Senior Neurosurgeon Research Articles

Advanced Manufacturing in the Fabrication of a Lifelike Brain Glioblastoma Simulator for the Training of Neurosurgeons.

Neurosurgeons require considerable expertise and practical experience to deal with the critical situations commonly encountered in complex surgical operations such as cerebral cancer; however, trainees in neurosurgery seldom have the opportunity to develop these skills in the operating room. Physical simulators can give trainees the experience they require. In this study, we adopted advanced molding and replication techniques in the fabrication of a physical simulator for use in practicing the removal of cerebral tumors. Our combination of additive manufacturing and molding technology with elastic material casting made it possible to create a simulator that realistically mimics the skull, brain stem, soft brain lobes, and cerebral cancer with cerebral tumors located precisely where they are likely to appear. Multiple and systematic experiments were conducted to prove that the elastic material used herein was appropriated for building professional medical physical simulator. One neurosurgical trainee reported that under the guidance of a senior neurosurgeon, the physical simulator helped to elucidate the overall process of cerebral cancer removal and provided a realistic impression of the tactile feelings involved in craniotomy. The trainee also learned how to make decisions when facing the infiltration of a cerebral tumor into normal brain lobes. Our results demonstrate the efficacy of the proposed physical simulator in preparing trainees for the rigors involved in performing highly delicate surgical operations.

Frame-Based Stereotactic Biopsy - A Single Neurosurgeon Experience of 604 Diagnostic Procedures and Literature Review.

Frame-based stereotactic biopsy (SB) is essential in managing patients with suspected intracranial lesions. This study aimed to evaluate the surgical experience of the senior neurosurgeon to define the lesion, radiology, and technique-related factors that affect the diagnostic yield and complications, along with the literature review. Documents were examined for consecutively performed frame-based SBs from 1999 to 2021. Procedures that are aimed at nondiagnostic purposes were excluded, thus leaving 604 diagnostic procedures. Diagnostic yield, complication rates, and their relationship with clinical variables were investigated. The diagnostic yield was 98%, with a symptomatic hemorrhage rate of 1.2%, a total morbidity rate of 4.8%, and a mortality rate of 0.83%. Larger tumors (odds ratio [OR] = 1.350), experienced neurosurgeon (OR = 1.339), and pathologist (OR = 462.743), and prebiopsy examination with both computed tomography and magnetic resonance imaging (MRI) (OR = 27.062) were associated with an increased diagnostic yield. None of the parameters were statistically significant for nonhemorrhagic morbidity, whereas the increasing number of specimens (OR = 1.395) and glial tumors (OR = 3.740) were associated with an increased hemorrhagic risk. Likewise, the increasing number of specimens (OR = 2.497) along with the increasing age (OR = 14.098) were associated with increased mortality risk. Knowledge of stereotactic techniques and meticulous surgical planning is required to enhance the diagnostic yield and safety of SB. Considering the results of this largest, MRI-guided, single-neurosurgeon SB series, we advocate training neurosurgeons on stereotactic techniques, routine use of intraoperative pathological examination, and working with dedicated neuropathologists when possible.

Assessment of the incidence and nature of adverse events and their association with human error in neurosurgery. A prospective observation

IntroductionAdverse events in surgery are a relevant cause of costs, disability, or death, and their incidence is a key quality indicator that plays an important role in the future of health care. In neurosurgery, little is known about the frequency of adverse events and the contribution of human error. Research questionTo determine the incidence, nature and severity of adverse events in neurosurgery, and to investigate the contribution of human error. Material and methodsProspective observation of all adverse events occurring at an academic neurosurgery referral center focusing on neuro-oncology, cerebrovascular and spinal surgery. All 4176 inpatients treated between September 2019 and September 2020 were included. Adverse events were recorded daily and their nature, severity and a potential contribution of human error were evaluated weekly by all senior neurosurgeons of the department. Results25.0% of patients had at least one adverse event. In 25.9% of these cases, the major adverse event was associated with human error, mostly with execution (18.3%) or planning (5.6%) deficiencies. 48.8% of cases with adverse events were severe (≥SAVES-v2 grade 3). Patients with multiple adverse events (8.6%) had more severe adverse events (67.6%). Adverse events were more severe in cranial than in spinal neurosurgery (57.6 vs. 39.4%). Discussion and conclusionAdverse events occur frequently in neurosurgery. These data can serve as benchmarks when discussing quality-based accreditation and reimbursement in upcoming health care reforms.The high frequency of human performance deficiencies contributing to adverse events shows that there is potential to further eliminate avoidable patient harm.

