World Neurosurg
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Paraspinal textiloma (ParaTex) is a well-known complication after posterior lumbar surgery. However, there are few articles on this topic, probably because of medicolegal concerns. In addition, patients with ParaTex can remain asymptomatic for months or even years unless it causes complications. The purpose of this study is to review our experience on this "undesirable" topic to increase awareness among spinal surgeons and radiologists and avoid unnecessary morbidity, which is still being encountered. ⋯ ParaTexs are more common in obese patients, after emergency surgery, and with unplanned changes in surgical procedure. On computed tomography scan, the classic spongiform appearance is highly suggestive. Magnetic resonance imaging findings are variable and less specific, but confrontation of imaging data with the surgical history helps with the preoperative diagnosis. In the early postoperative period symptoms are related to the exudative response; at later times symptoms may be linked to pseudotumor formation clinically and radiologically. Appropriate antibiotic therapy is recommended when a septic complication is present or suspected. Strict measures must be taken to prevent this complication. Surgical sponges should always be counted at least three times (preoperatively, at closure, and at the end), radiopaque markers should be used, and if there is doubt, intraoperative radiography must be performed.
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Lesions located in the pineal region represent a surgical challenge. Multiple approaches to this region have been described, each with its advantages and disadvantages. We report the first application of the endoscopic supracerebellar infratentorial approach for complete resection of a pineal tumor. Unlike transventricular endoscopy, this technique poses no risk to the fornices and can be applied independent of ventricular size. ⋯ Taking the advantages of the endoscope and peculiar supracerebellar infratentoria corridor, we could successfully remove the gross-total tumor without violating the critical neurovascular structures. Moreover, this approach can be performed regardless of the size of the ventricle. Consequently, it is an excellent minimally invasive surgical option for resection of symptomatic pineal tumor.
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Prompt access to arterial occlusion is the key to successful endovascular revascularization in acute stroke. We present the first reported case utilizing anterior-to-posterior circulation approach for a successful mechanical thrombectomy and chemical thrombolysis of an acute basilar artery (BA) occlusion using the Penumbra Aspiration System. ⋯ In patients with unfavorable VA anatomy, anterior-to-posterior thrombectomy of the BA can be successfully achieved using the Penumbra catheter via an anatomically suitable posterior communicating artery.
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The anterolateral approach is one of the main routes for accessing suprachiasmatic lesions involving the anterior communicating artery (AComA) complex. Pterional (PT) craniotomy and its alternatives, including orbitozygomatic, orbitopterional, and mini-supraorbital craniotomies, have been developed as tailored frontotemporal craniotomies. One of the main differences between PT craniotomy and its alternatives is the removal of the orbital bone along with the sphenoid wing. However, which bone part is the most important to remove has not been discussed in relation to frontal lobe retraction. We have evaluated how the removal of the supraorbital bar versus the removal of the lateral orbital wall along with the sphenoid wing affects the relationship between the levels of frontal lobe retraction and area of exposure (AOE) in the suprachiasmatic region. ⋯ Treatment of lesions in the suprachiasmatic region via an anterolateral route involving a frontotemporal craniotomy requires sufficient removal of the lateral orbital wall along with the greater sphenoid wing so that brain retraction is minimized.