Results in Neurosurgery Clinics of North America: 2,870
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Neurosurgery Clinics of North America, Volume 28; https://doi.org/10.1016/s1042-3680(17)30090-6
Neurosurgery Clinics of North America, Volume 28; https://doi.org/10.1016/s1042-3680(17)30092-x
Neurosurgery Clinics of North America, Volume 28; https://doi.org/10.1016/s1042-3680(17)30091-8
Neurosurgery Clinics of North America, Volume 28; https://doi.org/10.1016/s1042-3680(17)30088-8
Neurosurgery Clinics of North America, Volume 28, pp 465-475; https://doi.org/10.1016/j.nec.2017.05.002
The resolution and real-time navigation of intraoperative MRI (iMRI) has been leveraged in neurosurgery. We review frameless stereotactic biopsy platforms and focus on emerging technology integrating intraoperative MRI with frameless stereotaxy. Brain biopsy with iMRI allows for an accurate tissue sample with the ability to correct cannula trajectory during surgery, eliminating misdiagnosis secondary to faulty targeting. This technology allows for a percutaneous approach avoiding large incisions, obviates the need for frozen tissue evaluation, has the potential to reduce unnecessary specimen harvesting and operating room time, and optimizes safety of targeting deep brain lesions.
Neurosurgery Clinics of North America, Volume 28, pp 545-557; https://doi.org/10.1016/j.nec.2017.06.001
MRI-guided laser interstitial thermal therapy for epilepsy (LITT-E) has become an established, minimally invasive alternative to traditional epilepsy surgery. LITT-E is particularly valuable in cases in which open surgery poses unacceptably high morbidity or patient preference precludes craniotomy. Here we present a focused review of technical details and application of LITT to both focal and generalized epilepsy.
Neurosurgery Clinics of North America, Volume 28, pp 559-567; https://doi.org/10.1016/j.nec.2017.05.008
Magnetic resonance guided focused ultrasound surgery (MRgFUS) has potential noninvasive effects on targeted tissue. MRgFUS integrates MRI and focused ultrasound surgery (FUS) into a single platform. MRI enables visualization of the target tissue and monitors ultrasound-induced effects in near real-time during FUS treatment. MRgFUS may serve as an adjunct or replace invasive surgery and radiotherapy for specific conditions. Its thermal effects ablate tumors in locations involved in movement disorders and essential tremors. Its nonthermal effects increase blood-brain barrier permeability to enhance delivery of therapeutics and other molecules.
Neurosurgery Clinics of North America, Volume 28, pp 513-524; https://doi.org/10.1016/j.nec.2017.05.006
Spinal laser interstitial thermal therapy (LITT) appears to be a promising novel modality for treatment of epidural metastatic spine disease in patients who are poor candidates for larger-scale oncologic spinal surgery and can act synergetically with spinal stereotactic radiosurgery to maximize local control and palliate pain. This technique is ideally suited for the intraoperative MRI suite to monitor the extent of the ablation in the epidural space. As percutaneous navigation, imaging, and LITT technology improve, broader applicability of this minimally invasive technique in spinal oncology is foreseen.
Neurosurgery Clinics of North America, Volume 28, pp 615-622; https://doi.org/10.1016/j.nec.2017.05.012
Convection-enhanced delivery permits the direct homogeneous delivery of small- and large-molecular-weight putative therapeutics to the nervous system in a manner that bypasses the blood-nervous system barrier. The development of co-infused surrogate imaging tracers (for computed tomography and MRI) allows for the real-time, noninvasive monitoring of infusate distribution during convective delivery. Real-time image monitoring of convective distribution of therapeutic agents insures that targeted structures/nervous system regions are adequately perfused, enhances safety, informs efficacy (or lack thereof) of putative agents, and provides critical information regarding the properties of convection-enhanced delivery in normal and various pathologic tissue states.
