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Acta Neurochir (Wien) 2020 Jul 4. Epub 2020 Jul 4.

Department of Neurosurgery, Klinikum Kassel, Moencheberg Str. 41-43, 34125, Kassel, Germany.

Background: Cerebrospinal fluid (CSF) shunting is a highly effective treatment for idiopathic normal pressure hydrocephalus (iNPH). However, secondary deterioration can occur at a later time. Thus, the current study aimed to evaluate the incidence rate and causes of secondary deterioration. Read More

Acta Neurochir (Wien) 2020 Jul 3. Epub 2020 Jul 3.

Department of Oncology, Center for Cancer and Organ diseases, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.

Background: After posterior fossa tumour surgery, up to 39% of children experience postoperative cerebellar mutism syndrome (CMS) characterized by mutism and other motor and cognitive impairments. There is a lack of knowledge on the patient-reported challenges and long-term needs. Consequently, no specific recommendations exist for rehabilitative and supportive interventions for patients with CMS. Read More

Acta Neurochir (Wien) 2020 Jul 2. Epub 2020 Jul 2.

Southern Tohoku Research Institute for Neuroscience, Fukushima, Japan.

We report the case of a patient with hypothalamic hamartoma (HH) who was successfully treated with magnetic resonance-guided focused ultrasound (MRgFUS) for ablation as a disconnection surgery. A 26-year-old man with gelastic epilepsy had been diagnosed with HH at 3 years of age, and antiepileptic drugs were administered due to worsening episodes. Magnetic resonance imaging showed a sessile parahypothalamic hamartoma and MRgFUS ablation was performed, creating an oval-shaped lesion at the boundary area of the HH. Read More

Acta Neurochir (Wien) 2020 Jul 2. Epub 2020 Jul 2.

Department of Neuroscience, Neurosurgery, University Hospital, Uppsala University, S-751 85, Uppsala, Sweden.

Background: The postoperative course after surgery for primary brain tumours can be difficult to predict. We examined the time course of postoperative neurological deficits and analysed possible predisposing factors.

Method: Hundred adults with a radiological suspicion of low- or high-grade glioma were prospectively included and the postoperative course analysed. Read More

Acta Neurochir (Wien) 2020 Jul 2. Epub 2020 Jul 2.

Department of Neurosurgery, Univ. Lille, CHU Lille, F-59000, Lille, France.

Background: For glial tumor management, the extent of resection (EOR) is the key to enhance tumor control and improve patient outcomes. Intraoperative MRI (IoMRI) neuronavigated microsurgery emerged as a useful neuroimaging tool for performing optimal and safe tumor resection.

Method: Here, we present the different steps of the microsurgical resection of a challenging deeply located right fronto-temporal glioma, using intraoperative MRI in an integrated IoMRI imaging platform. Read More

Acta Neurochir (Wien) 2020 Jul 1. Epub 2020 Jul 1.

Department of Neurosurgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA.

Background: Endonasal endoscopic transsphenoidal surgery (EETS) for pituitary adenoma has become a mainstay of treatment over the last two decades and it is generally accepted that once this learning curve is achieved, a plateau is reached with little incremental improvement.

Objective: The objective of this study was to assess the slope of the learning curve over a long period of time for a variety of outcomes measures.

Methods: We examined outcomes and complications in a consecutive series of 600 EETS for pituitary adenoma grouped into quartiles based on date of surgery. Read More

Acta Neurochir (Wien) 2020 Jun 30. Epub 2020 Jun 30.

Menzies Institute for Medical Research, Hobart, Tasmania, University of Tasmania, Hobart, Australia.

Background: Women are over-represented in aSAH cohorts, but whether their outcomes differ to men remains unclear. We examined if sex differences in neurological complications and aneurysm characteristics contributed to aSAH outcomes.

Methods: In a retrospective cohort (2010-2016) of all aSAH cases across two hospital networks in Australia, information on severity, aneurysm characteristics and neurological complications (rebleed before/after treatment, postoperative stroke < 48 h, neurological infections, hydrocephalus, seizures, delayed cerebral ischemia [DCI], cerebral infarction) were extracted. Read More

Acta Neurochir (Wien) 2020 Jun 30. Epub 2020 Jun 30.

Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.

Background: To provide age- and sex-specific incidence and case fatality rates for non-traumatic aneurysmal subarachnoid hemorrhage (aSAH) in Norway. We also studied time trends in incidence and case fatality, as well as predictors of death following aSAH.

Methods: A nationwide study using discharge data for patients admitted with aSAH between 2008 and 2014. Read More

Acta Neurochir (Wien) 2020 Jun 29. Epub 2020 Jun 29.

Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.

Background: The benefits of early surgery in cases of superficial supratentorial spontaneous intracerebral hemorrhage (ICH) are unclear. This study aimed to assess the association between early ICH surgery and outcome, as well as the cost-effectiveness of early ICH surgery.

Methods: We conducted a retrospective, register-based multicenter study that included all patients who had been treated for supratentorial spontaneous ICH in four tertiary intensive care units in Finland between 2003 and 2013. Read More

Acta Neurochir (Wien) 2020 Jun 27. Epub 2020 Jun 27.

Department of Neurosurgery, Rigshospitalet, 2092, Blegdamsvej 9, 2100, Copenhagen Ø, DK, Denmark.

Introduction: Chronic subdural hematomas (CSDH) show different radiological characteristics on CT scans at the time of diagnosis. The reason for this is largely unknown. We hypothesize that the imaging characteristics reflect a time-linked pathophysiological evolution. Read More

Acta Neurochir (Wien) 2020 Jun 26. Epub 2020 Jun 26.

Peripheral Nerve Surgery Unit, Division of Functional Neurosurgery, Department of Neurosurgery, Institute of Psychiatry, University of São Paulo Medical School, Rua Virgilio de Carvalho Pinto, 381 / apt. 42, São Paulo, SP, 05415-030, Brazil.

Background: There is no consensus about which type of imaging study, computed tomography myelography (CTM) or magnetic resonance imaging (MRI), provides better information concerning root avulsion in adult brachial plexus injuries.

Methods: Patients with upper brachial plexus traumatic injuries underwent both CTM and MRI and surgical exploration. The imaging studies were analyzed by two independent radiologists and the data were compared with the intraoperative findings. Read More

Acta Neurochir (Wien) 2020 Jun 26. Epub 2020 Jun 26.

Department of Neurosurgery, Karolinska Hospital, S-17176, Stockholm, Sweden.

Objectives: With regard to the generally slow growth of meningioma, it is essential to analyse clinical treatment results in a long-term perspective. The purpose of the present analysis is to provide clinical data after Gamma Knife radiosurgery of meningioma in a 10-year perspective together with a review of the current literature.

Methods: The current study is a retrospective analysis of 86 consecutive Swedish patients with meningiomas treated using Gamma Knife radiosurgery at the Karolinska Hospital Stockholm between March 1991 and May 2001. Read More

Acta Neurochir (Wien) 2020 Jun 25. Epub 2020 Jun 25.

Department of Neurosurgery, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.

Strengths and limitations of subdural versus subperiosteal drain location after burr hole evacuation of chronic subdural hematoma (CSDH) are currently debated. The safety of subdural placement of a drain has been questioned in a recent study by Soleman et al. from 2019, showing a misplacement rate of 17%, and these results have been further highlighted by the same authors, with a slightly lower misplacement rate of 15. Read More

Acta Neurochir (Wien) 2020 Jun 25. Epub 2020 Jun 25.

Department of Pediatric Neurosurgery, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.

Background: The strategy for surgical treatment of tethered cord syndrome in pediatric patients is well established but still bares challenges for adult patients. This retrospective study was performed to assess the surgical outcome of adult patients with a secondary tethered cord syndrome and to evaluate the benefit of intraoperative neuromonitoring.

Methods: Clinical charts of 32 consecutive adult patients who underwent in total 38 surgical untethering procedures at our facility between 2008 and 2018 were retrospectively analyzed. Read More

Acta Neurochir (Wien) 2020 Jun 25. Epub 2020 Jun 25.

Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden.

