Cerebrospinal Fluid Leak Research Articles

Anterior Skull Base Reconstruction Using a Vascularized Pericranial Flap: A Promising Alternative in Sinonasal Malignancies

Abstract Background As the scope of endoscopic techniques continues to evolve in the treatment of advanced sinonasal malignancies, the primary challenge is the reconstruction of the resulting anterior skull base dural defect. Objective This study aimed to assess the efficacy of vascularized pericranial flap reconstruction in addressing anterior skull base defects in sinonasal malignancies, particularly when alternative reconstructive methods, such as nasoseptal flaps, are not viable. Methods We conducted a retrospective review of nine patients who underwent endoscopic resection of sinonasal malignancy followed by vascularized pericranial flap. Our analysis aimed to evaluate the surgical methods utilized, identify any complications that occurred, and assess the postoperative results of the patients. Results Excluding the singular instance of tension pneumocephalus that emerged during the immediate postoperative period, necessitating surgical intervention, our clinical experience was devoid of any complications, with a median follow-up duration of 18 months. It is worth noting that no cases of cerebrospinal fluid leaks or meningitis were reported. Moreover, the follow-up check endoscopy verified the successful integration of the flap and its efficacious coverage of the resection site. Conclusion This study underscores the benefits of using vascularized pericranial flaps as an alternative solution for anterior skull base reconstruction in sinonasal malignancies. The availability of the pericranial flap in the local region, along with its robust blood supply, and the positive outcomes observed in this preliminary series collectively indicate its potential as an integral component of multi-layered reconstruction techniques for addressing anterior skull base defects.

ENDOSCOPIC THIRD VENTRICULOSTOMY VS VENTRICULOPERITONEAL SHUNT IN OBSTRUCTIVE HYDROCEPHALUS IN TERMS OF POST-OPERATIVE COMPLICATIONS

: Obstructive Hydrocephalus is a condition characterized by increased cerebrospinal fluid (CSF) volume within the brain's ventricular system, leading to clinical deterioration and disability. Without treatment, it can be fatal. Two primary treatment modalities are Ventriculoperitoneal Shunting (VPS) and Endoscopic Third Ventriculostomy (ETV), with ongoing debate over the superiority of one approach over the other. Objective: To compare the complications associated with Ventriculoperitoneal Shunting (VPS) and Endoscopic Third Ventriculostomy (ETV) in patients with obstructive hydrocephalus. Methods: A randomized controlled trial was conducted at a tertiary care hospital from April 15, 2024, to September 15, 2024. A total of 100 patients diagnosed with obstructive hydrocephalus were randomly allocated into two groups: 50 patients received VPS treatment, and 50 received ETV. Complications, including surgical site infection, seizures, hematoma, and CSF leakage, were recorded and analyzed. Results: Complications were observed in 36% (n=18) of patients in the VPS group compared to 16% (n=8) in the ETV group, with a statistically significant difference (p=0.023). Surgical site infections occurred in 8% (n=4) of VPS patients, while no infections were reported in the ETV group. Seizures were significantly more common in the VPS group, affecting 26% (n=13) compared to 8% (n=4) in the ETV group (p=0.017). Hematoma formation was observed in 4% (n=2) of VPS patients and 6% (n=3) of ETV patients. CSF leakage occurred in 4% (n=2) of VPS patients and 2% (n=1) of ETV patients. Conclusion: Endoscopic Third Ventriculostomy (ETV) demonstrated a significantly lower complication rate compared to Ventriculoperitoneal Shunting (VPS) in the management of obstructive hydrocephalus. These findings support ETV as a safer alternative with fewer associated complications.

