Search

Introduction: Craniopharyngiomas are a big challenge in the neurosurgical field. Because these lesions involve important systems, surgeons must weigh the risks of aggressive resection against the long-term challenges of recurrence. We present the outcomes of our patients based on clinical results, degree of resection, recurrence and disease-free survival., Materials and Methods: We reviewed medical records in all patients who had undergone surgical resection for craniopharyngioma at (Hospital Italiano de Buenos Aires) between 2007 and 2019. We considered ophthalmological examinations, imaging studies, endocrinological studies and surgical complications. Radical resections were planned in all of the patients. To help choose the correct surgical approach, craniopharyngiomas were classified based on tumor location., Results: Thirty cases of craniopharyngioma were analysed. 12.5% were classified as intrasellar, 12.5% as prechiasmatic, 43.75% as retrochiasmatic, and 31.25% as intraventricular. Overall, 38 cases involved a transcranial surgery (15 orbitozygomatic approach; 19 pterional approach and 4 transcallosal approach), seven involved a transsphenoidal approach, two microscopic transnasal approach and one ventricular endoscopy for emptying the craniopharyngioma cyst. Gross-total resection was achieved in 43.7% and near-total resection (more than 90%) in 25%. The mean follow-up period after resection was 4.7 years. Tumor recurrence occurred in 48%, with an average of 42.7 disease-free months., Conclusion: Total tumor resection is the best treatment for craniopharyngioma. Due to its high morbidity and mortality, a multidisciplinary team is necessary for the management of these tumors., (Copyright © 2020 Sociedad Española de Neurocirugía. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To present the treatment algorithm, surgical technique, and results of a series of patients with spinal synovial cysts operated with minimally invasive techniques (MIS)., Introduction: Spinal synovial cysts originate from the dilation and potential rupture of the synovial sheath of a facet joint. Surgical resection is considered the treatment of choice in symptomatic patients. The use of MIS techniques could reduce the disruption of the facet joint involved, reducing the risk of postoperative instability., Materials and Methods: We retrospectively evaluated 21 patients with spinal synovial cysts operated by MIS approach and decompression. We analyzed the signs, symptoms, surgical time, hospital stay, evolution, and complications. The visual analog scale (VAS) was used to evaluate pain and the Weiner scale and the modified Macnab criteria to measure the patient's postoperative satisfaction., Results: A total of 21 patients were surgically treated with MIS technique; 76.2% ( n = 16) did not require arthrodesis, the remaining 23.8% ( n = 5) were fused. We performed 13 (61.9%) contralateral hemilaminectomies, 7 ipsilateral hemilaminectomies (33.3%), and 1 laminectomy in S1-S2. The average follow-up was 26 months; surgical time was 150.33 ± 63.31 min, with a hospital stay of 2.5 ± 1.78 days. The VAS decreased from 8.3 preoperatively to 2.3 postoperatively. Sixteen patients reported excellent results, four good and one regular in the scale of Macnab. 95.2% of patients perceived that the procedure was very/quite successful according to the Weiner scale., Conclusion: The minimally invasive approach is a safe and effective procedure for the complete resection of spinal synovial cysts. It provides excellent clinical-functional results by preserving muscles, ligaments, and joint facets., Competing Interests: There are no conflicts of interest.

Objective: To describe the surgical results and evolution of patients who underwent minimally invasive spine surgery (MISS) for the treatment of thoracolumbar spinal metastases, using the NOMS (Neurological, Oncological, Mechanical, Systemic) assessment for the therapeutic decision., Methods: Patients who underwent MISS technique for the treatment of thoracolumbar spinal metastases were prospectively enrolled at the Hospital Italiano de Buenos Aires, from June 2014 to June 2017. In all cases, the NOMS assessments were performed for therapeutic decision making. Surgical results were analyzed in terms of improvements in Karnofsky performance status, pain relief (VAS - visual analog scale), Frankel, blood loss, need for transfusions, complications, use of opioids and hospitalization length. A P < 0.05 value was considered statistically significant., Results: During the study period 26 patients were included, 13 of them were women. The average age was 57-year-old (27-83 years). Breast cancer was the most frequent primary tumor (27%). The main symptom was pain (96%), although 12 patients presented with myelopathy (46%). High-grade epidural spinal cord compression requiring decompression was observed in 17 cases (65%). According to the SINS (spinal instability neoplastic score), most lesions were potentially unstable or unstable (89%) requiring MISS stabilization. After surgery, pain relief (VAS) and neurological recovery (Frankel) improved significantly in the 77% and 67% of the cases, respectively, with low intraoperative blood loss and without any transfusions. Only one minor surgical complication was presented (4%). The average of hospital stay was 5.5 days., Conclusion: In our series and using the NOMS as a therapeutic algorithm, MISS was effective for decompression and spinal stabilization, with a low rate of complications and rapid postoperative recovery., Competing Interests: There are no conflicts of interest.

