Dynamic contrast-enhanced magnetic resonance imaging perfusion characteristics in meningiomas treated with resection and adjuvant radiosurgery.
Abstract OBJECTIVEThere is a need for advanced imaging biomarkers to improve radiation treatment planning and response assessment. T1-weighted dynamic contrast-enhanced perfusion MRI (DCE MRI) allows quantitative assessment of tissue perfusion and blood-brain barrier dysfunction and has entered clinical practice in the management of primary and secondary brain neoplasms. The authors sought to retrospectively investigate DCE MRI parameters in meningiomas treated with resection and adjuvant radiation therapy using volumetric segmentation.METHODSA retrospective review of more than 300 patients with meningiomas resect...
Source: Neurosurgical Focus - June 1, 2019 Category: Neurosurgery Authors: Chidambaram S, Pannullo SC, Roytman M, Pisapia DJ, Liechty B, Magge RS, Ramakrishna R, Stieg PE, Schwartz TH, Ivanidze J Tags: Neurosurg Focus Source Type: research

Introduction. Radiosurgery and radiotherapy for meningiomas: overview of the issue.
PMID: 31153142 [PubMed - in process] (Source: Neurosurgical Focus)
Source: Neurosurgical Focus - June 1, 2019 Category: Neurosurgery Authors: McDermott MW, Sheehan J, Braunstein S Tags: Neurosurg Focus Source Type: research

Management trends for anaplastic meningioma with adjuvant radiotherapy and predictors of long-term survival.
CONCLUSIONSAMs are aggressive tumors that carry a poor prognosis. Conventional adjuvant RT improves local control. However, the effect of adjuvant radiation on overall survival is unclear. Further investigation into this area is warranted. PMID: 31153143 [PubMed - in process] (Source: Neurosurgical Focus)
Source: Neurosurgical Focus - June 1, 2019 Category: Neurosurgery Authors: Alhourani A, Aljuboori Z, Yusuf M, Woo SY, Hattab EM, Andaluz N, Williams BJ Tags: Neurosurg Focus Source Type: research

Letter to the Editor. Parasitic spinal infections.
PMID: 31153144 [PubMed - in process] (Source: Neurosurgical Focus)
Source: Neurosurgical Focus - June 1, 2019 Category: Neurosurgery Authors: Xia Y, Chen LY Tags: Neurosurg Focus Source Type: research

Efficacy and toxicity of particle radiotherapy in WHO grade II and grade III meningiomas: a systematic review.
CONCLUSIONSDespite the lack of randomized prospective trials, this review of existing retrospective studies suggests that particle therapy, whether an adjuvant or a stand-alone treatment, confers survival benefit with a relatively low risk for severe treatment-derived toxicity compared to standard photon-based therapy. However, additional controlled studies are needed. PMID: 31153145 [PubMed - in process] (Source: Neurosurgical Focus)
Source: Neurosurgical Focus - June 1, 2019 Category: Neurosurgery Authors: Wu A, Jin MC, Meola A, Wong HN, Chang SD Tags: Neurosurg Focus Source Type: research

Glioblastoma multiforme as a secondary malignancy following stereotactic radiosurgery of a meningioma: case report.
This report serves to increase the awareness of this possible complication following SRS. The possibility of this rare complication should be explained to patients when obtaining their consent for radiosurgery. PMID: 31153146 [PubMed - in process] (Source: Neurosurgical Focus)
Source: Neurosurgical Focus - June 1, 2019 Category: Neurosurgery Authors: Labuschagne JJ, Chetty D Tags: Neurosurg Focus Source Type: research

Major complications from radiotherapy following treatment for atypical meningiomas.
CONCLUSIONSThe postoperative management of patients with atypical meningioma continues to be defined, with questions remaining regarding timing of RT, dose, target delineation, and fractionation. Both of the patients in this study received fractionated RT, which included a greater volume of normal brain than more focal treatment options such as would be required by stereotactic radiosurgery (SRS). Further research is needed to compare SRS and fractionated RT for the management of patients with grade II meningiomas. The more focused nature of SRS may make this a preferred option in certain cases of focal recurrence. PM...
Source: Neurosurgical Focus - June 1, 2019 Category: Neurosurgery Authors: Dawley T, Rana Z, Abou-Al-Shaar H, Goenka A, Schulder M Tags: Neurosurg Focus Source Type: research

