World Neurosurg
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This work aims to describe the evolution of the video-assisted Thoracoscopic Surgery (VATS) approach from a multiportal access to a biportal access for thoracic herniated disc surgery. Thoracic disc herniation remains a challenging pathology for spine surgeons. VATS of the thoracic spine was described in the 90s and represented an important technical leap by including minimally invasive options for thoracic pathology. Nowadays, VATS in thoracic surgery tends to evolve towards an even less invasive technique, from a multiportal approach to a biportal one. ⋯ This access allows the surgeon to manipulate the instrumentation confidently and the camera does not fog up as often. Extracting a piece of rib is unnecessary and theoretically, we only manipulate 1 or at most 2 intercostal nerves, so the patient's recovery is favorable.
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Chronic subdural hematoma (CSDH) is a prevalent neurosurgical condition that is known to recur and that leads to unfavorable clinical outcomes. Middle meningeal artery embolization (MMAE) has emerged as an alternative treatment to prevent recurrence. This study investigated the efficacy of combined 2 therapies in a hybrid operative suite for high-risk patients. ⋯ In our initial case experiences, one-stage burr hole surgery and adjuvant MMAE for treating chronic subdural hematoma in a hybrid operative angiography suite could be a feasible and effective treatment modality.
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Case Reports
MALIGNANT TRANSFORMATION OF PREVIOULSY RADIATED VESTIBULAR SCHWANNOMA: 2D operative video.
Malignant transformation of vestibular schwannomas (VSs), though rare,1 demands a comprehensive, multidisciplinary treatment approach to optimize patient outcomes.2 We present a rare case of malignant transformation in a VS after radiation treatment in a 58-year-old woman (Video 1). Initially diagnosed with a right cerebellopontine angle VS, the patient underwent CyberKnife (Accuray, Madison, Wisconsin, USA) treatment 16 years ago, receiving 18 Gy across 3 fractions. Despite initial stability, the patient experienced progressive hearing loss, ultimately requiring a bone-anchored hearing aid implant. ⋯ This case underscores the importance of vigilant monitoring for patients with VS, particularly patients with rapid symptom progression and tumor growth, highlighting the crucial role of adjuvant radiotherapy in treatment regimens. This study received institutional review board approval. The patient provided informed consent for the use of their image and information.
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Case Reports
3D-exoscope-assisted occlusion of a foraminal intradural left L5-S1 arteriovenous fistula - Operative Video.
Spinal dural arteriovenous fistulas (dAVFs) are a rare type of spinal lesion that can cause severe clinical consequences.1 Early and accurate diagnosis and treatment are crucial to avoid severe complications such as radicular pain, weakness, sensory deficits, and loss of bowel and bladder control.2 Spinal dAVFs are commonly found in the lower thoracic or upper lumbar vertebrae. Spinal dAVFs are the most common spinal vascular malformations, of unknown cause, accounting for 70%-85 % of spinal shunts, with an annual incidence of 5-10 cases/1,000,000.3 Recently, they have been classified into extradural and intradural types, which may be further divided into dorsal and ventral lesions.4,5 Spine magnetic resonance imaging (MRI) is the most performed imaging study for suspected dAVF diagnosis.1 Catheter digital subtraction angiography (DSA) represents the gold-standard diagnosing technique. It provides critical information about the anatomy of the lesion, arterial inflow vessels, venous outflow, and endovascular treatment feasibility. ⋯ Endovascular embolization might be safe and efficient, with high success rates, for selected vascular lesions.7,8 This video presents a rare case of left L5-S1 dAVF, surgically occluded with the aid of a three-dimensional (3D) exoscope (Video 1). There is little evidence about the application of the 3D exoscope in spinal vascular microsurgery, whereas it has been widely used and described in cranial surgery and spinal, degenerative, tumor, and traumatic surgery.9 In our experience, the advantages of this operating tool are the sharp color vividness, which allows adequate discrimination of anatomic structures, the distinct depth perception, the educational value for operating room attendants, and the ergonomics for surgeons. Ergonomics for surgeons, especially, is optimally adapted to spinal surgery, given the contraposed placement of surgeons and the disposition of screens during the operating procedure.
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Preoperative diagnoses of psychiatric disorders have a demonstrated association with higher rates of perioperative complications. However, recent studies examining the influence of psychiatric disorders on lumbar fusion outcomes are scarce. Our objective was to determine the relationship between the most common psychiatric disorders and perioperative outcomes after lumbar fusion. ⋯ Patients with depression, bipolar disorder, or anxiety exhibited higher rates of certain types of complications. However, they appeared to have fewer neurological injuries and wound complications than patients without these psychiatric disorders. These findings highlight the necessity for additional studies to elucidate underlying reasons for these disparities.