Wrapping method for better fat handling in endoscopic trans-sphenoidal surgery

Background: Fat is commonly used for preventing cerebrospinal fluid (CSF) leakage during endoscopic transsphenoidal surgery (ETSS). However, fat is soft, slippery, and sometimes not easy to handle. The present study aimed to examine the efficacy of our Surgicel® wrapping method, which allows for better fat handling, in preventing the occurrence of CSF leakage among patients undergoing ETSS. Methods: We used fat tissues removed from the abdomen. The fat was cut with scissors into pieces that were approximately 5 mm in size. Surgicel® was also cut into 2.5 cm2. The fat tissues were encased with these Surgicel® squares and slightly moistened with a saline solution. Results: Between January 2023 and August 2024, 34 patients aged 18–86 years (average 54.9 years) underwent ETSS. Among these patients, 20 had pituitary tumors, 6 had Rathke’s cysts, and 8 had other conditions. None of the patients had CSF leakage postoperatively. The use of Surgicel®-wrapped fat during ETSS is better than the use of fat alone. Conclusion: The Surgicel® wrapping method allows for better fat handling during ETSS.

Diagnosis and Treatment of Tethered Spinal Cord: A Systematic Review.

Tethered cord syndrome is associated with motor and sensory deficits. Our objective was to summarize evidence regarding the diagnosis, prophylactic surgery, symptomatic treatment, and repeat surgery of tethered spinal cord in a systematic review (CRD42023461296). We searched 13 databases, reference-mined reviews, and contacted authors to identify diagnostic accuracy studies and treatment studies published until March 2024. One reviewer abstracted data, and a content expert checked the data for accuracy. We assessed the risk of bias, strength of evidence (SoE), and applicability. The evidence base includes 103 controlled studies, many with risk of bias and applicability concerns, and 355 case series providing additional clinical information. We found moderate SoE for MRI diagnosing tethered spinal cord, with medium to high diagnostic sensitivity and specificity. A small number of prophylactic surgery studies suggested motor function benefits and stability of neurologic status over time, but also complications such as surgical site infection (low SoE). A larger body of evidence documents treatments for symptomatic patients; studies revealed improvement in neurologic status after surgical detethering (low SoE), but also postoperative complications such as cerebrospinal fluid leakage (moderate SoE). A small body of evidence exists for retethering treatment (low or insufficient SoE for all outcomes). There was insufficient evidence for key outcomes (eg, over- or undertreatment, clinical impact of diagnostic modalities, ambulation, quality of life). This comprehensive overview informs difficult clinical decisions that parents and their children with tethered spinal cords, as well as their health care providers, face.

Intradural Repair of Temporal Bone Encephalocele and Cerebrospinal Fluid Leak: Results from a Single Institution

Abstract Background Lateral temporal bone encephaloceles incidence is increasing with obesity rates. Middle fossa (MF) craniotomy, transmastoid (TM), or combined MF + TM access can be used for repair. Methods Retrospective review of MF or MF + TM repair with an intradural graft. Sex, age, and body mass index (BMI) were collected. Pre/postoperative audiometric results were included. Postoperative complications were reported. Results A total of 49 patients (50 repairs) were included. In addition, 74% were women (p < 0.05). Ten patients had a history of chronic otitis media and surgery. Average BMI was 35.8, and average age was 59. Furthermore, 54% had multiple skull base defects; 18 (36%) patients had a MF approach. In total, 32 (64%) patients had a MF + TM approach for repair; 13 (40.1%) of these patients had a concurrent tympanoplasty. Hearing improved for 74%. Air conduction pure-tone average improved by an average of 5 dB (p 0.27). No differences in hearing outcomes were observed between the MF and MF + TM groups. Two patients (6%) had hearing decline. Eight complications were reported (1 (2%) skin infection, 4 (8%) recurrent/persistent cerebrospinal fluid [CSF] leaks requiring lumbar drain or shunt, and 3 (6%) episodes of aphasia or mental status change). Age >65 years was not associated with risk of postoperative complication. Conclusion Intradural repair of encephalocele and CSF leak is a safe and effective surgical approach. Intradural reinforcement along the entire MF floor is beneficial for multiple areas of dehiscence and thin dura. Complication rates including recurrent/persistent CSF leak and aphasia related to temporal lobe retraction were similar to previously published reports and not associated with older patient age. Hearing was stable or improved in 94% with no difference noted between MF and MF + TM repair.