Determining the role of adjuvant radiotherapy in the management of meningioma: a Surveillance, Epidemiology, and End Results analysis.
CONCLUSIONSThe results of this study demonstrate that the role of adjuvant radiotherapy, especially after the resection of atypical meningioma, remains somewhat unclear. Thus, given these results, prospective randomized clinical studies are warranted to provide clear information on the effects of adjuvant radiation in meningioma treatment. PMID: 31153148 [PubMed - in process] (Source: Neurosurgical Focus)
Source: Neurosurgical Focus - June 1, 2019 Category: Neurosurgery Authors: Reddy AK, Ryoo JS, Denyer S, McGuire LS, Mehta AI Tags: Neurosurg Focus Source Type: research

Stereotactic radiosurgery versus stereotactic radiotherapy in the management of intracranial meningiomas: a systematic review and meta-analysis.
CONCLUSIONSSRS and SRT are both safe options in the management of ICMs. However, SRT carries a better radiographic tumor control rate and a lower incidence of posttreatment symptomatic worsening and symptomatic edema, with respect to SRS. However, further prospective studies are still needed to validate these results. PMID: 31153149 [PubMed - in process] (Source: Neurosurgical Focus)
Source: Neurosurgical Focus - June 1, 2019 Category: Neurosurgery Authors: Fatima N, Meola A, Pollom EL, Soltys SG, Chang SD Tags: Neurosurg Focus Source Type: research

Impact of 68Ga-DOTATOC PET/MRI on robotic radiosurgery treatment planning in meningioma patients: first experiences in a single institution.
CONCLUSIONSThis study demonstrated a relevant impact of PET/MRI on target volume delineation of meningiomas. The extent was highly dependent on the experience of the treating physician. This preliminary study supports the relevance of 68Ga-DOTATOC PET/MRI as a tool for radiosurgical treatment planning of meningiomas. PMID: 31153151 [PubMed - in process] (Source: Neurosurgical Focus)
Source: Neurosurgical Focus - June 1, 2019 Category: Neurosurgery Authors: Acker G, Kluge A, Lukas M, Conti A, Pasemann D, Meinert F, Anh Nguyen PT, Jelgersma C, Loebel F, Budach V, Vajkoczy P, Furth C, Baur ADJ, Senger C Tags: Neurosurg Focus Source Type: research

Fractionated Gamma Knife radiosurgery for skull base meningiomas: a single-institution experience.
CONCLUSIONSfGKRS with relocatable, noninvasive immobilization systems is well tolerated in patients with SBMs and demonstrated satisfactory tumor control as well as limited radiation toxicity. Future prospective studies with long-term follow-up and comparison to single-session GKRS or fractionated stereotactic radiotherapy are necessary to validate these findings and determine the efficacy of this approach in the management of SBMs. PMID: 31153152 [PubMed - in process] (Source: Neurosurgical Focus)
Source: Neurosurgical Focus - June 1, 2019 Category: Neurosurgery Authors: Joshi KC, Raghavan A, Muhsen B, Hsieh J, Borghei-Razavi H, Chao ST, Barnett GH, Suh JH, Neyman G, Kshettry VR, Recinos PF, Mohammadi AM, Angelov L Tags: Neurosurg Focus Source Type: research

Gamma Knife radiosurgery for intracranial benign meningiomas: follow-up outcome in 130 patients.
Abstract OBJECTIVEThe authors retrospectively analyzed the follow-up data in 130 patients with intracranial benign meningiomas after Gamma Knife radiosurgery (GKRS), evaluated the tumor progression-free survival (PFS) rate and neurological function preservation rate, and determined the predictors by univariate and multivariate survival analysis.METHODSThis cohort of 130 patients with intracranial benign meningiomas underwent GKRS between May 2012 and May 2015 at the Second Hospital of Tianjin Medical University. The median age was 54.5 years (range 25-81 years), and women outnumbered men at a ratio of 4.65:1. All ...
Source: Neurosurgical Focus - June 1, 2019 Category: Neurosurgery Authors: Ge Y, Liu D, Zhang Z, Li Y, Lin Y, Wang G, Zong Y, Liu E Tags: Neurosurg Focus Source Type: research

Trends in the utilization of radiotherapy for spinal meningiomas: insights from the 2004-2015 National Cancer Database.
Abstract OBJECTIVERecent studies have reported on the utility of radiosurgery for local control and symptom relief in spinal meningioma. The authors sought to evaluate national utilization trends in radiotherapy (including radiosurgery), investigate possible factors associated with its use in patients with spinal meningioma, and its impact on survival for atypical tumors.METHODSUsing the ICD-O-3 topographical codes C70.1, C72.0, and C72.1 and histological codes 9530-9535 and 9537-9539, the authors queried the National Cancer Database for patients in whom spinal meningioma had been diagnosed between 2004 and 2015. ...
Source: Neurosurgical Focus - June 1, 2019 Category: Neurosurgery Authors: Yolcu YU, Goyal A, Alvi MA, Moinuddin FM, Bydon M Tags: Neurosurg Focus Source Type: research

