Search

Background: Few studies of high quality exist on return to work (RTW) rate after surgery for degenerative cervical myelopathy (DCM). This study aims to examine the RTW rate in patients undergoing surgery for DCM. Methods: Nationwide prospectively collected data were obtained from the Norwegian Registry for Spine Surgery and the Norwegian Labour and Welfare Administration. The primary outcome was return to work, defined as being at work at a given time postoperatively without any medical income-compensation benefits. Secondary endpoints included the neck disability index (NDI) and quality of life measured by EuroQol-5D (EQ-5D). Results: Among 439 patients operated for DCM between 2012 and 2018, 20% of the patients received a medical income-compensation benefit one year before surgery. This number increased steadily towards the operation at which timepoint 100% received benefits. By 12 months after surgery, 65% had returned to work. By 36 months, 75% had returned to work. Patients that returned to work were more likely to be non-smokers and to have a college education. They had less comorbidity, more were without benefit 1-year pre-surgery, and significantly more patients were employed at operation date. Average days of sick leave in the year before surgery were significantly less in the RTW group, and they had a significantly lower baseline NDI and EQ-5D All PROMs reached statistical significance at 12 months, in favor of the group that achieved RTW. Conclusion: At 12 months following surgery, 65% had returned to work. At the end of the 36-month follow-up period, 75% had returned to work, 5% less than the working percentage in the beginning of the follow-up period. This study demonstrates that a large percentage of patients return to work after surgical treatment for DCM. [ABSTRACT FROM AUTHOR]

Introduction: Brain abscesses affect all age groups and are not peculiar to a particular country, race, or geographical location. It is a disease that, in the past, carried a high morbidity and mortality. With improvements in medical technology and expertise, outcomes have improved tremendously. The causative organisms vary vastly and have evolved with time. Treatment of brain abscesses is primarily with antimicrobial therapy but surgery plays a vital role in achieving better outcomes.Content: In this article, we review the literature to find out how the epidemiology of this disease has changed through the years and re-visit the basic pathological process of abscess evolution and highlight the new research in the biochemical pathways that initiate and regulate this process. We also highlight how magnetic resonance imaging and its various modalities have improved diagnostic accuracy. Finally, we discuss the pros and cons of traditional open surgery versus newer minimally invasive methods. [ABSTRACT FROM AUTHOR]

Objective: Endoscopic third ventriculostomy (ETV) provides a shunt-free treatment for obstructive hydrocephalus children. With rapidly evolving technology, the semi-rigid fiber optic neuroendoscopy shows a potential application in ETV by blunt fenestration. A retrospective analysis of our experience is reviewed.Methods: The authors review infants and children who underwent ETV using this technique from June 2004 to June 2016 with radiological and clinical follow-up done by a single surgeon. Patients who underwent ETV with channel scope were excluded. Demographic variables and operative reports were collected. Improvement of preoperative symptoms and avoidance of additional cerebrospinal fluid (CSF) diversion procedures were considered a success. The ETV success score (ETVSS) was used to correlate with clinical outcomes.Results: A total of 79 patients were included with a mean age of 8.3 ± 5.5 years, and 40.5% were female. The mean clinical and radiographic follow-up was 38.6 ± 40.9 months. The overall complication rate was 6.3%, while 73.4% were considered successful. The ETV failure cases received conversion to ventriculoperitoneal shunt or redo of ETV with a median time of 2 months. The mean ETV success score was 74.3 ± 11.8 with positive correlation between success rate (P < 0.05). Kaplan-Meier failure-free survival rates of 30-day, 90-day, 6-month, 1-year, and 2-year were 89.9, 83.5, 78.5, 75.9, and 74.6%. Eight patients required redo ETV, and five of these patients required eventual shunt placements. Approximately 61.9% of failure occurred within 3 months. Patients with post-intraventricular hemorrhage (IVH) /infection, and age younger than 12 months had the poorest outcome (P < 0.05).Conclusions: Blunt dissection of the third ventricle floor under endoscopic vision with the stylet tip of a fiber optic neuroendoscopy is safe and requires less equipment in the pediatric population. This technique is successful with an optimistic long-term outcome except for infants and the post-IVH and infectious subgroups. [ABSTRACT FROM AUTHOR]