Background: Years after a traumatic spinal cord injury (SCI), a subset of patients may develop progressive clinical deterioration due to intradural scar formation and spinal cord tethering, with or without an associated syringomyelia. Meningitis, intradural hemorrhages, or intradural tumor surgery may also trigger glial scar formation and spinal cord tethering, leading to neurological worsening. Surgery is the treatment of choice in these chronic SCI patients. Read More

Acta Neurochir (Wien) 2020 Jun 25. Epub 2020 Jun 25.

Department of Neurosurgery, University Hospital Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tubingen, Germany.

Background: For the segmentation of medical imaging data, a multitude of precise but very specific algorithms exist. In previous studies, we investigated the possibility of segmenting MRI data to determine cerebrospinal fluid and brain volume using a classical machine learning algorithm. It demonstrated good clinical usability and a very accurate correlation of the volumes to the single area determination in a reproducible axial layer. Read More

Acta Neurochir (Wien) 2020 Jun 25. Epub 2020 Jun 25.

Department of Neurological Surgery, Universitaetsmedizin Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany.

Background: Cervical spondylotic myelopathy (CSM) is a degenerative process of the cervical spine requiring surgical decompression to prevent neurological deterioration. While both anterior and posterior approaches yield satisfactory results, posterior decompression is preferred in cases of the multilevel disease. In 2015, we described a muscle-sparing, novel technique of bilateral osteoligamentous decompression via hemilaminectomy (OLD) for CSM. Read More

Acta Neurochir (Wien) 2020 Jun 24. Epub 2020 Jun 24.

Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, WC1N 3BG, London, UK.

Background: The hydrodynamics of cerebrospinal fluid shunts have been described in vitro; however, knowledge on the response of intracranial pressure (ICP) to valve settings adjustments in vivo is limited. This study describes the effect of adjusting the shunt valve setting on ICP in a cohort of patients with complex symptom management.

Method: Single-centre retrospective observational study. Read More

Acta Neurochir (Wien) 2020 Jun 23. Epub 2020 Jun 23.

Royal Sussex County Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.

Background: Surgery for symptomatic Chiari type I malformation (CM-I) patients include posterior fossa decompression (PFD) involving craniectomy with or without dural opening, and posterior fossa decompression with duraplasty (PFDD). This review aims to examine the evidence to aid surgical decision-making.

Methods: A medical database search was expanded to include article references to identify all relevant published case series. Read More

Acta Neurochir (Wien) 2020 Jun 23. Epub 2020 Jun 23.

Department of Neurosurgery, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland.

Background: Nonneoplastic cysts of the pituitary are common incidental findings; however, best management remains controversial as they are often asymptomatic but eventually may cause symptoms. The aims of this study are to describe the course of conservative and surgical approaches, to assess timing and results of surgery, and to identify predictors for growth.

Methods: This retrospective study reviewed medical records from the Swiss Pituitary registry. Read More

Acta Neurochir (Wien) 2020 Jun 23. Epub 2020 Jun 23.

UOC Anaesthesia and Intensive Care Unit, Department of Medicine-DIMED, University of Padua, Via Giustiniani 1, Padova, Italy.

Background: Subarachnoid hemorrhage is a severe subtype of hemorrhagic stroke, and deep-vein thrombosis is a frequent complication detected in these patients. In addition to other well-established risk factors, the early activation of coagulation systems present in patients with subarachnoid hemorrhage could potentially play a role in the incidence of deep-vein thrombosis. This study aims to identify possible predictors for deep-vein thrombosis related to subarachnoid hemorrhage. Read More

Acta Neurochir (Wien) 2020 Jun 23. Epub 2020 Jun 23.

Department of Neurological Surgery, The Wexner Medical Center, James Cancer Center, The Ohio State University, 410 W 10th Ave, 1014 N Doan Hall, Columbus, OH, 43210-1267, USA.

Background: Metastatic cervical spine disease can cause compression fractures, cervical spine instability, and pain. Vertebroplasty can stabilize a fracture, reduce the pain associated with a compression fracture, prevent or stop the progression of a fracture, thus avoiding cervical spine fixation, and decreased mobility. Transoral C2 vertebroplasty is less invasive than open fusion surgery, but it poses its own risk of infection and cement leak in this highly sensitive area. Read More

Acta Neurochir (Wien) 2020 Jun 22. Epub 2020 Jun 22.

