Advanced Surgical Techniques for Dural Venous Sinus Repair: A Comprehensive Literature Review

硬脑膜静脉窦修复的先进手术技术: 文献综述

The dural venous sinus (DVS) is a thin-walled blood channel composed of dura mater that is susceptible to injury during common neurosurgical approaches. DVS injuries are highly underreported, which is reflected by a lack of literature on the topic. Neurosurgeons should be familiar with appropriate techniques to successfully repair an injured DVS and prevent associated complications. This study presents a literature review on the surgical techniques for DVS repair after DVS injury during common neurosurgical approaches. The databases PubMed and Scopus were queried using the terms “cranial sinuses,” “superior sagittal sinus,” “transverse sinuses,” “injury,” and “surgery.” A total of 117 articles underwent full-text review and were analyzed for surgical approach, craniotomy, lesion location, lesion characteristics, and surgical repair techniques. A literature review was performed, and a comprehensive summary is presented. Data from publications describing DVS lacerations related to pathological conditions (eg, meningioma) were excluded. A total of 9 techniques aiding with bleeding control, hemostasis, and sinus repair and reconstruction were identified, including compression, hemostatic agents, bipolar cautery, dural tenting and tack-up suturing, dural flap, direct suturing, autologous patch, venous bypass, and ligation. The advantages and drawbacks of each technique are described. Multiple options to treat DVS injuries are available to the neurosurgeon. Treatment type is based on anatomic location, complexity of the laceration, cardiovascular status, the presence of air embolism, and the dexterity and experience of the surgeon.

硬脑膜静脉窦 (DVS) 是由硬脑膜组成的薄壁血液通道，在常见的神经外科手术中容易受到损伤。DVS受伤的报道严重不足，这反映在缺乏有关该主题的文献上。神经外科医生应熟悉适当的技术，以成功修复受伤的DVS并预防相关并发症。本研究对常见神经外科手术中DVS损伤后DVS修复的手术技术进行了文献综述。使用术语 “颅窦” 、 “上矢状窦” 、 “横窦” 、 “损伤” 和 “手术” 查询数据库PubMed和Scopus。对117篇文献进行全文回顾，并对手术入路、开颅、病灶位置、病灶特点、手术修复技术等进行分析。进行了文献回顾，并提出了全面的总结。排除了描述与病理状况 (例如脑膜瘤) 相关的DVS撕裂伤的出版物的数据。总共确定了9种有助于控制出血，止血以及鼻窦修复和重建的技术，包括压迫，止血剂，双极烧灼，硬脑膜罩和钉合缝合，硬脑膜瓣，直接缝合，自体补片，静脉旁路和结扎。描述了每种技术的优点和缺点。神经外科医生可以选择多种治疗DVS损伤的方法。治疗类型基于解剖位置，撕裂的复杂性，心血管状况，空气栓塞的存在以及外科医生的灵活性和经验。

REF: Madriñán-Navia HJ, Scherschinski L, Benet A, Lawton MT. Advanced Surgical Techniques for Dural Venous Sinus Repair: A Comprehensive Literature Review. Oper Neurosurg (Hagerstown). 2024;27(2):137-147. doi:10.1227/ons.0000000000001069 PMID: 38330415

Evolution of Deep Brain Stimulation Techniques for Complication Mitigation

并发症缓解脑深部电刺激技术的演变

Complication mitigation in deep brain stimulation has been a topic matter of much discussion in the literature. In this article, we examine how neurosurgeons as individuals and as a field generated and adapted techniques to prevent infection, lead fracture/lead migration, and suboptimal outcomes in both the acute period and longitudinally. The authors performed a MEDLINE search inclusive of articles from 1987 to June 2023 including human studies written in English. Using the Rayyan platform, two reviewers (J.P. and R.M.) performed a title screen. Of the 776 articles, 252 were selected by title screen and 172 from abstract review for full-text evaluation. Ultimately, 124 publications were evaluated. We describe the initial complications and inefficiencies at the advent of deep brain stimulation and detail changes instituted by surgeons that reduced them. Furthermore, we discuss the trend in both undesired short-term and long-term outcomes with emphasis on how surgeons recognized and modified their practice to provide safer and better procedures. This scoping review adds to the literature as a guide to both new neurosurgeons and seasoned neurosurgeons alike to understand better what innovations have been trialed over time as we embark on novel targets and neuromodulatory technologies.

