December 8, 2012, 0:00

Alvaro Campero, Pablo Ajler, Mariano Socolovsky, Carolina Martins, Albert Rhoton

Surgical Neurology International 2012 3(7):400-404

Background: Hypoglossal-facial anastomosis is the gold standard treatment for facial reanimation in those cases where the facial nerve has been damaged near the brainstem. The technique that requires temporal bone drilling and partial section of the hypoglossal nerve is usually preferred. This technique diminishes tongue morbidity while preserves good facial reanimation. The goal of the present work is to describe a simple technique to expose the mastoid portion of the facial nerve. Methods: The mastoid portion of the facial nerve runs on the anterior wall of the mastoid process; mean 18+/-3 mm deeply to the lateral wall. The supramastoid crest has to be identified; a parallel line is marked from the crest to the mastoid tip, and bone drilling is performed anterior to the line. Once the facial nerve is identified, proximal and distal dissection is performed. Results: This limited approach allows to a safe exposure of the mastoid segment of the facial nerve. This procedure is technically less demanding but should be restricted to hypoglossal-facial anastomosis Conclusion: Surgeons not fully experienced in temporal bone drilling can do this simple approach after performing some laboratory practice.

December 8, 2012, 0:00

Pablo Ajler, Santiago Hem, Ezequiel Goldschmidt, Federico Landriel, Alvaro Campero, Claudio Yampolsky, Antonio Carrizo

Surgical Neurology International 2012 3(7):389-394

Background: To explain the technique used and to describe the outcome of the first 52 patients who underwent endoscopic transnasal surgery to treat pituitary tumors at our institution. Methods: We carried out a retrospective analysis of 52 patients in whom endoscopic transnasal surgery for pituitary tumors was performed during the period from June 2011 to June 2012. We analyzed the demographic characteristics of these patients, their underlying disease, and the morbidity and mortality associated with surgery. Results: The mean age was 41.52 years, ranging from 18 to 79. The distribution was similar between men and women. The most common types of adenoma were: Non-functioning adenomas (40.4%), GH-producing tumors/Acromegaly (25%) and ACTH-producing tumors/Cushing's disease (23.1%). Approximately 70% were macroadenomas. Only one patient had complications. There was no death in this series. Conclusion: Although more definitive conclusions will be drawn after further study of this technique, our impression is that the endoscopic view seem to provide more anatomical details than microscopic one. Moreover, it allows direct visualization of remaining tumor, sites of cerebrospinal fluid leakage and the normal gland, since the endoscope may be introduced into the sella. These advantages may allow achieving better surgical outcomes in terms of disease control and complication prevention.

December 8, 2012, 0:00

lvaro Campero, Pablo Ajler, Ezequiel Goldschmidt, Damián Bendersky, Abraham Campero

Surgical Neurology International 2012 3(7):395-399

Background: Tension pneumocephalus is uncommon after transsphenoidal surgery. There are only few cases reported in the literature in which the air was located at the sellar region exclusively, constituting a sellar pneumocele. In this article, an unusual case of a late onset tension sellar pneumocele is reported. Case Description: A 57-year-old woman consulted because of bitemporal hemianopsia. She had undergone a transnasal surgery for pituitary adenoma and a shunt had been placed because of the presence of cerebrospinal fluid leakage. Furthermore, the patient had undergone a transcranial resection of an intracavernous component of the tumor and radiosurgical treatment had been perfomed too because of its aggressiveness. A magnetic resonance imaging was undertaken and it demonstrated a sellar and suprasellar pneumocele. Intervention: A transcilliary approach was performed. The sellar region was enclosed by scarring tissue from her earlier procedures. The scar was opened and the air was evacuated. The sellar floor was subsequently closed with fat and fibrin glue. After the procedure, her visual field returned to normal. One year after her last surgery, she is still asymptomatic. Conclusion: Sellar and suprasellar tension pneumocele is an extremely rare finding following transsphenoidal surgery. Its clinical manifestation would be visual disturbance due to compression on the optic pathway from below. When diagnosed, tension sellar pneumocele should be evacuated within a short time frame.