Analysis of myelomalacia and posterior longitudinal Ligament ossification as prognostic factors in patients with cervical spondylotic myelopathy submitted to laminoplasty

Background: Cervical spondylotic myelopathy is a degenerative disease of the intervertebral disc and vertebral body of the spine that causes cervical spinal cord injury due to central vertebral canal stenosis. Its prevalence is higher in the elderly. Treatment is usually surgical when the spinal cord is affected either clinically with pyramidal release or radiologically with the altered spinal cord. Objective: The rationale of this study is to analyze the myelomalacia and the ossification of posterior longitudinal ligament as prognostic factors in the postoperative evolution of patients with cervical canal compression who underwent laminoplasty by open-door or french-door techniques. Methods: We performed a retrospective analysis of 18 surgical cases of spondylotic cervical myelopathy of the same senior neurosurgeon, using the chi-square test to analyze prognostic factors for patients’ postoperative evolution in the Nurick scale, after open-door or french-door laminoplasty. Results: The comparison between pre and postoperative showed an improvement of 71.43% of cases that did not have ligament ossification compared to 45.45% of cases that presented posterior longitudinal ligament ossification. Also, there was a better prognosis in patients without myelomalacia, as 71.43% of them improved their condition against only 45.45% improvement in those with myelomalacia. Conclusion: There is a need for further studies with larger samples to expressively prove that the presence of longitudinal ligament ossification and the previous presence of myelomalacia are factors of worse prognosis in the postoperative evolution of patients with cervical spondylotic myelopathy submitted to laminoplasty.

Medical Analysis for Surgeryon Patients Complaining of Sciatic Pain

A prospective researchwas performed on 50 patients submitted for radiological screening in Samarra general hospital complaining of chronic backache and sciatica. The study was completed for patients recommended by senior neurosurgeons, orthopedicians, &rheumatologist, to the radiological unit in Samarra public hospital from October 2016 to October 2017. Radiological studies were analyzed by senior radiologists of Samarra public hospital in conjunction with the recommending senior doctors. Patients who are operated on were all proven to have chronic Lateral Recess Syndrome both radiological and surgically.

EP.TU.281Mind the Gap: Improving the Quality of Neurosurgical Discharge Summaries

Abstract Aims A discharge summary is a permanent record of a patient’s hospital visit and the primary means of handover between care providers. Studies show they often lack precision and omit important information. This may compromise quality and continuity of care yet they are frequently written by the most junior clinicians on a ward with little guidance or formal education on how to write one. The aim of this study was to develop some specific guidelines to improve the quality of discharge summaries in a busy neurosurgical unit. Methods A survey was designed to identify the challenges faced by junior medical staff in writing discharge summaries. The essential components of a good neurosurgical discharge summary were identified by group of senior neurosurgeons. Summaries were retrospectively audited against these components. We then designed a simple visual aid and placed it above computer stations in the junior doctors’ offices. Formal departmental teaching session followed. After three months we re-audited the discharge summaries retrospectively to measure any effect of our intervention. Results Half of the neurosurgical team rated summaries as below expectations. Challenges included poor ward round documentation and a lack of clear expectations regarding structure and essential components. After the intervention, ward round documentation and discharge summary quality improved dramatically. Conclusions Although various recommendations about writing good discharge summaries exist, they are generally vague and not specific to neurosurgical practice. The development of a simple specialty specific discharge summary guide can improve discharge summary quality and should be encouraged in all specialties.