Neurosurgery Clinics of North America, Volume 28, pp 569-583; https://doi.org/10.1016/j.nec.2017.05.009
Intraoperative fluorescence imaging allows real-time identification of diseased tissue during surgery without being influenced by brain shift and surgery interruption. 5-Aminolevulinic acid, useful for malignant gliomas and other tumors, is the most broadly explored compound approved for fluorescence-guided resection. Intravenous fluorescein sodium has recently received attention, highlighting tumor tissue based on extravasation at the blood-brain barrier (defective in many brain tumors). Fluorescein in perfused brain, unselective extravasation in brain perturbed by surgery, and propagation with edema are concerns. Fluorescein is not approved but targeted fluorochromes with affinity to brain tumor cells, in development, may offer future advantages.
Neurosurgery Clinics of North America, Volume 28, pp 499-512; https://doi.org/10.1016/j.nec.2017.05.005
A variety of intraoperative MRI (iMRI) systems are in use during transsphenoidal surgery (TSS). The variations in iMRI systems include field strengths, magnet configurations, and room configurations. Most studies report that the primary utility of iMRI during TSS lies in detecting resectable tumor residuals following maximal resection with conventional technique. Stereotaxis, neuronavigation, and complication avoidance/detection are enhanced by iMRI use during TSS. The use of iMRI during TSS can lead to increased extent of resection for large tumors. Improved remission rates from hormone-secreting tumors have also been reported with iMRI use. This article discusses the history, indications, and future directions for iMRI during TSS.
Neurosurgery Clinics of North America, Volume 28; https://doi.org/10.1016/j.nec.2017.07.001
Neurosurgery Clinics of North America, Volume 28, pp 585-594; https://doi.org/10.1016/j.nec.2017.06.002
Spinal instrumentation often involves placing implants without direct visualization of their trajectory or proximity to adjacent neurovascular structures. Two-dimensional fluoroscopy is commonly used to navigate implant placement, but with the advent of computed tomography, followed by the invention of a mobile scanner with an open gantry, three-dimensional (3D) navigation is now widely used. This article critically appraises the available literature to assess the influence of 3D navigation on radiation exposure, accuracy of instrumentation, operative time, and patient outcomes. Also explored is the latest technological advance in 3D neuronavigation: the manufacturing of, via 3D printers, patient-specific templates that direct implant placement.
Neurosurgery Clinics of North America, Volume 28, pp 633-652; https://doi.org/10.1016/j.nec.2017.05.014
Surgical excision of brain tumors provides a means of cytoreduction and diagnosis while minimizing neurologic deficit and improving overall survival. Despite advances in functional and three-dimensional stereotactic navigation and intraoperative MRI, delineating tissue in real time with physiologic confirmation is challenging. Raman spectroscopy has potential to be an important modality in the intraoperative evaluation of tissue during surgical resection. In vitro experimental studies have shown that this technique can be used to differentiate normal brain tissue from tissue with infiltrating cancer cells and dense cancerous masses with high specificity, indicating the feasibility of this method for in vivo application.
Neurosurgery Clinics of North America, Volume 28, pp 623-632; https://doi.org/10.1016/j.nec.2017.05.013
Offering real-time, high-resolution images via intraoperative ultrasound is advantageous for a variety of peripheral nerve applications. To highlight the advantages of ultrasound, its extraoperative uses are reviewed. The current intraoperative uses, including nerve localization, real-time evaluation of peripheral nerve tumors, and implantation of leads for peripheral nerve stimulation, are reviewed. Although intraoperative peripheral nerve localization has been performed previously using guide wires and surgical dyes, the authors' approach using ultrasound-guided instrument clamps helps guide surgical dissection to the target nerve, which could lead to more timely operations and shorter incisions.