Analysis of the impact of a rhinologist-assisted endoscopic approach on a single neurosurgeon’s outcomes in transsphenoidal resection of pituitary adenomas

ObjectivesDetermine the improvements in outcomes of transsphenoidal pituitary adenoma resection following addition of a skull base rhinologist to the neurosurgical team. DesignAll patients that underwent transsphenoidal resection of pituitary adenoma were identified. Demographic data, Otolaryngology (ENT) involvement, initial adenoma size, extent of resection, hormonal secretion status, visual field exam, post-operative DI, CSF leak, recurrence, need for nasoseptal flap (NSF), re-operation rate were all collected. A linear-regression model adjusteds for confounders. SettingA single academic institution Participants271 patients who underwent transsphenoidal surgery between 2015 and 2020.Main Outcome MeasuresThe main outcome measures were Extent of Resection and Endocrinologic remission. ResultsOf the 271 patients identified, 228 (84 %) patients had macroadenomas, one-third of patients presented with bitemporal hemianopsia, and 27 % (72) were hormonally active. For these and demographics there were no statistically significant differences between the microscopic or endoscopic approach (EEA) groups. For patients with cavernous sinus invasion of >50 %, EEA was more likely to achieve gross total resection (GTR) (OR 2.6; p<0.001). For patients who had prior sellar surgery, EEA was 2.5x more likely to get a GTR (p=0.05). The EEA approach resulted in an extra hospital day (1–2 vs 2–3 p<0.05) and surgery lasted an additional hour (1.17 vs 2.5, p<0.05), but did not require fat grafts or lumbar drains on a routine basis. ConclusionsWhile the operating time and LOS were longer, the EEA approach performed by two specialized co-surgeons demonstrates superior value for adenomas that have had a prior surgical attempt or with significant cavernous sinus invasion.

Prevalence and Impact of Constipation on Reconstructive Outcomes Following Endoscopic Skull Base Surgery

Abstract Objective Postoperative constipation in endoscopic skull base surgery (ESBS) may provoke undesired straining, which, in theory, may create intracranial pressure shifts and impact skull base reconstruction. The purpose of this study is to assess the prevalence and contributing factors to postoperative constipation after ESBS, and whether this impacts reconstructive outcomes. Methods Patients undergoing ESBS between July 2018 and December 2022 at a single-center, tertiary academic skull base surgery program were retrospectively reviewed. Chart reviews were performed to identify average bowel movements per day, indication for surgery, age, sex, body mass index (BMI), history of chronic pain, length of postoperative bedrest, length of stay (LOS), and postoperative use of opioid analgesics. Additionally, use of a standing stool bowel regimen, as-needed (PRN) stool softeners/laxatives, and enemas were recorded. Constipation was defined as greater than 48 hours without a bowel movement. Results In total, 213 patients (115 with intradural pathologies) were identified, of which 146 (69%) patients had postoperative constipation. Postoperative constipation was associated with longer bedrest (1.86 ± 0.20 vs. 1.06 ± 0.12 days; p = 0.011); increased morphine equivalent dose (MED) during postoperative days 2, 3, 5, and 6 (all p &lt; 0.05); and total postoperative MED (106.70 ± 14.01 vs. 46.88 ± 8.44 mg; p &lt; 0.001). Additionally, postoperative constipation was an independent predictor of LOS (p = 0.009). There were no differences in postoperative cerebrospinal fluid (CSF) leak between the groups (p = 0.622). Conclusion Postoperative constipation rates were high after ESBS and likely causative factors include increased immobilization and postoperative opioid use. Standing bowel regimens should be considered in ESBS patients. However, there was no increased rate of postoperative CSF leaks.

Potential of observing the diameter of the optic nerve sheath using computed tomography in diagnosing high intracranial pressure in patients with spontaneous CSF rhinorrhea.

