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• Reduction of localization time with preoperative marker. • Slightly improvement of effective dose (DAP). • No related complication. Intraoperative localization of the correct spine level can be challenging when dealing with the thoracic spine; especially in morbidly obese patients and in mid-thoracic spine lesions. Different radiological reference markers techniques for dorsal surgery have been reported without a clear DAP (effective dose), localization and surgical time analysis. The aim of the study is to analyze the radiological reference markers technique in terms of localization time and radiation dose during surgery for dorsal lesions. We used a radiopaque marker (fiducial) directly positioned before surgery over the lamina or the spinous process using CT scan for precise localization and vertebra count. We prospectively collected data about patients who underwent preoperative thoracic localization between April 2015 and September 2018 at Neurosurgery Department of Ferrara University Hospital. Clinical data as pathology, related surgical technique, radiological exams, localization time and radiation exposure were analyzed. 19 patients who underwent preoperative radiopaque marker (fiducial) positioning and 11 patients who underwent fluoroscopy technique were enrolled. No complications related to fiducial placement and no wrong-level occurred. The localization time with the fiducial was reduced dramatically (3 min vs 15 min of the standard technique). The average DAP (effective dose) for the fiducial group was 20 Gy-cm2 compared with 16 Gy-cm2 of the traditional group. The use of preoperative fiducial for intraoperative localization of the target level in the thoracic spine dramatically reduce the location time without a significantly higher DAP (effective dose). [ABSTRACT FROM AUTHOR]

Background Context: The load sharing classification (LSC) laid foundations for a scoring system able to indicate which thoracolumbar fractures, after short-segment posterior-only fixations, would need longer instrumentations or additional anterior supports.Purpose: We analyzed surgically treated thoracolumbar fractures, quantifying the vertebral body's fragment displacement with the aim of identifying a new parameter that could predict the posterior-only construct failure.Study Design: This is a retrospective cohort study from a single institution.Patient Sample: One hundred twenty-one consecutive patients were surgically treated for thoracolumbar burst fractures.Outcome Measures: Grade of kyphosis correction (GKC) expressed radiological outcome; Oswestry Disability Index and visual analog scale were considered.Methods: One hundred twenty-one consecutive patients who underwent posterior fixation for unstable thoracolumbar burst fractures were retrospectively evaluated clinically and radiologically. Supplementary anterior fixations were performed in 34 cases with posterior instrumentation failure, determined on clinic-radiological evidence or symptomatic loss of kyphosis correction. Segmental kyphosis angle and GKC were calculated according to the Cobb method. The displacement of fracture fragments was obtained from the mean of the adjacent end plate areas subtracted from the area enclosed by the maximum contour of vertebral fragmentation. The "spread" was derived from the ratio between this subtraction and the mean of the adjacent end plate areas. Analysis of variance, Mann-Whitney, and receiver operating characteristic were performed for statistical analysis. The authors report no conflict of interest concerning the materials or methods used in the present study or the findings specified in this paper. No funds or grants have been received for the present study.Results: The spread revealed to be a helpful quantitative measurement of vertebral body fragment displacement, easily reproducible with the current computed tomography (CT) imaging technologies. There were no failures of posterior fixations with preoperative spreads <42% and losses of correction (LOC)<10°, whereas spreads >62.7% required supplementary anterior supports whenever LOC>10° were recorded. Most of the patients in a "gray zone," with spreads between 42% and 62.7%, needed additional anterior supports because of clinical-radiological evidence of impending mechanical failures, which developed independently from the GKC. Preoperative kyphosis (p<.001), load sharing score (p=.002), and spread (p<.001) significantly affected the final surgical treatment (posterior or circumferential).Conclusions: Twenty-two years after the LSC, both improvements in spinal stabilization systems and software imaging innovations have modified surgical concepts and approach on spinal trauma care. Spread was found to be an additional tool that could help in predicting the posterior construct failure, providing an objective preoperative indicator, easily reproducible with the modern viewers for CT images. [ABSTRACT FROM AUTHOR]

