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Purpose: Full-endoscopic spine surgery (FESS) is associated with specific complications, possibly linked to increased intracranial pressure (ICP) resulting from continuous saline infusion into the epidural space. This study aimed to assess the impact of saline irrigation and its correlation with noninvasively obtained ICP waveform changes., Methods: Patients undergoing FESS between January 2019 and November 2020 were included. Noninvasive ICP (n-ICP) monitoring utilized an extracranial strain sensor generating ICP waveforms, from which parameters P2/P1 ratio and time to peak (TTP) values were derived and correlated to irrigation and vital parameters. Documentation occurred at specific surgical intervals (M0-preoperatively; M1 to M4-intraoperatively; M5-postoperatively). Mixed-model analysis of variance and multiple comparisons tests were applied, with M0 as the baseline., Results: Among 31 enrolled patients, three experienced headaches unrelated to increased ICP at M5. The P2/P1 ratio and TTP decreased during surgery (p < 0.001 and p < 0.004, respectively). Compared to baseline, P2/P1 ratio and vital parameters remained significantly lower at M5. No significant differences were observed for fluid parameters throughout surgery., Conclusions: This study demonstrated a decline in the n-ICP parameters after anesthetic induction despite the anticipated increase in ICP due to constant epidural irrigation. The n-ICP parameters behaved independently of fluid parameters, suggesting a potential protective effect of anesthesia.

Background: Neurological complications during full-endoscopic spine surgery (FESS) might be attributed to intracranial pressure (ICP) increase due to continuous saline infusion (CSI). Understanding CSI and ICP correlation might modify irrigation pump usage. This study aimed to evaluate invasive ICP during interlaminar FESS; correlate ICP with irrigation pump parameters (IPPs); evaluate ICP during saline outflow occlusion, commonly used to control bleeding and improve the surgeon's view; and, after durotomy, simulate accidental dural tear., Methods: Five swine were monitored, submitted to total intravenous anesthesia, and positioned ventrally. A parenchymal catheter was installed through a skull burr for ICP monitoring. Lumbar interlaminar FESS was performed until exposure of neural structures. CSI was used within progressively higher IPPs (A [60 mm Hg, 350 mL/minute] to D [150 mm Hg, 700 mL/minute]), and ICP was documented. During each IPP, different situations were grouped: intact dura with open channels (A1-D1) or occlusion test (A2-D2); dural tear with open channels (Ax1-Dx1) or occlusion test (Ax2-Dx2). ICP <20 mm Hg was defined as safe., Results: Basal average ICP was 8.1 mm Hg. Adjustment in total intravenous anesthesia or suspension of tests was necessary due to critical ICP or animal discomfort. It was safe to operate with all IPPs with opened drainage channels (A1-D1) even with dural tear (Ax1-Dx1). Several occlusion tests (A2-D2, Ax2-Dx2) caused ICP increase (e.g., 86.1 mm Hg) influenced by anesthetic state and hemodynamics., Conclusions: During FESS, CSI might critically raise ICP. Keeping drainage channels open, with ideal anesthetic state, ICP remains safe even with high IPPs, despite dural tear. Drainage occlusions can quickly raise ICP, being even more severe with higher IPPs. Total intravenous anesthesia may protect from ICP increase and may allow longer drainage occlusion or higher IPPs., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective  To determine time period for hospital discharge and pain and function improvement in patients submitted to percutaneous endoscopic lumbar discectomy (PELD). Methods  Retrospective evaluation of length of stay and visual analog scale (VAS), Oswestry disability index (ODI), and Roland-Morris questionnaire results in 32 patients undergoing PELD at the preoperative period and at 2 days and 1, 2, 4, 6 and 12 postoperative weeks. Results  All patients were discharged in less than 6 hours. There was a statistically significant improvement between the results obtained before the procedure and 2 days postsurgery: the mean VAS for axial pain went from 6.63 to 3.31, the VAS for irradiated pain went from 6.66 to 2.75, the Oswestry score went from 44.59 to 33.17%, and the Roland-Morris score went from 14.03 to 10.34. This difference progressively improved up to 12 weeks in all questionnaires. Regarding the Oswestry score, minimum disability values (19.39%) were observed at 6 weeks. Conclusion  All 32 patients were discharged within 6 hours. Pain and function improved significantly after 48 hours, with further significant and progressive improvement until the 3 rd month., Competing Interests: Conflito de Interesses Os autores declaram não haver conflito de interesses.

Background: Endoscopic spinal surgery is becoming quite popular, and the pursuit of a training model to improve surgeons' skills is imperative to overcome the limited availability of human cadavers. Our goal was to determine whether the porcine spine could be a representative model for learning and practicing interlaminar percutaneous endoscopic lumbar procedures (IL-PELPs)., Methods: Lumbar and cervical segments of the porcine cadaver spine were used for the IL-PELP. We have described the technical notes on the difficulties of the procedure and the relevant anatomical features. To endorse the porcine cadaver for this procedure, 5 neurosurgeons underwent 1 day of training and completed a survey., Results: The porcine lumbar spine has small interlaminar windows, and laminectomy is necessary, mimicking the translaminar approaches for higher human lumbar spine levels. The porcine cervical spine has wide and high interlaminar windows and mimics the human L5-S1 interlaminar approach. Entering the spinal canal with the working sheath and endoscope and training the rotation maneuver to access the disc space is only possible in the lumbar segment. It was possible to perform flavectomy and to identify and dissect the dural sac and nerve root in both the lumbar and cervical spine. The neurosurgeons considered the porcine model of good operability and, although different, possible to apply in humans., Conclusions: The porcine spine is an effective and representative model for learning and practicing IL-PELPs. Although the described anatomical differences should be known, they did not interfere in performing the main surgical steps and maneuvers for IL-PELPs in the porcine model., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: To ascertain the safety, effectiveness and reproducibility of screening potential neurosurgical patients by means of smartphones., Methods: This is a retrospective and multicentric study. Data were collected from the medical records of patients subjected to real emergency neurosurgical evaluations and compared with assessments by neurosurgeons using smartphones to determine the feasibility of identifying changes in cranial computed tomography scans, potentially serious conditions of patients, and the need for transfer to reference centers., Results: We analyzed 232 cases. The main diagnosis was traumatic brain injury, with 119 cases (51.3%). Of this, 105 (45.3%) patients were discharged immediately after the assessment. The telemedicine evaluators presented 95.69% accuracy in the identification of changes in computed tomography scans, with 0.858 concordance. Accuracy in the identification of severity was 95.26%, with 0.858 concordance. As for procedure, the concordance among evaluators was 0.672, increasing to 100% in cases that required surgical treatment., Conclusion: Our study indicated that the use of telemedicine for screening patients with acute neurological disorders was safe, effective and reproducible. Implementation of the method shows a promising potential to improve the patient's outcome by reducing unnecessary transfers and decreasing the time elapsed until a specialist can be consulted.

Purpose: To validate the porcine spine as a model for learning and practicing transforaminal percutaneous endoscopic lumbar procedures (TF-PELP)., Methods: TF-PELP was performed in three porcine cadaver lumbar spine levels. Anatomical features of the current cadaver were compared to human and porcine spines. Performance and documentation of endoscopic procedures were described., Results: This study shows that this representative animal model reflects anatomical characteristics of the human spine. Transforaminal approaches were successfully completed. Although lower disc heights make disc puncture more difficult, the outside-in technique is feasible and more useful to identify anatomical parameters and to practice different surgical steps and maneuvers., Conclusion: This is an effective and representative model for learning and practicing this procedure. Difficulties of the procedure, as well as the differences compared to the human spine, were described.