Efficacy of the Suboccipital Paracondylar-Lateral Cervical Approach: The Series of 64 Jugular Foramen Tumors Along With Follow-Up Data.

ObjectiveComplete resection of jugular foramen tumors with minimal cranial nerve complications remains challenging even for skilled neurosurgeons. Here, we introduce a modified paracondylar approach, named the suboccipital paracondylar-lateral cervical (SPCLC) approach for this purpose. We also share the follow-up data of our series and discuss the advantages and limitations of this modified paracondylar approach.MethodsWe included 64 patients with jugular foramen tumors who underwent surgery by the same senior neurosurgeon between November 2011 and August 2020. All patients were treated with the SPCLC approach, which aimed for gross total tumor removal in a single-stage operation. The clinical characteristics, including preoperative and postoperative neurological status, the extent of surgical resection, and follow-up data were retrospectively acquired and evaluated.ResultsThere were 48 schwannomas, nine meningiomas, three paragangliomas, one hemangiopericytoma, one chordoma, one endolymphatic sac tumor, and one Langerhans’ cell histiocytosis. The median age of our patients was 43 years (range: 21–77 years). Dysphagia, hoarseness, and tongue deviation were observed in 36, 26, and 28 patients, respectively. Thirty-two patients had hearing function impairments, including hearing loss or tinnitus. Gross total resection was achieved in 59 patients (59/64, 92.2%). Gamma Knife treatment was used to manage residual tumors in five patients. Postoperatively, new-onset or aggravative dysphagia and hoarseness occurred in 26 and 18 cases, respectively. Nine patients developed new-onset facial palsy, and one patient developed new-onset hearing loss. There were no cases of intracranial hematoma, re-operation, tracheostomy, or death. At the latest follow-up, hearing loss and tinnitus had improved in 20 cases (20/32, 62.5%), dysphagia alleviated in 20 cases (20/36, 55.6%), and hoarseness improved in 14 cases (14/26, 53.8%). Over a mean follow-up period of 27.8 ± 19.5 months (range: 3–68 months), tumor recurrence was observed in one patient.ConclusionThe SPCLC approach, modified from the paracondylar approach, and was less invasive, safe, and efficient for certain jugular foramen tumors. Taking advantage of the anatomic understanding, clear operational vision, and appropriate surgical skills, it is possible to achieve gross total tumor removal and the preservation of neurological function.

Factors affecting diagnostic yield in stereotactic biopsy for brain lesions: a 5-year single-center series.

The objective of this study is to determine the factors that are associated with the diagnostic yield of stereotactic brain biopsy. A retrospective analysis was performed on 50 consecutive patients who underwent stereotactic brain biopsies in a single institute from 2014 to 2019. Variables including age, gender, lesion topography and characteristics, biopsy methods, and surgeon's experience were analyzed along with diagnostic rate. This study included 31 male and 19 female patients with a mean age of 48.4 (range: 1-76). Of these, 25 underwent frameless brain-suite stereotactic biopsies, 15 were frameless Portable Brain-lab® stereotactic biopsies and 10 were frame-based CRW® stereotactic biopsies. There was no statistical difference between the diagnostic yield of the three methods. The diagnostic yield in our series was 76%. Age, gender, and biopsy methods had no impact on diagnostic yield. Periventricular and pineal lesion biopsies were significantly associated with negative diagnostic yield (p = 0.01) whereas larger lesions were significantly associated with a positive yield (p = 0.01) with the mean volume of lesions in the positive yield group (13.6cc) being higher than the negative yield group (7cc). The diagnostic yields seen between senior and junior neurosurgeons in the biopsy procedure were 95% and 63%, respectively (p = 0.02). Anatomical location of the lesion, volume of the lesion, and experience of the surgeon have significant impacts on the diagnostic yield in stereotactic brain biopsy. There was no statistical difference between the diagnostic yield of the three methods, age, gender, and depth of lesion.