Department of Radiology, Keio University School of Medicine, Tokyo, Japan.

Sinking skin flap syndrome is a craniectomy complication characterized by new neurological dysfunction that typically worsens in the upright position and improves after cranioplasty. We present a 33-year-old man who experienced hemiparesis in the upright position after craniectomy. Upright computed tomography (CT) before cranioplasty showed a remarkable shift of the brain compared to supine CT. Read More

Acta Neurochir (Wien) 2020 Jun 19. Epub 2020 Jun 19.

Department of Neurosurgery, George Washington University, 2150 Pennsylvania Avenue, 7th floor, Washington, DC, 20037, USA.

Background: Removal of a pontine cavernous malformation requires sufficient exposure since any restriction on surgical freedom may lead to suboptimal visualization of the lesion, injury to the brainstem, and neurological catastrophe.

Methods: We describe and demonstrate the subtemporal transtentorial approach to a cavernous malformation of the upper pons, with emphasis on adequate surgical exposure while avoiding the need for extensive bone removal of the skull base.

Conclusions: The meticulous technique is paramount to the successful removal of any brainstem cavernous malformation. Read More

Acta Neurochir (Wien) 2020 Jun 19. Epub 2020 Jun 19.

Division of Neurosurgery, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD, 20889, USA.

Object: The purpose of this study was to evaluate whether endoscopic third ventriculostomy (ETV) and endoscopic cyst fenestration are effective minimally invasive alternatives to a craniotomy with cyst resection for the treatment of symptomatic pineal cyst-associated aqueductal stenosis.

Methods: Sixteen patients with symptomatic pineal cysts were operatively managed endoscopically and these cases were retrospectively reviewed. There were 12 females and 4 males. Read More

Acta Neurochir (Wien) 2020 Jun 18. Epub 2020 Jun 18.

Division of Neurosurgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.

Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has an impact also on neurosurgical training and education, especially in most affected countries. We surveyed Italian neurosurgical residents, asking them to provide a brief description and analyze the situation they are experiencing and how the educational system reacted to the pandemic in one of the most affected countries all over the world.

Methods: An 18-question, web-based survey was administered to Italian neurosurgical residents from May 3 to May 11, 2020, by web-link or e-mail invitation. Read More

Acta Neurochir (Wien) 2020 Jun 18. Epub 2020 Jun 18.

Peripheral Nerve & Brachial Plexus Surgery Program, Department of Neurosurgery, Hospital de Clinicas, University of Buenos Aires School of Medicine, 1175 Torre 2 5A, 1428, Buenos Aires, La Pampa, Argentina.

Background: The purpose of this study was to assess the results of elbow flexion strength fatigue, rather than the maximal power of strength, after brachial plexus re-innervation with phrenic and spinal accessory nerves. We designed a simple but specific test to study whether statistical differences were observed among those two donor nerves.

Method: We retrospectively reviewed patients with severe brachial plexus palsy for which either phrenic nerve (PN) or spinal accessory nerve (SAN) to musculocutaneous nerve (MCN) transfer was performed. Read More

Acta Neurochir (Wien) 2020 Jun 18. Epub 2020 Jun 18.

Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, W1B 3GG, UK.

Background: Midline shift in trauma relates to the severity of head injury. Large craniectomies are thought to help resolve brain shift but can be associated with higher rates of morbidity. This study explores the relationship between craniectomy size and subtemporal decompression for acute subdural haematomas with the resolution of brain compression and outcomes. Read More

Acta Neurochir (Wien) 2020 Jun 18. Epub 2020 Jun 18.

Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Faculty of Biology and Medicine (FBM), Centre Hospitalier Universitaire Vaudois, and University of Lausanne (UNIL), Lausanne, Switzerland.

Introduction: The Gamma Knife planning software (TMR 10, Elekta Instruments, AB, Sweden) affords two ways of defining the skull volume, the "historical" one using manual measurements (still perform in some centers) and the new one using image-based skull contours. Our objective was to assess the potential variation of the dose delivery calculation using consecutively in the same patients the two above-mentioned techniques.

