World Neurosurg
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This study aimed to determine the effects of sacral nerve electrical stimulation (SNS) on neuronal nitric oxide synthase (nNOS) in the colon and sacral cord of rats with defecation disorder after spinal cord injury (SCI). ⋯ SNS could reduce nNOS expression in the colon and sacral cord of SCI rats. This reduction may be an important neuromodulation mechanism for SNS to improve defecation reflex and promote the recovery of intestinal transit function.
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Excision through craniotomy is used for pediatric craniopharyngioma removal. However, residual tumors can sometimes be found in the blind spot of the microscopic field, such as the third ventricle wall, back of the optic chiasm, and brainstem surface, during surgery. Video 1 demonstrates the surgery using a flexible endoscope for the removal of residual tumor located within the blind spot of the first resection. ⋯ Recurrence may occur following even a presumed total excision and radiation therapy. Residual tumors located in the third ventricle are resected through various approaches, such as the transsphenoidal or transcallosal approach. Our approach using a flexible endoscope was minimally invasive and useful for the removal of residual tumor of the third ventricle in craniopharyngioma surgery because the approach offered a wide field of view and visual angle and forceps could be applied according to the view.
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Case Reports
Resection of Pontine Cavernoma with the Hemorrhage via Unilateral Uvulotonsillar Keyhole Approach.
The telovelar approach and its modifications are widely used to remove lesions of the fourth ventricle and brainstem. We offer a variant of a unilateral uvulotonsillar approach, which is performed using an open-door keyhole suboccipital craniotomy (Video 1). A 56-year-old woman presented with symptoms of 2 months' duration. ⋯ The attached bone flap was then turned upward and reattached using nonresorbable sutures. Postoperatively, the patient had resolution of sensory and motor disturbances on the right half of the body, and coordination was improved in the left limbs. Postoperative imaging confirmed complete removal of the lesion.
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Arterial supply of the spinal cord is derived from the anterior spinal artery (ASA) and 2 posterior spinal arteries. In the thoracic spine, a few segmental arteries give origins to radiculomedullary arteries (RMAs) that supply the ASA and posterior spinal arteries.1 In the lower thoracic spine, the supply is provided by the Adamkiewicz artery. Spinal meningiomas may be embedded and/or supplied by the RMA, which may be sacrificed to obtain complete resection. ⋯ The clipping test with MEP monitoring is a useful and simple intraoperative tool to identify the critical afferents of the ASA. It doesn't require planification or supplementary materials. Further study might be performed to validate the technique.