Pituitary surgery for Cushing's disease.

Surgery is currently the first-line treatment of Cushing's disease. Surgery for Cushing's patients requires technical specificity, especially if no adenoma is identified on dedicated preoperative pituitary MRI. From 2006 to 2020, 683 patients with Cushing's disease were operated on with a mononostril endoscopic endonasal approach by the same two senior neurosurgeons. Here, we report the particularities of this challenging surgery. A rigorous and planned surgical strategy avoids the pitfalls of Cushing's disease surgery and leads to a high rate of endocrine remission.

Evaluation of a Novel Teleradiology Technology for Image-Based Distant Consultations: Applications in Neurosurgery.

In emergency settings, fast access to medical imaging for diagnostic is pivotal for clinical decision making. Hence, a need has emerged for solutions that allow rapid access to images on small mobile devices (SMD) without local data storage. Our objective was to evaluate access times to full quality anonymized DICOM datasets, comparing standard access through an authorized hospital computer (AHC) to a zero-footprint teleradiology technology (ZTT) used on a personal computer (PC) or SMD using national and international networks at a regional neurosurgical center. Image datasets were sent to a senior neurosurgeon, outside the hospital network using either an AHC and a VPN connection or a ZTT (Image Over Globe (IOG)), on a PC or an SMD. Time to access DICOM images was measured using both solutions. The mean time using AHC and VPN was 250 ± 10 s (median 249 s (233–274)) while the same procedure using IOG took 50 ± 8 s (median 49 s (42–60)) on a PC and 47 ± 20 s (median 39 (33–88)) on a SMD. Similarly, an international consultation was performed requiring 23 ± 5 s (median 21 (16–33)) and 27 ± 1 s (median 27 (25–29)) for PC and SMD respectively. IOG is a secure, rapid and easy to use telemedicine technology facilitating efficient clinical decision making and remote consultations.

The “STARS-CASCADE” Study: Virtual Reality Simulation as a New Training Approach in Vascular Neurosurgery

Surgical clipping has become a relatively rare procedure in comparison to endovascular exclusion of cerebral aneurysms. Consequently, there is a declining number of cases where young neurosurgeons can practice clipping. For this reason, we investigated the application of a new 3-dimensional (3D) simulation and rehearsal device, Surgical Theater, in vascular neurosurgery. We analyzed data of 20 patients who underwent surgical aneurysm clipping. In 10 cases, Surgical Theater was used to perform the preoperative 3D planning (CASCADE group), while traditional imaging was used in the other cases (control group). Preoperative 3D simulation was performed by 4 expert and 3 junior neurosurgeons (1 fellow, 2 residents). During postoperative debriefings, expert surgeons explained the different aspects of the operation to their younger colleagues in an interactive way using the simulator. Questionnaires were given to the surgeons to get qualitative feedback about the simulator, and the junior surgeons' performance at simulator was also analyzed. There were no differences in surgery outcomes, complications, and surgical duration (P > 0.05) between the 2 groups. Senior neurosurgeons performed similarly when operating at the simulator as compared with in the operating room, while junior neurosurgeons improved their performance at the simulator after the debriefing session (P < 0.005). Surgical Theater proved to be realistic in replicating vascular neurosurgery scenarios for rehearsal and simulation purposes. Moreover, it was shown to be useful for didactic purposes, allowing young neurosurgeons to take full advantage and learn from senior colleagues to become familiar with this demanding neurosurgical subspecialty.