Materials And Methods: We included in this self-case-control study, 50 patients, treated with GKRS between July 2016 and January 2017 in Lausanne University Hospital, Switzerland, distributed among four groups: convexity targets (n = 18), deep-seated targets (n = 13), vestibular schwannomas (n = 11), and trigeminal neuralgias (n = 8). Read More

Acta Neurochir (Wien) 2020 Jun 18. Epub 2020 Jun 18.

Department of Neurosurgery, Institute of Neurosciences Kolkata, 185/1 A. J. C. Bose Road, Kolkata, West Bengal, 700017, India.

Background: Microvascular decompression (MVD) for glossopharyngeal neuralgia (GPN) is associated with high complication and incomplete cure rates because of its poor ability to visualize neurovascular conflicts.

Method: Fully endoscopic MVD for GPN was carried out through a retrosigmoid keyhole approach. Neurovascular conflicts were clearly demonstrated with a loop of the posterior inferior cerebellar artery (PICA) under a 30° endoscopic view, and no significant cerebellar retraction was observed. Read More

Acta Neurochir (Wien) 2020 Jun 15. Epub 2020 Jun 15.

Laboratory of Surgical Neuroanatomy, Faculty of Medicine, Universidad de Barcelona, Barcelona, Spain.

Background And Objective: Surgical approaches to the petrous apex region are extremely challenging; while subtemporal approaches and variations represent the milestone of the surgical modules to reach such deep anatomical target, in a constant effort to develop minimally invasive neurosurgical routes, the endoscopic endonasal approach (EEA) has been tested to get a viable corridor to the petroclival junction. Lately, another ventral endoscopic minimally invasive route, i.e. Read More

Acta Neurochir (Wien) 2020 Jun 15. Epub 2020 Jun 15.

Department of Neurosurgery, College of Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Republic of Korea.

Background: The aim of this study was to evaluate clinical and morphological factors associated with recurrence in anterior communicating artery (AcomA) aneurysms after clipping or coiling.

Methods: We retrospectively reviewed the clinical and radiologic features of consecutive 214 patients with AcomA aneurysms treated between January 2012 and December 2016 in a single tertiary institute. Univariate and multivariate analyses were performed to identify the relationship between clinical and morphological variables and recurrence. Read More

Acta Neurochir (Wien) 2020 Jun 17. Epub 2020 Jun 17.

Dep. of Surgery, Div. of Neurosurgery, National University Hospital, Singapore, Singapore.

Acta Neurochir (Wien) 2020 Jun 16. Epub 2020 Jun 16.

Department of Neurosurgery, Bâtiment Babinski, Groupe Hospitalier Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, Sorbonne Universités, 47-83 boulevard de l'Hôpital, 75013, Paris, France.

Background: Little information about the natural history of peripheral nerve schwannomas exists in the literature. The aim of this study was to determine the natural history of those tumors both in sporadic and schwannomatosis cases to determine their growth rates and patterns.

Methods: In 44 patients from 3 surgical centers, hospital charts, follow-up records, and imaging studies were reviewed. Read More

Acta Neurochir (Wien) 2020 Jun 16. Epub 2020 Jun 16.

Innovation in Neurosurgery, Department of Neurosurgery, Hospital del Rosario, Universidad Autonoma de Madrid, Madrid, Spain.

Background: Glioblastoma (GBM) is the most frequent intraaxial malignant brain tumour, in which recurrence management is a frequent and demanding issue. Recently, reintervention has emerged as a useful tool for treatment. However, some new evidence has shown that most of the articles published could have overestimated its effects. Read More

Acta Neurochir (Wien) 2020 Jun 16. Epub 2020 Jun 16.

Department of Neurosurgery, Karolinska University Hospital, Elite Hotel Carolina, 4th floor, 171 76, Stockholm, Sweden.

Background: The first line of treatment for most cervical intradural tumors is surgical resection through laminotomy or laminectomy. This may cause a loss of posterior pulling force leading to kyphosis, which is associated with decreased functional outcome. However, the incidence and predictors of kyphosis in these patients are poorly understood. Read More

Acta Neurochir (Wien) 2020 Jun 13. Epub 2020 Jun 13.