Neurosurgery Clinics of North America, Volume 28, pp 477-485; https://doi.org/10.1016/j.nec.2017.05.003
Intraoperative MRI (iMRI) is a neurosurgical adjunct used to maximize the removal of glioma, the most common primary brain tumor. Increased extent of resection of gliomas has been shown to correlate with longer survival times. iMRI units are variable in design and magnet strength, which can affect patient selection and image quality. Multiple studies have shown that surgical resection of gliomas using iMRI results in increased extent of resection and survival time. Level II evidence supports the use of iMRI in the surgical treatment of glioma.
Neurosurgery Clinics of North America, Volume 28, pp 453-464; https://doi.org/10.1016/j.nec.2017.05.001
Intraoperative imaging has become widely accepted in neurosurgery in recent years. The possibility to objectively determine the extent of tumor removal is highly advantageous. If the resection is incomplete, clinicians can attempt to remove the residual tumor that was missed during the same operation. Furthermore, the positioning of implants in spinal surgery, as well as in cranial surgery, can be controlled and modified during the procedure. Intraoperative imaging acts as immediate quality control and offers improved patient safety. This article gives a brief overview of the different intraoperative imaging modalities and their potential applications in modern neurosurgery.
Neurosurgery Clinics of North America, Volume 28, pp 525-533; https://doi.org/10.1016/j.nec.2017.05.015
Recent technological advancements in intraoperative imaging are shaping the way for a new era in brain tumor surgery. Magnetic resonance thermometry has provided intraoperative real-time imaging feedback for safe and effective application of laser interstitial thermal therapy (LITT) in neuro-oncology. Thermal ablation has also established itself as a surgical option in epilepsy surgery and is currently used in spine oncology with promising results. This article reviews the principles and rationale as well as the clinical application of LITT for brain tumors. It also discusses the technical nuances of the current commercially available systems.
Neurosurgery Clinics of North America, Volume 28, pp 535-544; https://doi.org/10.1016/j.nec.2017.05.007
Current knowledge of the functional anatomy of the subthalamic nucleus and globus pallidus, discovered through microelectrode recording and postoperative imaging, justifies purely anatomic targeting for deep brain stimulation (DBS). Interventional MRI (iMRI)-DBS is more anatomically accurate than traditional awake procedures and has similar clinical outcomes without increased risk or increased operative times. iMRI lead implantation allows patients to receive DBS therapy who cannot tolerate or do not agree to undergo an awake procedure. This article describes considerations for iMRI-DBS implantation in the subthalamic nucleus and globus pallidus, including patient selection, technique of electrode placement, expected outcomes, and potential complications.
Neurosurgery Clinics of North America, Volume 28, pp 595-602; https://doi.org/10.1016/j.nec.2017.05.010
The challenge for treating complex lesions with the aim of minimal surgery-related morbidity has generated an increasing demand for sophisticated intraoperative imaging modalities. Newest generations of intraoperative computed tomography (CT) scanners offer a multitude of hardware and software improvements resulting in higher image quality that further propagates its everyday usage in the interdisciplinary operative setting. This article describes workflow and applicability of intraoperative CT scanning in cranial neurosurgery, in subspecialties like skull base or vascular neurosurgery, and its advantages and limitations.
Neurosurgery Clinics of North America, Volume 28, pp 487-497; https://doi.org/10.1016/j.nec.2017.05.004
Maximal safe resection is the cornerstone of treatment for low-grade and high-grade gliomas. In addition to high-resolution anatomic MRI studies that highlight tumor architecture, it is important to determine the relationship of the tumor to the eloquent cortical and subcortical areas to avoid introducing or exacerbating a neurologic deficit. The goal of this review was to highlight imaging modalities that provide functional information and can be integrated with intraoperative MRI navigation to maximize the extent of resection while preserving a patient's neurologic function.