Spontaneous cerebrospinal fluid rhinorrhea (sCSFR) is often accompanied by an increase in intracranial pressure (ICP). The widening of optic nerve sheath diameter (ONSD) is an indicator of increased ICP. Using CT to measure ONSD is a simple and noninvasive auxiliary method for determining high ICP in sCSFR patients.

Safety and risk analysis of total resection surgery for thoracic and lumbar spinal tumors: a decadal analysis of 103 cases

Study designRetrospective cohort study.PurposeTo explore the complications and risk factors for total resection (TR) of primary thoracic and lumbar spinal tumors over the past decade at our institution.MethodsPatients meeting inclusion criteria (primary spinal tumors, thoracic or lumbar location, TR at our center) were included. Demographic characteristics, surgical data, perioperative complications and management results were reviewed. Patients were stratified by tumor site, the number of excised segments, and recurrence status to elucidate distinctive characteristics.ResultsThe cohort comprised 103 patients, with a mean age of 35.8 years. On average, 1.83 vertebral segments were resected per patient. Perioperative complications were substantial, totaling 166 events, with 71 classified as major and 95 as minor, yielding an average of 1.61 complications per patient. No perioperative deaths occurred, but 79 patients (76.7%) experienced at least one complication. Multiple vertebral sections correlated with a higher complication rate (P = 0.031), and lumbar surgeries exhibited elevated risks of large vascular injury (P = 0.001), neurological deterioration, and cerebrospinal fluid leakage compared to thoracic cases. Conversely, thoracic spinal procedures showed a higher rate of pleural effusion (P = 0.004). Binary logistics stepwise regression identified multi-segmental resection as the independent risk factor for major perioperative complications.ConclusionsTR of primary spinal tumors is associated with a high perioperative complication rate, although most events have a favorable prognosis. Complication characteristics vary based on the surgical site, number of excised segments, and surgical history. A nuanced preoperative evaluating approach considering patient age, surgical segments, and extent of resection is crucial.

Translabyrinthine versus Retrosigmoid Approach for Vestibular Schwannoma: A Systematic Review and An Updated Meta-Analysis.

Several approaches can be used in the surgical treatment of vestibular schwannoma (VS), and the best approach remains uncertain in the literature. This systematic review and meta-analysis aim to compare the translabyrinthine approach (TLA) with the retrosigmoid approach (RSA) for VS in terms of postoperative complications. PubMed, Web of Science, Embase, and Cochrane. The primary outcome was cerebrospinal fluid (CSF) leak; secondary outcomes were facial nerve dysfunction (FND), length of stay (LOS), and meningitis. Statistical analysis was performed using RStudio 2024.04.1 + 748. Heterogeneity was assessed with I² statistics. We performed sensitivity analysis with subgroup analysis and meta-regression. Risk of bias was assessed using ROBINS-I. Out of 1140 potential articles, 21 met the inclusion criteria. Among the 4572 patients, 2687 and 1885 patients in the TLA and RSA groups, respectively. No significant differences were found in CSF leak (odds ratio [OR] 1.03; 95% confidence interval [CI] 0.81,1.32; P = .794) or meningitis (OR 1.05; 95% CI 0.45, 2.43; P = .73). Meta-regression showed no association with CSF leak and the number of cases per center or publication year. The TLA is associated with a shorter LOS (MD -1.20; 95% CI -1.39, -1.01; P < .01) and a higher chance of having and HB 4 or lower compared to patients who underwent RSA (OR 0.30; 95% CI 0.10, 0.89; P = .03). There was no difference in the odds of CSF leak or meningitis between the groups. In addition, the TLA has a shorter LOS and a higher chance of a better facial nerve outcome compared to the RSA.

Safety, Sequelae, and Efficacy of Nerve Root Clipping in Patients With Spontaneous Spinal Cerebrospinal Fluid Leaks.