Brain Physics Laboratory, Neurosurgical Unit, Department of Clinical Neuroscience, University of Cambridge Hospitals, Cambridge, UK.

Acta Neurochir (Wien) 2020 Jun 13. Epub 2020 Jun 13.

Neurosurgery Department, APHM, CHU Timone, La Timone Hospital, Aix-Marseille University, 264 rue Saint-Pierre, 13005, Marseille, France.

Ventriculoperitoneal shunt (VPS) is an adequate treatment for congenital hydrocephalus or chronic hydrocephalus in adults. Yet, it is a surgery associated with a significant rate of complications amongst neurosurgical procedures, with frequent shunt obstructions and infections. We report the first-ever case of peritonitis caused by Roseomonas mucosa, shortly after the revision of a VPS ventricular catheter. Read More

Acta Neurochir (Wien) 2020 Jun 12. Epub 2020 Jun 12.

Department of Neurosurgery, Oslo University Hospital - Rikshospitalet, P.O.Box 4950, Nydalen, 0424, Oslo, Norway.

Background: The dementia subtype idiopathic normal pressure hydrocephalus (iNPH) has unknown etiology, but one characteristic is elevated intracranial pressure (ICP) wave amplitudes in those individuals who respond with clinical improvement following cerebrospinal fluid (CSF) diversion. To explore the mechanisms behind altered ICP wave amplitudes, we correlated central aortic blood pressure (BP) and ICP waveform amplitudes (intracranial aortic amplitude correlation) and examined how this correlation relates to ICP wave amplitude levels and systemic hemodynamic parameters.

Methods: The study included 29 patients with probable iNPH who underwent continuous multi-hour measurement of ICP, radial artery BP, and systemic hemodynamic parameters. Read More

Acta Neurochir (Wien) 2020 Jun 12. Epub 2020 Jun 12.

Department of Neurosurgery, University of Texas McGovern Medical School, 6400 Fannin St, Suite 2800, Houston, TX, 77030, USA.

Background: Patients with cerebral vasospasm caused by aneurysmal subarachnoid hemorrhage (aSAH) are often treated with intra-arterial (IA) vasodilator infusion. However, the optimal drug regimen is yet to be elucidated.

Methods: A retrospective review of patients with aSAH and cerebral vasospasm treated with IA vasodilator infusion was performed. Read More

Acta Neurochir (Wien) 2020 Jun 11. Epub 2020 Jun 11.

Department of Neurology, Mayo Clinic, Rochester, MN, USA.

Background: Neurofibromatosis type 2 (NF2) is a genetic disorder characterized by mutations of the NF2 tumor suppressor gene that predisposes patients to develop multiple tumors in the peripheral and central nervous system. The most common neoplasms associated with the disease are schwannomas and meningiomas. Both have been shown to contain abnormalities in chromosome 22 and the NF2 gene, suggesting a genetic component to their pathogenesis. Read More

Acta Neurochir (Wien) 2020 Jun 10. Epub 2020 Jun 10.

Department of Neurosurgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.

Background: Superior medullary velum cerebral cavernous malformations pose a challenge in terms of appropriate microsurgical approach. Safe access to this deep location as well as preservation of surrounding anatomical structures, in particular the superior cerebellar peduncle just lateral to the superior medullary velum and the dentate nuclei, is paramount to achieve a good functional outcome.

Methods: Cadaveric dissections provide useful knowledge of the normal anatomy while tractography allows a better understanding of the individual anatomy in the presence of a lesion. Read More

Acta Neurochir (Wien) 2020 Jun 10. Epub 2020 Jun 10.

Department of Neurological Surgery, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA.

Background: The superficial temporal artery-middle cerebral artery (STA-MCA) bypass augments blood flow in patients with cerebral ischemia or replaces flow in patients with complex aneurysms or skull base tumors requiring vessel sacrifice.

Method: We provide a description of the STA-MCA bypass with figures and video to illustrate the procedure.

Conclusion: The STA-MCA end-to-side anastomosis is a foundational skill for the cerebrovascular surgeon and a building block for more complex bypasses. Read More

Acta Neurochir (Wien) 2020 Jun 10. Epub 2020 Jun 10.