For neurosurgeons, who are accustomed to the binocular microscope, there is a new learning curve that must be overcome for monocular endoscopic pituitary surgery. Different studies describe a learning curve between 15 and 200 procedures, after which both operative time and complications stabilize. In this retrospective study, we evaluate the endoscopic learning curve of our group, already trained in microsurgical transsphenoidal surgery, with the assistance of ear, nose, and throat (ENT) surgeons. From 2010 to 2015, a total of 95 patients with pituitary adenomas were treated with a purely endoscopic approach. The latest 48 patients treated with the endoscope (L group) were compared with the 47 initial patients treated with the endoscope (E group) and with 43 patients treated with the microscope (M group), in terms of surgical time, complications, and tumor removal rate. The complication rate was similar in all the groups, as was the rate of total adenoma resection. Mean surgical time was shorter in the L group than in the E group (115 ± 36 min vs. 157 ± 46 min, p < 0.001); the average operative time was also shorter in the L group than in the M group (135 ± 43 min). The estimated reduction in duration of surgery per 10 patients was 9 min ( p < 0.001). Over time, blood transfusions discrepantly increased from the E group to the L group (11% vs. 31%). Because of the pivotal role of ENT in the transnasal stage of 50 endoscopic procedures, we obtained an operative time comparable to that of microscopic procedures, with similar complication rate and gross total resections. Neurosurgical-ENT combined follow-up proved to be a fundamental protection from late complications. [ABSTRACT FROM AUTHOR]

An appropriate time (5–7 days) of discontinuation of low-dose acetylsalicylic acid (ASA) in patients undergoing surgery for chronic subdural hematoma (CSDH) is recommended. However, patient clinical deterioration often does not allow to wait the recommended time for surgery. Clear guidelines regarding the perioperative management of patients with ASA therapy are still lacking. The aim of this study is to compare the surgical outcome, complications, and mortality of patients suffering from CSDHs who underwent urgent surgery or before and after 5 days of discontinuation of low-dose ASA. A retrospective 3-center study included patients treated for CSDH taking low-dose ASA. Aspirin was discontinued on hospital admission. Based on the timing of discontinuation, we classified patients in 3 groups: urgent (surgery at admission), surgery within 5 days, and surgery 5 days after discontinuation. Surgery consisted of minicraniotomy or burr holes. Variables analyzed were age, comorbidities, modified Rankin Scale, complications, rebleedings, and mortality. Outcome measures were acute rebleeding requiring surgery, recurrence, mortality, complications, and clinical conditions. The χ2 test and the Fisher exact test were used to compare variables. Logistic regression analysis was used for defining the impact on outcome measures. We enrolled 164 patients. After aspirin discontinuation, patients underwent surgery: on admission (69 cases [42.1%]), within 5 days (59 patients [36%]), and after 5 days (36 cases [22%]). No correlation was observed between time of discontinuation and outcome measures, including having a worse clinical outcome. Our data showed that the time of discontinuation of ASA does not influence outcome. [ABSTRACT FROM AUTHOR]

Objective: Dural closure is one of the most critical steps in neurosurgical procedures as it prevents many common postoperative complications. Methods of dural closure include the use of allogenic, autogenic, xenogenic, absorbable or synthetic materials together with sealant/glues or hemostatic compounds. Most common autogenic graft is galea-pericranium. This study aims to demonstrate how the intrinsic properties of the galea-pericranium make effectively useless the application of any glue in order to ensure the watertight integrity of the graft. Patients and methods: 276 cases were included in the study. Postoperative dural-closure related complication in patients subjected to duraplasty were analysed in three groups undergoing different duraplasty techniques: galea-pericranium graft without sealants, galea-pericranium graft plus sealant, non-autologous dural patch plus sealant. Results: No statistically significant differences between the three groups were observed in terms of subcutaneous fluid collection rate, CSF fistulas, brain abscesses, subdural empyemas, wound dehiscence, radiotherapic sequelae. Conclusions: Our study shows that galea-pericranium alone (without sealants) is comparable to other duraplasty techniques that involve the use of sealants or of non-autologous pathches in terms of long term postoperative results. [ABSTRACT FROM AUTHOR]