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Acta Neurochir (Wien) 2021 Jun 11. Epub 2021 Jun 11.

Centre of Epilepsy Surgery "C. Munari", Department of Neuroscience, Niguarda Hospital, Piazza dell'Ospedale Maggiore 3, 20162, Milan, Italy.

Acta Neurochir (Wien) 2021 Jun 11. Epub 2021 Jun 11.

Department of Neurosurgery, Paracelsus Medical University, Breslauer Strasse 201, 90471, Nuremberg, Germany.

Acta Neurochir (Wien) 2021 Jun 10. Epub 2021 Jun 10.

Laboratory of Surgical Neuroanatomy, Faculty of Medicine, University of Barcelona, Barcelona, Spain.

Background: The endoscopic transorbital approach (eTOA) is a new mini-invasive procedure used to explore different areas of the skull base. Authors propose an extradural anterior clinoidectomy (AC) through this corridor, defining the anatomical landmarks of the anterior clinoid process (ACP) projection onto the posterior orbit wall and the technical feasibility of this approach. We describe the exposure of the opticocarotid region and the surgical freedom and the angles of attack obtained with this novel approach. Read More

Acta Neurochir (Wien) 2021 Jul;163(7):1909

Frontlab, Institut du Cerveau (ICM), CNRS UMR 7225, INSERM U1127, Paris, France.

Acta Neurochir (Wien) 2021 Jun 8. Epub 2021 Jun 8.

Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, 16150, Kota Bharu, Kelantan, Malaysia.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known as coronavirus disease 2019 (COVID-19) is a highly transmissible virus and has become pandemic. Part of the prevention of disease spread by the Malaysian government is by getting COVID-19 vaccine. Using the mRNA technology, the Pfizer/BioNTech vaccine is one of the vaccines been approved by the Drug Control Authority in Malaysia. Read More

Acta Neurochir (Wien) 2021 Jun 8. Epub 2021 Jun 8.

Center for Biotechnology Department of Biology, College of Science and Technology, Temple University, Philadelphia, PA, USA.

Acta Neurochir (Wien) 2021 Jun 7. Epub 2021 Jun 7.

Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.

Background: The retrosigmoid approach (RSA) is one of the routes of choice to approach tumors and vascular lesions of the cerebellopontine angle. Among different types of skin incisions and soft tissue dissection techniques, the most widely used variants comprise the straight/lazy S-shaped and the C-shaped incisions. Several reports discuss advantages in terms of functional and clinical outcomes of the C-shaped incision, but scientific considerations about the critical impact of this kind of incision on surgical operability are still extremely limited. Read More

Acta Neurochir (Wien) 2021 Jul 25;163(7):1843-1848. Epub 2021 May 25.

Department of Neurosurgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.

Background: With chronic subdural hematoma (CSDH), surgery is the therapeutic mainstay for large or symptomatic cases. Statins are reported to be effective as the primary therapy of CSDH to obviate the need for surgery. However, the effect of statins on the postoperative course of CSDH is largely unclear. Read More

Acta Neurochir (Wien) 2021 Jul 24;163(7):1819-1827. Epub 2021 May 24.

School of Earth and Environment, University of Leeds, Leeds, UK.

Background: Aerosol is a health risk to theatre staff. This laboratory study quantifies the reduction in particulate matter aerosol concentrations produced by electrocautery and drilling when using mitigation strategies such as irrigation, respirator filtration and suction in a lab environment to prepare for future work under live OR conditions.

Methods: We combined one aerosol-generating procedure (monopolar cutting or coagulating diathermy or high-speed diamond- or steel-tipped drilling of cadaveric porcine tissue) with one or multiple mitigation strategies (instrument irrigation, plume suction and filtration using an FFP3 respirator filter) and using an optical particle counter to measure particulate matter aerosol size and concentrations. Read More

Acta Neurochir (Wien) 2021 May 22. Epub 2021 May 22.

Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, EH16 4SA, UK.

Introduction: Burnout is becoming an increasingly recognised phenomenon within the medical profession. This study aims to investigate the presence of burnout amongst neurosurgical trainees in the UK and Ireland as well as investigating potential exacerbating and protective factors.

Method: An online survey was sent to all neurosurgical trainees in the UK and Ireland via the British Neurosurgical Trainees' Association (BNTA) mailing list. Read More

Acta Neurochir (Wien) 2021 May 20. Epub 2021 May 20.

Department of Neurosurgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan.

Endovascular revascularization of a chronically occluded internal carotid artery (ICA) is challenging because the occlusive segment can be long and tortuous. A case is presented of a successful recanalization of a chronically occluded ICA by retrograde passing of a guidewire from the intracranial ICA to the cervical ICA via the posterior communicating artery. This case suggests that a retrograde approach for reopening an occluded artery may be useful during neurovascular interventions, similar to percutaneous coronary interventions. Read More

Acta Neurochir (Wien) 2021 May 18. Epub 2021 May 18.

Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.

Background: A vestibular schwannoma (VS) is a benign nerve sheath tumor derived from the vestibular nerves. The growth rate of VS during long-term follow-up has not yet been fully evaluated. We aimed to investigate the growth rate of newly diagnosed VS and the related predictive factors for tumor growth. Read More

Acta Neurochir (Wien) 2021 Jul 17;163(7):1935-1939. Epub 2021 May 17.

Division of Neurosurgery, Department of Surgery, National University Hospital, 1E Kent Ridge Rd, Singapore, 119228, Singapore.

Gamma knife radiosurgery (GKS), a technique which involves delivery of a high dose of radiation to a precisely defined target, has become the predominant treatment option for brain metastases (BM) because of its high effectiveness and relatively minimal toxicity. Herein, we report a case of late-onset radiation-induced edema around an asymptomatic cyst, more than 20 years after salvage GKS, with 27 years of imaging follow-up, allowing the description of the evolutionary trajectory of these relatively rare complications. Our reported case also demonstrated the benign nature of delayed cyst formation (DCF), emphasizing that observation alone is reasonable for asymptomatic patients. Read More

Acta Neurochir (Wien) 2021 Jul 15;163(7):2077-2087. Epub 2021 May 15.

Department of Neurosurgery, Stanford University, 300 Pasteur Drive, R293, Stanford, CA, 94305, USA.

Background: The goal of this survey-based study was to evaluate the current practice patterns of clinicians who assess patients with peripheral nerve pathologies and to assess variance in motor grading on the Medical Research Council (MRC) scale using example case vignettes.

Methods: An electronic survey was distributed to clinicians who regularly assess patients with peripheral nerve pathology. Survey sections included (1) demographic data, (2) vignettes where respondents were asked to assess on the MRC scale, and (3) assessment of practice patterns regarding the use of patient-reported outcome measures. Read More

Acta Neurochir (Wien) 2021 May 14. Epub 2021 May 14.

Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.

Background: The genesis of central post-stroke pain (CPSP) is important but difficult to understand. We evaluated the involvement of the thalamic anterior part of the ventral posterolateral nucleus (VPLa) and central lateral nucleus (CL) in the occurrence of CPSP.

Method: Stereotactic thalamotomy was performed on the posterior part of the ventral lateral nucleus (VLp)-VPLa and CL in 9 patients with CPSP caused by deep-seated intracerebral hemorrhage. Read More

Acta Neurochir (Wien) 2021 May 14. Epub 2021 May 14.

London Bridge Hospital, London, UK.

The authors report a very rare case of bilateral occipital condyle fractures (OCF) that was associated with complete separation fracture of the inferior clivus resulting in craniocervical dislocation alongside dissociation of C1-C2 joint complex. Also, a new type of the Anderson and Montesano classification system is presented with two subtypes of injuries. Type IVA occurs when the OCF is associated a clivus avulsion fracture, while Type IVB occurs when the OCF is associated with complete "en piece" separation fracture of the inferior clivus. Read More

Acta Neurochir (Wien) 2021 May 13. Epub 2021 May 13.

Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.

Background: Magnetic resonance imaging (MRI)-guided laser interstitial thermal therapy (MRIgLITT) was demonstrated to be a viable neurosurgical tool. Apart from its variety of indications, different operative and technical nuances exist. In the present report, for the first time, the use and ability of a traditional Riechert-Mundinger (RM) stereotactic system combined with a novel drill guide kit for MRIgLITT are described. Read More

Acta Neurochir (Wien) 2021 Jul 11;163(7):2005-2014. Epub 2021 May 11.

Department of Diagnostic Radiology, Oulu University Hospital, Oulu and Research Unit of Medical Imaging, Physics, and Technology, Oulu University Hospital and University of Oulu, Kajaanintie 50, OYS, P.O. Box 50, 90029, Oulu, Finland.

Background: The purpose of our study was to research the parameters of magnetic resonance imaging (MRI) that would predict the outcome of surgery in patients with Chiari 1 malformation (CM1) and to evaluate changes in MRI parameters after surgery.

Methods: Fifty-one patients (19 children, 13 adolescents, and 19 adults) operated on due to CM1 in Oulu University Hospital between 2004 and 2018 were evaluated. Seventeen parameters were measured from the preoperative MRI and 11 from the postoperative MRI. Read More

Acta Neurochir Suppl 2021 ;132:145-149

Department of Neurosurgery, Asahi University Hospital, Gifu, Japan.

Objective: In Japan, hybrid neurosurgeons who perform both open surgical clipping as well as endovascular embolization for the treatment of intracranial aneurysms are common. Although many Japanese neurosurgeons can perform surgical clipping of middle cerebral artery aneurysms or internal carotid artery-posterior communicating artery aneurysms and coil embolization of cerebral aneurysms using simple techniques-only a limited number of neurosurgeons are able to perform surgical clipping and endovascular procedures for anterior communicating artery aneurysms, paraclinoid, or posterior circulation aneurysms using both treatment modalities equally and safely.

Materials And Methods: The senior author's personal experience of more than 500 cases each of surgical clipping and endovascular embolization over the past 25 years included 110 cases of basilar tip aneurysms and 104 cases of paraclinoid internal carotid artery (ICA) aneurysms. Read More

Acta Neurochir Suppl 2021 ;132:139-143

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

Blood oxygenation-level dependent cerebrovascular reactivity (BOLD-CVR) has gained attention in recent years as an effective way to investigate CVR, a measure of the hemodynamic state of the brain, with high spatial and temporal resolution. An association between impaired CVR and diverse pathologies has been observed, especially in ischemic cerebrovascular diseases and brain gliomas. The ability to obtain this information intraoperatively is novel and has not been widely tested. Read More

Acta Neurochir Suppl 2021 ;132:129-135

Department of Neuroendovascular Surgery, Kameda Medical Center, Kamogawa City, Chiba, Japan.

Spinal dural arteriovenous fistulas (SDAVFs) are the most common vascular shunts of the spine. They occur predominantly in men (more than 80%), commonly involve the thoracolumbar spine, and usually cause progressive myelopathy because of venous congestion of the spinal cord. Recent advanced imaging technology can visualize the detailed angioarchitecture of the spinal cord, and this provides more information of the regional microanatomy related with the shunt disease. Read More

Acta Neurochir Suppl 2021 ;132:123-127

Department of Neurosurgery, University of Toyama, Toyama, Japan.

Aims: To report the endovascular treatment and complications of intracranial and spinal dural arteriovenous (AV) fistulas.

Methods: A retrospective analysis of 863 cases with dural AV fistulas was completed in the nationwide registry study of the Japanese Society of Neuroendovascular Therapy.