Neurosurgical Clinic, Clinic of the University of Munich (Ludwig Maximilians University), Campus Grosshadern, Marchioninistrasse 15, D-81377, Munich, Germany.

Background: Intraspinal epidermoid/dermoid cysts are very rare, benign tumors arising from pathological displacement of epidermal cells into the spinal canal. Literature data about the long-term outcome after microsurgical resection with multimodal intraoperative neurophysiological monitoring (IONM) are lacking. We analyzed one of the largest case series with special regard to intraoperative characteristics and long-term outcome after IONM-aided surgery. Read More

Acta Neurochir (Wien) 2020 Jun 10. Epub 2020 Jun 10.

Department of Neurosurgery, Tampere University Hospital and Tampere University, Tampere, Finland.

Objective: To examine the population-based incidence, complications, and total, direct hospital costs of chronic subdural hematoma (CSDH) treatment in a neurosurgical clinic during a 26-year period. The aim was also to estimate the necessity of planned postoperative follow-up computed tomography (CT).

Methods: A retrospective cohort (1990-2015) of adult patients living in Pirkanmaa, Finland, with a CSDH was identified using ICD codes and verified by medical records (n = 1148, median age = 76 years, men = 65%). Read More

Acta Neurochir (Wien) 2020 Jun 10. Epub 2020 Jun 10.

Neurosurgical Unit, Faculty of Medicine, Geneva University Hospitals, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.

Background: Osteoid osteoma is a benign primary bony tumor involving the spinal posterior arches. Surgical treatment is reserved to patients with severe pain or not responding to nonsteroidal anti-inflammatory medications. We report a minimally invasive transmuscular resection of an L5 isthmic osteoid osteoma, assisted by intraoperative 3D-fluoroscopy-based navigation. Read More

Acta Neurochir (Wien) 2020 Jun 9. Epub 2020 Jun 9.

Department of Neurological Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, 90 Bergen Street, Suite 8100, Newark, NJ, 07103, USA.

Although the symptoms of trigeminal neuralgia (TN) have been well described throughout the history of medicine, its etiology was initially not well understood by most surgeons. The standard procedure used to treat TN today, microvascular decompression (MVD), evolved due to the efforts of numerous neurosurgeons throughout the twentieth century. Walter Dandy was the first to utilize the cerebellar (suboccipital) approach to expose the trigeminal nerve for partial sectioning. Read More

Acta Neurochir (Wien) 2020 Jun 9. Epub 2020 Jun 9.

Department of Neurosurgery, Leipzig University, Liebigstraße 12, 04103, Leipzig, Germany.

Background: Computer-assisted design and manufacturing (CAD/CAM) techniques have been implemented in craniosynostosis surgery to facilitate cranial remodeling. However, until now, computed tomography (CT) scans with ionizing radiation were necessary to plan the procedure and create guiding templates. The purpose of this study was to present our series using CAD/CAM techniques in planning and conducting fronto-orbital advancement surgery in patients with trigonocephaly with datasets acquired only by "black bone" magnetic resonance imaging (MRI). Read More

Acta Neurochir (Wien) 2020 Jun 9. Epub 2020 Jun 9.

Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland.

Background: Burr hole trepanation (BHT) is the most commonly used surgical method for the treatment of chronic subdural haematoma (cSDH).

Method: We give a brief overview on the indication for surgical treatment of cSDH, the surgical technique of BHT, and specific perioperative considerations. In particular, we emphasise on the technique of a subperiosteal drain placement. Read More

Acta Neurochir (Wien) 2020 Jun 8. Epub 2020 Jun 8.

Department of Orthopedic Surgery, Spine Center, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1, Singil-ro, Yeongdeungpo-gu, Seoul, 07441, South Korea.

Background: The biportal endoscope-assisted unilateral foraminal approach is an option for various foraminal pathologies. Lumbar interbody fusion is the standard treatment for foraminal stenosis because both direct and indirect neural decompressions can be obtained.

Method: We used the biportal endoscopic technique for extraforaminal lumbar interbody fusion (BE-EFLIF) and have described the steps, with discussion regarding the indications, advantages, possible complications, and ways to overcome complications. Read More