The “STARS–CT-MADE” Study: Advanced Rehearsal and Intraoperative Navigation for Skull Base Tumors

Skull base meningiomas represent a challenge for neurosurgeons, and the procedures are typically performed by experienced neurosurgeons, thus limiting resident training. A new simulation and rehearsal device can be used as an aid for senior surgeons during these operations and serve as a training tool for junior surgeons. Forty patients harboring an anterior/middle fossa meningioma were recruited. Surgical Theater, a rehearsal/simulation platform, was used for preoperative planning and intraoperative 3D navigation on 20 patients (CT-MADE group), while the remaining (control group) underwent a traditional navigation. Qualitative comparisons between the 2 groups were made with regard to surgical procedure and patient outcome. Satisfaction questionnaires were completed by expert neurosurgeons and residents to assess the overall usefulness of the platform. Furthermore, the surface of the simulated craniotomy performed during the planning was compared with the one actually performed during surgery in order to evaluate the reliability of the planning. No differences between the 2 groups were found (surgery duration: P= 0.4; visual impairment: P=0.56). Both residents and senior neurosurgeons enjoyed using the platform for intraoperative navigation and planning; simulated craniotomies were significantly smaller as compared with the real ones (P= 0.009), probably because it was not intuitive to depict the exact margins of the operculum with the platform. Surgical Theater helped residents to improve their anatomic and procedural comprehension and was deemed as a useful aid to safely perform some demanding neurosurgical procedures, by both senior and junior surgeons.

Endoscopic Endonasal Approach in the Smart Cyber Operating Theater (SCOT): Preliminary Clinical Application

A next-generation networked operating room, Smart Cyber Operating Theater (SCOT), has been developed in cooperation with medical engineers that integrates standalone medical devices, including intraoperative magnetic resonance imaging (MRI) using the OPeLiNK communication interface. Here, we report the application of this newly developed advanced type of operating theater for the endoscopic endonasal approach (EEA), along with an evaluation of our initial experiences. The study population consisted of 18 patients with parasellar tumor. All patients underwent surgery via the EEA in SCOT. During all procedures, various types of intraoperative information, including electrophysiologic monitoring, anatomic orientation with navigation system, intraoperative MRI, and endoscopic images of the operative field, were collected and stored by OPeLiNK. Furthermore, the intraoperative information was shared with the surgical strategy desk, where a senior neurosurgeon can direct and manage the surgical procedure in real-time. We successfully completed the surgical procedures in SCOT in all cases. Using OPeLiNK, operators in SCOT were able to share various data, such as images obtained intraoperatively and surgical instrument position from navigation systems, as well as images of the surgical field, with senior neurosurgeons at the surgical strategy desk in all cases. Surgically relevant information from these sources was transmitted through an application and displayed to all surgical staff. The necessary nuances were reflected in the surgical procedures. SCOT, which is considered an innovative operation system in neurosurgery, enables both quality and safety in the EEA. Furthermore, the use of SCOT may also contribute to the education of young neurosurgeons.

PATIENT SIZE INDICES AND DOSE IN FLUOROSCOPICALLY GUIDED LUMBAR DISCECTOMY AND FUSION: A PRELIMINARY STUDY.

Patient dose values varied significantly during interventional procedures, mainly due to the patient size, operators' choices and clinical complexity. In this study, the effect of applying a previously described and validated size-correction method to normalise kerma-area product (KAP) and average KAP rate values of the whole procedure (KAP rate) and isolate variations in dose due to the patient size and complexity, during lumbar discectomy and fusion (LDF) procedures, was investigated. Fluoroscopy time (FT), KAP, KAP rate and patient size data (weight, height and equivalent diameter) were recorded, for 96 patients who underwent single or multilevel LDF procedures by three senior neurosurgeons, defining three different patient groups (surgeon 1, surgeon 2, surgeon 3). Simple linear regression and coefficients of determination were used to investigate the relationship between uncorrected and corrected KAP and KAP rate values and patient size indices in these groups. The results showed that the size correction decreased the influence of patient size and could contribute to the isolation of the variations in patient dose due to the patient size. From this point of view, dose surveys during lumbar spine interventions may include dosimetric data from all patients independently of their body size and not only for standard-sized patients, providing the advantage of accessible data collection for the establishment of local dose reference levels and optimisation purposes, within the framework of the radiation protection program in the Neurosurgery Department.