Spinal cerebrospinal fluid (CSF) leaks may cause a myriad of clinical symptoms, the most common being orthostatic headache. Lateral leaks (Type II) and direct CSF-venous fistulas (Type III) are a subgroup of spinal CSF leaks, representing about 1/3 of spinal CSF leaks. This study aimed to analyze the risk and efficacy of nerve root clipping in patients with Type II and Type III CSF leaks. All consecutive patients with Type II and Type III CSF fistulas treated with nerve root clipping at our institution from May 2018 to December 2022 were included. Patients were evaluated for postoperative sensory motor deficits and neuropathic pain using the "Douleur Neuropathique 4" questionnaire, and the outcome was evaluated using the "Patient Global Impression of Change" and the return-to-work rate. A total of 40 patients were included, and the mean follow-up time was 22 months. According to the Patient Global Impression of Change, significant symptoms improvement was reported in 85% of patients. Over 87% of patients returned to work fully or partially. One patient experienced a low-grade motor deficit after T1-nerve root clipping. 2.5% of patients developed postoperative neuropathic pain requiring medical treatment under which they fully improved. Over 80% of patients developed dermatomal hypoesthesia, with no reported effect on quality of life. The surgical strategy of noneloquent nerve root clipping shows favorable outcomes and return-to-work rates. There are instances of neuropathic pain and dermatomal hypoesthesia with no significant morbidity. Despite the favorable outcome and low recurrence rate, nerve root-sparing surgical techniques should be further explored.

What is the risk of meningitis, utilising a single agent, single dose perioperative antibiotic following endonasal endoscopic repair of a CSF leak?

What is the risk of meningitis, utilising a single agent, single dose perioperative antibiotic following endonasal endoscopic repair of a CSF leak?

Audiological Outcomes following Middle Cranial Fossa Repair of Spontaneous CSF Leaks.

Audiological Outcomes following Middle Cranial Fossa Repair of Spontaneous CSF Leaks.

Dural Injury During Spinal Surgery and Postoperative Cerebrospinal Fluid Leakage: A Single-Center Experience

Dural Injury During Spinal Surgery and Postoperative Cerebrospinal Fluid Leakage: A Single-Center Experience

Spontaneous Cerebrospinal Fluid Rhinorrhea in Pre-operative Pituitary Adenoma: A Report of Two Cases

Spontaneous Cerebrospinal Fluid Rhinorrhea in Pre-operative Pituitary Adenoma: A Report of Two Cases

SINGLE INSTITUTION RETROSPECTIVE ANALYSIS OF COMPLICATIONS ASSOCIATED WITH SURGICAL DEBULKING OF BRAIN METASTASIS

Abstract AIMS Surgical resection of brain metastasis is associated with complications, which worsen patient’s quality of life, results in oncological treatment delays and death. Surgical complication data aids decision making, leads to objective risk benefit analysis and informed consent. The aim of this study is to quantify rates, types and risk factors for complications related to surgical debulking of brain metastasis. METHOD Retrospective analysis on adult patients with brain metastasis, who underwent surgical debulking between 2017 and 2023 at Royal Preston Hospital. Data collected included demographics, diagnosis, 30-days post-operative complications, 30-days mortality, 30-days post-operative palliation, primary tumour, Karnofsky-Performance Score (KPS), first vs. repeat resection, use of drain and type of suture materials etc. Univariate analysis was carried out using Graphpad software. RESULTS Two-hundred and twenty-seven patients qualified. The most common primaries were lung (n=93, 41%), breast (n=43, 18.9%), and skin (n=31, 13.7%). The most common complications were Hospital-acquired pneumonia (HAP) (n=27, 11.9%), surgical site infection (SSI) (n=19, 8.4%), wound dehiscence (n=14, 6.2%), thromboembolic events (n=12, 5.3%) and CSF leak (n=8, 3.5%). Thirty days mortality and post-operative palliation (due to surgical complications) were both 3.5% each (n=8). Two-hundred and six (93.2%) had KPS ³70 whilst 15 (6.8%) had KPS &amp;lt; 70 [range 30-60 pre-operatively (median 60)). KPS &amp;lt; 70 was statistically significant for post-operative palliation (p=0.01), HAP (0=0.02) and urine infection (p=0.002), but not for 30-day mortality. Twenty-five (11.1%) patients undergoing repeat resections, experienced higher wound infections (p=0.002). CONCLUSION Surgical debulking is associated with significant post-operative complications, with 7% either dying or not receiving any further treatment, 18.1% percent developing serious wound complications (SSI, CSF leak, Wound dehiscence) and 19.4% experiencing significant medical complications (HAP/UTI/Thromboembolism). Pre- operative KPS &amp;lt; 70 and repeat resections are associated with statistically increased risk of complications.