减轻脑深部电刺激的并发症一直是文献中讨论的话题。在本文中，我们研究了神经外科医生作为个体和作为一个领域如何产生和适应技术，以防止感染，导线骨折/导线迁移以及在急性期和纵向上的次优结果。作者进行了MEDLINE搜索，包括1987年至2023年6月的文章，包括用英语撰写的人类研究。使用Rayyan平台，两个审阅者 (j.p.和r.m.) 执行标题屏幕。在776篇文章中，有252篇是通过标题筛选选择的，并从摘要评论中172以进行全文评估。最终，评估了124篇出版物。我们描述了脑深部电刺激出现时的最初并发症和效率低下，以及外科医生为减少并发症而进行的细节更改。此外，我们讨论了不期望的短期和长期结果的趋势，重点是外科医生如何识别和修改其实践以提供更安全和更好的手术。这项概况性综述增加了文献作为新的神经外科医生和经验丰富的神经外科医生的指南，以便更好地理解随着时间的推移，随着我们开始新的目标和神经调节技术，哪些创新已经被试验过。

REF: Mayer R, Desai K, Aguiar RST, et al. Evolution of Deep Brain Stimulation Techniques for Complication Mitigation. Oper Neurosurg (Hagerstown). 2024;27(2):148-157. doi:10.1227/ons.0000000000001071 PMID: 38315020

Efficacy of Biportal Endoscopic Decompression for Lumbar Spinal Stenosis: A Meta-Analysis With Single-Arm Analysis and Comparative Analysis With Microscopic Decompression and Uniportal Endoscopic Decompression

单臂镜下双孔减压术治疗腰椎管狭窄症的Meta分析及与单孔镜下减压术的对比分析

Biportal endoscopic decompression is a minimally invasive surgical technique for lumbar spinal stenosis (LSS). This meta-analysis aimed to evaluate the efficacy and safety of biportal endoscopic decompression through both a single-arm analysis and a comparative analysis. Biportal endoscopic decompression emerges as a safe and effective alternative for LSS, presenting potential advantages over the microscopic technique and comparable efficacy with the uniportal endoscopic technique.

双孔内窥镜减压术是治疗腰椎管狭窄症 (LSS) 的一种微创手术技术。本荟萃分析旨在通过单臂分析和比较分析来评估双孔内窥镜减压术的有效性和安全性。双孔内窥镜减压术是LSS的一种安全有效的替代方法，与显微镜技术相比具有潜在的优势，并且与单孔内窥镜技术具有相当的疗效。

REF: Lv S, Lv H, He Y, Xia X. Efficacy of Biportal Endoscopic Decompression for Lumbar Spinal Stenosis: A Meta-Analysis With Single-Arm Analysis and Comparative Analysis With Microscopic Decompression and Uniportal Endoscopic Decompression. Oper Neurosurg (Hagerstown). 2024;27(2):158-173. doi:10.1227/ons.0000000000001097 PMID: 38511959

Preoperative Ultrasound-Guided Localization of the Lateral Femoral Cutaneous Nerve: From Guide Wire to Novel Clip

术前超声引导下股外侧皮神经定位: 从导丝到新型夹子

Lateral femoral cutaneous nerve (LFCN) decompression and transposition are surgical treatment options for meralgia paresthetica. Identifying the LFCN during surgery may be challenging, and preoperative localization is a valuable adjunct in this case. The objective of this study was to explore a new technique using preoperative ultrasound-guided clip localization (USCL) of the LFCN. USWL or USCL is safe and time-efficient in LFCN surgeries.

股外侧皮神经 (LFCN) 减压和移位是治疗痛经性感觉异常的手术治疗选择。在手术期间识别LFCN可能具有挑战性，并且在这种情况下，术前定位是有价值的辅助手段。这项研究的目的是探索一种使用LFCN术前超声引导的夹子定位 (USCL) 的新技术。USWL或USCL在LFCN手术中是安全且省时的。

REF: Koueik J, Bethel JA, Lee KS, Tuite MJ, Hanna AS. Preoperative Ultrasound-Guided Localization of the Lateral Femoral Cutaneous Nerve: From Guide Wire to Novel Clip. Oper Neurosurg (Hagerstown). 2024;27(2):174-179. doi:10.1227/ons.0000000000001072IF: 1.7 Q2 PMID: 38289069