Long-term clinical outcomes after bilateral laminotomy or total laminectomy for lumbar spinal stenosis: a single-institution experience.
CONCLUSIONSBilateral laminotomy allows adequate and safe decompression of the spinal canal in patients with LSS; this technique ensures a significant improvement in patients' symptoms, disability, and quality of life. Clinical outcomes are similar in both groups, but a lower incidence of complications and iatrogenic instability has been shown in the long term in the bilateral laminotomy group. PMID: 31042648 [PubMed - in process] (Source: Neurosurgical Focus)
Source: Neurosurgical Focus - May 1, 2019 Category: Neurosurgery Authors: Pietrantonio A, Trungu S, Famà I, Forcato S, Miscusi M, Raco A Tags: Neurosurg Focus Source Type: research

Decompression of lumbar canal stenosis with a bilateral interlaminar versus classic laminectomy technique: a prospective randomized study.
CONCLUSIONSBilateral interlaminar decompression is an effective method that provides sufficient canal decompression with decreased instability in cases of LCS and increases patient comfort in the postoperative period. PMID: 31042649 [PubMed - in process] (Source: Neurosurgical Focus)
Source: Neurosurgical Focus - May 1, 2019 Category: Neurosurgery Authors: Soliman MAR, Ali A Tags: Neurosurg Focus Source Type: research

Introduction. Lumbar spinal stenosis.
PMID: 31042650 [PubMed - in process] (Source: Neurosurgical Focus)
Source: Neurosurgical Focus - May 1, 2019 Category: Neurosurgery Authors: Heary RF, Anderson PA, Arnold PM Tags: Neurosurg Focus Source Type: research

Radiographic outcomes of endoscopic decompression for lumbar spinal stenosis.
The objective of this study was to quantify the 3D volume of bone removed from the lamina and facet joints during endoscopic decompression for lumbar central and lateral recess stenosis.METHODSThis retrospective study included adults with lumbar spinal stenosis who underwent endoscopic decompression of a single level or 2 noncontiguous lumbar levels. Central stenosis on MRI was graded preoperatively and postoperatively using the Schizas scale. A computer program was developed in MATLAB to semiautomatically perform a 3D volumetric analysis of preoperative and postoperative lumbar CT scans. The volumetric percentage of bone ...
Source: Neurosurgical Focus - May 1, 2019 Category: Neurosurgery Authors: Khalsa SS, Kim HS, Singh R, Kashlan ON Tags: Neurosurg Focus Source Type: research

Reduction and monosegmental fusion for lumbar spondylolisthesis with a long tab percutaneous pedicle screw system: "swing" technique.
CONCLUSIONSMIS-TLIF with the "swing" technique with long tab percutaneous pedicle screws is a safe and effective reduction method for monosegmental spondylolisthesis. This technique cannot only alleviate symptoms but also achieve nearly completely reduction of slippage. PMID: 31042652 [PubMed - in process] (Source: Neurosurgical Focus)
Source: Neurosurgical Focus - May 1, 2019 Category: Neurosurgery Authors: Park B, Noh SH, Park JY Tags: Neurosurg Focus Source Type: research

Predictive model for long-term patient satisfaction after surgery for grade I degenerative lumbar spondylolisthesis: insights from the Quality Outcomes Database.
CONCLUSIONSCurrent findings from a large multiinstitutional study indicate that most patients undergoing surgery for grade I lumbar spondylolisthesis achieved long-term satisfaction. Moreover, the authors found that older age, preoperative active employment, and fusion surgery are associated with higher odds of achieving satisfaction. PMID: 31042653 [PubMed - in process] (Source: Neurosurgical Focus)
Source: Neurosurgical Focus - May 1, 2019 Category: Neurosurgery Authors: Mummaneni PV, Bydon M, Alvi MA, Chan AK, Glassman SD, Foley KT, Potts EA, Shaffrey CI, Shaffrey ME, Coric D, Knightly JJ, Park P, Wang MY, Fu KM, Slotkin JR, Asher AL, Virk MS, Kerezoudis P, Guan J, Haid RW, Bisson EF Tags: Neurosurg Focus Source Type: research

