1,721,606 research outputs found
Is Full Endoscopic Lumbar Discectomy Less Invasive Than Conventional Surgery? A Randomized MRI Study
Full text linkBackground: In the present randomized prospective study, we compared the surgical invasiveness using a quantitative volumetric analysis of postoperative paravertebral muscle signal intensity changes between transforaminal full endoscopic lumbar discectomy (FELD) and open discectomy (OD). Methods: We prospectively collected the data from 50 patients with a single-level lumbar foraminal herniation, invalidating radicular pain, and adequate imaging studies available (postoperative magnetic resonance imaging [MRI] <24 hours). These patients had been randomly assigned to FELD (n = 25) or OD (n = 25). Data were collected on age, sex, leg and back pain, complications, and follow-up time. Muscle segmentations were performed manually using 3DSlicer software on postoperative isovolumetric T1-weighted contrast-enhanced and T2-weighted short tau inversion recovery MRI scans. Both sequences were processed using multiplanar reconstruction in orthogonal planes. The clinical and demographic characteristics and volumetric data were then compared between the 2 groups. Results: We found a higher mean volume of paravertebral muscle signal alterations among the OD-treated patients in both T2-weighted short tau inversion recovery MRI (P ≤ 0.001) and T1-weighted contrast-enhanced MRI (P ≤ 0.001) scans than among the FELD-treated patients. No differences were found between the median preoperative and postoperative leg pain between the 2 groups (P = 1.000). The median scores for postoperative back pain were significantly lower for the FELD group (P ≤ 0.001), as was the median interval from surgery to autonomous mobilization (P = 0.001). Conclusions: We found a significant difference in signal intensity of the paravertebral muscles between the FELD and OD groups, reflective of the minor surgical invasiveness of endoscopic discectomy. FELD resulted in less trauma to the paraspinal muscles, possibly also reducing inflammatory cytokine release and, therefore, is a valuable tool for spinal surgeons
Skin Glue for Wounds Closure in Brain Surgery: Our Updated Experience
No full textBackground: Traditional wound closure techniques include skin sutures and metal clips. Cyanoacrylate has good neovascularization, epithelialization, and antimicrobial activity properties and a fast application procedure. This study presents our long-term experience. Methods: We retrospectively selected 362 patients who underwent brain surgery from January 2007 to March 2017. Exclusion criteria were applied for repeat surgeries, emergency/posttraumatic procedures, wound infections, wounds longer than 16 cm, skull base cases, and postoperative patients who stayed in the intensive care unit more than 1 day. We collected data from 250 cases of supratentorial procedures and 112 cases of infratentorial procedures. The median wound length was 11 cm (range, 4–15 cm); the median age was 51 years. We followed-up all patients for 1, 3, and 12 months focusing on wound complications, cosmetic results, based on the Hollander Wound Evaluation Scale (HWES), and patient satisfaction using a visual analog scale. Results: Cosmetic results were very good (HWES score of 5–6) in 99.5% of cases at 12 months. Patient satisfaction reached almost 100% at 12 months. We experienced 2 cases of wound dehiscence and 2 others with poor cosmetic results. The main complaint was a feeling of discomfort, during the first 2 weeks after surgery, because of the dried glue along the wound's edges. Conclusions: With additional research, we can confirm that cyanoacrylate glue may be a valid and useful alternative to traditional techniques for wound closure in brain surgery, carrying several advantages. However, a randomized controlled trial with a large number of patients is warranted to confirm our findings
The prevention of deep venous thrombosis in neurosurgery: An update from our institution
Full text linkProphylactic low weight molecular subcutaneous heparin combined with mechanical devices and elastic stockings has already been correlated to a low incidence of deep venous thrombosis. However, there is still concern with the use of heparin in the neurosurgical field due to the potential hemorrhagic risks. We would like to update this topic with new data coming from a larger cohort of patients operated on at our Department in the last 8 years both for cranial and spinal procedures. We collected information on 5347 patients: 1497 were cranial and 3850 were spinal cases. We recorded 35 clinically symptomatic DVTs (0.6%) and 18 cases (0.3%) of hemorrhagic complications and no cases of pulmonary embolus. It is our opinion that the protocol we have implemented in our Unit for the prevention of deep venous thrombosis and pulmonary embolus is safe and effective and does not seem to increase the incidence of hemorrhagic complications
Endoscopic Approach Technique for Recurrent Lumbar Prolapsed Disc
No full textIntroduction: Recurrent disc after lumbar discectomy is not uncommon, with most of the patients requiring a new surgery. A greater bone decompression and scar tissue dissection become necessary with the new procedure, resulting in a higher chance of postoperative complications. Recently, many surgeons have begun to treat recurrent disc with endoscopic approaches, in order to reach the prolapsed disc avoiding tissue dissection. We present our up-to-dated experience on the treatment of recurrent disc by endoscopic technique.
