Variability in Surgical Treatment of Spondylolisthesis among Spine Surgeons.

Variability in Surgical Treatment of Spondylolisthesis among Spine Surgeons.

World Neurosurg. 2017 Dec 27;:

Authors: Lubelski D, Alentado V, Williams S, O'Rourke C, Obuchowski N, Wang JC, Steinmetz M, Melillo A, Benzel E, Modic M, Quencer R, Mroz T

Abstract
BACKGROUND: There are a multitude of treatments for low grade lumbar spondylolisthesis. There are no clear guidelines for the optimal approach.
OBJECTIVE: To identify the surgical treatment patterns for spondylolisthesis, among United States spine surgeons METHODS: 445 US spine surgeons completed a survey of clinical/radiographic case scenarios on patients with lumbar spondylolisthesis with neurogenic claudication with (S+BP) or without (S-BP) associated mechanical back pain. Treatment options included decompression, laminectomy with posterolateral fusion, posterior lumbar interbody fusion, or none of the above. The primary outcome measure was the probability of two randomly chosen surgeons disagreeing on the treatment method.
RESULTS: There was 64% disagreement (36% agreement) among surgeons for treatment of spondylolisthesis with mechanical back pain (S+BP) and 71% disagreement (29% agreement) for spondylolisthesis without mechanical back pain (S-BP). For S+BP, disagreement was 52% for those practicing 5-10 years versus 70% among those practicing >20 years. Orthopedic surgeons had greater disagreement compared to neurosurgeons (76% vs 56%) for S+BP. Greater clinical equipoise was seen for S-BP compared to S+BP regardless of surgeon characteristics. For spondylolisthesis without mechanical back pain, neurosurgeons were significantly more likely to select decompression-only as compared to orthopedic surgeons who more commonly fused.
CONCLUSIONS: Clinical equipoise exists for the treatment of spondylolisthesis. Differences are greater when the patient presents without associated back pain. Surgeon case volume, practice duration, and specialty training influence operative decisions for a given pathology. Recognizing this practice variation will hopefully lead to better evidence and practice guidelines for the optimal and most cost effective treatment paradigms.

PMID: 29288862 [PubMed - as supplied by publisher]

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Resolution of tachyarrhythmia following posterior fossa decompression surgery for chiari malformation type I: A case report.

Resolution of tachyarrhythmia following posterior fossa decompression surgery for chiari malformation type I: A case report.

World Neurosurg. 2017 Dec 27;:

Authors: Elia C, Brazdzionis J, Tashjian V

Abstract
INTRODUCTION: Chiari malformation type I (CM) commonly present with symptoms such as tussive headaches, paresthesias and in severe cases, corticobulbar dysfunction.3 However, patients may present with atypical symptoms lending to the complexity in this patient population. We present a case of a CM patient presenting with atypical cardiac symptoms and arrhythmias, all of which resolved after surgical decompression.
CASE DESCRIPTION: A 31-year-old female presented with atypical chest pain, palpitations, tachycardia, headaches, and dizziness for 2 years. Multiple anti-arrhythmics and ultimately cardiac ablation procedure proved to be ineffective. MRI revealed CM and patient ultimately underwent surgical decompression with subsequent resolution of her symptoms.
CONCLUSION: The surgical management of CM patients presenting with atypical symptoms can be challenging and often times leading to delay in intervention. To our knowledge this is the only reported case of a patient presenting with tachyarrhythmia and atypical chest pain with resolution after chiari decompression. We believe the dramatic improvement documented in the present case should serve to advance chiari decompression in CM patients presenting with refractory tachyarrhythmia in whom no other discernable cause has been elucidated. Further studies are needed to better correlate the findings and to hopefully establish a criteria for patients that will likely benefit from surgical decompression.

PMID: 29288861 [PubMed - as supplied by publisher]

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Association between IDH1/2 mutation and preoperative seizures in patients with low-grade versus high-grade glioma: a systematic review and meta-analysis.

Association between IDH1/2 mutation and preoperative seizures in patients with low-grade versus high-grade glioma: a systematic review and meta-analysis.