November 30, 2012, 17:54

The University of Chicago Journal Club Participating Faculty: Brown, Lam, Hekmat-Panah, Roitberg Participating Residents: Ferguson, Hobbs, Bhansali, Shakur, Stamates   Topic: How strong is the evidence for non-operative management of degenerative spine disease?   1) Walker B., French S., Grant W., Green S. A Cochrane Review of Combined Chiropractic Interventions for Low-Back Pain. Spine (Phila … Continue reading How strong is the evidence for non-operative management of degenerative spine disease? — Journal Club No. 3, 2012 →

November 27, 2012, 13:45

For those of you who are using Windows 8 on their computer (desktop, laptop, ultrabook, tablet) I am happy to inform you that NeuroMind for Windows is now officially available. (click for full size version) You can download this app for free from the Windows Store. Enjoy! Pieter Kubben IT editor Surgical Neurology International

November 27, 2012, 0:00

Patrick Graupman, Archie Defillo, Leslie Nussbaum, Eric S NussbaumSurgical Neurology International 2012 3(1):141-141Background: Lesions of the vermis and 4 th ventricle are commonly addressed through a midline suboccipital approach. Most neurosurgeons ...

November 27, 2012, 0:00

Ara J Deukmedjian, Augusto Cianciabella, Jason Cutright, Arias Deukmedjian

Surgical Neurology International 2012 3(1):142-142

Background: Cervical Deuk Laser Disc Repair® is a novel full-endoscopic, anterior cervical, trans-discal, motion preserving, laser assisted, nonfusion, outpatient surgical procedure to safely treat symptomatic cervical disc diseases including herniation, spondylosis, stenosis, and annular tears. Here we describe a new endoscopic approach to cervical disc disease that allows direct visualization of the posterior longitudinal ligament, posterior vertebral endplates, annulus, neuroforamina, and herniated disc fragments. All patients treated with Deuk Laser Disc Repair were also candidates for anterior cervical discectomy and fusion (ACDF). Methods: A total of 142 consecutive adult patients with symptomatic cervical disc disease underwent Deuk Laser Disc Repair during a 4-year period. This novel procedure incorporates a full-endoscopic selective partial decompressive discectomy, foraminoplasty, and posterior annular debridement. Postoperative complications and average volume of herniated disc fragments removed are reported. Results: All patients were successfully treated with cervical Deuk Laser Disc Repair. There were no postoperative complications. Average volume of herniated disc material removed was 0.09 ml. Conclusions: Potential benefits of Deuk Laser Disc Repair for symptomatic cervical disc disease include lower cost, smaller incision, nonfusion, preservation of segmental motion, outpatient, faster recovery, less postoperative analgesic use, fewer complications, no hardware failure, no pseudoarthrosis, no postoperative dysphagia, and no increased risk of adjacent segment disease as seen with fusion.

November 26, 2012, 0:00

Mark L Prasarn, Mary B Horodyski, Caleb Behrend, John Wright, Glenn R RechtineSurgical Neurology International 2012 3(6):366-369Background: When initiating treatment for patients with spinal disorders, we examined the impact of smoking, workers compens...

November 26, 2012, 0:00

Francis W Gamache

Surgical Neurology International 2012 3(6):350-354

Background: Neck or back problems are experienced at some time by many Americans and many patients receive recommendations for spinal surgery. Patients naturally seek another opinion to confirm the need for surgery, or for the particular procedure recommended. Methods: Over approximately a 14-month period, the author prospectively collected data regarding 240 consecutive patients seeking a surgical opinion regarding a spine problem. Imaging studies were reviewed and patients were asked to comment on the consultation experience. Results: Of the 240 patients, 155 (65%) came for a second, third, or fourth surgical opinion following an earlier opinion from a surgeon who recommended an operation. Of these patients, the author recommended no surgery for 69 (44.5%) patients. The remaining 85 (35%) were referred by primary care doctors or neurologists for initial surgical (first) opinions because of magnetic resonance imaging (MRI) or computed tomography (CT) reports indicating the presence of surgical lesions. The author recommended no surgery for 37 (43%) of these 85 patients. Conclusions: Patients request and deserve the attention of a physician who will listen to their history and perform a careful neurological examination. The results of the neurological examination and the imaging studies must then be carefully integrated and correlated with the patient's complaints. The results should be explained to the patient so that he or she will understand the surgical or non surgical nature of his or her problem.

November 16, 2012, 0:00

Miguel A FariaSurgical Neurology International 2012 3(1):135-135The need for reducing gun violence is discussed along with the necessity for citizens to assume some responsibility for protecting themselves, their families, and their property from crimi...