Results: Treatments included transarterial/transvenous embolization (TAE/TVE), open surgery, stereotactic radiation, and their combinations. Read More

Acta Neurochir Suppl 2021 ;132:113-122

Department of Neurosurgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.

Introduction: Dural arteriovenous fistulas (dAVFs) account for 10-15% of all intracranial arteriovenous lesions. Different classification strategies have been proposed in the course of the years. None of them seems to guide the treatment strategy. Read More

Acta Neurochir Suppl 2021 ;132:107-112

Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.

The actual role of preoperative embolization of brain arteriovenous malformations (AVMs) is undervalued.The present study aims to describe the effectiveness, safety, technics, and results of the endovascular-based functional downgrading of brain AVMs.Data regarding 31 Spetzler-Martin (SM) grade III AVMs that consecutively underwent a combined endovascular-surgical treatment were reviewed. Read More

Acta Neurochir Suppl 2021 ;132:101-106

Department of Neurosurgery, ASST Ovest Milanese, Legnano, Italy.

Brain arteriovenous malformations (AVMs) classification has been the subject of extensive discussion. The aim of our work was to review the main classification schemes proposed in the literature, which can be summarized in four main groups: (a) traditional schemes oriented to evaluate the operability of AVMs have been joined by (b) specific classifications that evaluate the outcome and the predictability of obliteration of other treatment modalities and (c) others that evaluate the outcome of intracerebral hemorrhages in ruptured AVMs. Eventually, (d) topographical classifications that categorize the subtypes of AVMs located in specific anatomical regions have been drawn. Read More

Acta Neurochir Suppl 2021 ;132:91-100

Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.

Background: Eloquent location of a brain arteriovenous malformation (BAVM) is known to increase the surgical risk. Surgical removal of such BAVMs is challenging. Useful indicators for the safe removal of eloquent BAVMs are needed. Read More

Acta Neurochir Suppl 2021 ;132:87-90

National Medical Research Center "Burdenko Neurosurgical Institute", Moscow, Russia.

Unruptured brain AVMs (bAVMs) remain a controversial subject for practicing neurosurgeons, especially in the light of ARUBA and other observational studies. This retrospective study aims to analyze our experience with unruptured bAVMs to see whether it is beneficial in the long-term and how it corresponds to large literature trials. The study comprised 160 adult patients with unruptured bAVMs surgically treated in Burdenko NMC (Moscow) in 2009-2017. Read More

Acta Neurochir Suppl 2021 ;132:83-86

Department of Neurosurgery, Toranomon Hospital, Minato-ku, Tokyo, Japan.

In arteriovenous malformation (AVM) surgery, vessel structures should be well evaluated with angiography. However, with conventional angiography, it is sometimes difficult to distinguish each feeder and its feeding territory in the nidus. In this study, we used two software systems to create three-dimensional (3D) fusion images using multiple imaging modalities and evaluated their clinical use. Read More

Acta Neurochir Suppl 2021 ;132:77-81

Department of Neurosurgery, Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore, Milan, Italy.

In AVM surgery perioperative complications can arise and can have serious perioperative consequences. Surgically related complications in AVM treatment, in many cases, can be avoided by paying attention to details:1. Careful selection of the patient: - addressing a patient with eloquent AVM to Gamma Knife treatment - preoperative treatment with selective embolization of the accessible deep feeders - preoperative gamma knife or embolize those patient with an over-expressed venous pattern2. Read More

Acta Neurochir Suppl 2021 ;132:71-76

National Institute of Clinical Neurosciences, Budapest, Hungary.

Background And Purpose: Brain arteriovenous malformations (AVM) are uncommon vascular lesions with the risk of hemorrhage, epileptic seizures, neurological deficits, and headache. Comparing the risks of the natural history and that of preventive treatment, a recent study has found observation more beneficial than treatment for unruptured AVMs. This study, however, did not consider the long-term impact of carrying a brain AVM on everyday activities. Read More