An Evaluation of Neurosurgical Practices During the Coronavirus Disease 2019 Pandemic

ObjectiveWe sought to understand how the coronavirus disease 2019 pandemic has affected the neurosurgical workforce.MethodsWe created a survey consisting of 22 questions to assess the respondent's operative experience, location, type of practice, subspecialty, changes in clinic and operative volumes, changes to staff, and changes to income since the pandemic began. The survey was distributed electronically to neurosurgeons throughout the United States and Puerto Rico.ResultsOf the 724 who opened the survey link, 457 completed the survey. The respondents were from throughout the United States and Puerto Rico and represented all practices types and subspecialties. Nearly all respondents reported hospital restrictions on elective surgeries. Most reported a decline in clinic and operative volume. Nearly 70% of respondents saw a decrease in the work hours of their ancillary providers, and almost one half (49.1%) of the respondents had had to downsize their practice staff, office assistants, nurses, schedulers, and other personnel. Overall, 43.6% of survey respondents had experienced a decline in income, and 27.4% expected a decline in income in the upcoming billing cycle. More senior neurosurgeons and those with a private practice, whether solo or as part of a group, were more likely to experience a decline in income as a result of the pandemic compared with their colleagues.ConclusionThe coronavirus disease 2019 pandemic will likely have a lasting effect on the practice of medicine. Our survey results have described the early effects on the neurosurgical workforce. Nearly all neurosurgeons experienced a significant decline in clinical volume, which led to many downstream effects. Ultimately, analysis of the effects of such a pervasive pandemic will allow the neurosurgical workforce to be better prepared for similar events in the future.

Stereotactic Brain Biopsy Hemorrhage Risk Factors and Implications for Postoperative Care at a Single Institution: An Argument For Postoperative Imaging

To determine preoperative factors contributing to postoperative hemorrhage after stereotactic brain biopsy (STB), clinical implications of postoperative hemorrhage, and the role of postoperative imaging in clinical management. Retrospective review of STB (2005-2018) across 2 institutions including patients aged >18 years undergoing first STB. Patients with prior craniotomy, open biopsy, or prior STB were excluded. Preoperative variables included age, sex, neurosurgeon seniority, STB method. Postoperative variables included pathology, postoperative hemorrhage on computed tomography, immediate and 30-day postoperative seizure, infection, postoperative hospital stay duration, and 30-day return to operating room (OR). Analysis used the Fisher exact tests for categorical variables. Overall, 410 patients were included. Average age was 56.5 (±16.5) years; 60% (n= 248) were men. The majority of biopsies were performed by senior neurosurgeons (66%, n= 270); frontal lobe (42%, n= 182) and glioblastoma (45%, n= 186) were the most common location and pathology. Postoperative hemorrhage occurred in 28% (114) of patients with 20% <0.05 cm3 and 8% >0.05 cm3. Postoperative hemorrhage of any size was associated with increased rate of postoperative deficit within both 24 hours and 30 days, postoperative seizure, and length of hospital stay when controlling for pathology. Hemorrhages >0.05 cm3 had a 16% higher rate of return to the OR for evacuation, due to clinical deterioration as opposed to radiographic progression. Postbiopsy hemorrhage was associated with higher risk of immediate and delayed postoperative deficit and seizure. Postoperative computed tomography should be used to determine whether STB patients can be discharged same day or admitted for observation; clinical evaluation should determine return to OR for evacuation.