Material and methods: We prospectively collected 30 patients treated for recurrent lumbar disc prolapse, from May 2016 to December 2017, with an endoscopic procedure. We collected data on age, sex, location, diagnosis, leg pain by VAS, and degree of disability via the Oswestry Disability Index (ODI), and if any adverse events occurred. All patients underwent an ODI (Oswestry Disability Index) and a VAS (Visual Analogue Scale) questionnaire before the operation and after 3, 6 and 15 months [3-6] at the follow-up visit. No patients were lost at follow-up.
Patients characteristics: Age at presentation ranged between 23 and 78 years with a male to female ratio of 1.5 to 1. The level treated more was L4-L5. In all cases, we performed transforaminal route access, except for two, where an interlaminar approach was necessary because of the disc fragment location. Twenty-six cases had been operated previously by microsurgical access and the remaining by an endoscopic technique. In one case the disc had recurred for a second time, requiring open revision surgery.
Results: Median operative time was 52 minutes (range 44 to 79 minutes). After a median follow up of 15 months (range 15-24 months) 93% of patients were pain-free. Pain by VAS ranged from a mean value of 6.3 at admission to 1.9 at 15 months of follow-up. ODI scores went from a mean preoperative value of 59.8% to 14.6% at the same follow- up. Four patients experienced transient paresthesia along the dermatomeric distribution of the involved nerve, while 3 had an intraoperative dural tear. One patient had to undergo new revision surgery for a disc recurrence. No late adverse events occurred.
Conclusions: Endoscopic discectomy might be a valuable procedure for recurrent lumbar disk prolapse treatment. Our results showed good outcomes with only a few transient complications and less postoperative pain. Also, iatrogenic mechanical instability might be avoided with this technique
Microsurgical Disconnection of Ruptured Intracranial Pial Arteriovenous Fistula Guided by Indocyanine Green Videoangiography
No full textIntracranial arteriovenous fistulas, rare causes of spontaneous intracerebral bleeding, are direct communications between an arterial feeder and an arterialized vein that drains a normal brain. Arteriovenous disconnection is the only effective treatment for this type of vascular malformation, which is often reached microsurgically due to the difficult endovascular access. Intraoperative indocyanine green videoangiography (ICG-VA) is a valuable help in identifying the arterialized draining vein and its direct communication with the arterial feeder and in confirming real-time interruption of the fistula. We describe the case of a 46-year-old man presenting with sudden onset of headache and left arm motor and sensory deficits associated with a frontoparietal hematoma evacuated 1 week earlier in another institution. Digital subtraction angiography showed a direct communication between an anterior parietal branch of the right middle cerebral artery and a parietal vein. Given the difficulty to reach the point of the fistula endovascularly because of the small caliber and tortuosity of the arterial feeder, as well as the short and relatively rapid flow through the arteriovenous communication, we decided to proceed with microsurgical treatment. Under intraoperative neurophysiologic monitoring the fistula was located with the aid of ICG-VA and interrupted (Video 1). Both control ICG-VA and postoperative angiogram confirmed resolution of the fistula. At a 3-month follow-up the patient had a complete neurologic recovery
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