Outcomes of Hydroxyapatite Bone Cement for Craniofacial Reconstruction in 1983 Patients.

Hydroxyapatite bone cement (HABC) has evolved to have diverse applications in craniofacial reconstruction. This ranges from filling cranial defects to secondary contouring of residual defects after primary surgeries. This study aims to determine patient outcomes after reconstruction with HABCs. A systematic review and meta-analysis were conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. PubMed, Embase, Web of Science, and Cochrane Library databases were queried. The results were limited to English-language literature with extractable data on HABC for craniofacial reconstruction. A total of 1983 patients were included in the final analysis from 35 studies. HABCs were mostly used for large defect cranioplasty (21.5%), retrosigmoid (44.6%) and translabyrinthine cranioplasty (8.9%), and correction of residual craniofacial defects after congenital craniofacial surgeries (25%). The rates of cerebrospinal fluid (CSF) leak and infection/explantation were 0% and 7.5% [95% CI: 2.4-11.8] for large defect cranioplasty and 0.8% [0.03-2.07] and 1.5% [95% CI: 0.92-3.3] for retrosigmoid cranioplasty, respectively. The infection/explantation rate was 6.2% [95% CI: 2.6-18.7] for HABCs in the correction of residual craniofacial defects after congenital craniofacial surgeries. The total reoperation rates were 20.4% % [95% CI: 4.8-11.8] for large defect cranioplasty and 12% [95% CI: 3.3-15.3] for correction of residual defects after congenital craniofacial surgeries. Aesthetic satisfaction rates were 93.1% [95% CI: 90.3-98.8] for large defect cranioplasty, 99.4% [95% CI 97.2-99.9] for retrosigmoid cranioplasty, and 92.6% [95% CI: 83.3-95.8] for HABC use in the correction of residual craniofacial defects after congenital craniofacial surgeries. HABC is versatile and associated with a high level of patient reported aesthetic satisfaction after cranioplasty and may have a comparably lower complication profile than those of most other alloplastic materials.

Diagnostic Accuracy of Beta-2 Transferrin Gel Electrophoresis for Detecting Cerebrospinal Fluid Rhinorrhea.

Unilateral thin clear rhinorrhea (UTCR) may represent a variety of pathologies including cerebrospinal fluid (CSF) rhinorrhea. Beta-2 transferrin (B2Tf) gel electrophoresis (GE) has become the preferred testing modality due to reportedly high sensitivity (87%-100%) and specificity (71%-100%). However, there have been relatively few studies assessing its diagnostic accuracy. The purpose of this single-institution study was to determine the accuracy of B2Tf GE in detecting CSF rhinorrhea. A single-center retrospective review was conducted from 2016 and 2024 for all patients who presented with UTCR and underwent B2Tf GE. Institutional review board approval was obtained. The gold standard for diagnostic confirmation of true and false positives (TP, FP) as well as false negatives (FN) was endoscopic exploration. The gold standard for true negative (TN) was response to medical therapy. A total of 105 patients underwent 149 B2Tf GE tests. 40 (38.1%) patients were diagnosed with CSF rhinorrhea. Of the 149 B2-Tf GE tests, there were 51 TPs, 72 TNs, 20 FPs, and 6 FNs yielding 89.5% sensitivity, 78.3% specificity, 71.8% positive predictive value, and 92.3% negative predictive value, respectively. Of the false results the most common causes for error were purulent sinusitis (n = 6, 23.1%), possible mucous contamination from nose-blowing during collection (n = 3, 11.5%), patient collection error (n = 3, 11.5%), and blood contamination (n = 1, 3.8%). Although these single-institutional data demonstrate test accuracy within ranges previously reported in the literature, they also demonstrate diagnostic limitations. Future studies should explore reasons for erroneous B2Tf GE results and how these may change clinical decision-making. IV Laryngoscope, 2024.