Can Young Vascular Neurosurgeons Become Proficient in Microsurgical Clip Reconstruction in the Endovascular Era? A Rotterdam Cohort Spanning 2 Decades with Propensity Score Matching for Complexity

Little is known about the results of young vascular neurosurgeons who perform only microsurgical clip reconstruction in the era since the International Subarachnoid Aneurysm Trial (ISAT) or about the training and caseload required to equivocate the results of senior, more experienced colleagues. The aim of this study was to compare clinical outcomes of patients treated by young and senior vascular neurosurgeons at Erasmus MC University Medical Center Rotterdam, adjusting for case mix. A partially prospective and partially retrospective database was used. Hierarchical mixed models with a random intercept for surgeon were used for confounder adjustment, and propensity score matching for complexity was used to create comparable groups. The study included 609 patients harboring 767 aneurysms. Most (86%) of the aneurysms had at least 1 complexity characteristic, with the majority having 3 characteristics. The most often encountered complexity characteristics were the presence of a broad neck and the presence of branches emerging from the aneurysm. Use of temporary clipping and skull base approaches was significantly higher in the young vascular neurosurgeons group (P < 0.0001). The complexity score differed significantly between senior and young vascular neurosurgeons (P < 0.001). After propensity score matching for complexity, multivariable logistic regression showed young vascular neurosurgeons to be significantly associated with better outcomes for ruptured aneurysms (propensity score weighted odds ratio 0.55 [95% confidence interval 0.35-0.88], P= 0.01). In a high-volume neurovascular center where both endovascular and microsurgical treatment options are available, young vascular neurosurgeons can be trained to achieve at least the same results as their senior colleagues despite increased complexity.

Prospective Nonrandomized Analytical Comparative Study of Clinicoradiological Relationship and Quality of Life between Lumbar Interbody Fusion and Posterolateral Lumbar Fusion.

Study Design:This prospective, nonrandomized, analytic comparative study analyzed the outcome of 100 patients who underwent spinal fusion surgeries (Posterolateral fusion (PLF) and posterior lumbar interbody fusion [PLIF]) with 6 months of follow-up.Objective:The aim of our study was to compare clinicoradiological outcome of the lumbar spinal fusion surgeries (PLF vs. PLIF/transforaminal lumbar interbody fusion [TLIF]), to assess the quality of life pre- and post-operatively in all patients, and to compare the results within the groups.Summary of Background Data:We retrieved the articles related to posterolateral fusion (PLF) and PLIF/TLIF through computer-assisted PubMed and Cochrane database search. Most of the studies in previous literature did not show any significant difference in the success of fusion between the two groups. However, the global outcome in terms of clinical and radiological parameters was good in all the studies.Materials and Methods:Senior neurosurgeons who are part of the study treated 100 patients presented with degenerative disc disease (DDD). Patients underwent two types of spinal fusion surgeries: Posterolateral fusion (PLF) and PLIF/TLIF, and those two groups were compared for clinicoradiological outcome, successful fusion, and quality of life at 6 months of follow-up. Results were analyzed statistically using SPSS version 21.0 and presented in terms of frequency, percentage, mean, and standard deviation. Measurements were compared between groups using the Student's t-test (independent and paired) for normally distributed variables. Percentage was compared with Chi-square test in various parameters. Statistical significance was determined with P values; P < 0.05 was considered statistically significant.Results:Patients aged between 30and 65 years with lumbar DDD who met the inclusion criteria were included in the study. Patients were operated for 1–3 vertebral levels and showed clinical satisfactory outcome on visual analog scale (P = 0.004) and modified-Oswestry low back pain disability questionnaire (Oswestry disability index) (P = 0.000) at 6 months as compared to the preoperative data, which was statistically significant. Radiological outcome in terms of lumbar lordotic angle (LLA, P = 0.000) and ratio of disc space height (DSH) and height of immediate superior vertebral body (P = 0.000) at 3 months of follow-up was also statistically significant. All of our patients showed a well-placed implant (screws and cage) in the follow-up period. Our patients showed successful fusion more in the PLIF group (81.25%) as compared to the PLF group (67.30%), but those results are not statistically significant (P = 0.112), and all of our patients showed statistically significant difference (P = 0.000) in quality of life score at 6 months of follow-up when compared with the preoperative score.Conclusions:We concluded from our study and after the review of literature that the patients with lumbar DDD should undergo spinal instrumentation surgery either PLF or PLIF as per the requirement as these surgeries provide good clinical and radiological outcomes in terms of pain, disability index, LLA, and maintenance of DSH. Although both the groups have few degrees of risks and complications, these are not major one and can be managed easily. The fusion rates are similar in both the groups (PLF and PLIF). Quality of life index showed significant difference within 1 week, after 3 months, and after 6 months of surgery in all of our patients.