Intrasellar Arachnoid Diverticulae as a Risk Factor for Intraoperative Cerebrospinal Fluid Leakage in Patients Undergoing Endoscopic Transsphenoidal Surgery

鞍内蛛网膜憩室是内镜经鼻蝶手术患者术中脑脊液漏的危险因素

Intrasellar arachnoid diverticulae can often be identified on preoperative imaging in patients undergoing endoscopic transsphenoidal surgery. The objective of this study was to characterize arachnoid diverticulae both qualitatively and quantitatively in a large institutional cohort of patients with pituitary tumors and to evaluate its association with intraoperative cerebrospinal fluid (CSF) leak. The presence of an intrasellar arachnoid diverticulum should alert the surgeon to an elevated risk of intraoperative CSF leak during transsphenoidal surgery for pituitary tumors. A relatively limited surgical exposure tailored to the craniocaudal extent of the sellar pathology should be considered in these patients.

对于接受内窥镜经蝶窦手术的患者，通常可以在术前成像中识别出蛛网膜下腔憩室。这项研究的目的是在大型垂体瘤患者的机构队列中定性和定量地表征蛛网膜憩室，并评估其与术中脑脊液 (CSF) 泄漏的关系。鞍内蛛网膜憩室的存在应提醒外科医生在经蝶窦入路垂体瘤手术中发生术中CSF泄漏的风险增加。在这些患者中，应考虑针对鞍区病变的颅尾范围进行相对有限的手术暴露。

REF: Sarkar S, Corrales CE, Laws ER Jr, Smith TR. Intrasellar Arachnoid Diverticulae as a Risk Factor for Intraoperative Cerebrospinal Fluid Leakage in Patients Undergoing Endoscopic Transsphenoidal Surgery. Oper Neurosurg (Hagerstown). 2024;27(2):180-186. doi:10.1227/ons.0000000000001079 PMID: 38329346

Endoscopic Supracerebellar Infratentorial Transpineal Approach for Posterior-Medial Thalamic Lesions: Surgical Technique and Clinical Experience

内镜小脑上经小脑幕下入路治疗丘脑后内侧病变: 手术技巧和临床经验

Accessing lesions in the posterior-medial thalamus can be challenging because of their deep location and intricate neurovascular anatomy. This study aims to describe the techniques and feasibility of the endoscopic supracerebellar infratentorial transpineal approach for treating posterior-medial thalamus lesions. The endoscopic supracerebellar infratentorial transpineal approach is an effective approach for removing posterior-medial thalamic lesions that require access through the third ventricle surfaces of the thalamus. The endoscopic contralateral paramedian supracerebellar infratentorial transpineal approach provides a more superior and lateral view of the posterior-medial thalamic lesions.

进入后内侧丘脑的病变可能具有挑战性，因为它们的位置较深，神经血管解剖结构复杂。本研究旨在描述内窥镜小脑上小脑幕下经尿道入路治疗丘脑后内侧病变的技术和可行性。内窥镜小脑上小脑幕下经尿道入路是去除需要通过丘脑第三脑室表面进入的丘脑后内侧病变的有效方法。内窥镜对侧正中小脑上小脑幕下经尿道入路提供了丘脑后内侧病变的更优越和外侧视图。

REF: Xie T, Liu S, Zhang X, et al. Endoscopic Supracerebellar Infratentorial Transpineal Approach for Posterior-Medial Thalamic Lesions: Surgical Technique and Clinical Experience. Oper Neurosurg (Hagerstown). 2024;27(2):187-193. doi:10.1227/ons.0000000000001114 PMID: 38451089

Endoscope-Assisted Microsurgery for Posterior Fossa Skull Base Meningioma Surgery: Technique and Results

内窥镜辅助显微手术治疗后颅窝颅底脑膜瘤: 技术和结果

Surgery of posterior fossa meningiomas is extremely challenging even for experienced skull base surgeons because of the close proximity to cranial nerves and tight spaces. Endoscope-assisted surgery for posterior fossa meningiomas can enable a high degree of tumor resection even when using small approaches. This study describes the advantage of endoscope-assisted microneurosurgery in resection of posterior fossa skull base meningiomas and the clinical outcome. Endoscope-assisted surgery for posterior fossa skull base meningiomas enables a high degree of tumor resection, avoids more invasive skull base approaches, and reduces the amount of cerebellar retraction.

