Confirmation of accuracy/inaccuracy of lumbar pedicle screw placement using postoperative computed tomography

Mohamed M. Arnaout, Magdy O. ElSheikh, Mansour A. Makia

Date of publication: 11-Oct-2021

Background: Transpedicular screws are extensively utilized in lumbar spine surgery. The placement of these screws is typically guided by anatomical landmarks and intraoperative fluoroscopy. Here, we utilized 2-week postoperative computed tomography (CT) studies to confirm the accuracy/inaccuracy of lumbar pedicle screw placement in 145 patients and correlated these findings with clinical outcomes.

Prospective comparative study of intraoperative balloon electronic brachytherapy versus resection with multidisciplinary adjuvant therapy for recurrent glioblastoma

Aleksey Krivoshapkin, Aleksey Gaytan, Orkhan Abdullaev, Nidal Salim, Gleb Sergeev, Ilya Marmazeev, Evaldas Cesnulis, Tim Killeen, Vladimir Tyuryn, Roman Kiselev, Pavel Syomin, Aldo Spallone

Date of publication: 11-Oct-2021

Background: Intraoperative balloon electronic brachytherapy (IBEB) may provide potential benefit for local control of recurrent cerebral glioblastomas (GBMs).

A case of Bertolotti’s syndrome as a cause of sciatica

Sarah Kawtharani, Shadi Abdelatif Bsat, Mohamad El Housheimy, Charbel Moussalem, Adham Halaoui, Tarek Sunna

Date of publication: 11-Oct-2021

Background: Bertolotti’s syndrome (i.e., varying extent of fusion between the last lumbar vertebra and the first sacral segment) or lumbosacral transitional vertebrae is a rare cause of back pain. Notably, this syndrome is one of the differential diagnoses for patients with refractory back pain/sciatica.

Blood preservation techniques in complex spine surgery: Illustrative case and review of therapeutic options

James P. Caruso, Mark N. Pernik, Zachary D. Johnson, Tarek Y. El Ahmadieh, Babatunde Ogunnaike, Owoicho Adogwa, Salah G. Aoun, Carlos A. Bagley

Date of publication: 11-Oct-2021

Background: Complex spine surgery predisposes patients to substantial levels of blood loss, which can increase the risk of surgical morbidity and mortality.

Identification and surgical ligation of spinal CSF-venous fistula

Kashif Majeed, Samuel Z. Hanz, Michelle Roytman, J. Levi Chazen, Jeffrey P. Greenfield

Date of publication: 11-Oct-2021

Background: CSF-venous fistulas (CVF) may cause incapacitating positional headaches resulting from spontaneous intracranial hypotension/hypovolemia (SIH). Their etiology remains unknown, although unrecognized local trauma may precipitate SIH. In addition, they are diagnostically challenging despite various imaging tools available. Here, we present CVF identification using magnetic resonance myelography (MRM) and elaborate on their surgical management techniques.

Initial experience of subcutaneous nitroglycerin for distal transradial access in neurointerventions

Maham Ahmed, Stephanie Zyck, Grahame C. Gould

Date of publication: 11-Oct-2021

Background: Transradial access (TRA) for diagnostic and interventional neuroendovascular procedures has gained significant popularity in recent years due to its improved safety profile and appeal to patients compared with transfemoral access. However, risks of TRA include hand ischemia in cases of poor ulnar collateral circulation and inability to cannulate the radial artery due to its relatively small diameter. By accessing the radial artery distal to the superficial palmar arch where ulnar collateral blood flow arises, in the anatomic snuffbox, the risk of hand ischemia is theoretically eliminated. The use of subcutaneous nitroglycerin and lidocaine to improve rates of success in radial artery access has been reported in the cardiac literature, however, has yet to be described for neurointerventional procedures. We discuss our technique and report our initial experience using subcutaneous nitroglycerin and lidocaine cocktail for access to the distal transradial artery in a variety of neuroendovascular procedures.

Hemorrhage due to attempted excision of a frontal exophytic lesion: A cautionary tale

Caio Perret, Raphael Bertani, Mauricio Mendes Barbosa, Savio Batista, Stefan W. Koester, Paulo Santa Maria, Hugo Schiavini

Date of publication: 11-Oct-2021

Background: Despite mainly benign, exophytic subcutaneous cranial masses present with a myriad of differential diagnosis possibilities, ranging from simple, superficial lesions to complex lesions involving the central nervous system. Although the gold standard imaging modality for the diagnosis of these lesions is magnetic resonance imaging, Doppler Ultrasonography can be a useful, inexpensive, and available tool for evaluation of lesions that could potentially be safely treated in the primary care setting, and lesions that would demand advanced neurosurgical care.

A combined approach for stabilization and endoscopic/ endonasal odontoid and clivus resection for treatment of basilar invagination

Lance Michael Villeneuve, Zoya Voronovich, Alexander Evans, Edward T. El Rassi, Ian F. Dunn, Zachary A. Smith

Date of publication: 11-Oct-2021

Background: Basilar invagination (BI) is a complex condition characterized by prolapse of the odontoid into the brain stem/upper cervical cord. This lesion is often associated with Chiari malformations, and rheumatoid arthritis (RA). Treatment options for BI typically include cervical traction, an isolated anterior transoral odontoidectomy, anterior endonasal odontoidectomy, an isolated posterior fusion, or combined anterior/ posterior surgical approach.

Ventral cervico-thoracic meningeal cyst resulting in myelopathy: Case report and literature review

Shiwei Huang, David Freeman, Walter Galicich, Thomas Bergman

Date of publication: 11-Oct-2021

Background: Spinal meningeal (dural) cysts rarely cause spinal cord compression and/or myelopathy.

“NIMS” nasal mucoperiosteal flap for sublabial trans-sphenoidal surgical defect repair: A new technique under microscope

Rajesh Alugolu, Vasundhara Rangan, Raghu Ram, M. Vijaya Saradhi

Date of publication: 11-Oct-2021

Background: CSF rhinorrhea is a known complication that may occur after cranial base surgery, especially the trans-sphenoidal approaches to sellar tumors. It may occur following both microscopic and endoscopic procedures. Over a period, the balance has tilted toward endoscopy due to development of pedicled Hadad flap. Microscopic trans-sphenoidal surgery (TSS) continues to be performed in our institute as well as many other centers across the world due to familiarity of technique and unavailability of endoscopic equipment. Despite the fairly widespread use of this surgery, literature is devoid of any description of a local mucosal flap for repair of the surgical defect in microscopic TSS.