Neurosurgery
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Multicenter Study
Reconstructive Endovascular Treatment of Compensative-Flow-Related Posterior Circulation Aneurysms With Anterior Circulation Artery Occlusion.
The aim of this study was to delineate the reconstructive endovascular treatment and periprocedural management of compensative-flow-related posterior circulation aneurysms with anterior circulation artery occlusion. ⋯ Our study indicates that reconstructive endovascular treatments are feasible and effective strategies for compensative-flow-related posterior circulation aneurysms with anterior circulation artery occlusion. However, these treatments are associated with a risk of periprocedural ischemic complications, which can be reduced by collateral arterial assessment, appropriate periprocedural anesthesia management, and antiplatelet treatment.
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Image guidance has transformed minimally invasive spine surgery (MISS), allowing for safer procedures without excessive bony exposure and reducing radiation exposure for the surgical team. Robotic platforms have enhanced the benefits of navigation by providing high precision and accuracy. Here we describe a case series to demonstrate the accuracy and low complication rates of real-time image-guided robotic-assisted (RA) MISS at a tertiary referral center. In addition, we performed a narrative review on how robotics and navigation facilitate MISS. ⋯ Robotic platforms have further enhanced navigation benefits by providing high precision and accuracy, with low complication rates.
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Many patients with unruptured intracranial aneurysms (UIAs) remain untreated if the risk of treatment exceeds the estimated risk of aneurysm rupture, potentially leading to diagnosis-related stress and anxiety. Working status may serve as a marker for the total level of function including mental health and psychological burden of the condition. The aim of the study was to assess the working status before and after a diagnosis of an untreated UIA. ⋯ The work participation of patients diagnosed with UIA is low prediagnosis compared with the general population and decreases significantly postdiagnosis.
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Anterior lumbar interbody fusion (ALIF) is an established surgical approach for spinal fusion, offering distinct advantages in restoring lumbar lordosis, indirectly decompressing neural elements, and facilitating high fusion rates because of the increase in the fusion surface area. Traditionally, ALIF is performed with the patient in a supine position, necessitating repositioning for additional posterior interventions, which increases operative time, anesthetic time, and complexity. The recent development of single position lateral ALIF (SPL-ALIF) enables anterior and posterior access without repositioning, enables gravity facilitated retroperitoneal access, and optimizes surgical efficiency, particularly in cases necessitating multilevel anterior column fusion. ⋯ The technique may be less effective in cases requiring direct decompression or in patients with complex vascular anatomy or extensive retroperitoneal scarring. These challenges necessitate careful patient selection to optimize outcomes and minimize intraoperative risks. Future studies are warranted to validate the clinical benefits of SPL-ALIF, particularly concerning fusion rates, patient-reported outcomes, and complication profiles, thereby solidifying its role in the evolving landscape of minimally invasive spine surgery.
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Silent corticotroph adenoma (SCA) is a high-risk pituitary neuroendocrine tumor (PitNET) which exhibits more aggressive behavior than other nonfunctioning PitNETs. Some SCAs are observed to recur after total resection (TR). We aim to discuss the long-term outcomes after endoscopic endonasal surgery for SCAs and explore optimal treatment after operation. ⋯ CS invasion was commonly seen in SCAs, often precluding GTR. Radical surgery and close follow-up were proposed. Early postoperative adjuvant SRS for remnant tumor should be considered.