard palate, thus achieving an extended endoscopic approach to odontoid (ETO) and to compare the accuracy of predictive lines, (Nasopalatine line (NPL), Nasoaxial line (NAxL), and Rhinopalatine line (RPL)) in predicting the caudal limit of the approach.
Virtual reality for patient informed consent in skull base tumors and intracranial vascular pathologies: A pilot study
Westarp E, Saemann A, Zelechovski M, Faludi B, Cattin P, Soleman J and Guzman R
With the growing demand for shared decision-making and patient-centered care, optimal informed consent (IC) has gained relevance. Virtual reality (VR) has seen significant technological advancements, and its medical applications currently include surgical planning and medical education. This pilot study investigates the feasibility of VR-enhanced informed consent (VR-IC) in neurosurgery to improve preoperative IC and patient satisfaction.
Technical challenges and outcomes of stereotactic biopsies in the posterior fossa: Experience with ZD-inomed and leksell vantage frames
Prilop I, Sobottka SB, Buszello C, Eyüpoglu IY and Polanski WH
Stereotactic brain biopsies are essential for obtaining tissue samples from brain lesions, crucial for comprehensive histological analysis and subsequent adjuvant therapies. While most biopsies target supratentorial lesions, those involving the posterior fossa are less frequent but pose significant technical and surgical challenges, necessitating careful patient management.
Real-time intraoperative ultrasound imaging of the posterior pituitary gland during endoscopic endonasal approach
Juncker RB, Finger G, Damante MA, Prevedello LM, Prevedello DM and Wu KC
Pituitary adenomas are amongst the most common benign central nervous system tumors, and often require resection via an endoscopic endonasal approach (EEA). Two of the most common associated complications are central diabetes insipidus (DI) and syndrome of inappropriate antidiuretic hormone secretion (SIADH). Both are thought to be caused by manipulation of the posterior pituitary gland (PPG), making intraoperative visualization and preservation of this structure critical. Intraoperative endoscopic endonasal ultrasound (IEUS) may present an optimal tool for this purpose. This study aims to describe the appearance and morphology of the PPG on IEUS.
Volumes and velocities: Meta-analysis of PC-MRI studies in normal pressure hydrocephalus
Whitley H, Skalický P, Zazay A, Bubeníková A and Bradáč O
PURPOSE  : Phase contrast magnetic resonance imaging (PC-MRI) represents an opportunity to non-invasively investigate cerebral spinal fluid (CSF) flow in patients with idiopathic normal pressure hydrocephalus (iNPH). Studies in recent years have explored the diagnostic and prognostic value of PC-MRI derived parameters. This review aims to identify all PC-MRI studies of iNPH published since 2010, synthesise a review based on collated results, and analyse specific flow parameters identified in the selected studies.
Intensive 2-days training on perfused human placenta for microvascular anastomoses
Colombo E, Wolf F, Helg F, Höbner L, Watson JA, Sebök M, Haslinger C, van Doormaal T, Regli L and Esposito G
We report on an intensive two-day training program on microanastomoses performed on perfused human placenta models. A specific scoring system was elaborated to evaluate the participants' microsurgical skills and report the participants' results.
Surgical management of spinal dural arteriovenous fistulae: systematic review of current practices and open questions
Garcia-Garcia S, Barić H and Niemelä M
Spinal dural arteriovenous fistulae(sDAVF) represent the most common spinal vascular malformation. Therapeutic strategies include both surgical and endovascular approaches. Surgical interruption of the fistula is crucial to prevent the onset and progression of neurological symptoms. Despite a range of surgical techniques, little research has evaluated their relative efficacy. This review aims to summarize the available surgical techniques and identify open questions for future research.
Spontaneous brain abscess formation: challenge of a shifting pathogen spectrum over the last 21 years - a single center experience
Kraus LM, Overstijns M, Rahal AE, Behringer S, Buttler KJ, Andereggen L, Beck J, Schnell O, Hornuss D, Wagner D and Cipriani D
Spontaneous intracerebral abscess formation is a rare condition presenting with a disabling sequela. The origin of infection can either be primary or secondary to an infection at another location. The site of primary infection - due to the proximity, often the oral cavity, the sinuses, and the orbit - determines the causative pathogens. Treatment often combines surgical and antimicrobial therapies. To determine the microbiology and respective changes and treatment outcome, we performed this retrospective monocentric cohort study of patients requiring surgical treatment of brain abscesses.
Radiation exposure and safety in low-dose CT-guided glycerol rhizotomy for trigeminal Neuralgia outside the operating room
Dostal J, Baxa J, Stepankova J, Seidl M, Mracek J, Lavicka P, Malkus T and Priban V
Percutaneous rhizotomy of the Gasserian ganglion is a well-established intervention for patients suffering from refractory trigeminal pain, not amenable to pharmacological management or microvascular decompression. Traditionally conducted under fluoroscopic guidance using Hartel's technique, this study investigates a modified approach employing low-dose CT guidance to achieve maximal procedural precision and safety with the emphasis on minimizing radiation exposure.