即使对于经验丰富的颅底外科医生来说，后颅窝脑膜瘤的手术也极具挑战性，因为它紧邻颅神经和狭窄的空间。后颅窝脑膜瘤的内窥镜辅助手术即使使用较小的入路，也可以实现高度的肿瘤切除。这项研究描述了内窥镜辅助的显微神经外科手术在后颅窝颅底脑膜瘤切除术中的优势和临床结果。后颅窝颅底脑膜瘤的内窥镜辅助手术可实现高度的肿瘤切除，避免更多的侵入性颅底入路，并减少小脑回缩量。

REF: Nowak S, Matthes M, Baldauf J, Schroeder HWS. Endoscope-Assisted Microsurgery for Posterior Fossa Skull Base Meningioma Surgery: Technique and Results. Oper Neurosurg (Hagerstown). 2024;27(2):194-204. doi:10.1227/ons.0000000000001093 PMID: 38385687

The Learning Curve and Clinical Outcomes With 250 Laser Ablations for Brain Tumors: A Pathway to Experience

250激光消融治疗脑肿瘤的学习曲线和临床结果: 经验之路

Laser interstitial thermal therapy (LITT) has gained popularity as a minimally invasive technique for treating brain tumors. Despite its proven safety profile, LITT is not yet widely available, and there is a lack of data on the learning curve required to achieve proficiency. This study analyzes a 250-patient cohort of laser-ablated tumors to describe changes in patient selection and clinical outcomes over time and experience, with the aim of providing insight into the learning curve for incorporating LITT into a neuro-oncology program and identifying a cutoff point that distinguishes novice from expert performance. After treating 74 patients, a downward trend in the operative time is observed. Patient selection is broadened as experience increases.

激光间质热疗法 (LITT) 作为治疗脑肿瘤的微创技术已经得到普及。尽管LITT已被证明具有安全性，但尚未广泛使用，并且缺乏达到熟练程度所需的学习曲线的数据。这项研究分析了一个由250名患者组成的激光消融肿瘤队列，以描述患者选择和临床结果随时间和经验的变化，目的是深入了解将LITT纳入神经肿瘤学计划的学习曲线，并确定区分新手和专家表现的分界点。治疗74例患者后，观察到手术时间呈下降趋势。患者选择随着经验的增加而扩大。

REF: Merenzon MA, Bhatia S, Levy A, et al. The Learning Curve and Clinical Outcomes With 250 Laser Ablations for Brain Tumors: A Pathway to Experience. Oper Neurosurg (Hagerstown). 2024;27(2):205-212. doi:10.1227/ons.0000000000001101 PMID: 38385677

Real-Time Intraoperative Ultrasound Using a Minimally Invasive Transducer During Anterior Cervical Spine Surgery

在前路颈部脊柱手术中使用微创换能器进行实时术中超声检查

Intraoperative ultrasound (IOUS) during anterior cervical surgery is hindered by large transducer size and small operative corridor. We hypothesized that a linear (minimally invasive) transducer designed for transsphenoidal surgery can visualize the spinal cord, nerve roots, and surrounding structures during anterior cervical approaches, facilitating intraoperative assessment of central and foraminal decompression. The neural elements and their relationships to surrounding bone/soft tissue can be visualized using a minimally invasive IOUS transducer during anterior cervical surgery without having to remove pin-based distraction. This allows surgeons to intraoperatively verify the extent of central and foraminal decompression.

前颈部手术期间的术中超声 (IOUS) 受到较大的换能器尺寸和较小的手术通道的阻碍。我们假设设计用于经蝶窦手术的线性 (微创) 换能器可以在颈部前路手术中可视化脊髓，神经根和周围结构，从而有助于术中评估中央和椎间孔减压。神经元件及其与周围骨/软组织的关系可以在前颈部手术期间使用微创IOUS换能器可视化，而不必去除基于销的牵引。这使外科医生可以在术中验证中央和椎间孔减压的程度。

REF: Chryssikos T, Tawil ME, Ambati VS, et al. Real-Time Intraoperative Ultrasound Using a Minimally Invasive Transducer During Anterior Cervical Spine Surgery. Oper Neurosurg (Hagerstown). 2024;27(2):213-219. doi:10.1227/ons.0000000000001065 PMID: 38295396