World Neurosurg. 2017 Dec 27;:

Authors: Phan K, Ng W, Lu VM, McDonald KL, Fairhall J, Reddy R, Wilson P

Abstract
BACKGROUND: Seizures are a common presentation of brain tumors particularly in gliomas. Higher incidences of seizure have been reported in low-grade glioma and tumors located within the temporal and insular area. The association between IDH1/2 mutations with preoperative seizures in glioma and the magnitude of this association in low versus high-grade gliomas remains unclear. To clarify this relationship, a systematic review and meta-analysis was performed.
METHOD: Following the PRISMA guidelines and systematic review recommendations, electronic searches were performed on varies journal database and included literature up to May 2017. Data were extracted and pooled via meta-analysis.
RESULTS: 8 studies including 782 IDH1/2 mutation patients were compared with 803 IDH1/2 wild-type patients before surgery. There was a significant difference between seizure incidence in the IDH1 mutation group (61.6%) compared to the IDH1 wild-type group (32.1%) (OR 2.76; 95% CI 1.26-6.02; I2=73%, p = 0.01). Similar findings were observed during the analysis of IDH1/2 mutation (OR 2.74; 95% CI 1.74-4.33; I2=58%, p < 0.0001). The difference remained in both the IDH1 mutation group and the IDH1/2 mutation group within grade II gliomas but not in grade III and IV gliomas. Grade II glioma patients also showed a higher rate of IDH1/2 mutations and seizure compared to grade III or IV patients.
CONCLUSION: This study demonstrated a significant association between the presence of IDH1/2 mutation with the incidence of preoperative seizures. This association is only significant in patients with low-grade glioma (grade II) but not with higher grade (grade III and grade IV gliomas).

PMID: 29288860 [PubMed - as supplied by publisher]

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In Reply to the Letter to the Editor Regarding "WHO grade II meningiomas: the Role of Adjuvant/Salvage Gamma Knife Surgery After Initial Surgery and Prognostic Factor Assessment".

In Reply to the Letter to the Editor Regarding "WHO grade II meningiomas: the Role of Adjuvant/Salvage Gamma Knife Surgery After Initial Surgery and Prognostic Factor Assessment".

World Neurosurg. 2017 Dec 27;:

Authors: Liu X, Shan B, Wang M, Xu J

PMID: 29288859 [PubMed - as supplied by publisher]

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Risk factors associated with meningitis after neurosurgery operation: a retrospective cohort study in a Chinese hospital.

Risk factors associated with meningitis after neurosurgery operation: a retrospective cohort study in a Chinese hospital.

World Neurosurg. 2017 Dec 27;:

Authors: Chen S, Cui A, Yu K, Huang C, Zhu M, Chen M

Abstract
OBJECTIVE: Meningitis is a serious complication occurring after neurosurgical operations, which can result in severe morbidity and high mortality. This retrospective cohort study aimed to determine the risk factors of postoperative meningitis in a large clinical center of Neurosurgery in China.
METHODS: Patients who underwent neurosurgeries between January 2014 and December 2015 were selected and 1016 cases were included the final analysis. On the basis of propensity scores, 84 post-operative meningitis patients were successfully matched to the 84 patients without post-operative meningitis.
RESULTS: After propensity score matching, age, hospitalization duration, intraoperative use of corticoids, intraoperative use of antibiotics, external ventricular drainage, lumbar drainage, enteral nutrition, surgery duration, major craniotomy and transsphenoidal surgery were associated with post-operative meningitis. Also, we further confirmed preoperative use of corticoids, intraoperative use of corticoids, intraoperative use of antibiotics, external ventricular drainage, lumbar drainage, and major craniotomy were independent predictors of postoperative meningitis in propensity score-matched cohort. Then prediction model including these 6 independent predictors above was established. Finally, ROC curve and discriminant analysis validated this model has strong predictive power to evaluate post-operative meningitis.
CONCLUSION: The prediction model built in our study can be an excellent tool to predict meningitis after neurosurgical procedures.

PMID: 29288858 [PubMed - as supplied by publisher]

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Differentiating Optic Meningioma from Cavernous Hemangioma Using Multiparametric MRI.

Differentiating Optic Meningioma from Cavernous Hemangioma Using Multiparametric MRI.

World Neurosurg. 2017 Dec 27;:

Authors: Lecler A, Savignac A

PMID: 29288857 [PubMed - as supplied by publisher]

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Risk Factors and Management of Dural Defects in Anterior Surgery for Cervical Ossification of the Posterior Longitudinal Ligament.

Risk Factors and Management of Dural Defects in Anterior Surgery for Cervical Ossification of the Posterior Longitudinal Ligament.