Analysis of Myelomalacia and Posterior Longitudinal Ligament Ossification as Prognostic Factors in Patients with Cervicalspondylotic Myelopathy Submitted Tolaminoplasty

Background: Cervical spondyloticmyelopathy is a degenerative disease of the intervertebral disc and vertebral body of the spine that causes cervical spinal cord injury due to central vertebral canal stenosis. Its prevalence is higher in the elderly. Treatment is usually surgical when the spinal cord is affected either clinically with pyramidal release or radiologically with the altered spinal cord. The rationale of this study is to analyze the myelomalacia and the ossification of posterior longitudinal ligament as prognostic factors in the postoperative evolution of patients with cervical canal compression who underwent laminoplasty by Open-door or French-door techniques. Methods and Findings: We performed a retrospective analysis of 18 surgical cases of spondylotic cervical myelopathy of the same senior neurosurgeon, using the chi-square test to analyze prognostic factors for patients’ postoperative evolution in the Nurick scale, after Opendoor or French-door laminoplasty. The comparison between pre and postoperative showed an improvement of 71.43% of cases that did not have ligament ossification compared to 45.45% of cases that presented posterior longitudinal ligament ossification. Also, there was a better prognosis in patients without myelomalacia, as 71.43% of them improved their condition against only 45.45% improvement in those with myelomalacia. Conclusion: There is a need for further studies with larger samples to expressively prove that the presence of longitudinal ligament ossification and the previous presence of myelomalacia are factors of worse prognosis in the postoperative evolution of patients with cervical spondylotic myelopathy submitted to laminoplasty.

The Role of Laser Interstitial Thermal Therapy in Surgical Neuro-Oncology: Series of 100 Consecutive Patients.

Laser interstitial thermal therapy (LITT) is an adjuvant treatment for intracranial lesions that are treatment refractory or in deep or eloquent brain. Initial studies of LITT in surgical neuro-oncology are limited in size and follow-up. To present our series of LITT in surgical neuro-oncology to better evaluate procedural safety and outcomes. An exploratory cohort study of all patients receiving LITT for brain tumors by a single senior neurosurgeon at a single center between 2013 and 2018. Primary outcomes included extent of ablation (EOA), time to recurrence (TTR), local control at 1-yr follow-up, and overall survival (OS). Secondary outcomes included complication rate. Outcomes were compared by tumor subtype. Predictors of outcomes were identified. A total of 91 patients underwent 100 LITT procedures; 61% remain alive with 72% local control at median 7.2 mo follow-up. Median TTR and OS were 31.9 and 16.9 mo, respectively. For lesion subtypes, median TTR (months, not applicable [N/A] if <50% rate observed), local control rates at 1-yr follow-up, and median OS (months) were the following: dural-based lesions (n=4, N/A, 75%, 20.7), metastases (n=45, 55.9, 77.4%, 16.9), newly diagnosed glioblastoma (n=11, 31.9, 83.3%, 32.3), recurrent glioblastoma (n=14, 5.6, 24.3%, 7.3), radiation necrosis (n=20, N/A, 67.2%, 16.4), and other lesions (n=6, 12.3, 80%, 24.4). TTR differed by tumor subtype (P=.02, log-rank analysis). EOA predicted local control (P=.009, multivariate proportional hazards regression); EOA > 85% predicted longer TTR (P=.006, log-rank analysis). Complication rate was 4%. Our series of LITT in surgical neuro-oncology, 1 of the largest to date, further evidences its safety and outcomes profile.