Upright MRI after decompression of spinal stenosis and concurrent spondylolisthesis.
CONCLUSIONSThere seems to be a substantial subset of patients who develop morphological micro-instability after sole decompression procedures but do not experience any clinically significant effect of the instability. PMID: 31042654 [PubMed - in process] (Source: Neurosurgical Focus)
Source: Neurosurgical Focus - May 1, 2019 Category: Neurosurgery Authors: Kern M, Setzer M, Weise L, Mroe A, Frey H, Frey K, Seifert V, Duetzmann S Tags: Neurosurg Focus Source Type: research

A comparison of minimally invasive transforaminal lumbar interbody fusion and decompression alone for degenerative lumbar spondylolisthesis.
In this study, the authors compared the 24-month patient-reported outcomes (PROs) after MIS transforaminal lumbar interbody fusion (TLIF) and MIS decompression for degenerative lumbar spondylolisthesis.METHODSA total of 608 patients from 12 high-enrolling sites participating in the Quality Outcomes Database (QOD) lumbar spondylolisthesis module underwent single-level surgery for degenerative grade 1 lumbar spondylolisthesis, of whom 143 underwent MIS (72 MIS TLIF [50.3%] and 71 MIS decompression [49.7%]). Surgeries were classified as MIS if there was utilization of percutaneous screw fixation and placement of a Wiltse plan...
Source: Neurosurgical Focus - May 1, 2019 Category: Neurosurgery Authors: Chan AK, Bisson EF, Bydon M, Glassman SD, Foley KT, Potts EA, Shaffrey CI, Shaffrey ME, Coric D, Knightly JJ, Park P, Wang MY, Fu KM, Slotkin JR, Asher AL, Virk MS, Kerezoudis P, Alvi MA, Guan J, Haid RW, Mummaneni PV Tags: Neurosurg Focus Source Type: research

Comparison of full-endoscopic and minimally invasive decompression for lumbar spinal stenosis in the setting of degenerative scoliosis and spondylolisthesis.
Abstract OBJECTIVEThe management of lumbar spinal stenosis (LSS) with concurrent scoliosis and/or spondylolisthesis remains controversial. Full-endoscopic unilateral laminotomy for bilateral decompression (ULBD) facilitates neural decompression while preserving stabilizing osseoligamentous structures and may be uniquely suited for the treatment of LSS with concurrent mild to moderate degenerative deformity. The safety and efficacy of full-endoscopic versus minimally invasive surgery (MIS) ULBD in this patient population is studied here for the first time.METHODSA retrospective analysis of prospectively collected d...
Source: Neurosurgical Focus - May 1, 2019 Category: Neurosurgery Authors: Hasan S, McGrath LB, Sen RD, Barber JK, Hofstetter CP Tags: Neurosurg Focus Source Type: research

Letter to the Editor. Early decompressive craniectomy and limited tract debridement: a proven strategy?
PMID: 31042657 [PubMed - in process] (Source: Neurosurgical Focus)
Source: Neurosurgical Focus - May 1, 2019 Category: Neurosurgery Authors: Martin JE Tags: Neurosurg Focus Source Type: research

The biomechanical effect of single-level laminectomy and posterior instrumentation on spinal stability in degenerative lumbar scoliosis: a human cadaveric study.
Abstract OBJECTIVEDegenerative lumbar scoliosis, or de novo degenerative lumbar scoliosis, can result in spinal canal stenosis, which is often accompanied by disabling symptoms. When surgically treated, a single-level laminectomy is performed and short-segment posterior instrumentation is placed to restore stability. However, the effects of laminectomy on spinal stability and the necessity of placing posterior instrumentation are unknown. Therefore, the aim of this study was to assess the stability of lumbar spines with degenerative scoliosis, characterized by the range of motion (ROM) and neutral zone (NZ) stiffn...
Source: Neurosurgical Focus - May 1, 2019 Category: Neurosurgery Authors: Rustenburg CME, Faraj SSA, Holewijn RM, Kingma I, van Royen BJ, Stadhouder A, Emanuel KS Tags: Neurosurg Focus Source Type: research

Use of Hounsfield units of S1 body to diagnose osteoporosis in patients with lumbar degenerative diseases.
Abstract OBJECTIVEThe aim of this study was to evaluate the use of Hounsfield unit (HU) values of the S1 body to diagnose osteoporosis in patients with lumbar degenerative diseases.METHODSThe records of 316 patients of ages ≥ 50 years and requiring surgery for lumbar degenerative diseases were reviewed. The bone mineral density (BMD) of the S1 body and L1 was measured in HU with preoperative lumbar CT. Circular regions of interest (ROIs) were placed on midaxial and midsagittal images of the S1 body. Dual-energy x-ray absorptiometry (DXA) and the criterion of L1 HU ≤ 110 HU were used to diagnose osteoporosis....
Source: Neurosurgical Focus - May 1, 2019 Category: Neurosurgery Authors: Zou D, Li W, Xu F, Du G Tags: Neurosurg Focus Source Type: research

