World Neurosurg
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Biportal endoscopic spine surgery is gaining popularity in managing degenerative lumbar diseases and has optimal indications and contraindications. The perioperative complications related to the biportal endoscopic approach affect the postoperative outcomes. Therefore, this study aimed to review the indications, contraindications, and complications of biportal endoscopic decompression for lumbar stenosis. ⋯ Favorable indications for a biportal endoscopic approach are central lumbar, lateral recess, foraminal, extraforaminal stenoses, and the Bertolotti syndrome. Incidental durotomy and postoperative epidural hematomas are common complications of biportal endoscopic decompression.
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Case Reports
Acute Spinal Hemorrhage from a Cauda Equina Arteriovenous Fistula Fed by the Proximal Radicular Artery.
Spinal cauda equina arteriovenous fistulas (CEAVFs) and spinal hemorrhage from spinal AVF are relatively unusual. To our knowledge, such a case of CEAVF presenting with hemorrhage has not been reported. Here, we describe such a rare case of CEAVF. ⋯ CEAVF presenting with spinal hemorrhage is extremely rare. This case demonstrated the angioarchitecture features of CEAVF. The clinicians should be aware of the possibility of this condition and the importance of treatment selection.
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Laser interstitial thermal therapy (LITT) is a minimally invasive ablative technique with specific indications for neuro-oncology, especially in the case of lesions in eloquent areas. Even being performed through a small catheter under stereotactic conditions, the risk of damaging vital structures such as white matter tracts or cortical eloquent areas is not negligible. The mechanism of damage can be related to catheter insertion or to excessive laser ablation. An accurate preoperative workup, aimed at locating the eloquent structures, can be combined with a real-time intraoperative neurophysiologic monitoring to reduce surgical morbidity while maximizing the efficacy of LITT. ⋯ An integrated approached guided by neurophysiology is able to reduce the surgical morbidity even in a relatively accurate technique such as LITT. To the best of our knowledge, this represents the first report on this synergistic approach which could really impact the treatment of tumors in eloquent areas. Future studies are needed in the effort to implement this approach in functional or epilepsy neurosurgery as well.
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Facial nerve (FN) schwannomas are extremely rare. According to their origin and involved segment(s), they constitute distinct subtypes. Intact FN function presents a management challenge, particularly in the cerebellopontine angle cisternal subtype that masquerades as a vestibular schwannoma. Fascicular-sparing technique with subtotal resection can maintain a good FN function. This study focuses on management to maintain good FN function. ⋯ FN schwannomas management is individualized according to the subtype and the FN function at presentation. When FN function is normal, observation can be applied for prolonged period of time. At the early sign of deterioration, sub- or near-total resection with fascicle sparing technique can be performed. The cisternal subtype masquerade as vestibular schwannoma and should be recognized at the initial exposure by the appearance of finely splayed nerve fascicles at the perimetry of the tumor which elicits a motor response at low threshold stimulation.
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Klinger's fiber dissection technique is widely used for studying the anatomy of white matter. Herein, we present a technical description of Klinger's proposed fiber dissection algorithm with neuronavigation assistance which allows for a more accurate determination of the projection of association fibers. ⋯ Electromagnetic navigation is an accurate and useful technique. It allows the researcher the ability to virtually project the association fibers and their cortico-cortical terminations to the surface of the brain, even at the final stages of dissection when the superficial structures are removed. To obtain accurate targeting, it is important to use the appropriate neuronavigation protocol.