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- Agosti, Edoardo, et al.
(författare)
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Quantitative Anatomic Comparison of Endoscopic Transnasal and Microsurgical Transcranial Approaches to the Anterior Cranial Fossa
- 2022
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Ingår i: Operative Neurosurgery. - : Congress of Neurological Surgeons. - 2332-4252 .- 2332-4260. ; 23:4, s. e256-e266
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Several microsurgical transcranial approaches (MTAs) and endoscopic transnasal approaches (EEAs) to the anterior cranial fossa (ACF) have been described.OBJECTIVE: To provide a preclinical, quantitative, anatomic, comparative analysis of surgical approaches to the ACF.METHODS: Five alcohol-fixed specimens underwent high-resolution computed tomography. The following approaches were performed on each specimen: EEAs (transcribriform, transtuberculum, and transplanum), anterior MTAs (transfrontal sinus interhemispheric, frontobasal interhemispheric, and subfrontal with unilateral and bilateral frontal craniotomy), and anterolateral MTAs (supraorbital, minipterional, pterional, and frontotemporal orbitozygomatic approach). An optic neuronavigation system and dedicated software (ApproachViewer, part of GTx-Eyes II—UHN) were used to quantify the working volume of each approach and extrapolate the exposure of different ACF regions. Mixed linear models with random intercepts were used for statistical analyses.RESULTS: EEAs offer a large and direct route to the midline region of ACF, whose most anterior structures (ie, crista galli, cribriform plate, and ethmoidal roof) are also well exposed by anterior MTAs, whereas deeper ones (ie, planum sphenoidale and tuberculum sellae) are also well exposed by anterolateral MTAs. The orbital roof region is exposed by both anterolateral and lateral MTAs. The posterolateral region (ie, sphenoid wing and optic canal) is well exposed by anterolateral MTAs.CONCLUSION: Anterior and anterolateral MTAs play a pivotal role in the exposure of most anterior and posterolateral ACF regions, respectively, whereas midline regions are well exposed by EEAs. Furthermore, certain anterolateral approaches may be most useful when involvement of the optic canal and nerves involvement are suspected.
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| 2. |
- Kristiansson, Helena, et al.
(författare)
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Dura Management Strategies in the Surgical Treatment of Adult Chiari Type I Malformation : A Retrospective, Multicenter, Population-Based Parallel Cohort Case Series
- 2022
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Ingår i: Operative Neurosurgery. - : Lippincott Williams & Wilkins. - 2332-4252 .- 2332-4260. ; 23:4, s. 304-311
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Symptomatic Chiari I malformation is treated with suboccipital decompression and C1 laminectomy. However, whether the dura should be opened (durotomy) or enlarged with a graft (duraplasty) remains unclear. OBJECTIVE: To compare outcomes in adult Chiari I malformation patients treated with duraplasty, durotomy, or without dural opening ("mini-decompression").METHODS: A retrospective, multicenter, population-based cohort study was performed of all adult patients surgically treated for a Chiari I malformation at 3 regional neurosurgical centers between 2005 and 2017. Three different dura management strategies were favored by the participating hospitals, with data stratified accordingly. The primary outcome was measured using the Chicago Chiari Outcome Scale (CCOS), dichotomized into favorable (CCOS >= 13) or unfavorable (CCOS <= 12). Propensity score matching was used to adjust for potential confounders in outcome comparisons.RESULTS: In total, 318 patients were included, of whom 52% were treated with duraplasty, 37% with durotomy, and 11% with mini-decompression. In total, 285 (90%) showed a favorable surgical outcome (CCOS >= 13). Duraplasty was associated with more favorable CCOS and shorter hospital stay compared with durotomy, both in unadjusted (93% vs 84%. P = .018 and 6.0 vs 8.0 days, P < .001) and adjusted analyses (92% vs 84%, P = .044 and 6.0 vs 8.0 days, P < .001). Mini-decompression was excluded from the adjusted analyses because of its small sample size.CONCLUSION: In this study of adult Chiari I malformation, posterior fossa decompression with duraplasty was associated with more favorable postoperative outcome, as determined by the CCOS, compared with posterior fossa decompression with durotomy alone.
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| 3. |
- Trang, Jason, et al.
(författare)
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Microscopic Unilateral Laminotomy for Bilateral Decompression : 2-Dimensional Operative Video
- 2022
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Ingår i: Operative Neurosurgery. - : Lippincott Williams & Wilkins. - 2332-4252 .- 2332-4260. ; 22:4, s. e162-e163
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- The open laminectomy for treatment of lumbar spinal stenosis was first described by Verbiest(.1) Although efficacious, it may result in postoperative instability because of violation of the posterior ligamentous complex, pain from a larger incision and greater muscle dissection, and atrophy of the paraspinal musculature. Several less invasive techniques have been developed to mitigate these effects.(2-4) The unilateral laminotomy for bilateral decompression (ULBD) involves a midline incision with unilateral exposure and muscle dissection. This allows the preservation of posterior midline tension band structures, resulting in comparable outcomes with open laminectomy, but with decreased blood loss and a shorter length of stay.(5-7) It seems to be effective in patients with and without degenerative spondylolisthesis.(8-10)Here, we present the case of an 80-year-old man with multiple medical comorbidities who presented with neurogenic claudication and bilateral leg pain. Imaging demonstrated diffuse lumbar spondylosis, with severe central canal and bilateral subarticular stenosis at L4/5 because of disk, facet, and ligamentum flavum pathology, in addition to a grade 1 spondylolisthesis at that level. Given his age, comorbidities, and subtle spondylolisthesis, a minimally invasive approach was chosen. The patient consented to the procedure. A microscopic unilateral laminotomy for bilateral decompression was performed. The patient was discharged on the first postoperative day and had no postoperative opioid requirement. He had complete resolution of his neurogenic claudication symptoms postoperatively.The microscopic ULBD is a safe and effective option for decompression of lumbar spinal stenosis, where a conventional open laminectomy or fusion approach is not indicated. Image at 5:06 used by permission from CCC: Springer Nature, Acta Neurochir (Wien), Unilateral laminotomy for bilateral decompression of lumbar spinal stenosis. Part I: Anatomical and surgical considerations, Spetzger et al, 2 (c) 1997 (doi: 10.1007/BF01808872.) Top image at 5:17 from Hong et al,3 (c) Lippincott Williams & Wilkins, Inc., used with permission.
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