Machine learning-based preoperative predictive analytics for lumbar spinal stenosis.
CONCLUSIONSPreoperative prediction of a range of clinically relevant endpoints in decompression surgery for LSS using ML is feasible, and may enable enhanced informed patient consent and personalized shared decision-making. Access to individualized preoperative predictive analytics for outcome and treatment risks may represent a further step in the evolution of surgical care for patients with LSS. PMID: 31042660 [PubMed - in process] (Source: Neurosurgical Focus)
Source: Neurosurgical Focus - May 1, 2019 Category: Neurosurgery Authors: Siccoli A, de Wispelaere MP, Schröder ML, Staartjes VE Tags: Neurosurg Focus Source Type: research

Editorial. Use of fixation/fusion to treat lumbar spinal stenosis.
PMID: 31042661 [PubMed - in process] (Source: Neurosurgical Focus)
Source: Neurosurgical Focus - May 1, 2019 Category: Neurosurgery Authors: Heary R Tags: Neurosurg Focus Source Type: research

Lumbar canal stenosis: analyzing the role of stabilization and the futility of decompression as treatment.
CONCLUSIONSSpinal instability is the nodal point of pathogenesis of spinal degeneration-related lumbar canal stenosis. Only fixation of the involved spinal segments is necessary-decompression by bone or soft-tissue resection is not necessary. PMID: 31042662 [PubMed - in process] (Source: Neurosurgical Focus)
Source: Neurosurgical Focus - May 1, 2019 Category: Neurosurgery Authors: Goel A, Ranjan S, Shah A, Patil A, Vutha R Tags: Neurosurg Focus Source Type: research

Objective functional assessment using the "Timed Up and Go" test in patients with lumbar spinal stenosis.
Objective functional assessment using the "Timed Up and Go" test in patients with lumbar spinal stenosis. Neurosurg Focus. 2019 May 01;46(5):E4 Authors: Stienen MN, Maldaner N, Joswig H, Corniola MV, Bellut D, Prömmel P, Regli L, Weyerbrock A, Schaller K, Gautschi OP Abstract OBJECTIVEPatient-reported outcome measures (PROMs) are standard of care for the assessment of functional impairment. Subjective outcome measures are increasingly complemented by objective ones, such as the "Timed Up and Go" (TUG) test. Currently, only a few studies report pre- and postoperative TUG test a...
Source: Neurosurgical Focus - May 1, 2019 Category: Neurosurgery Authors: Stienen MN, Maldaner N, Joswig H, Corniola MV, Bellut D, Prömmel P, Regli L, Weyerbrock A, Schaller K, Gautschi OP Tags: Neurosurg Focus Source Type: research

Comparative analysis of three types of minimally invasive decompressive surgery for lumbar central stenosis: biportal endoscopy, uniportal endoscopy, and microsurgery.
Abstract OBJECTIVERecently, minimally invasive unilateral laminotomy with bilateral decompression (ULBD) has been performed for lumbar stenosis using endoscopic approaches. The object of this retrospective study was to compare the clinical and radiological outcomes of three types of minimally invasive decompressive surgery: microsurgery, percutaneous uniportal endoscopic surgery, and percutaneous biportal endoscopic surgery.METHODSIn the period from March 2016 to December 2017, minimally invasive ULBD was performed using microscopy, a uniportal endoscopic approach, or a biportal endoscopic approach to treat lumbar...
Source: Neurosurgical Focus - May 1, 2019 Category: Neurosurgery Authors: Heo DH, Lee DC, Park CK Tags: Neurosurg Focus Source Type: research

Enhanced recovery after spine surgery: review of the literature
ore E Abstract The concept of Enhanced Recovery After Surgery (ERAS) entails recovery facilitation of patients who undergo surgery through the implementation of a multidisciplinary and multimodal perioperative care approach. By its application, ERAS improves the overall functional outcome after surgery while maintaining high standards of care. A review of the essential aspects of ERAS in spine surgery was undertaken. Special consideration was given to the risks and benefits for patients and caregivers, as well as the medical and economical aspects of this concept. ABBREVIATIONS EBL = estimated blood loss; ERAS = ...
Source: Neurosurgical Focus - April 1, 2019 Category: Neurosurgery Authors: Corniola MV, Debono B, Joswig H, Lemée JM, Tessitore E Tags: Neurosurg Focus Source Type: research