World Neurosurg. 2017 Dec 27;:

Authors: Du YQ, Duan WR, Chen Z, Wu H, Jian FZ

Abstract
OBJECTIVE: To investigate risk factors and outcomes and to develop a cogent perioperative management algorithm for dural defects (DDs) in anterior surgery for cervical ossification of the posterior longitudinal ligament (OPLL).
METHODS: Ninety OPLL patients underwent anterior cervical decompression between January 2014 and December 2016 were reviewed. DDs occurred in 12 patients. Demographic, clinical and radiological data; intra- and postoperative management; and complications were analyzed. Risk factors for DDs were assessed using multivariate analysis. A treatment algorithm was identified based on these findings and our experience.
RESULTS: The prevalence of DDs is 13.3% (12/90). Univariate and multivariate analyses showed that the ratio of OPLL base to spinal canal (OR 1.09, P=0.012), kyphotic cervical alignment with thick OPLL masses (OR 9.44, P=0.026), and lateral, curved and irregular OPLL masses (OR 8.28, P=0.037) could be risk factors for DDs. DDs were repaired intraoperatively using onlay grafts, and lumbar drains were placed in all DD patients. The treatment was successful in all DD patients, and outcome measures did not differ between the DD and no DD groups. No patient developed complications associated with DDs and CSF leaks at the final follow-up.
CONCLUSIONS: Patients with broad-based OPLL, kyphotic cervical alignment with thick OPLL masses, and lateral, curved and irregular OPLL masses are associated with higher risks of DDs in anterior surgery for OPLL. Intraoperative primary repair using onlay grafts combined with early lumbar drains are simple, safe and effective strategies for DDs. The long-term sequelae of DDs are optimistic if they are managed adequately.

PMID: 29288856 [PubMed - as supplied by publisher]

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Biomechanical Analysis of Porous Additive Manufactured Cages for Lateral Lumbar Interbody Fusion: a Finite Element Analysis.

Biomechanical Analysis of Porous Additive Manufactured Cages for Lateral Lumbar Interbody Fusion: a Finite Element Analysis.

World Neurosurg. 2017 Dec 27;:

Authors: Zhang Z, Li H, Fogel GR, Liao Z, Li Y, Liu W

Abstract
BACKGROUND: A porous additive manufactured (AM) cage may provide stability similar to that of traditional solid cages, and may be beneficial to bone ingrowth. The biomechanical influence of various porous cages on stability, subsidence, stresses in cage, and facet contact force has not been fully described. The purpose of this study was to verify biomechanical effects of porous AM cages.
METHODS: The surgical FE models with various cages were constructed. The partially porous titanium (PPT) cages and fully porous titanium (FPT) cages were applied. The mechanical parameters of porous materials were obtained by mechanical test. Then the porous AM cages were compared to solid titanium (TI) cage and solid PEEK cage. The four motion modes were simulated. Range of motion (ROM), cage stress, endplate stress, and facet joint force (FJF) were compared.
RESULTS: For all the surgical models, ROM decreased by more than 90%. Compared with TI and PPT cages, PEEK and FPT cages substantially reduced the maximum stresses in cage and endplate in all motion modes. Compared with PEEK cages, the stresses in cage and endplate for FPT cages decreased, whereas the ROM increased. Compared among FPT cages, the stresses in cage and endplate decreased with increasing porosity, whereas ROM increased with increasing porosity. After interbody fusion, FJF was substantially reduced in all motion modes except for flexion.
CONCLUSIONS: Fully porous cages may offer an alternative to solid PEEK cages in lateral lumbar interbody fusion. However, it may be prudent to further increase the porosity of cage.

PMID: 29288855 [PubMed - as supplied by publisher]

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Lesional Temporal Lobe Epilepsy: Beware the Deceitful "Panic Attack".

Lesional Temporal Lobe Epilepsy: Beware the Deceitful "Panic Attack".

World Neurosurg. 2017 Dec 27;:

Authors: Kulason KO, Schneider JR, Rahme R, Pramanik B, Chong D, Boockvar JA

Abstract
BACKGROUND: Ganglioglioma is a rare, benign, intraaxial glioneuronal tumor, but a relatively common cause of pharmacoresistant temporal lobe epilepsy (TLE). Given its often nonspecific neuropsychiatric manifestations and frequently negative electroencephalographic workup, TLE can be easily misdiagnosed as a psychiatric disorder, particularly panic attacks.
CASE DESCRIPTION: We present a case of a 17-year old boy who was found to have lesional TLE secondary to a left temporal ganglioglioma, 5 years after having been misdiagnosed with panic disorder and undergone ineffective and unnecessary psychotherapy. He was successfully cured by surgery. Although a few similar cases of TLE masquerading as a panic disorder have been previously reported in the literature, this is the youngest and only pediatric patient described to date.
CONCLUSION: This report underscores the challenges in making an accurate clinical diagnosis of TLE and the importance of timely brain imaging whenever an atypical or medically refractory panic disorder is encountered.

