Neurosurgery
-
Tobacco use is known to affect incidence and postoperative outcome for several neurosurgical disorders, but its relationship to trigeminal neuralgia (TN) is not known. We sought to identify unique population characteristics that correlate with tobacco use in a cohort of patients with TN who underwent microvascular decompression (MVD), including effect on long-term postoperative outcome. ⋯ In patients undergoing MVD for TN, smoking is associated with younger age of TN onset, more widespread facial pain, and worse long-term postoperative outcome after MVD. These features suggest that TN in smokers may represent a more severe disease form compared with TN in nonsmokers with different responses to treatment.
-
Spinal chordomas are primary bone tumors where surgery remains the primary treatment. However, their low incidence, lack of evidence, and late disease presentation make them challenging to manage. Here, we report the postoperative outcomes of a large cohort of patients after surgical resection, investigate predictors for overall survival (OS) and local recurrence-free survival (LRFS) times, and trend functional outcomes over multiple time periods. ⋯ Surgeons must often weigh the pros and cons of en bloc resection and sacrificing important but affected native tissues. Our findings can provide a benchmark for counseling patients with spinal chordoma. Tumors ≥100 cm 3 appear to have a 5.89-times higher risk of recurrence, mobile spine chordomas have a 7.73 times higher risk, and neoadjuvant radiotherapy confers an 11.1 times lower risk for local recurrence. Patients age ≥65 years at surgery have a 16.70 times higher risk of mortality than those <65 years.
-
Multicenter Study Comparative Study
Transforaminal Full-Endoscopic Surgery for Lumbar Foraminal Pathologies: A Comparative Clinical Effectiveness Study.
Full-endoscopic surgery is increasingly used for treating lumbar foraminal pathologies, though the specific indications remain unclear. This study aims to evaluate patient-reported outcomes after transforaminal full-endoscopic spine surgery for various lumbar foraminal conditions. ⋯ Endoscopic foraminotomies result in clinically meaningful symptomatic improvement for most lumbar foraminal pathologies. However, the effectiveness of decompression surgery for vertical foraminal stenosis is limited and requires further investigation.
-
The transforaminal lumbar interbody fusion remains one of the most common surgical techniques used for spinal arthrodesis. Spine surgery over the last three decades has increasingly emphasized approaches that reduce tissue trauma, iatrogenic injury, and perioperative morbidity. ⋯ In this paper, the authors review the techniques and considerations underlying visualization within both methods, as well as provide summary of a hybrid system incorporating the advantages of both. Minimally invasive transforaminal lumbar interbody fusion modalities must be selected in accordance with patient factors to achieve optimal outcomes.
-
Symptomatic thoracic disc herniation (TDH) is relatively uncommon, and surgical management poses significant challenges owing to restricted anatomic corridors, limited space within the spinal canal, tenuous blood supply, and proximity to vital organs and vasculature. Calcified TDH adds further complexity, necessitating meticulous preoperative planning to determine the safest and most effective approach. ⋯ However, research specifically focusing on the efficacy of this technique remains limited. This narrative review examines the existing literature on the lateral retropleural approach, discussing reported outcomes, technical considerations, and potential challenges.