Neurosurgery Clinics of North America, Volume 28, pp 603-613; https://doi.org/10.1016/j.nec.2017.05.011
Neurovascular surgery is a broad and challenging, yet exciting field within neurologic surgery. The neurovascular surgeon must be meticulous; because the brain and spinal cord are unforgiving to ischemic insults. Along with the pressures of this demanding subspecialty comes the potential to help patients recover from potentially devastating pathology to go on and lead normal, healthy lives. Several intraoperative imaging modalities are available to help maximize treatment success while reducing risk. This article reviews each of these modalities, including digital subtraction angiography, fluorescence angiography, Doppler ultrasonography, laser Doppler, laser speckle contrast imaging, neuronavigation, and neuroendoscopy.
Neurosurgery Clinics of North America, Volume 28, pp 313-320; https://doi.org/10.1016/j.nec.2017.02.001
Pain related to joint dysfunction can be treated with joint fusion; this is a long-standing principle of musculoskeletal surgery. However, pain arising from the sacroiliac (SI) joint is difficult to diagnose. Several implant devices are available that promote fusion by simply crossing the joint space. Evidence establishing outcomes is misleading because of vague diagnostic criteria, flawed methodology, bias, and limited follow-up. Because of nonstandardized indications and historically inferior reconstruction techniques, SI joint fusion should be considered unproven. The indications and procedure in their present form are unlikely to stand up to close scrutiny or weather the test of time.
Neurosurgery Clinics of North America, Volume 28, pp 389-396; https://doi.org/10.1016/j.nec.2017.02.006
Advances in neuroimaging and its widespread use for screening have increased the diagnosis of unruptured intracranial aneurysms (UIAs), including small-sized UIAs. The clinical management of these small-sized UIAs requires a patient-specific judgment of the risk of aneurysm rupture, if not treated, versus the risk of complications from surgical or endovascular treatment. Experienced cerebrovascular teams recommend treating small UIAs in young patients or in patients with more than one aneurysm rupture risk factor who also have a reasonable life expectancy. However, individual overall assessment of risk is critical for patients with UIAs to decide the next steps of care.
Neurosurgery Clinics of North America, Volume 28, pp 397-406; https://doi.org/10.1016/j.nec.2017.02.008
Detailed brain imaging studies discover gliomas incidentally before clinical symptoms or signs show. These tumors represent an early stage in the natural history of gliomas. Left untreated, they are likely to progress to a symptomatic stage and transform to malignant gliomas. A greater extent of resection delays the onset of malignant transformation and prolongs patient survival. Because incidental gliomas are typically smaller and less likely to be in eloquent brain locations, there is a strong case for early surgical intervention to maximize resection and improve outcomes. This article discusses developments in the surgical management of low-grade gliomas.
Neurosurgery Clinics of North America, Volume 28; https://doi.org/10.1016/s1042-3680(17)30046-3
Neurosurgery Clinics of North America, Volume 28, pp 375-388; https://doi.org/10.1016/j.nec.2017.02.011
Flow diversion after aneurysmal subarachnoid hemorrhage (SAH) is the last treatment option for aneurysm occlusion when other methods of aneurysm treatment cannot be used because of the need for dual antiplatelet therapy. The authors' general protocol for treatment selection after aneurysmal SAH is provided to share with readers our approach to securing the aneurysm before embarking flow diversion for primary treatment or delayed adjunctive treatment to primary coiling. The authors' experience with flow diversion after aneurysmal SAH, review of pertinent literature, and the future of flow diversion after aneurysmal SAH are discussed.
Neurosurgery Clinics of North America, Volume 28, pp 301-312; https://doi.org/10.1016/j.nec.2017.03.003
The sacroiliac joint moves 2.5°. It is innervated with nociceptive fibers. It is a common cause of low back pain (15%-30%). Degenerative changes occur, especially after lumbosacral fusion. When performed in series, physical examination maneuvers are diagnostic. Confirmatory image-guided injections can aid the diagnosis. In randomized clinical trials, surgical treatment in appropriately selected patients has been demonstrated to be statistically and clinically superior to nonsurgical management.