PMID: 29288854 [PubMed - as supplied by publisher]

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Evaluation of Patient Perspectives Toward Awake, Frame-Based Deep-Brain Stimulation Surgery.

Evaluation of Patient Perspectives Toward Awake, Frame-Based Deep-Brain Stimulation Surgery.

World Neurosurg. 2017 Dec 27;:

Authors: Ben-Haim S, Falowski S

Abstract
BACKGROUND: Deep brain stimulation (DBS) is an effective therapeutic modality, however only a percentage of eligible patients undergo the procedure.
OBJECTIVES: To study patients perspectives towards Deep-Brain Stimulation (DBS) surgery.
METHODS: A survey was sent to 95 consecutive adult patients who underwent DBS surgery for Parkinson's disease, essential tremor, or dystonia with a 73% response rate(69 patients). Post-hoc analyses were performed evaluating factors that led to favorable outcomes. The average time between surgical procedure to survey completion was 16 months.
RESULTS: Awake-surgery, use of a rigid head-frame, and having hair clipped were seldom reported as major deterrents to surgery. Patients retrospectively report an average comfort level of 8.3±1.8 during surgery. The average comfort level with head-frame placement was reported as 5.2±3.15, and those patients reporting discomfort with the frame nonetheless reported overall comfort with the procedure (8.7±1.8). An analysis of satisfaction revealed that 90% of patients would recommend the procedure to a family member or friend, and that 78 % of patients would undergo the procedure again. A post-hoc analysis of patients that were not satisfied with the procedure revealed that this subset reported significantly less overall comfort (6.9+/-1.7, p=0.0003), and were less likely to report that the goals and expectations of surgery were clearly discussed prior to surgery (p=0.0004) CONCLUSIONS: Frame placement, awake surgery, and head shaving did not appear to play a significant role in most patients' decision-making process to undergo DBS, as analyzed in this retrospective cohort. The majority of patients are satisfied with the procedure and report being comfortable. Managing goals and expectations pre-operatively plays a significant role in ultimate overall satisfaction.

PMID: 29288853 [PubMed - as supplied by publisher]

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An infratentorial pure pleomorphic xanthoastrocytoma arising from middle cerebellar peduncle: a rare location of an uncommon tumor.

An infratentorial pure pleomorphic xanthoastrocytoma arising from middle cerebellar peduncle: a rare location of an uncommon tumor.

World Neurosurg. 2017 Dec 27;:

Authors: Gupta S, Mehrotra A, Pal L, Bhiashora KS, Jaiswal AK, Kumar R

Abstract
Pleomorphic xanthoastrocytomas (PXA) are rare tumors of glial origin comprising <1% of all astrocytic tumors of brain. These are rare in the infratentorial compartment and have not known to arise from middle cerebellar peduncle till date. The authors here discuss a case of a 16 year boy who presented in an altered sensorium and features of raised intracranial pressure and was found to have a 4 x 4 x 3 cms mass arising from the middle cerebellar peduncle. The authors also discuss the histopathological features of these tumors suggesting their resemblance to other mal-developmental tumors, the rarity of pure WHO grade II PXA in infratentorial compartment, as well as the appropriate management.

PMID: 29288852 [PubMed - as supplied by publisher]

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Flat posterior cranial fossa affects outcomes of microvascular decompression for trigeminal neuralgia.

Flat posterior cranial fossa affects outcomes of microvascular decompression for trigeminal neuralgia.