Introduction. Enhanced recovery after surgery (ERAS) in spine.
PMID: 30933910 [PubMed - in process] (Source: Neurosurgical Focus)
Source: Neurosurgical Focus - April 1, 2019 Category: Neurosurgery Authors: Wang MY, Tessitore E, Berrington N, Dailey A Tags: Neurosurg Focus Source Type: research

Does an enhanced recovery after surgery protocol change costs and outcomes of single-level lumbar microdiscectomy?
CONCLUSIONSERAS had clinical and economic benefits and is associated with improved outcomes in lumbar microdiscectomy. PMID: 30933911 [PubMed - in process] (Source: Neurosurgical Focus)
Source: Neurosurgical Focus - April 1, 2019 Category: Neurosurgery Authors: Tarıkçı Kılıç E, Demirbilek T, Naderi S Tags: Neurosurg Focus Source Type: research

Development and implementation of a comprehensive spine surgery enhanced recovery after surgery protocol: the Cleveland Clinic experience.
Abstract Enhanced recovery after surgery (ERAS) protocols have been shown to be effective at reducing perioperative morbidity and costs while improving outcomes. To date, spine surgery protocols have been limited in scope, focusing only on specific types of procedures or specific parts of the surgical episode. The authors describe the creation and implementation of one of the first comprehensive ERAS protocols for spine surgery. The protocol is unique in that it has a comprehensive perioperative paradigm encompassing the entire surgical period that is tailored based on the complexity of each individual spine patie...
Source: Neurosurgical Focus - April 1, 2019 Category: Neurosurgery Authors: Chakravarthy VB, Yokoi H, Coughlin DJ, Manlapaz MR, Krishnaney AA Tags: Neurosurg Focus Source Type: research

Characterizing the risk and outcome profiles of lumbar fusion procedures in patients with opioid use disorders: a step toward improving enhanced recovery protocols for a unique patient population.
Abstract OBJECTIVEThe authors set out to conduct the first national-level study assessing the risks and outcomes for different lumbar fusion procedures in patients with opioid use disorders (OUDs) to help guide the future development of targeted enhanced recovery after surgery (ERAS) protocols for this unique population.METHODSData for patients with or without OUDs who underwent an anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), or lateral transverse lumbar interbody fusion (LLIF) for lumbar disc degeneration (LDD) were collected from the 2013-2014 National (Nationwide) Inpatient...
Source: Neurosurgical Focus - April 1, 2019 Category: Neurosurgery Authors: Martini ML, Nistal DA, Deutsch BC, Caridi JM Tags: Neurosurg Focus Source Type: research

Editorial. The opioid crisis: an opportunity to alter morbidity through the implementation of enhanced recovery after surgery protocols during spinal surgery?
PMID: 30933914 [PubMed - in process] (Source: Neurosurgical Focus)
Source: Neurosurgical Focus - April 1, 2019 Category: Neurosurgery Authors: Berrington NR Tags: Neurosurg Focus Source Type: research

Endoscopic transforaminal lumbar interbody fusion without general anesthesia: operative and clinical outcomes in 100 consecutive patients with a minimum 1-year follow-up.
CONCLUSIONSThis series of the first 100 patients to undergo awake endoscopic MIS-TLIF demonstrates outcomes comparable to those reported in our earlier papers. This procedure can provide a safe and efficacious option for lumbar fusion with less morbidity than open surgery. Further refinements in surgical technique and technologies will allow for improved success. PMID: 30933915 [PubMed - in process] (Source: Neurosurgical Focus)
Source: Neurosurgical Focus - April 1, 2019 Category: Neurosurgery Authors: Kolcun JPG, Brusko GD, Basil GW, Epstein R, Wang MY Tags: Neurosurg Focus Source Type: research

Editorial. Reducing the burden of spine fusion.
PMID: 30933916 [PubMed - in process] (Source: Neurosurgical Focus)
Source: Neurosurgical Focus - April 1, 2019 Category: Neurosurgery Authors: Mazur MD, Dailey AT Tags: Neurosurg Focus Source Type: research

A novel technique for awake, minimally invasive transforaminal lumbar interbody fusion: technical note.
Abstract Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) is associated with improved patient-reported outcomes in well-selected patients. Recently, some neurosurgeons have aimed to further improve outcomes by utilizing multimodal methods to avoid the use of general anesthesia. Here, the authors report on the use of a novel awake technique for MI-TLIF in two patients. They describe the successful use of liposomal bupivacaine in combination with a spinal anesthetic to allow for operative analgesia. PMID: 30933917 [PubMed - in process] (Source: Neurosurgical Focus)
Source: Neurosurgical Focus - April 1, 2019 Category: Neurosurgery Authors: Kai-Hong Chan A, Choy W, Miller CA, Robinson LC, Mummaneni PV Tags: Neurosurg Focus Source Type: research

