World Neurosurg
-
Multisession staged stereotactic radiosurgery (SRS) represents an alternative approach for management of large brain metastases (LBMs), with potential advantages over fractionated SRS. This study investigated clinical efficacy and safety of 2-stage stereotactic radiosurgery (2-SSRS) in patients with LBMs. ⋯ Our study supports the effectiveness and safety of 2-SSRS as a treatment modality for patients with LBMs, especially in poor surgical candidates. The local failure rate and low occurrence of adverse effects are comparable to other staged radiosurgery studies.
-
Malignant ischemic stroke (MIS) occurs in a subgroup of patients with cerebrovascular accident who sustain massive or significant cerebral infarction. It is characterized by neurological deterioration owing to progressive edema, raised intracranial pressure, and cerebral herniation. Decompressive craniectomy (DC) is a surgical technique that can be used to treat select cases of this condition in the presence of medically refractory intracranial hypertension. This study aimed to identify prognostic factors associated with clinical outcome, including timing of the procedure, and postoperative mortality. ⋯ Patients in whom more time passed from presentation to the neurosurgical procedure, owing to living in a distant city or taking more time to be seen by a specialist, tended to have a worse prognosis. The timing of procedure, surgical side, and hospitalization length were independent predictors in determining the prognosis of patients who underwent DC after an MIS.
-
In order to mitigate the challenges in microsurgical skill acquisition and training, especially in the COVID-19 era, we devised a novel microsurgical telementoring protocol for imparting microsurgical skill training in a socially distanced setting. We objectively analyzed its feasibility among neurosurgical trainees. ⋯ Telementoring is a viable alternative for neurosurgical resident training in the COVID-19 era, where reduction in elective surgeries and social distancing norms preclude conventional teaching. Lazy glass microsurgical simulator-based structured telementoring protocol is a cost-effective tool to augment surgical proficiency and finesse, irrespective of stage of residency.
-
Case Reports
Microsurgical Clipping of a Post-Coiling, Residual or Recurrent, Ruptured Anterior Communicating Artery Aneurysm.
Endovascular treatment modalities for intracranial aneurysms have seen a significant increase in popularity since the initial advent of the Guglielmi detachable coils in the early nineties.1 The publication of the International Subarachnoid Aneurysm Trial (ISAT) in addition to significant improvement in catheter and coil technology further cemented the endovascular-first approach, specifically for ruptured aneurysms.2 However, the increase in aneurysm coiling also led to a heightened awareness of its shortcomings, namely a significantly greater rate of recurrence and need for retreatment.3 The Cerebral Aneurysm Rerupture After Treatment (CARAT) study revealed that even though the rate of rerupture is low with both microsurgical and endovascular treatment modalities, the rate of rerupture is greater with incomplete versus complete aneurysm occlusion.4 Previously coiled aneurysms can be challenging to treat. While in some cases further endovascular therapies can be performed, microsurgical clipping remains a compelling alternative, specifically for small recurrent or residual ruptured aneurysms. However, microsurgical clipping of previously coiled aneurysms presents its own set of unique challenges. ⋯ In addition, coil extrusion, which is often misdiagnosed as coil compaction on diagnostic imaging and therefore underreported, can further increase the risk of microsurgical dissection. In this operative video, we present a case of a postcoiling, residual or recurrent, ruptured anterior communicating artery aneurysm successfully treated through microsurgical clipping. The patient consented to the procedure as shown in this operative video (Video 1) and gave informed written consent for use of her images in publication.
-
Selective dorsal rhizotomy (SDR) has been a well-established neurosurgical treatment option for ambulatory children with spastic diplegic cerebral palsy to reduce spasticity. Outcomes for SDR for spastic lower extremity hemiparesis has been less well described. In our experience, hemi-SDR has been an excellent intervention for children with suboptimal spasticity control despite maximizing pharmacologic and chemodenervation treatments. ⋯ He also demonstrated a step length ratio closer to 1 (0.89) showing a more equal step length bilaterally and improved weight acceptance on the affected side. There were no changes observed on the left upper extremity. This positive outcome on spasticity control and function supports the need for further prospective studies for hemi-SDR as a treatment option for children with spastic hemiparesis.