World Neurosurg. 2017 Dec 27;:

Authors: Fukuoka T, Nishimura Y, Hara M, Nomura K, Ryu H, Yoshikawa S, Wakabayashi T

Abstract
OBJECTIVE: The aim of this study was to investigate prognostic factors for microvascular decompression (MVD) in patients with primary trigeminal neuralgia (TN), with a particular focus on the morphology of the posterior cranial fossa (PCF).
METHODS: The present study investigated 126 surgically treated primary TN patients with more than 1-year follow-up who underwent high-resolution magnetic resonance imaging between April 2003 and September 2015. We retrospectively reviewed clinical information and operative findings. Outcomes of MVD were also evaluated and patients were classified into "success" and "failure" groups. Furthermore, length, width, and height of the PCF were measured by approximation to an ellipsoid with reference to the anterior commissure-posterior commissure line. These values were compared between groups.
RESULTS: Atypical type-2 TN (P<0.001) and weak neurovascular compression (NVC) (P<0.001) correlated significantly with poor outcomes of MVD for primary TN. In terms of PCF morphology, the failure group showed a flatter PCF than the success group, while sex, age, affected side, topography of facial pain, interval between onset and surgery, responsible vessel, location of compression along the nerve, and site of compression around the circumference of the nerve root did not significantly affect outcomes of MVD for primary TN.
CONCLUSIONS: The present study identified type-2 TN, weak NVC, and flatness of the PCF as predictors of poor prognosis after MVD for primary TN.

PMID: 29288851 [PubMed - as supplied by publisher]

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Angiographic "blush" after stereotactic radiosurgery ablation of a residual arteriovenous malformation in a pediatric patient: case report and review of the literature.

Angiographic "blush" after stereotactic radiosurgery ablation of a residual arteriovenous malformation in a pediatric patient: case report and review of the literature.

World Neurosurg. 2017 Dec 27;:

Authors: Szujewski CC, Heiferman DM, Rosenbaum MD, Reynolds MR, Anderson DE, Serrone JC

PMID: 29288850 [PubMed - as supplied by publisher]

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Intractable Hiccups After Coil Embolization of Partially Thrombosed Posterior Inferior Cerebellar Artery Aneurysm.

Intractable Hiccups After Coil Embolization of Partially Thrombosed Posterior Inferior Cerebellar Artery Aneurysm.

World Neurosurg. 2017 Dec 27;:

Authors: Hashiguchi M, Fujita A, Ikeda M, Morikawa M, Kohmura E

PMID: 29288849 [PubMed - as supplied by publisher]

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Repeated short-term recurrence of a chronic subdural hematoma associated with metastasis to hematoma capsule originating from extracranial malignant tumor.

Repeated short-term recurrence of a chronic subdural hematoma associated with metastasis to hematoma capsule originating from extracranial malignant tumor.

World Neurosurg. 2017 Dec 27;:

Authors: Ikeda H, Nakajima N, Terashima T, Kawabata Y, Miyake H, Miyamoto S

Abstract
BACKGROUND: The recurrence rate of chronic subdural hematoma (CSDH) after trepanation is relatively high, and involves various factors. We encountered an extremely rare case in which metastasis of an extracranial malignant tumor to the hematoma capsule was thought to be causing short-term repeated recurrences of CSDH.
CASE DESCRIPTION: The patient was a 74-year-old man who had undergone burr-hole evacuation of left CSDH 7 months earlier and had been receiving chemotherapy for stage IV gastric cancer for the preceding 6 months. He presented with symptoms of right hemiparesis and was diagnosed with left CSDH. Burr-hole evacuation was performed twice, but the hematoma enlarged again both times within a short period. A third burr-hole evacuation was performed after middle meningeal artery embolization, but the hematoma again enlarged shortly thereafter. Hematoma enlargement was finally suppressed by extracting the hematoma capsule under craniotomy. In histopathological examinations, hematoxylin and eosin staining showed poorly differentiated adenocarcinoma primarily along the luminal side of the hematoma capsule, and immunohistochemical staining showed results identical to findings from the existing gastric cancer. Pathological results confirmed metastasis of the gastric cancer to the hematoma capsule, and this was considered to be the cause of short-term repeated recurrence of CSDH.
CONCLUSIONS: To the best of our knowledge, this is the first report of metastasis to a hematoma capsule originating from an extracranial malignant tumor. The clinical course in the present case suggests metastasis of extracranial malignant tumor to the CSDH capsule as an extremely rare cause of recurrence.

PMID: 29288848 [PubMed - as supplied by publisher]

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Decision making for the surgical treatment of vertebral metastases among patients with short predicted survival.

Decision making for the surgical treatment of vertebral metastases among patients with short predicted survival.