Objective: To study the efficacy of transcallosal, transforaminal approach in excision of colloid cysts of third ventricle in terms of complete excision and post-operative complications. Study Design: Prospective observational study. Place and Duration of Study: Study was carried out in neurosurgery department of CMH Rawalpindi, from July 2009 to Jun 2014. Material and Methods: All suspected cases were subjected to CT scan and MRI of brain for diagnosis and size and site of colloid cyst. All patients having colloid cyst of anterior third ventricle irrespective of age, sex and size of the cyst were included in the study. Patients with recurrence or previous surgery were excluded from the study. Patients with psychiatric illness and abnormalities of memory were also excluded. A uniform approach in terms of position of patients, craniotomy site and flap elevation was adopted for all patients. Post operatively the complications were recorded at 2nd day and 6th week. Derangement of short and long term memory, beads stringing and touch localization were recorded on a specific proforma. Results: A total of 19 patients with colloid cyst of 3rd ventricle were included, thirteen were male and 6 were female patients. The most common presentation was headache and vomiting. Most frequent cyst size was 1-2 cm and was present in 57.9%, while 4 patients presented with a large cystic swelling measuring 2-3 cm. A preoperative shunt had to be inserted in two cases due to sudden deterioration of the neurological status. Most of the cases (68.4%) presented with hydrocephalus, and it was absent only in 6 cases. Complete excision was obtained in 17 cases while in 2 cases the cyst could not be removed completely. Most frequent complication on 2nd postoperative day was the impaired short term memory which was present in 13 patients. Beads stringing was impaired in 9 patients on 2nd post-operative day. On sixth post-operative week, only 2 cases had short term memory loss as improvement occurred in all complications. Conclusion: Transcallosal, transforaminal approach is an effective and safe approach for the excision of colloid cysts of anterior third ventricle. Very few complications of less severity and temporary nature are associated with this approach. [ABSTRACT FROM AUTHOR]

Objective and importance: We report Septated Chronic Subdural Hematoma (sCSDH) cases with the neovessel in the hematoma cavity, and evaluate surgical effect of the neuroendoscope-assisted neovessel coagulation for these sCSDH patients. Clinical presentation: Four patients suffered from sCSDH with different clinical symptoms. Magnetic resonance imaging (MRI) was applied to differentiate the neovessel from the bridge vein and septa fibra. Endoscopic surgeries were performed after their admission. Technique: Through the small bone window, we used suction to clean the surgical field so that the neovessels can be exposed, which is thought to be the one of recurrence factors for the sCSDH, then we coagulated and cut them under the neuroendoscope. Case examples are described here to illustrate the technique. Conclusion: This report illustrates that the neovessel is one of recurrence factors of sCSDH and has special characteristics showed on MRI. Through this technique with the guidance of MRI the recurrence rate of sCSDH can be reduced. [ABSTRACT FROM AUTHOR]

Background: Endoscopic resection is becoming a well-established treatment option for patients with colloid cysts of the third ventricle. A disadvantage of this approach is the decreased ability to resect cysts in their entirety. Correlations between magnetic resonance imaging (MRI) features and cyst content could potentially help surgeons decide on the extent of resection and approach. We attempted to identify a correlation between patients' MRI imaging patterns and difficult cyst removal, post-operative adverse outcomes and the need for cerebrospinal fluid (CSF) diversion, in order to detect markers that may affect pre-surgical planning. Method: A retrospective examination of all patients' records that underwent a colloid cyst excision attempt at our institution between 2001 and 2014, and which had a minimum 1-year follow-up was compiled. Results: Of the 25 patients fulfilling the criteria, we found cysts with a low T2 signal, specifically when combined with high T1 signal, to be significantly correlated with piecemeal, difficult removals. Correlation was also found between high T2 signal cysts and pre-operative hydrocephalus. Among patients that had pre-existing hydrocephalus, those that required a piecemeal removal possessed a strong trend towards a need for subsequent shunting. Conclusions: We found specific MRI features suggestive of difficult cyst excision. In a subgroup of patients with pre-operative hydrocephalus and imaging features suggestive of difficult removal, significantly higher rates of shunting were observed. We therefore recommend an open approach in cases of low T2, high T1 signal cysts with a diameter of over 15 mm, or CSF shunting in poor surgical candidates. Smaller cysts, with a low T1 signal, a high T2 signal and pre-operative hydrocephalus, constitute a subgroup in which we recommend endoscopic intervention as the procedure of choice. [ABSTRACT FROM AUTHOR]

The article presents a study on the quality of interventional embolization of middle meningeal artery (MMA) toward chronic subdural hematoma (CSDH). It mentions that patients with the disease are treated through surgical intervention. It also provides a chart depicting the history and medical course of patients.