Background: With pituitary macroadenomas, there is a high incidence of visual loss from optic pathway compression. Surgical removal of the tumor usually prevents progression and allows visual recovery. Our objective was to evaluate if optical coherence tomography (OCT) predicts visual outcomes after surgical decompression., Methods: Patients with pituitary macroadenomas were prospectively recruited between February 2015 and November 2016. We evaluated preoperative and postoperative visual acuity, automated perimetry, and OCT. We compared the results 6-12 weeks and 6-9 months after surgical removal of the tumor. Dependent and independent continuous variables were analyzed by Student's t -test, linear regression analysis, and Pearson's correlation coefficients, considering P < 0.05 as statistically significant., Results: Visual acuity and visual field defects were much worse in patients with a thin preoperative retinal nerve fiber layer (RNFL). Both patients with normal RNFL thickness and patients with thin RNFL experienced significant improvement in postoperative visual perimetry 6-12 weeks after surgery. OCT values correlated inversely with pre- and postoperative visual fields, which means that, if the nerve was thicker, the visual field was better. Patients with a normal OCT had greater recovery because their preoperative perimetry values were better. The correlation between OCT values and visual field improvement was weak, suggesting that patients' visual fields improved after decompressive surgery independent of the nerve's thickness., Conclusion: The computerized visual field continues to be the gold standard in the evaluation of patients with pituitary macroadenomas with optic pathway compression. Our results suggest that OCT might not be an accurate predictor of visual outcomes., Competing Interests: There are no conflicts of interest.

Objective: The aim of this study was to estimate the learning curve needed for correct placement of minimally invasive percutaneous pedicle screws (PPS)., Introduction: PPS are the most common system used for instrumentation of spinal lesions that require stabilization., Methods: We retrospectively assessed the insertion of 422 PPS (T5 to S1) in 75 patients operated between 2013-2016 under two-dimensional fluoroscopic guidance. The surgeon 1 always placed the PPS on the right side and the surgeon 2 on the left side. Screw positioning and pedicle rupture was determined with the Gertzbein tomographic classification. We compared the accuracy of PPS placement in our series with a reference rupture rate of 8.08%, value obtained from a meta-analysis., Results: Of the 422 TTP, 395 were inserted into the pedicle without violation of its cortical wall (Grade 1 = 93.6%), 27 (6.4%) disrupted the pedicle, of which 3.8% were Grade 2, 1.65% Grade 3 and only 0.9% Grade 4. The Surgeon 1, presented an overall break rate of 6.6% reaching standard values of accuracy by placing 74 PPS, Surgeon 2 showed a disruption rate of 6.1%, reaching baseline values at 64 PPS; the difference between them was not statistically significant ( P = 0.9009)., Conclusion: In our series, it was necessary to place approximately 70 PPS to achieve intrapedicular accuracy comparable to results reported by experienced surgeons in this minimally invasive technique., Competing Interests: There are no conflicts of interest.

Objectives: The objective of the present study was to determine the indications, surgical technique, results, and complications of minimally invasive extraforaminal lumbar interbody fusion (ELIF)., Introduction: ELIF is characterized as removal of the superior articular process (SAP) to access the intra-canalicular root and disc through Kambin's triangle., Methods: A retrospective study was conducted of 40 patients operated upon between 2013 and 2015. Patients with low back pain or root pain due to degenerative disc disease, spondylolisthesis grade 1 and 2, recurrent disc herniation, and recess-foraminal stenosis were included. A visual analogue scale (VAS), the Oswestry index, the Weiner scale and the modified MacNab criteria were used to assess pain, clinical and functional results and patient satisfaction one year after surgery. Complications were documented and rated according to their severity, in four degrees., Results: We operated on 25 women and 15 men of average age 57 years. Of the forty, 47.5% were treated for spondylolisthesis, 25% by recess foraminal stenosis. In total, 54 interbody cages and 188 percutaneous pedicle screws were placed; and the mean duration of surgery was 245 (±25.4) minutes. The mean hospitalization time was 3.5 (±0.49) days. We observed nine Grade 1 and one Grade 2 complication. The mean preoperative ODI score was 51.9 ± 4.96, which improved to 12.2 ± 3.19 at one year ( P < 0.0001). The mean VAS low back pain rating improved from 8.81 ± 0.62 to 2.12 ± 0.89 ( P < 0.0001). By one year post-operatively, 77.5% of the patients had fusion (Bridwell grade 1 or 2)., Conclusions: ELIF is a safe and effective surgical approach. Satisfactory clinical outcomes, comparable to traditional techniques, can be achieved with facet resection limited to the superior articular process., Competing Interests: There are no conflicts of interest.