World Neurosurg. 2017 Dec 27;:

Authors: Bouras T, Zairi F, Arikat A, Vieillard MH, Allaoui M, Assaker R

Abstract
BACKGROUND: A wide spectrum of treatment choices is proposed for poor-prognosis patients with vertebral metastases. The continuous increase of this population and the propagation of less invasive techniques necessitate further study concerning which patients could benefit from palliative surgery.
METHODS: All patients with a Tokuhashi score ≤ 8 undergone palliative surgical treatment for vertebral metastasis within four years were retrospectively reviewed. Demographics, clinical parameters, and data concerning the disease and the operation were recorded. Patients were assessed on discharge and at two months concerning eventual benefit from surgery, based on pain measurements, motor function (Frankel grade), spinal stability assessment and complications. Statistical analysis was performed to detect possible inter-relations.
RESULTS: Eighty-eight patients were reviewed. Average age was 56.5 years. The mean Tokuhashi score was 5.9 with a mean Karnofsky score of 56.4. Thirty-six patients were immediately improved, 12 were lost on follow-up and 42 were found to have benefitted from surgery two months later. High Karnofsky score, radicular pain, morphine use, absence of complications and immediate improvement predicted benefit from surgery.
CONCLUSIONS: Decision making for a patient with poor prognosis concerning eventual surgery for a vertebral metastasis should be based mainly on the patient's clinical presentation and the primary cancer site is of less importance.

PMID: 29288847 [PubMed - as supplied by publisher]

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Symptomatic brainstem cavernoma of elderly patients: timing and strategy of surgical treatment: Two case reports and review of the literature.

Symptomatic brainstem cavernoma of elderly patients: timing and strategy of surgical treatment: Two case reports and review of the literature.

World Neurosurg. 2017 Dec 27;:

Authors: Negoto T, Terachi S, Baba Y, Yamashita S, Kuramoto T, Morioka M

Abstract
BACKGROUND: Brainstem cavernoma (BSC) is rare and difficult to treat. The treatment strategy for symptomatic lesions in elderly patients remains unclear. This review discusses the optimal treatment strategy and considers the effective surgical strategy in elderly patients.
CASE DESCRIPTION: The clinical data of eight elderly patients (>70 years) with symptomatic BSC drawn from the literature and two of our own cases have been summarized in this review. The mean age of the patients was 73.3±3.13 years and the most common location was the pons. Multiple rebleeding before surgery was seen in at least four cases and clinical presentation and surgical approach varied depending on the location. Surgical removal was performed in nine cases and one case was treated with radiosurgery. The mean duration of clinical follow up was 26.1±18.2 months. Neurological improvement was found in five cases and postoperative decline in one of the surgery cases.
CONCLUSIONS: Radical resection of the cavernoma with severe symptoms might be recommended even in elderly patients, especially in those with multiple rebleeding events. From the viewpoint of surgery, we consider the subacute phase as the optimal time to remove the cavernoma in elderly hemorrhagic patients. However, multiple rebleeding events might exacerbate the neurological deficit. Therefore, the subacute phase from the first or second rebleeding might be the best timing for the surgical resection. At surgical intervention, preservation of the surrounding brain should be prioritized over complete removal of the cavernoma and hematoma.

PMID: 29288846 [PubMed - as supplied by publisher]

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Surgical revascularization for the treatment of complex anterior cerebral artery aneurysms: Experience and illustrative review.

Surgical revascularization for the treatment of complex anterior cerebral artery aneurysms: Experience and illustrative review.

World Neurosurg. 2017 Dec 27;:

Authors: Lee SH, Jung Y, Ryu JW, Choi SK, Kwun BD

Abstract
BACKGROUND: A variety of methods for tackling complex anterior cerebral artery (ACA) aneurysms are available; however, there is substantial variation among methods because of various aneurysm locations, the relationship of the aneurysm to arterial branches, aneurysm size and other morphological characteristics, and/or the diameters of the parent or branching arteries.
METHODS: We review complex ACA aneurysm cases based on both our own experience as well as the available literature. Each unique case is analyzed in terms of the characteristics of the aneurysm, along with an analysis and classification of the revascularization method used. Computer tablet-drawn illustrations of every unique technique are provided for easy comprehension and application in various possible situations.
RESULTS: Over the prior six years, we have treated a total of five cases of complex ACA aneurysms (one precommunicating, one communicating, one postcommunicating, and two precallosal-supracallosal segment) with revascularization. Side-to-side anastomosis was performed between A3-A3 in three cases, between A4-A4 in another case, and between the ipsilateral callosomarginal artery-pericallosal in the remaining case. Final modified Rankin scale was 0 in four of the five cases, and three in one case. Six treatment strategies were used for the precommunicating case, eight for the communicating case, seven for the postcommunicating case, and nine for the two precallosal-supracallosal segment aneurysms.
CONCLUSION: Treatment of complex ACA aneurysms should be tailored according to the location and nature of the aneurysm, as well as collateral circulation. Viable and feasible treatment strategies must be established by the neurovascular surgeon.