Objective : The aim of this study is to assess outcomes during first one year for patients with severe motor weakness caused by lumbar disc herniation that underwent surgical or nonsurgical treatment. Methods : The 46 patients with motor weakness because of lumbar disc herniation who were treated at neurosurgical department and rehabilitation in our hospital from 2006 to 2010, retrospectively. Each group had 26 surgical treatments and 20 conservative treatments. We followed up 1, 3, 6 months and 12 month and monitored a Visual Analogue rating Scale (VAS) of back and leg pain, Oswestry Disability Index (ODI) and degree of motor weakness. We analyzed the differences between surgical and nonsurgical groups using Mann-Whitney U test and repeat measure ANOVA in each follow-up periods. Results : In the recovery of motor weakness, surgical treatment uncovered a rapid functional recovery in the early periods (p=0.003) and no difference between groups at the end of follow-up period was found (p>0.05). In VAS of back and leg, the interaction between time and group was not found (p>0.05) and there was no difference between groups (p>0.05). In ODI, the interaction between time and group was not found (p>0.05) and there was no difference between groups (p>0.05). Conclusion : Surgical treatment for motor weakness caused by herniated intervertebral disc resulted in a rapid recovery in the short-term period, especially 1 month. We think early and proper surgical treatment in a case of motor weakness from disc herniation could be a good way for providing a chance for rapid alleviation. [ABSTRACT FROM AUTHOR]

Purpose: Pineal cysts (PC) are found in children as often asymptomatic and without change in their size over the time. However, there are some debatable issues about their evolution and management in the pediatric population. The aim of the present paper is to update the information regarding pathogenesis, clinical presentation, and management of these lesions. Methods: All the pertinent literature was reviewed, and a meta-analysis of operated on cases was carried out. An illustrative case regarding the clinical evolution of a 13-year-old girl is also presented. Results and conclusions: PC are often asymptomatic and do not evolve over the time. However, since there is a certain risk of clinical and/or radiological progression, or even sudden and severe clinical onset (apoplexy), both a clinical and radiological follow-up is recommended in the pediatric age. The surgical excision is usually limited to symptomatic patients or to cases with clear radiological evolution. [ABSTRACT FROM AUTHOR]

Background: The main purpose of this project is to define the major indications, preferences, techniques, limitations, and complications associated with intraventricular tumor removal using purely endoscopic techniques. Methods: Published papers on neuroendoscopy were reviewed, and a questionnaire about purely endoscopic surgery for intraventricular brain tumors was designed. The questionnaire included details regarding neuroendoscopic techniques, surgeons' endoscopic experience, and clinical vignettes. 20 experienced neuroendoscopists from the 10 represented countries were surveyed. Results: 15 physicians (75 %) responded to the survey, having an estimated 264 cumulative years of endoscopic experience. There was general agreement regarding: the instrumentation used, endoscope features, irrigation, technique of colloid cyst and solid intraventricular tumor removal, complications, future technologies, and the treatment of sample clinical vignettes. There was appreciable variability in endoscope control preferences. Conclusions: Endoscopic intraventricular surgery is a feasible minimally invasive alternative to open transcranial surgery for specific ventricular tumors. With the currently available instrumentation, the technique can be applied to small avascular solid intraventriclular tumors and colloid cysts of the third ventricle. The majority of the complications are based on hemostasis potential. The development of compatible instrumentation with an enhanced ability for solid tumor removal and more adequate hemostasis appear to be the principle limitations in furthering the technique of endoscopic removal of intraventricular brain tumors. [ABSTRACT FROM AUTHOR]