Rotational thromboelastometry-guided transfusion during lumbar pedicle subtraction osteotomy for adult spinal deformity: preliminary findings from a matched cohort study.
The objective of this study was to investigate the effect of ROTEM-guided blood product management on perioperative blood loss and transfusion requirements in ASD patients undergoing correction with pedicle subtraction osteotomy (PSO).METHODSThe authors retrospectively reviewed patients with ASD who underwent single-level lumbar PSO at the University of Virginia Health System. All patients who received ROTEM-guided blood product transfusion between 2015 and 2017 were matched in a 1:1 ratio to a historical cohort treated using conventional laboratory testing (control group). Co-primary outcomes were intraoperative estimated...
Source: Neurosurgical Focus - April 1, 2019 Category: Neurosurgery Authors: Buell TJ, Taylor DG, Chen CJ, Dunn LK, Mullin JP, Mazur MD, Yen CP, Shaffrey ME, Shaffrey CI, Smith JS, Naik BI Tags: Neurosurg Focus Source Type: research

Clinical results of percutaneous biportal endoscopic lumbar interbody fusion with application of enhanced recovery after surgery.
The objective of this study was to introduce ERAS with biportal endoscopic transforaminal lumbar interbody fusion (TLIF) and to investigate the clinical results.METHODSPatients were divided into two groups based on the fusion procedures. Patients who received microscopic TLIF without ERAS were classified as the non-ERAS group, whereas those who received percutaneous biportal endoscopic TLIF with ERAS were classified as the ERAS group. The mean Oswestry Disability Index (ODI) and visual analog scale (VAS) scores were compared between the two groups. In addition, demographic characteristics, diagnosis, mean operative time, e...
Source: Neurosurgical Focus - April 1, 2019 Category: Neurosurgery Authors: Heo DH, Park CK Tags: Neurosurg Focus Source Type: research

Enhanced recovery after spine surgery: a systematic review.
CONCLUSIONSThese introductory studies demonstrate the potential of ERAS protocols, when applied to spine procedures, to reduce lengths of stay, accelerate return of function, minimize postoperative pain, and save costs. PMID: 30933920 [PubMed - in process] (Source: Neurosurgical Focus)
Source: Neurosurgical Focus - April 1, 2019 Category: Neurosurgery Authors: Elsarrag M, Soldozy S, Patel P, Norat P, Sokolowski JD, Park MS, Tvrdik P, Kalani MYS Tags: Neurosurg Focus Source Type: research

Reductions in length of stay, narcotics use, and pain following implementation of an enhanced recovery after surgery program for 1- to 3-level lumbar fusion surgery.
CONCLUSIONSIn this very initial implementation of the first phase of an ERAS program for short-segment lumbar fusion, the authors were able to demonstrate substantial positive effects on the early recovery process. Importantly, these effects were not surgeon-specific and could be generalized across surgeons with disparate technical predilections. The authors plan additional iterations to their ERAS protocols for continued quality improvements. PMID: 30933921 [PubMed - in process] (Source: Neurosurgical Focus)
Source: Neurosurgical Focus - April 1, 2019 Category: Neurosurgery Authors: Brusko GD, Kolcun JPG, Heger JA, Levi AD, Manzano GR, Madhavan K, Urakov T, Epstein RH, Wang MY Tags: Neurosurg Focus Source Type: research

Enhanced perioperative care and decreased cost and length of stay after elective major spinal surgery.
CONCLUSIONSThe implementation of a multimodal EPOC pathway decreased LOS and cost in major elective spine surgeries. PMID: 30933922 [PubMed - in process] (Source: Neurosurgical Focus)
Source: Neurosurgical Focus - April 1, 2019 Category: Neurosurgery Authors: Carr DA, Saigal R, Zhang F, Bransford RJ, Bellabarba C, Dagal A Tags: Neurosurg Focus Source Type: research

Benefits of Enhanced Recovery After Surgery for fusion in degenerative spine surgery: impact on outcome, length of stay, and patient satisfaction.
Abstract OBJECTIVEEnhanced Recovery After Surgery (ERAS) proposes a multimodal, evidence-based approach to perioperative care. Thanks to the improvement in care protocols and the fluidity of the patient pathway, the first goal of ERAS is the improvement of surgical outcomes and patient experience, with a final impact on a reduction in the hospital length of stay (LOS). The implementation of ERAS in spinal surgery is in the early stages. The authors report on their initial experience in applying an ERAS program to several degenerative spinal fusion procedures.METHODSThe authors selected two 2-year periods: the firs...
Source: Neurosurgical Focus - April 1, 2019 Category: Neurosurgery Authors: Debono B, Corniola MV, Pietton R, Sabatier P, Hamel O, Tessitore E Tags: Neurosurg Focus Source Type: research