Neurosurgery Clinics of North America, Volume 28, pp 407-428; https://doi.org/10.1016/j.nec.2017.02.007
The role of reoperation for glioblastoma multiforme (GBM) recurrence is currently unknown. However, multiple studies have indicated that survival and quality of life are improved with a repeat operation at the time of disease recurrence. Prognosis is likely interdependent on several factors, including age, functional status, initial resection status, disease location, and surgical efficacy. However, there are significant data indicating no survival benefit for reoperation. This comprehensive literature review considering the controversial question of whether to operate for progressive or recurrent GBM seeks to evaluate the current available evidence and report on its conclusions.
Neurosurgery Clinics of North America, Volume 28, pp 361-374; https://doi.org/10.1016/j.nec.2017.02.004
Moyamoya disease is a progressive occlusive vasculopathy that involves the supraclinoid internal carotid arteries and Circle of Willis, and results in the formation of collateral vessels at the skull base. The progressive nature of this disease leads to cerebral ischemia and sometimes intracerebral hemorrhage. The treatment of moyamoya disease is mainly surgical revascularization, using revascularization techniques that include direct, indirect, and combined strategies. Here we discuss the available options for revascularization as well as our opinions regarding the surgical management of patients with moyamoya disease.
Neurosurgery Clinics of North America, Volume 28, pp 449-451; https://doi.org/10.1016/s1042-3680(17)30050-5
Neurosurgery Clinics of North America, Volume 28, pp 321-330; https://doi.org/10.1016/j.nec.2017.02.002
Lumbar spinal stenosis with neurogenic claudication is prevalent in the elderly population. Decompression for this condition is the operation most commonly used to treat older patients. Because of the risks associated with open decompression procedures, particularly in older patients with comorbidities, minimally invasive procedures with implantation of interspinous process devices have been developed. This article reviews the current role of interspinous spacers in the treatment of lumbar spinal stenosis with neurogenic claudication and discusses the body of literature surrounding this treatment alternative.
Neurosurgery Clinics of North America, Volume 28; https://doi.org/10.1016/j.nec.2017.04.001
Neurosurgery Clinics of North America, Volume 28; https://doi.org/10.1016/s1042-3680(17)30041-4
Neurosurgery Clinics of North America, Volume 28; https://doi.org/10.1016/s1042-3680(17)30047-5
Neurosurgery Clinics of North America, Volume 28; https://doi.org/10.1016/s1042-3680(17)30042-6
Neurosurgery Clinics of North America, Volume 28; https://doi.org/10.1016/s1042-3680(17)30045-1
Neurosurgery Clinics of North America, Volume 28, pp 349-360; https://doi.org/10.1016/j.nec.2017.02.010
Malignant large artery stroke is associated with high mortality of 70% to 80% with best medical management. Decompressive craniectomy (DC) is a highly effective tool in reducing mortality. Convincing evidence has accumulated from several randomized trials, in addition to multiple retrospective studies, that demonstrate not only survival benefit but also improved functional outcome with DC in appropriately selected patients. This article explores in detail the evidence for DC, nuances regarding patient selection, and applicability of DC for supratentorial intracerebral hemorrhage and posterior fossa ischemic and hemorrhagic stroke.
Neurosurgery Clinics of North America, Volume 28, pp 331-334; https://doi.org/10.1016/j.nec.2017.03.001
Bone morphogenic protein (BMP) provides excellent enhancement of fusion in many spinal surgeries. BMP should be a cautionary tale about the use of industry-sponsored research, perceived conflicts of interest, and holding the field of spinal surgery to the highest academic scrutiny and ethical standards. In the case of BMP, not having a transparent base of literature as it was approved led to delays in allowing this superior technology to help patients.