Pediatric colloid cysts (CC) have a congenital origin, and yet, there are very few studies focussing exclusively on their occurrence in the pediatric population. Pediatric CC has been associated with more aggressive clinical and radiological patterns than their adult counterparts. In this study, undertaken on children with anterior third ventricular CC, excised using the interhemispheric transcallosal approach, the characteristic clinicoradiological features and management options are studied. Five pediatric patients (aged 16 years or less; mean age 13.8 years; mean duration of symptoms:7.6 months) out of 38 patients with CC operated between 1995 to 2009 were included. The clinical manifestations included those of raised intracranial pressure ( n = 4); exacerbation of occipital headache on reading ( n = 1); secondary optic atrophy ( n = 3); and, drop attacks ( n = 1). On computed tomography scan, the cyst was hyperdense, enhancing in two patients and not enhancing in three patients. All had bilateral lateral ventricular dilatation with periventricular lucency. On magnetic resonance imaging ( n = 3), the cyst was T1 hypointense and T2 isointense in one, hyperintense on both T1 and T2 with a hypointense capsule and nonenhancing on contrast in one (with a giant colloid cyst), and T1 hyperintense and T2 hypointense in one patient. An interhemispheric, transcallosal trajectory combined with transforminal approach ( n = 3); combined transforminal and subchoroidal approaches ( n = 1); and, interforniceal approach ( n = 1) were used. Total excision was performed in four patients. In one patient, a small part of capsule was left attached to thalamostriate vein. Symptoms of raised intracranial pressure showed improvement in all the patients with resolution of hydrocephalus. There was no tumor recurrence at follow-up. Pediatric colloid cysts are rarer than their adult counterparts due to their late detection only after manifestations of raised intracranial pressure, visual or cognitive dysfunction or drop attacks occur. Their radiological appearance varies depending upon the amount of mucoid content, cholesterol, proteins, and water content. The fast development of clinical manifestations in children may be related to rapid enlargement of cyst due to higher water content within them. The transcallosal approach is the “gold standard” of surgery and usually ensures gratifying and lasting results. [ABSTRACT FROM AUTHOR]

Background: The benefits of endoscopic assistance to remove intracranial tumors in small animals are not described. Objective: To evaluate the effectiveness of endoscopic-assisted intracranial tumor removal in dogs and cats. Animals: Thirty-three dogs and 6 cats with intracranial tumors. Methods: Retrospective study. CBC, serum chemistry profile, coagulation testing, blood typing, and systemic tumor staging, which included 3-view thoracic radiographs and abdominal ultrasound examination, were performed to detect other significant underlying disease in preparation of the animal for surgery. Magnetic resonance imaging was used in 37/39 cases to image the brain tumor. Surgical approach was dictated by the location of the tumor. Histopathologic examination of the tumor tissue was performed in all cases. Animals were followed throughout their postoperative course for complications and survival times. Statistical analysis (Kaplan-Meier curves) was performed to obtain median survival times in dogs with meningiomas. Results: Use of an endoscope resulted in visualization of residual tumor and potentially more complete removal of the brain tumors. There were no clinically important complications associated with the use of the endoscope. Median survival time was 2,104 days for dogs with forebrain meningiomas surgically removed with endoscopic assistance and 702 days for dogs with caudal brain meningiomas. Conclusions and Clinical Importance: These results demonstrate that the use of an endoscope to assist in brain tumor removal is apparently safe and might result in improved survival times. [ABSTRACT FROM AUTHOR]

Colloid cysts are benign space-occuping lesions, which arise from the velum interpositum or the choroid plexus of the third ventricle and are able to produce symptomatic obstruction of the foramina of Monro with resultant hydrocephalus. In our department, we have operated on colloid cysts routinely in an endoscope-assisted microsurgical manner via a key–hole approach. During a period of 10 years, 28 microsurgical resections of colloid cysts of the third ventricle were performed. Seven patients demonstrated colloid cysts inside the third ventricle with obstruction of the right foramen Monro, two patients demonstrated cysts with obstruction of the left foramen Monro. Twelve patients suffered from cysts inside the third ventricle with obstruction of both foramina Monro and five patients demonstrated cysts lying into the third ventricle without obstruction of the foramina. In 21 patients no preoperative therapy was performed outside. Three patients had received shunt systems before in other hospitals, two patients received aspiration of the cysts under stereotactic conditions and two patients received external ventricular drains. Total removal of the cyst was achieved in all patients (100%). No patient received a second operation, because none had a recurrent cyst. All cysts were removed with the cyst wall. Overall clinical improvement was achieved in a long-standing period between 6 and 83 months in 27 (96%) patients. In one patient (4%) the psychomotor disturbance was unchanged and no patient deteriorated. From the microsurgical point of view, the combination of keyhole surgery under endoscopic visual control using preexisting anatomical windows offers an effective minimally invasive approach. [ABSTRACT FROM AUTHOR]

This article reviews chronic subdural haematoma in terms of evidence relating to incidence, pathogenesis and treatment. While it is one of the commonest neurosurgical conditions, unanswered questions persist, particularly in terms of treatment options, with a multitude of personal preferences. Current management strategies are summarized and the need to rationalise treatment backed up by Class I randomized studies is discussed. [ABSTRACT FROM AUTHOR]