Transcarotid flow reversal for proximal control during cerebral aneurysm clip reconstruction: illustrative case.

Paraclinoid aneurysms can pose an operative challenge during clip reconstruction, given the complex surrounding anatomy and the aneurysmal tendency to maintain turgor despite standard approaches to proximal control. This report demonstrates the use of intraoperative retrograde arteriovenous shunting with the transcarotid artery revascularization (TCAR) system to assist in the safe clip reconstruction of an irregular paraclinoid aneurysm. A 33-year-old woman presented with perimesencephalic subarachnoid hemorrhage and was found to have an incidental 9-mm ophthalmic aneurysm. Coil embolization was not successful. During microsurgical clip reconstruction, the left common carotid artery was exposed to allow for proximal control as well as transcarotid arterial sheath placement. Flow reversal was instituted throughout the aneurysm dissection and clipping, with a visible softening of the aneurysm. Intraoperative angiography confirming successful clip reconstruction was performed utilizing the TCAR sheath. The case was complicated by the development of cerebrospinal fluid rhinorrhea postoperatively, requiring surgical repair. The patient has since made a complete recovery. Transcarotid flow reversal utilizing the TCAR system has potential for use in the surgical treatment of paraclinoid aneurysms, as it may aid in softening the aneurysm for safer dissection and clip reconstruction, protect against aneurysm-associated emboli, and provide an avenue for intraoperative angiography. https://thejns.org/doi/10.3171/CASE24330.

Ultrasonography-guided canal decompression combined with vertebroplasty and cement-augmented pedicle screw fixation for stage III Kümmell’s disease with neurological deficits: a retrospective cohort study

BackgroundPercutaneous vertebroplasty or kyphoplasty is the preferred procedure for stage I and II Kümmell’s diseases (KDs), but there exist controversies on the operative option of stage III KD. This study aimed at exploring the safety and efficacy of ultrasonography-guided canal decompression (UG-CD) combined with vertebroplasty and cement-augmented pedicle screw fixation (CA-PSF) for treating stage III KD with neurological deficit (ND).MethodsBetween September 2017 and December 2023, all patients who received the UG-CD combined with vertebroplasty and CA-PSF for managing stage III KD with NDs were reviewed retrospectively with their demographic and operation data, and complications recorded. Besides, the scores of Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI), together with imaging data including the kyphotic Cobb angle (KCA), wedge angle (WA), spinal canal area (SCA) at the narrowest level as well as anterior (AHR) and middle (MHR) height ratios were measured and compared between pre- and post-operation.ResultsA total of eleven patients with a mean age of 70.09 ± 2.98 years old were included in our study with their surgical time, hospitalization length, blood loss, and follow-up time being 150.91 ± 17.94 min, 202.09 ± 39.95 ml, 8.18 ± 1.17 days, and 16.91 ± 4.09 months, respectively. During the final follow-up, the KCA, WA, VAS scores, ODI scores, AHR, MHR, and SCA were significantly improved (P < 0.01). Intraoperatively, one case suffered a transient decrease in the motor evoked potential. Another case experienced a cerebrospinal fluid leakage postoperatively that was then successfully treated.ConclusionUG-CD combined with vertebroplasty and CA-PSF could be a feasible procedure for safely and effectively handling stage III KD with NDs.