Improving recovery after elective degenerative spine surgery: 5-year experience with an enhanced recovery after surgery (ERAS) protocol.
ML Abstract OBJECTIVEEnhanced recovery after surgery (ERAS) has led to a paradigm shift in various surgical specialties. Its application can result in substantial benefits in perioperative healthcare utilization through preoperative physical and mental patient optimization and modulation of the recovery process. Still, ERAS remains relatively new to spine surgery. The authors report their 5-year experience, focusing on ERAS application to a broad population of patients with degenerative spine conditions undergoing elective surgical procedures, including anterior lumbar interbody fusion (ALIF).METHODSA multimodal ...
Source: Neurosurgical Focus - April 1, 2019 Category: Neurosurgery Authors: Staartjes VE, de Wispelaere MP, Schröder ML Tags: Neurosurg Focus Source Type: research

Opioid-free anesthesia within an enhanced recovery after surgery pathway for minimally invasive lumbar spine surgery: a retrospective matched cohort study.
CONCLUSIONSOFA within an ERAS pathway for lumbar spinal decompression represents an opportunity to minimize perioperative opioid exposure without adversely affecting pain control or recovery. This study reveals opportunities for patient and provider education to reinforce ERAS and highlights the postoperative phase of care as a time when resources should be focused to increase ERAS adherence. PMID: 30933925 [PubMed - in process] (Source: Neurosurgical Focus)
Source: Neurosurgical Focus - April 1, 2019 Category: Neurosurgery Authors: Soffin EM, Wetmore DS, Beckman JD, Sheha ED, Vaishnav AS, Albert TJ, Gang CH, Qureshi SA Tags: Neurosurg Focus Source Type: research

An enhanced recovery after surgery pathway: association with rapid discharge and minimal complications after anterior cervical spine surgery.
CONCLUSIONSAn ERAS pathway for anterior cervical spine surgery facilitates safe, prompt discharge. The ERAS pathway was associated with minimal complications, and no readmissions within 90 days of surgery. Pain and respiratory compromise were both linked with extended LOS in this cohort. Further prospective studies are needed to confirm the potential benefits of ERAS for anterior cervical spine surgery, including longer-term complications, cost, and functional outcomes. PMID: 30933926 [PubMed - in process] (Source: Neurosurgical Focus)
Source: Neurosurgical Focus - April 1, 2019 Category: Neurosurgery Authors: Soffin EM, Wetmore DS, Barber LA, Vaishnav AS, Beckman JD, Albert TJ, Gang CH, Qureshi SA Tags: Neurosurg Focus Source Type: research

Transarterial and transvenous approaches for embolization of tentorial dural arteriovenous fistula.
Abstract Tentorial dural arteriovenous fistulas (DAVFs) are uncommon, complex fistulas located between the leaves of the tentorium cerebelli with a specific anatomic and clinical presentation characterized by high hemorrhagic risk. They have an extensive arterial supply and complex venous drainages, making them difficult to treat. There is recent literature favoring treatment through an endovascular transarterial route. The authors present an uncommon tentorial/ambient cistern region DAVF with feeders arising from the external and internal carotid arteries. The patient underwent a combined transarterial and transv...
Source: Neurosurgical Focus - April 1, 2019 Category: Neurosurgery Authors: Beer-Furlan A, Dasenbrock HH, Joshi KC, Chen M Tags: Neurosurg Focus Source Type: research

Staged transarterial endovascular embolization of a malignant dural arteriovenous fistula using Onyx and n-butyl cyanoacrylate.
Abstract Dural arteriovenous fistulae (dAVFs) are vascular anomalies formed by abnormal connections between branches of dural arteries and dural veins or dural venous sinus(es). These pathologic shunts constitute 10%-15% of all intracranial arteriovenous malformations. The hallmark of malignant dAVFs is the presence of cortical venous drainage, a finding that increases the likelihood of nonhemorrhagic neurologic deficit, intracranial hemorrhage, and mortality if left unaddressed. Endovascular approaches have become the primary modality for the treatment of dAVFs. The authors present a case of staged endovascular t...
Source: Neurosurgical Focus - April 1, 2019 Category: Neurosurgery Authors: Gesheva S, Couldwell WT, Mortimer V, Taussky P, Grandhi R Tags: Neurosurg Focus Source Type: research