One hundred four patients with pituitary tumours were treated using the direct transnasal approach. The data of these patients were analysed prospectively with regard to duration of surgery and occurrence of complications and compared with retrospective data from 52 patients in whom the traditional sublabial trans-sphenoidal approach was performed. Using the direct transnasal approach, mean operative time was significantly lower than with the sublabial technique. In addition, even though major complications were observed in neither treatment group, minor complications were significantly less frequent after the direct transnasal approach. Due to minimised dissection of normal tissue, this approach is less time-consuming and less traumatic, and the rate of minor complications is significantly lower than with the sublabial procedure. [ABSTRACT FROM AUTHOR]

Colloid cysts of the third ventricle account for 0.5–2% of all intracranial tumors. The treatment of these benign tumors remains controversial, and the best surgical option has not yet been determined. Between 1995 and 2002, 27 patients with colloid cysts of the third ventricle presented at our clinic. Twenty-six underwent transcortical-transventricular approaches. One refused surgical treatment. There was no surgical mortality. The main morbidity was epileptic seizures in two patients. Overall outcome was good in all patients. The mean follow-up period was 3.4 years. There were no tumor recurrences. The transcortical-transventricular approach can be used safely to excise third ventricle colloid cysts with low risk of mortality and morbidity. [ABSTRACT FROM AUTHOR]

Objective: To undertake a prospective study of the long term neuropsychological outcome in patients with late onset idiopathic aqueduct stenosis (LIAS) after endoscopic third ventriculostomy.Methods: Six patients with LIAS were evaluated pre- and postoperatively using magnetic resonance imaging (MRI) and standardised psychometric testing procedures. Endoscopic third ventriculostomy was done using standard surgical techniques. The mean long term follow up was 81.2 weeks.Results: Preoperatively, all patients had cognitive impairment, four of them showing deficits in several cognitive domains. After endoscopic third ventriculostomy, all patients improved clinically and had ventricular size reduction on MRI. Postoperative neuropsychological testing showed that five patients achieved normal or near normal cognitive functions, and one improved moderately.Conclusions: Endoscopic third ventriculostomy caused a substantial improvement in the neuropsychological deficit of LIAS patients. This was also true for patients with enlarged ventricles that might be diagnosed radiologically as "arrested hydrocephalus." [ABSTRACT FROM AUTHOR]

A 17-year-old man underwent an incomplete excision of a left fronto-parietal arterio-venous malfor mation (AVM), under image guidance. An initial attempt to treat the residual AVM by embolization was unsuccessful. The craniotomy was then re-opened in the angiography suite and the residual AVM was excised by, first, following the microcatheter within the arterial feeding vessel to the AVM and, secondly, by using metallic clips as radiographic markers to locate the position of the AVM during superselective angiography. The dual technique described is likely to be useful in selected cases with small residual AVMs and AVMs near eloquent areas of the brain, where the extent of surgical dissection and postoperative morbidity can be minimized by the precise localization of the AVM. [ABSTRACT FROM AUTHOR]

Different authors recommend different time spans for conservative treatment before considering surgery in patients suffering from lumbar disc herniation. We analyzed the time of onset of symptoms such as pain, sensory deficit, and motor deficit in a surgically treated group in comparison to outcome after surgery in order to define a time threshold when surgical results deteriorate and operation should therefore be considered. General data, symptoms, signs, and neurological findings of 219 patients were preoperatively recorded. The outcome was evaluated according to the Prolo scale after a mean of 9.9 months. In the statistical workup, we calculated the duration of symptoms, sensory deficits, and motor deficit as continuous variables. Additionally, the population was divided into three groups of duration of symptoms, sensory deficit, or motor deficit for ≤30 days, 30–60 days, and >60 days. Statistically significant predictors for unfavourable outcome were, for example, a longer duration of preoperative pain and motor and sensory deficit. Patients suffering for more than 60 days from disc herniation were found to have statistically worse outcome than patients suffering for 60 days or less. Findings were similar for the different time groups concerning the duration of sensory deficit but not for duration of motor deficit. The overall outcome seems to be better when patients are operated on for lumbar disc herniations within 2 months after onset of symptoms and sensory deficits. Due to these findings, we recommend conservative treatment up to 2 months and, if conservative management does not succeed, consideration of surgery. [ABSTRACT FROM AUTHOR]