Neurosurgery Clinics of North America, Volume 28, pp 341-347; https://doi.org/10.1016/j.nec.2017.03.002
The management of adult deformity varies significantly. Options range from nonoperative care to limited decompression to decompression with limited or extensive fusion. The appropriate surgical management is the approach that optimizes the likelihood of improvement in health-related quality of life, while limiting risks of complications and costs. Decompression alone is unreliable in the setting of significant deformity contributing to radiculopathy. Decompression with limited fusion is most appropriate for patients with age-appropriate global alignment of the spine, and decompression with more extensive fusion is most appropriate for patients with progressive deformity or with global sagittal or coronal malalignment.
Neurosurgery Clinics of North America, Volume 28, pp 335-339; https://doi.org/10.1016/j.nec.2017.02.003
Surgery for adult spinal deformity (ASD) has emerged as an efficient treatment alternative, but it is fraught with potential perioperative morbidity, incompletely mitigated by emerging minimally invasive surgical techniques. In mild-to-moderate ASD balanced in the sagittal plane, there are situations in which the counterintuitive simple decompression through a foraminotomy or laminectomy, or even a short-segment fusion may be an attractive treatment. This article presents a case example and the authors' treatment rationale and reviews the limited available literature supporting it.
Neurosurgery Clinics of North America, Volume 28, pp 429-438; https://doi.org/10.1016/j.nec.2017.02.009
Trigeminal neuralgia is characterized by severe, episodic pain in the trigeminal nerve distribution. Medical therapy is the first line treatment. For patients with refractory pain, a variety of procedures including microvascular decompression, percutaneous radiofrequency rhizotomy, percutaneous glycerol rhizotomy, percutaneous balloon compression, and stereotactic radiosurgery are available. We review the literature and suggest that microvascular decompression remains the gold standard operative therapy. For patients with recurrent pain or who are poor operative candidates, percutaneous radiofrequency rhizotomy offers the best pain response rates and has the advantage of being able to selectively target affected trigeminal divisions.
Neurosurgery Clinics of North America, Volume 28, pp 439-448; https://doi.org/10.1016/j.nec.2017.02.005
Myelomeningocele (MMC) is a costly lifetime disease with many comorbidities, including sensory and motor lower limb disability, bladder/bowel dysfunction, scoliosis, club foot, and hydrocephalus. MMC treatment options have changed over time because routine use of fetal ultrasonography and MRI has provided prenatal diagnosis and the potential for fetal surgery. There is still no consensus on how to treat the MMC diagnoses prenatally, mainly related to the infrastructure required to operate on pregnant patients. This article provides an overview of prenatal and postnatal MMC repair and the features in the prenatal diagnosis.
Neurosurgery Clinics of North America, Volume 28; https://doi.org/10.1016/j.nec.2017.01.001
Neurosurgery Clinics of North America, Volume 28; https://doi.org/10.1016/s1042-3680(17)30007-4
Neurosurgery Clinics of North America, Volume 28; https://doi.org/10.1016/s1042-3680(17)30005-0
Neurosurgery Clinics of North America, Volume 28; https://doi.org/10.1016/s1042-3680(17)30006-2
Neurosurgery Clinics of North America, Volume 28, pp 297-300; https://doi.org/10.1016/s1042-3680(17)30009-8
Neurosurgery Clinics of North America, Volume 28; https://doi.org/10.1016/s1042-3680(17)30008-6
Neurosurgery Clinics of North America, Volume 28, pp 229-237; https://doi.org/10.1016/j.nec.2016.11.005
Chronic subdural hematomas are commonly encountered pathologies in neurologic surgery. Primary management for a symptomatic lesion usually entails surgical intervention. There is controversy regarding ideal modality selection among twist drill craniostomy, bur hole craniostomy, and craniotomy. Variations of the craniotomy include a minicraniotomy (usually defined as 30-40 mm diameter), minicraniectomy, and with or without either a partial or full membranectomy. In addition to medical complications, potential surgical complications include recurrence, seizures, intraparenchymal hemorrhage, and infection. Prior studies are summarized as well as rates of mortality, morbidity, reaccumulation requiring repeat operation, and clinical outcomes.