PMID: 29288845 [PubMed - as supplied by publisher]

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Primary Extradural Melanoma Arising in Cervical Spinal Nerve Root.

Primary Extradural Melanoma Arising in Cervical Spinal Nerve Root.

World Neurosurg. 2017 Dec 27;:

Authors: Zou C, Cheng W, Zhu C, Guo Q, Wu A

Abstract
BACKGROUND: Primary cervical melanoma is rare; this is especially true of extradural melanoma arising in the nerve root. Characterizing these cases can provide a basis for improved melanoma management.
CASE DESCRIPTION: A 42-year-old female patient with numbness and pain in the right shoulder and arm persisting for 5 years was admitted. Preoperative magnetic resonance imaging revealed an epidural ladle-shaped mass shape beyond the C7-T1 intervertebral foramen that resembleda nerve sheath tumor. Histopathologic analysis following complete resection confirmed the lesion as malignant melanoma. Radiotherapy and temozolomide and cisplatin chemotherapy were administered in an accompanying hospital with regular follow-ups atour institution. After 2 months of postoperative adjuvant therapy, hepatic metastatic lesions developed. The chemotherapy regimen was changed to carboplatin, nab-paclitaxel, and recombinant human endostatin injections for a 6-month period. A follow-up 8months after chemotherapy (16 months post-surgery) indicated a good prognosis.
CONCLUSIONS: In the past 10 years only one case of primary extradural spinal melanoma incervical intervertebral foramen has been described, with no reported cases of hepatic metastasis. As radiographic results are not unequivocal, a diagnosis of spinal melanoma must be based on post-operative histological confirmation. However, to date there is no standard post-operative adjuvant therapy for these patients. The chemotherapy regimen described in this report has broader implications for melanoma treatment.

PMID: 29288844 [PubMed - as supplied by publisher]

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Collin S. MacCarty (1915-2003): Inventor of the "MacCarty keyhole" as the starting burr hole for orbitozygomatic craniotomy.

Collin S. MacCarty (1915-2003): Inventor of the "MacCarty keyhole" as the starting burr hole for orbitozygomatic craniotomy.

World Neurosurg. 2017 Dec 27;:

Authors: Jumah F, Adeeb N, Dossani RH

Abstract
INTRODUCTION: Dr. Collin S. MacCarty (1915-2003) invented the MacCarty keyhole, which is now widely used as the starting burr hole for orbitozygomatic craniotomy. We present a historical vignette on MacCarty's life and chronicle his contributions to neurosurgery.
METHODS: A detailed search for articles relating to the biography and professional career of Dr. MacCarty was conducted on PubMed and Google Scholar using the keywords "Collin MacCarty" and "MacCarty keyhole". References found in those article were also reviewed.
RESULTS: On September 20, 1915, Collin MacCarty was born in Rochester, Minnesota. MacCarty was exposed to the medical field at an early age. He witnessed legendary surgeons like Alfred Adson perform brain and spine operations. Expectedly, MacCarty pursued a career in neurosurgery. He was influenced by Walter Dandy as a house office at Johns Hopkins and completed his neurosurgical training at the Mayo Clinic under Adson. In a distinguished career in neurosurgery at the Mayo Clinic, MacCarty served many important roles, including Chairman of the Department of Neurosurgery from 1963-1975, and president of the AANS. He was world-renowned for his vast experience with meningiomas. In 1961, MacCarty described a burr hole to expose the periorbita and frontal dura while approaching intraorbital meningiomas. This burr hole became immortalized as the "MacCarty keyhole" and is used widely today in frontotemporal orbitozygomatic approaches.
CONCLUSION: Collin S. MacCarty was an influential neurosurgeon who invented the "MacCarty keyhole." In a distinguished career in neurosurgery, he served as AANS President and Chairman of Department of Neurosurgery at the Mayo Clinic.

PMID: 29288843 [PubMed - as supplied by publisher]

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