Surgical Technology International
36th Edition
Contains 69 peer-reviewed articles featuring the latest advances in surgical techniques and technologies.
472 pages
May 2020 - ISSN:1090-3941
1 year Institutional Subscription
both electronic and print versions
Principles of Cortical Plasticity in Peripheral Nerve Surgery
Bianca Maria Baldassarre, MD, Andrea Lavorato, MD, Francesca Vincitorio, MD, Diego Garbossa, MD, PhD, Professor, University of Turin, Turin, Italy, Giulia Colzani, MD, Bruno Battiston, MD, PhD, Professor, Paolo Titolo, MD, CTO Hospital, Torino, Italy, Michele Rosario Colonna, MD, PhD, Professor, University of Messina, Messina, Italy
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Cortical plasticity is a finely regulated process that allows the central nervous system (CNS) to change in response to internal and external stimuli. While these modifications occur throughout normal brain development, interestingly, they are also elicited after peripheral nerve injury and surgery. This article provides an overview of the principle mechanisms of synaptic, neuronal, cortical and subcortical neuroplasticity, with special attention to cortical and subcortical modifications–as suggested by modern neuroimaging techniques–after peripheral nerve surgery. The main nerve transfer techniques for the superior extremities and their effect on cortical plasticity are also described.
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5-ALA False-Positive in Anaplastic Oligodendroglioma, IDH-mutant and 1p/19q-codeleted
Giuseppe La Rocca, MD, Giovanni Sabatino, MD, PhD, Alessandro Olivi, MD, Giuseppe Maria Della Pepa, MD, Fondazione Policlinico Universitario A. Gemelli Irccs, Catholic University, Rome, Italy, Edoardo Mazzucchi, MD, Fabrizio Pignotti, MD, Mater Olbia Hospital, Olbia, Italy, Valeria Barresi, MD, PhD, University And Hospital Trust of Verona, Verona, Italy, Roberto Altieri, MD, Policlinico "G.Rodolico" University Hospital, Catania, Italy, Tamara Ius, MD, PhD, Santamaria Dellamisericordia , University Hospital, Udine, Italy
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Pr5-ALA has been well-established for use in intraoperative fluorescence-guided resection of malignant glioma. It is not as strongly supported for use with low-grade gliomas (LGG) because only a few of these, less than 20%, have visible porphyrin accumulation, which is useful for 5-ALA-guided surgery. We report here our experience with 5-ALA uptake in a case of suspected relapse of anaplastic oligodendroglioma, IDH-mutant and 1p/19q-codeleted. Fluorescence-guided surgery is one of the most significant innovations in the surgical management of HGG over the past decade. Nevertheless, 5-ALA-guided surgery is not yet feasible for most cases of LGG. To our knowledge, this is the first report of strong 5-ALA activation in non-tumoral or peritumoral tissue.
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Minimally Invasive Decompression with Posterior Elements Preservation Versus Laminectomy and Fusion for Lumbar Degenerative Spondylolisthesis: A Systematic Review and Meta-Analysis of Surgical Clinical and Radiological Outcomes
Luca Ricciardi, MD, Pia Fondazione di Culto e Religione Cardinal G. Panico, Tricase (LE), Italy, Vito Stifano, MD, Carmelo Lucio Sturiale, MD, PhD, Ginevra Federica D’Onofrio, MD, Alessandro Olivi, MD, Professor of Neurosurgery, Nicola Montano, MD, PhD, Assistant Professor in Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
1270
Introduction: Chronic low back pain can be due to many different causes, including degenerative spondylolisthesis (DS). For patients who do not respond to conservative management, surgery remains the most effective treatment. Open laminectomy alone and laminectomy and fusion (LF) for DS have been widely investigated, however, no meta-analyses have compared minimally invasive decompression with posterior elements preservation (MID) techniques and LF. Minimally invasive techniques might provide specific advantages that were not recognized in previous studies that pooled different decompression strategies together.
Materials and Methods: This was a systematic review and meta-analysis, according to the PRISMA statement, of comparative studies reporting surgical, clinical and radiological outcomes of MID and LF for DS.
Results: A total of 3202 papers were screened and 7 were finally included in the meta-analysis. MID is associated with a shorter surgical duration and hospitalization stay, and a lower intraoperative blood loss and residual low back pain; however, the residual disability grade was lower in the LF group. Complication rates were similar between the two groups. The rate of adjacent segment degeneration was lower in the MID group, whereas data on radiological outcomes were heterogeneous and not suitable for data-pooling.
Conclusions: This meta-analysis suggests that MID might be considered as an effective alternative to LF for DS. Further clinical trials will be needed to confirm our results, better investigate radiological outcomes, and identify patient subgroups that may benefit the most from specific techniques.
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Cortical Laminar Necrosis as a Result of Status Epilepticus After Resection of Parafalcal Meningioma
Giuseppe La Rocca, MD, Giuseppe Maria Della Pepa, MD, Simona Gaudino, MD, Giovanni Sabatino, MD, PhD, Edoardo Mazzucchi, MD, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy, Cesare Zoia, MD, PhD, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy, Giovanni Raffa, MD, PhD, BIOMORF Department. University of Messina, Messina, Italy, Roberto Altieri, MD, Policlinico "Gaspare Rodolico" University Hospital, Catania, Italy
1215
Status epilepticus during the post-operative period is a rare complication for neurosurgery patients. Acute encephalopathic syndromes can present a diagnostic challenge due to the wide range of possible etiologies, and can also have vastly different outcomes. Posterior reversible encephalopathy syndrome is a rare neurological disorder, usually associated with specific medical conditions, that causes a disturbance of CNS homeostasis, while cortical laminar necrosis (CLN) is an unusual type of infarction characterized by selective necrosis of the cerebral cortex with sparing of the white matter. We present a 45-year-old woman who was operated on for left frontal lesion with radiological features compatible with anterior falx meningioma. Postoperative clinical and electroencephalographic data were compatible with non-convulsive status epilepticus originating from the occipito-mesial area. MRI showed bilateral diffuse temporo-occipital abnormally bright cortex as a consequence of neuronal apoptosis compatible with laminar cortical necrosis, and clinical examination revealed persistent cortical blindness. The pathogenesis of encephalopathic syndromes is still unclear. Non-convulsive status epilepticus should be considered as a possible cause of late recovery of consciousness in neurosurgery patients. Delayed treatment may cause irreversible lesions, including in brain areas far from the surgical field.
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Transforaminal Endoscopic Lumbar Decompression for Isthmic Spondylolisthesis: Technique Description and Clinical Outcome
Kaixuan Liu, MD, PhD, Praveen Kadimcherla, MD, Atlantic Spine Center, West Orange, NJ
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Objectives: To describe a transforaminal endoscopic spinal decompression technique for treating adult patients with isthmic spondylolisthesis and report preliminary surgical and radiological results.
Background: Spondylolisthesis is prevalent in the general population. Surgical approaches for symptomatic spondylolisthesis that is refractory to conservative treatment vary. Direct repair of pars fractures and spinal nerve decompression with or without fusion have been reported with varied clinical results. The de facto gold standard, “fusion,” is often associated with high complication rates and costs, and may not be necessary for many patients whose spine is relatively stable.
Methods: Transforaminal endoscopic lumbar decompression (TFELD) was performed to resect fractured bone or bone fragments and inflamed tissue compressing the exiting nerve root in 2 patients with isthmic spondylolisthesis (grade 1 in one patient and grade 2 in another). We describe the technique step-by-step and assess the Oswestry Disability Index and pain scores for back and leg pain before and after surgery.
Results: Radiographic images demonstrated spondylolisthesis with L5 pars fracture. The fractured bone and bone fragment were intraoperatively visible in the gap between facets and fractured pars in patients with isthmic spondylolisthesis. The core pathology of the patients was fractured bone and bone fragment coupled with scar or inflamed tissue compressing the exiting L5 nerve roots. After the bone fragments and scar tissue were removed using TFELD, the patients’ back and leg pain was significantly reduced, and physical function was restored.
Conclusion: For patients with spondylolisthesis-associated low back and leg pain without spinal instability, TFELD is a safe and effective surgical treatment option.
